Montreal Behavioural Medicine Centre, Division of Chest Medicine, Research Center, Hôpital du Sacré-Coeur de Montréal--University of Montréal affiliated hospital, 5400 Gouin West, Montréal, Québec, Canada.
Respir Res. 2009 Dec 17;10(1):125. doi: 10.1186/1465-9921-10-125.
Low socioeconomic status (SES) has been linked to higher morbidity in patients with chronic diseases, but may be particularly relevant to asthma, as asthmatics of lower SES may have higher exposures to indoor (e.g., cockroaches, tobacco smoke) and outdoor (e.g., urban pollution) allergens, thus increasing risk for exacerbations.
This study assessed associations between adult SES (measured according to educational level) and asthma morbidity, including asthma control; asthma-related emergency health service use; asthma self-efficacy, and asthma-related quality of life, in a Canadian cohort of 781 adult asthmatics. All patients underwent a sociodemographic and medical history interview and pulmonary function testing on the day of their asthma clinic visit, and completed a battery of questionnaires (Asthma Control Questionnaire, Asthma Quality of Life Questionnaire, and Asthma Self-Efficacy Scale). General Linear Models assessed associations between SES and each morbidity measure.
Lower SES was associated with worse asthma control (F = 11.63, p < .001), greater emergency health service use (F = 5.09, p = .024), and worse asthma self-efficacy (F = 12.04, p < .01), independent of covariates. Logistic regression analyses revealed that patients with <12 years of education were 55% more likely to report an asthma-related emergency health service visit in the last year (OR = 1.55, 95%CI = 1.05-2.27). Lower SES was not related to worse asthma-related quality of life.
Results suggest that lower SES (measured according to education level), is associated with several indices of worse asthma morbidity, particularly worse asthma control, in adult asthmatics independent of disease severity. Results are consistent with previous studies linking lower SES to worse asthma in children, and add asthma to the list of chronic diseases affected by individual-level SES.
低社会经济地位（SES）与慢性病患者的发病率较高有关，但可能与哮喘尤其相关，因为 SES 较低的哮喘患者可能会接触到更多的室内（例如蟑螂、烟草烟雾）和室外（例如城市污染）过敏原，从而增加加重的风险。
本研究评估了加拿大 781 名成年哮喘患者中 SES（根据教育水平衡量）与哮喘发病率之间的关联，包括哮喘控制；与哮喘相关的紧急卫生服务使用；哮喘自我效能感和哮喘相关生活质量。所有患者在哮喘就诊当天都接受了社会人口统计学和病史访谈以及肺功能测试，并完成了一系列问卷（哮喘控制问卷、哮喘生活质量问卷和哮喘自我效能感量表）。一般线性模型评估了 SES 与每种发病率指标之间的关联。
SES 较低与哮喘控制较差（F = 11.63，p <.001）、紧急卫生服务使用增加（F = 5.09，p =.024）和哮喘自我效能感降低（F = 12.04，p <.01）有关，独立于协变量。Logistic 回归分析显示，受教育程度<12 年的患者在过去一年中报告与哮喘相关的紧急卫生服务就诊的可能性增加了 55%（OR = 1.55，95%CI = 1.05-2.27）。SES 较低与哮喘相关生活质量的恶化无关。
结果表明，SES 较低（根据教育水平衡量）与成年哮喘患者的几种哮喘发病率指标较差有关，尤其是哮喘控制较差，这与疾病严重程度无关。结果与先前将 SES 与儿童哮喘恶化联系起来的研究一致，并将哮喘纳入受个体 SES 影响的慢性疾病之列。
