Abstract
BackgroundLow socioeconomic status (SES) has been linked to higher morbidity in patients with chronic diseases, but may be particularly relevant to asthma, as asthmatics of lower SES may have higher exposures to indoor (e.g., cockroaches, tobacco smoke) and outdoor (e.g., urban pollution) allergens, thus increasing risk for exacerbations.MethodsThis study assessed associations between adult SES (measured according to educational level) and asthma morbidity, including asthma control; asthma-related emergency health service use; asthma self-efficacy, and asthma-related quality of life, in a Canadian cohort of 781 adult asthmatics. All patients underwent a sociodemographic and medical history interview and pulmonary function testing on the day of their asthma clinic visit, and completed a battery of questionnaires (Asthma Control Questionnaire, Asthma Quality of Life Questionnaire, and Asthma Self-Efficacy Scale). General Linear Models assessed associations between SES and each morbidity measure.ResultsLower SES was associated with worse asthma control (F = 11.63, p < .001), greater emergency health service use (F = 5.09, p = .024), and worse asthma self-efficacy (F = 12.04, p < .01), independent of covariates. Logistic regression analyses revealed that patients with <12 years of education were 55% more likely to report an asthma-related emergency health service visit in the last year (OR = 1.55, 95%CI = 1.05-2.27). Lower SES was not related to worse asthma-related quality of life.ConclusionsResults suggest that lower SES (measured according to education level), is associated with several indices of worse asthma morbidity, particularly worse asthma control, in adult asthmatics independent of disease severity. Results are consistent with previous studies linking lower SES to worse asthma in children, and add asthma to the list of chronic diseases affected by individual-level SES.
Highlights
Low socioeconomic status (SES) has been linked to higher morbidity in patients with chronic diseases, but may be relevant to asthma, as asthmatics of lower SES may have higher exposures to indoor and outdoor allergens, increasing risk for exacerbations
Logistic regression analyses revealed that patients with < 12 years of education were 55% more likely to report being hospitalized or having an emergency department visit in the last year (OR = 1.55, 95%CI = 1.05-2.27), independent of age, sex, and asthma severity
We found that patients with less than 12 years of education were 55% more likely to report any emergency health service use, compared to those with 12 or greater years of education, when controlling for age, sex, and severity
Summary
Low socioeconomic status (SES) has been linked to higher morbidity in patients with chronic diseases, but may be relevant to asthma, as asthmatics of lower SES may have higher exposures to indoor (e.g., cockroaches, tobacco smoke) and outdoor (e.g., urban pollution) allergens, increasing risk for exacerbations. Asthma is a chronic disorder of the airways characterized by reversible and intermittent airway obstruction, airway inflammation, and hyper-reactivity of the airways in response to a variety of stimuli (e.g., dust, animal hair, smoke, and airborne pollutants). Despite important advances in diagnosis and treatment, asthma remains one of the most prevalent chronic respiratory disorders, affecting 7-10% of the world's population. In Canada, asthma remains poorly controlled in nearly 60% of patients, which places an excess burden on the health care system, and accounts for between 250-300 deaths per year [4,5]. Given that asthma can be well controlled for the vast majority of patients [2,3], identifying those patients who may be at greater risk for poorly controlled asthma represents an important goal for global asthma prevention
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