TY - JOUR
T1 - Income is an independent risk factor for worse asthma outcomes
AU - Vitamin D Add-On Therapy Enhances Corticosteroid Disparities Working Group members on behalf of the AsthmaNet investigators
AU - Cardet, Juan Carlos
AU - Louisias, Margee
AU - King, Tonya S.
AU - Castro, Mario
AU - Codispoti, Christopher D.
AU - Dunn, Ryan
AU - Engle, Linda
AU - Giles, B. Louise
AU - Holguin, Fernando
AU - Lima, John J.
AU - Long, Dayna
AU - Lugogo, Njira
AU - Nyenhuis, Sharmilee
AU - Ortega, Victor E.
AU - Ramratnam, Sima
AU - Wechsler, Michael E.
AU - Israel, Elliot
AU - Phipatanakul, Wanda
N1 - Publisher Copyright:
© 2017 American Academy of Allergy, Asthma & Immunology
PY - 2018/2
Y1 - 2018/2
N2 - Background: Socioeconomic status (SES) is associated with asthma morbidity in observational studies, but the factors underlying this association are uncertain. Objective: We investigated whether 3 SES correlates—low income, low education, and high perceived stress—were independent risk factors for treatment failure and asthma exacerbations in the context of a randomized controlled trial. Methods: The effect of low SES (household income of <$50,000/y and household educational level of less than a Bachelor's degree) and high perceived stress (defined as a score of >20 on a perceived stress scale) on asthma morbidity was analyzed in 381 participants by using Poisson regression models. The primary outcome was treatment failure (defined in the trial protocol as a significant clinical or airflow deterioration), and the secondary outcome was asthma exacerbations requiring systemic corticosteroids. Results: Fifty-four percent of participants had a low income, 40% had a low educational level, and 17% had high perceived stress levels. Even after adjusting for race and other important confounders, participants with lower income had higher rates of both treatment failures (rate ratio, 1.6; 95% CI, 1.1-2.3; P =.03) and exacerbations (rate ratio, 1.9; 95% CI, 1.1-3.3; P =.02). Adherence with inhaled corticosteroids was similarly high for both income categories. Education and perceived stress were not significantly associated with either outcome. Conclusions: In the context of a randomized controlled trial, participants with lower income were more likely to experience adverse asthma outcomes independent of education, perceived stress, race, and medication adherence.
AB - Background: Socioeconomic status (SES) is associated with asthma morbidity in observational studies, but the factors underlying this association are uncertain. Objective: We investigated whether 3 SES correlates—low income, low education, and high perceived stress—were independent risk factors for treatment failure and asthma exacerbations in the context of a randomized controlled trial. Methods: The effect of low SES (household income of <$50,000/y and household educational level of less than a Bachelor's degree) and high perceived stress (defined as a score of >20 on a perceived stress scale) on asthma morbidity was analyzed in 381 participants by using Poisson regression models. The primary outcome was treatment failure (defined in the trial protocol as a significant clinical or airflow deterioration), and the secondary outcome was asthma exacerbations requiring systemic corticosteroids. Results: Fifty-four percent of participants had a low income, 40% had a low educational level, and 17% had high perceived stress levels. Even after adjusting for race and other important confounders, participants with lower income had higher rates of both treatment failures (rate ratio, 1.6; 95% CI, 1.1-2.3; P =.03) and exacerbations (rate ratio, 1.9; 95% CI, 1.1-3.3; P =.02). Adherence with inhaled corticosteroids was similarly high for both income categories. Education and perceived stress were not significantly associated with either outcome. Conclusions: In the context of a randomized controlled trial, participants with lower income were more likely to experience adverse asthma outcomes independent of education, perceived stress, race, and medication adherence.
KW - Disparities
KW - Vitamin D Add-On Therapy Enhances Corticosteroid trial
KW - asthma exacerbation
KW - education
KW - low income
KW - psychological stress
KW - socioeconomic status
UR - http://www.scopus.com/inward/record.url?scp=85020809121&partnerID=8YFLogxK
U2 - 10.1016/j.jaci.2017.04.036
DO - 10.1016/j.jaci.2017.04.036
M3 - Article
C2 - 28535964
AN - SCOPUS:85020809121
SN - 0091-6749
VL - 141
SP - 754-760.e3
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
IS - 2
ER -