Factors Associated with Persistent Disease in Women with Asthma

Noreen Clark, PhD Molly Gong, MDJimmy Yu, PhD CandidateXihong Lin, PhDMelissa Valerio, MPH William Bria, MD Timothy Johnson, MD

University of Michigan

School of Public HealthSupported by NHLBI Grant # HL60884

Background

Five million women are currently diagnosed with asthma (Crespo 1997)

Morbidity rates are disproportionately higher for women compared to men (CDC 1995).

Women also have consistently higher rates of asthma clinic visits, hospital admissions and re-admissions (CDC 1995).

Purpose

To examine demographic, psychosocial, and lifestyle factors associated with persistent asthma in women.

Data collection

Participants– 439 women– 18 years and older– physician diagnosis– University of Michigan Asthma & Airways

Clinic and University of Michigan Health System

Data collection

Data: telephone interview– asthma symptoms– gender related management– psychosocial factors and lifestyle

Data Analyses

A dichotomous dependent variable (1=persistent asthma including mild, moderate, and severe; 0=otherwise) was created to explore the factors associated with persistent asthma.

Univariate and multivariate logistic regression models were conducted.

Odds Ratio and p-value were computed.

Sample demographics

Age8%

17%

24%25%

17%

9%

18-30

31-40

41-50

51-60

61-70

>71

Sample demographics

2%

26%

21%30%

21%

< High School

High School

2-year College

4-year College

Post Grad

Education Level

Sample demographics

Annual Household Income

4% 6%

16%

20%

14%

12%

17%

11%<10,000

10,001-20,000

10,001-20,000

40,001-60,000

60,001-80,000

80,000-100,000

>100,000

refusal

Sample demographics

Race/Ethnicity

85%

2%

8%

2%

1%

2% Caucasian/White

African American/Black

Asian/Pacific Islander

Hispanic/Latino

Native American

Other

Asthma severity

Classified by NAEPP criteria, USA, Guidelines and Diagnosis and Treatment of Asthma

Percent of Women

Mild intermittent

52.62

Mild persistent 14.35

Moderate persistent

18.45

Severe persistent

14.58

Classified by NAEPP criteria, Guidelines and Diagnosis and Treatment of Asthma, NHLBI, NIH, 1997

Findings

Factor (1) N Estimate SE OR P-value

Education 438 -.1856 .084 1.20 .03

Educational level was significantly associated with persistent disease. The lower the education level, the higher the probability of persistent asthma.

Significant demographics factors associated with persistent asthma

Findings

Factor (2) N Estimate SE OR P-value

Annual Household Income 386 -.1474 .063 1.13 .02

Annual household income was significantly related to persistent disease. The lower the income, the higher the probability of persistent asthma.

Significant demographic factors associated with persistent asthma

Findings

Factor (3) N Estimate SE OR P-value

Working for pay 438 -.47 .198 1.59 .02

Not working for pay was significantly associated with persistent asthma.

Significant demographics factors associated with persistent asthma

Findings

Factor N Estimate SE OR P-value

BMI (mean=29.5, SD=7.97) 430 .0302 .0124 1.03 .02

The higher the BMI, the higher the probability of persistent asthma.

Significant physical factors associated with persistent asthma

Findings

Factor N Estimate SE OR P-value

Frequency of exercise (mean=3.46, SD=1.79)

436 -.149 .0547 1.16 .006

The less the exercise, the higher the probability of persistent asthma.

Significant lifestyle factors associated with persistent asthma

Findings

The lower the level of self-esteem, the higher the probability of persistent asthma.

.01761.04.0191-.0454438Self-esteem score (mean=24.66, SD=2.33)

P-valueORSEEstimateNFactor (1)

Significant psycho social factors associated with persistent asthma

Findings

The more the social support, the higher the probability of persistent asthma.

.0341.04.0181.0385438Overall social support score (mean=12.61, SD=5.20)

P-valueORSEEstimateNFactor (2)

Significant psycho social factors associated with persistent asthma

The higher the self-regulation level, the higher the probability of persistent asthma.

.00011.66.214.5056439Self-regulation phases (mean=2.17, SD=1.20)

P-valueORSEEstimateNFactor (3)

Findings

Significant psycho social factors associated with persistent asthma

Study Limitations

This study sample includes a number of women with high levels of education and income.

The findings reported here are from preliminary analysis.

Conclusions

1. Low annual household income, a lower level of education, and not working for pay were associated with persistent asthma, whereas, age, marital status, and ethnicity were not.

Conclusions (con’t)

2. Women with persistent asthma were more likely to have high BMI, maintain a low level of exercise, have lower self-esteem, had more social support, and be at a higher level of self-regulation related to asthma compared to women with intermittent disease.