Juan Carlos Cardet1, Margee Louisias2, Tonya S King3, Mario Castro4, Christopher D Codispoti5, Ryan Dunn6, Linda Engle3, B Louise Giles7, Fernando Holguin8, John J Lima9, Dayna Long10, Njira Lugogo11, Sharmilee Nyenhuis12, Victor E Ortega13, Sima Ramratnam14, Michael E Wechsler3, Elliot Israel1, Wanda Phipatanakul15. 1. Department of Medicine, Brigham and Women's Hospital, Boston, Mass. 2. Department of Medicine, Brigham and Women's Hospital, Boston, Mass; the Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass. 3. Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pa. 4. Washington University School of Medicine, St Louis, Mo. 5. Rush University, Chicago, Ill. 6. National Jewish Health, Denver, Colo. 7. University of Chicago, Chicago, Ill. 8. University of Pittsburgh School of Medicine, Pittsburgh, Pa. 9. Nemours Children's Health System, Jacksonville, Fla. 10. Department of Pediatrics, University of California at San Francisco's Benioff Children's Hospital at Oakland, Oakland, Calif. 11. Duke University, Durham, NC. 12. University of Illinois at Chicago, Chicago, Ill; University of Illinois Hospital & Health Sciences System, Chicago, Ill. 13. Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC. 14. University of Wisconsin Hospital and Clinics, Madison, Wis. 15. Department of Medicine, Brigham and Women's Hospital, Boston, Mass; the Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass. Electronic address: wanda.phipatanakul@childrens.harvard.edu.
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.
RCT Entities:
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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