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Factors associated with persistent disease in women with asthma Noreen Clark Center for Managing Chronic Disease University of Michigan
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Factors Associated with Persistent Disease in Women with Asthma
Noreen Clark, PhD Molly Gong, MDJimmy Yu, PhD CandidateXihong Lin, PhDMelissa Valerio, MPH William Bria, MD Timothy Johnson, MD
University of Michigan
School of Public HealthSupported 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
Age8%
17%
24%25%
17%
9%
18-30
31-40
41-50
51-60
61-70
>71
Sample demographics
2%
26%
21%30%
21%
< High School
High School
2-year College
4-year College
Post Grad
Education Level
Sample demographics
Annual Household Income
4% 6%
16%
20%
14%
12%
17%
11%<10,000
10,001-20,000
10,001-20,000
40,001-60,000
60,001-80,000
80,000-100,000
>100,000
refusal
Sample demographics
Race/Ethnicity
85%
2%
8%
2%
1%
2% Caucasian/White
African American/Black
Asian/Pacific Islander
Hispanic/Latino
Native American
Other
Asthma severity
Classified by NAEPP criteria, USA, Guidelines and Diagnosis and Treatment of Asthma
Percent of Women
Mild intermittent
52.62
Mild persistent 14.35
Moderate persistent
18.45
Severe persistent
14.58
Classified by NAEPP criteria, Guidelines and Diagnosis and Treatment of Asthma, NHLBI, NIH, 1997
Findings
Factor (1) N Estimate SE OR P-value
Education 438 -.1856 .084 1.20 .03
Educational level was significantly associated with persistent disease. The lower the education level, the higher the probability of persistent asthma.
Significant demographics factors associated with persistent asthma
Findings
Factor (2) N Estimate SE OR P-value
Annual Household Income 386 -.1474 .063 1.13 .02
Annual household income was significantly related to persistent disease. The lower the income, the higher the probability of persistent asthma.
Significant demographic factors associated with persistent asthma
Findings
Factor (3) N Estimate SE OR P-value
Working for pay 438 -.47 .198 1.59 .02
Not working for pay was significantly associated with persistent asthma.
Significant demographics factors associated with persistent asthma
Findings
Factor N Estimate SE OR P-value
BMI (mean=29.5, SD=7.97) 430 .0302 .0124 1.03 .02
The higher the BMI, the higher the probability of persistent asthma.
Significant physical factors associated with persistent asthma
Findings
Factor N Estimate SE OR P-value
Frequency of exercise (mean=3.46, SD=1.79)
436 -.149 .0547 1.16 .006
The less the exercise, the higher the probability of persistent asthma.
Significant lifestyle factors associated with persistent asthma
Findings
The lower the level of self-esteem, the higher the probability of persistent asthma.
.01761.04.0191-.0454438Self-esteem score (mean=24.66, SD=2.33)
P-valueORSEEstimateNFactor (1)
Significant psycho social factors associated with persistent asthma
Findings
The more the social support, the higher the probability of persistent asthma.
.0341.04.0181.0385438Overall social support score (mean=12.61, SD=5.20)
P-valueORSEEstimateNFactor (2)
Significant psycho social factors associated with persistent asthma
The higher the self-regulation level, the higher the probability of persistent asthma.
.00011.66.214.5056439Self-regulation phases (mean=2.17, SD=1.20)
P-valueORSEEstimateNFactor (3)
Findings
Significant psycho social factors associated with persistent asthma
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.