Prevalence, socio-demographic and environmental determinants of asthma in 4621 Ghanaian adults: Evidence from Wave 2 of the World Health Organization's study on global AGEing and adult health.

Justice Moses K Aheto,Emilia A Udofia,George Mensah,Minicuci Nadia,Alfred E Yawson,Somnath Chatterji,Eugene Kallson,Paul Kowal,Naidoo Nirmala,Richard Biritwum

doi:10.1371/journal.pone.0243642

Abstract

A previous multi-site study involving lower- and middle-income countries demonstrated that asthma in older adults is associated with long-term exposure to particulate matter, male gender and smoking. However, variations may occur within individual countries, which are relevant to inform health promoting policies as populations live longer. The present study estimates asthma prevalence and examines the sociodemographic characteristics and environmental determinants associated with asthma in older adults in Ghana. This study utilised data from the nationally representative World Health Organization Study on global AGEing and adult health (SAGE) Ghana Wave 2. A final sample of 4621 individuals residing in 3970 households was used in analytical modelling. Factors associated with asthma were investigated using single level and multilevel binary logistic regression models. Asthma was reported by 102 (2.2%) respondents. Factors associated with asthma in the univariate model were: those aged 60-69 (OR = 5.22, 95% CI: 1.24, 21.95) and 70 or more (OR = 5.56, 95% CI: 1.33, 23.26) years, Ga-Adangbe dialect group (OR = 1.65, 95% CI: 1.01, 2.71), no religion (OR = 3.59, 95% CI: 1.77, 7.28), having moderate (OR = 1.76, 95% CI: 1.13, 2.75) and bad/very bad (OR = 2.75, 95% CI: 1.58, 4.80) health state, and severe/extreme difficulty with self-care (OR = 3.49, 95% CI: 1.23, 9.88) and non-flush toilet facility (OR = 0.62, 95% CI: 0.39, 0.99). Factors independently associated with asthma in the adjusted models were: those aged 60-69 (OR = 4.49, 95% CI: 1.03, 19.55) years, father with primary education or less (OR = 0.40, 95% CI: 0.17, 0.94), no religion (OR = 2.52, 95% CI: 1.18, 5.41), and households with non-flush toilet facility (OR = 0.58, 95% CI: 0.35, 0.96). Significant residual household-level variation in asthma was observed. Over 40% of variance in asthma episodes could be attributable to residual household-level variations. Individual as well as household factors were seen to influence the prevalence of asthma in this national survey. Clinical management of these patients in health facilities should consider household factors in addition to individual level factors.

Highlights

Over 544 million people worldwide had a chronic respiratory disease (CRD) in the year 2017, representing a rise of 39 8% compared with 1990, with asthma (3.6%) remaining the second most prevalent CRD after chronic obstructive pulmonary disease (3.9%)
Factors associated with asthma in the univariate model were: those aged 60–69 (OR = 5.22, 95% CI: 1.24, 21.95) and 70 or more (OR = 5.56, 95% CI: 1.33, 23.26) years, Ga-Adangbe dialect group (OR = 1.65, 95% CI: 1.01, 2.71), no religion (OR = 3.59, 95% CI: 1.77, 7.28), having moderate (OR = 1.76, 95% CI: 1.13, 2.75) and bad/very bad (OR = 2.75, 95% CI: 1.58, 4.80) health state, and severe/ extreme difficulty with self-care (OR = 3.49, 95% CI: 1.23, 9.88) and non-flush toilet facility
The data is provided to researchers freely but the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Team only releases the data to researchers upon request made directly to WHO, and individual researchers granted permission to use the data are not allowed to make the data available to third parties

Summary

Introduction

Over 544 million people worldwide had a chronic respiratory disease (CRD) in the year 2017, representing a rise of 39 8% compared with 1990, with asthma (3.6%) remaining the second most prevalent CRD after chronic obstructive pulmonary disease (3.9%). In 2015, over 3 million people worldwide died from asthma and chronic obstructive pulmonary disease, with an increase in prevalence of 12.6% between 1990 and 2015 in lower income countries [2]. Asthma remains a concern even into older ages, where chronic obstructive pulmonary disease comorbidity is more often overlaid [3]. A previous multi-site study involving lower- and middle-income countries demonstrated that asthma in older adults is associated with long-term exposure to particulate matter, male gender and smoking.

Methods

Results

Conclusion