Less social deprivation is associated with better health-related quality of life (HRQoL) in asthma and is mediated by less anxiety and better sleep quality.

Abstract

Previous studies on health-related quality of life (HRQoL) in asthma have mainly focused on clinical and environmental determinants. Little is known about the role of social determinants on HRQoL in asthma. We aimed to investigate the association between social deprivation and HRQoL in asthma. 691 adult asthmatics from Canada, India, New Zealand, and the United Kingdom were administered a digital questionnaire containing demographic information, and questions about social and psychological attributes, sleep disturbances, and alcohol abuse. HRQoL was measured using the short-form chronic respiratory disease questionnaire (SF-CRQ). We analyzed the direct and indirect relationships between social deprivation and HRQoL using structural equation models with social deprivation as a latent variable. We tested for mediation via anxiety, depression, sleep disturbances, and alcohol abuse. We found that less social deprivation (latent variable) was directly associated with better SF-CRQ domain scores such as dyspnea (β: 0.33; 95%CI: 0.07 to 0.58), fatigue (β: 0.39; 95%CI: 0.14 to 0.64), and emotional function (β: 0.37; 95%CI: 0.11 to 0.62), but with worse mastery score (β: -0.29; 95%CI: -0.55 to -0.03); however, those associations varied across participating countries. We also observed that among all individual social deprivation indicators, education, companionship, emotional support, instrumental support, and social isolation were directly associated with HRQoL and the relationship between social deprivation and HRQoL was mediated through anxiety and sleep disturbances. Our results demonstrated that less social deprivation was directly, and indirectly through less anxiety and better sleep quality, associated with better HRQoL in asthma.