Factors associated with persistent disease in women with asthma
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Factors associated with persistent disease in women with asthma

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Factors associated with persistent disease in women with asthma

Factors associated with persistent disease in women with asthma

Noreen Clark
Center for Managing Chronic Disease
University of Michigan

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  • The findings reported were from univariate logistic regression models. The model is like that –logit (y)=b0+b1 (x). Dependent variable y is a dichotomous variable—persistent asthma (yes=1, no=0). Independent or predictor variable (x) is the factor we want to check to see if there is an association with y (persistent asthma or not). The estimate (b1) is slope of unit increase or decrease of independent or predictor variable. Each increase or decrease in predictor results in same increase or decrease in dependent variable. Positive sign means x and y tend to be in the same direction (high high; low low) and vise versa for negative sign (high low; low high). The odds ratio gives the ratio of the probabilities given unite increase for x. The p-value shows statistical significance level. Using the Univariate logistic regression, we checked the factors we were interested one by one. We reported significant results including education, income, wok for pay, BMI, exercise, self-esteem, self-regulation, social support in the presentation. We did not report non-significant results including age, marital status, ethnicity, and family history here. We also conducted multi variate logistic regression analysis using backward stepwise selection method to explore the relationship for multiple factors. Only three of the factors (exercise, self-esteem, and social support) left to be significant (p<0.05). No association between BMI and self-esteem in this sample.
  • About 50% of the participants are 41 to 60 years of age. One fourth are older than 60 years of age and other one fourth are younger than 40 years old. .
  • Twenty-six% of the participants are high school graduates, 21% two-year college, 30% 4-year year college, and 21% post graduate.
  • Eleven percent of the women have less than 20,000 annually household income and 11% of the women refused to report. Eighteen % between 20,000 to 40,000. About 35% of the women reported in a range of 40,000 to 60,000 annual household income.
  • About 16% of the participants are minorities
  • Classified by NAEPP criteria, USA, Guidelines and Diagnosis and Treatment of Asthma, NHLBI, NIH, 1997
  • Education levels: 1> high school, 2=high school, 3=2 year college, 4=4 year college, 5 post graduate
  • Annual household income 0=less than 10,000, 1=10,001-20,000, 2=20,001-40,000, 3=40,001-60,000, 4=60,001-80,000, 5=80,000-100,000, 6=>100,000
  • Working for pay 1=yes, 0=no
  • Body Mass Index formula BMI=(weight in kilograms) / (height in meters)/(height in meters) or BMI=(weight in pounds/height in inches /height in inches) x 703 Classification of BMI: 18.5 or less=underweight, 18.5=24.9=normal, 25-29.9=overweight, 30-34.9=obese, 35-39.9=obese, 40 or greater=extremely obese. The Centers for Disease Control now estimates that more than 60 percent of American adults are overweight, while almost one out of three is obese. In the last 20 years, the proportion of overweight children between ages 6 and 19 has tripled, to nearly one of every three kids. In December, 2001, Surgeon General David Satcher stated that 300,000 deaths per year are associated with overweight and obesity, and projected the annual public health cost of this condition at $117 billion, due to the life-threatening complications of diabetes, hypertension, heart disease, cancer, kidney failure and many other ailments.
  • On average how often did you engage in exercise such as running, walking, swimming, playing tennis, weight lifting, or aerobics? 0=never, 1=less than once/mo, 2=1-2 times/mo, 3=once/wk, 4=2 times/wk, 5=more than 2 times/wk.
  • Self-esteem items (strongly agree, agree, disagree, strongly disagree) 1. On the whole, I am satisfied with myself.2. at times, I think I am no good at all. 3. I feel that I have a number of good qualities. 4. I am able to do things as well as other people. 5. I feel I do not have much to be proud of. 6. I certainly feel useless at times. 7. I feel that I am a person of worth, at least on an equal plane with others. 8. I wish I could have more respect for myself. 9. All in all, I am inclined to feel that I am a failure. 10. I take a positive attitude toward myself. 40 is the highest score. The lower the level of self-esteem, the higher the probability of persistent asthma
  • Social support (0=never, 1=rarely, 2=sometime, 3=often, 4=always) 5 items (the highest score =20): how much 1. did people help you with things that needed to be done to control your asthma, like help you to keep away from things that irritate your lungs or remind you to take asthma prescription medication when you have asthma symptoms. 2. did they help you with the regular day-to-day demands of care for your asthma, for example, baby sitting, providing transportation, helping in an emergency, etc. 3. were they willing to listen when you needed to talk about your concerns about your asthma. 4. did they make you feel loved and cared for. 5. did other people give you support to help manage your asthma. 20 is the highest score.
  • Self-regulation phases (Zimmerman, 2000) 1=asthma avoidance, 2=asthma acceptance, 3=asthma compliance, 4=asthma self-regulation. 4 is the highest score.

Factors associated with persistent disease in women with asthma Factors associated with persistent disease in women with asthma Presentation Transcript

  • Factors Associated with Persistent Disease in Women with Asthma Noreen Clark, PhD Molly Gong, MD Jimmy Yu, PhD Candidate Xihong Lin, PhD Melissa Valerio, MPH William Bria, MD Timothy Johnson, MD University of Michigan School of Public Health Supported 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 Age
  • Sample demographics Education Level
  • Sample demographics
    • Annual Household Income
  • Sample demographics
    • Race/Ethnicity
  • Asthma severity
    • Classified by NAEPP criteria, USA, Guidelines and Diagnosis and Treatment of Asthma
    Classified by NAEPP criteria, Guidelines and Diagnosis and Treatment of Asthma, NHLBI, NIH, 1997 14.58 Severe persistent 18.45 Moderate persistent 14.35 Mild persistent 52.62 Mild intermittent Percent of Women
  • Findings Significant demographics factors associated with persistent asthma Educational level was significantly associated with persistent disease. The lower the education level, the higher the probability of persistent asthma. .03 1.20 .084 -.1856 438 Education P-value OR SE Estimate N Factor (1)
  • Findings Significant demographic factors associated with persistent asthma Annual household income was significantly related to persistent disease. The lower the income, the higher the probability of persistent asthma. .02 1.13 .063 -.1474 386 Annual Household Income P-value OR SE Estimate N Factor (2)
  • Findings Significant demographics factors associated with persistent asthma Not working for pay was significantly associated with persistent asthma. .02 1.59 .198 -.47 438 Working for pay P-value OR SE Estimate N Factor (3)
  • Findings Significant physical factors associated with persistent asthma The higher the BMI, the higher the probability of persistent asthma. .02 1.03 .0124 .0302 430 BMI (mean=29.5, SD=7.97) P-value OR SE Estimate N Factor
  • Findings Significant lifestyle factors associated with persistent asthma The less the exercise, the higher the probability of persistent asthma. .006 1.16 .0547 -.149 436 Frequency of exercise (mean=3.46, SD=1.79) P-value OR SE Estimate N Factor
  • Findings Significant psycho social factors associated with persistent asthma The lower the level of self-esteem, the higher the probability of persistent asthma. .0176 1.04 .0191 -.0454 438 Self-esteem score (mean=24.66, SD=2.33) P-value OR SE Estimate N Factor (1)
  • Findings Significant psycho social factors associated with persistent asthma The more the social support, the higher the probability of persistent asthma. .034 1.04 .0181 .0385 438 Overall social support score (mean=12.61, SD=5.20) P-value OR SE Estimate N Factor (2)
  • Findings Significant psycho social factors associated with persistent asthma The higher the self-regulation level, the higher the probability of persistent asthma. .0001 1.66 .214 .5056 439 Self-regulation phases (mean=2.17, SD=1.20) P-value OR SE Estimate N Factor (3)
  • 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.