Income is an independent risk factor for worse asthma outcomes

Publication date: Available online 20 May 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Juan Carlos Cardet, Margee Louisias, Tonya S. King, Mario Castro, Christopher D. Codispoti, Ryan Dunn, Linda Engle, B. Louise Giles, Fernando Holguin, John J. Lima, Dayna Long, Njira Lugogo, Sharmilee Nyenhuis, Victor E. Ortega, Sima Ramratnam, Michael E. Wechsler, Elliot Israel, Wanda Phipatanakul
BackgroundSocioeconomic status (SES) is associated with asthma morbidity in observational studies but the factors underlying this association are uncertain.ObjectiveWe investigated whether three 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 (RCT).MethodsThe effect of low SES [household income (defined as <$50,000/year), household educational level (defined as 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 utilizing 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.Results54% 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 [RR=1.6, 95%CI 1.1-2.3, p=0.03] and exacerbations [RR=1.9, 95%CI 1.1-3.3, p=0.02]. Adherence with inhaled corticosteroids was similarly high for both income categories. Education and perceived stress were not significantly associated with either outcome.ConclusionsIn the context of a RCT, participants with lower income were more likely to experience adverse asthma outcomes independent of education, perceived stress, race, and medication adherence.

Teaser

Asthma outcomes are worse in low income groups, regardless of race, BMI, perceived stress, inhaled corticosteroid dose or adherence, baseline asthma control, and second-hand smoke exposure. This suggests that clinicians and researchers should consider income when managing patients and designing interventions.


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