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
9% 8%

17%
17%
18-30
31-40
41-50
51-60
61-70
24%
25% >71
Sample demographics

Education Level
2%
21%
26%
< High School

High School

2-year College

4-year College
30% Post Grad
21%
Sample demographics

Annual Household Income

11% 4% 6%
<10,000
10,001-20,000
16%
17% 10,001-20,000
40,001-60,000
60,001-80,000
80,000-100,000
12% >100,000
20%
refusal
14%
Sample demographics

Race/Ethnicity

2% Caucasian/White
85%
1% African American/Black
2%
Asian/Pacific Islander
2%
Hispanic/Latino
8% Native American

Other
 Asthma severity

Percent of
Women
Mild intermittent 52.62

Mild persistent 14.35

Moderate 18.45 Classified by NAEPP

persistent criteria, Guidelines and
Diagnosis and Treatment
Severe 14.58 of Asthma, NHLBI, NIH,
persistent 1997

 Classified by NAEPP criteria, USA, Guidelines and Diagnosis and Treatment of Asthma
Findings

Significant demographics factors associated with persistent asthma

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.
Findings

Significant demographic factors associated with persistent asthma

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.
Findings

Significant demographics factors associated with persistent asthma

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.
Findings

Significant physical factors associated with persistent asthma

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.
Findings

Significant lifestyle factors associated with persistent asthma

Factor N Estimate SE OR P-value

Frequency of exercise 436 -.149 .0547 1.16 .006

(mean=3.46, SD=1.79)
The less the exercise, the higher the probability of persistent asthma.
Findings

Significant psycho social factors associated with persistent asthma

Factor (1) N Estimate SE OR P-value

Self-esteem score 438 -.0454 .0191 1.04 .0176
(mean=24.66, SD=2.33)
The lower the level of self-esteem, the higher the probability of persistent
asthma.
Findings

Significant psycho social factors associated with persistent asthma

Factor (2) N Estimate SE OR P-value

Overall social support score 438 .0385 .0181 1.04 .034
(mean=12.61, SD=5.20)
The more the social support, the higher the probability of persistent
asthma.
Findings

Significant psycho social factors associated with persistent asthma

Factor (3) N Estimate SE OR P-value

Self-regulation phases 439 .5056 .214 1.66 .0001
(mean=2.17, SD=1.20)

The higher the self-regulation level, the higher the probability of 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.