Factors associated with persistent disease in women with asthma

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.

Factors associated with persistent disease in women with asthma

by Center for Managing Chronic Disease

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