Income is an independent risk factor for worse asthma outcomes

Vitamin D Add-On Therapy Enhances Corticosteroid Disparities Working Group members on behalf of the AsthmaNet investigators

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)754-760.e3
JournalJournal of Allergy and Clinical Immunology
Volume141
Issue number2
DOIs
StatePublished - Feb 1 2018

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Asthma
Treatment Failure
Social Class
Education
Adrenal Cortex Hormones
Randomized Controlled Trials
Morbidity
Medication Adherence
Clinical Protocols
Observational Studies

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology

Cite this

Vitamin D Add-On Therapy Enhances Corticosteroid Disparities Working Group members on behalf of the AsthmaNet investigators (2018). Income is an independent risk factor for worse asthma outcomes. Journal of Allergy and Clinical Immunology, 141(2), 754-760.e3. https://doi.org/10.1016/j.jaci.2017.04.036
Vitamin D Add-On Therapy Enhances Corticosteroid Disparities Working Group members on behalf of the AsthmaNet investigators. / Income is an independent risk factor for worse asthma outcomes. In: Journal of Allergy and Clinical Immunology. 2018 ; Vol. 141, No. 2. pp. 754-760.e3.
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title = "Income is an independent risk factor for worse asthma outcomes",
abstract = "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.",
author = "{Vitamin D Add-On Therapy Enhances Corticosteroid Disparities Working Group members on behalf of the AsthmaNet investigators} and Cardet, {Juan Carlos} and Margee Louisias and Tonya King and Mario Castro and Codispoti, {Christopher D.} and Ryan Dunn and Linda Engle and Giles, {B. Louise} and Fernando Holguin and Lima, {John J.} and Dayna Long and Njira Lugogo and Sharmilee Nyenhuis and Ortega, {Victor E.} and Sima Ramratnam and Wechsler, {Michael E.} and Elliot Israel and Wanda Phipatanakul",
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Vitamin D Add-On Therapy Enhances Corticosteroid Disparities Working Group members on behalf of the AsthmaNet investigators 2018, 'Income is an independent risk factor for worse asthma outcomes', Journal of Allergy and Clinical Immunology, vol. 141, no. 2, pp. 754-760.e3. https://doi.org/10.1016/j.jaci.2017.04.036

Income is an independent risk factor for worse asthma outcomes. / Vitamin D Add-On Therapy Enhances Corticosteroid Disparities Working Group members on behalf of the AsthmaNet investigators.

In: Journal of Allergy and Clinical Immunology, Vol. 141, No. 2, 01.02.2018, p. 754-760.e3.

Research output: Contribution to journalArticle

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

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

PY - 2018/2/1

Y1 - 2018/2/1

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.

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Vitamin D Add-On Therapy Enhances Corticosteroid Disparities Working Group members on behalf of the AsthmaNet investigators. Income is an independent risk factor for worse asthma outcomes. Journal of Allergy and Clinical Immunology. 2018 Feb 1;141(2):754-760.e3. https://doi.org/10.1016/j.jaci.2017.04.036