Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
Department of Medicine, Brigham and Women's Hospital, Boston, Mass; the Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass.
J Allergy Clin Immunol. 2018 Feb;141(2):754-760.e3. doi: 10.1016/j.jaci.2017.04.036. Epub 2017 May 20.
Socioeconomic status (SES) is associated with asthma morbidity in observational studies, but the factors underlying this association are uncertain.
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.
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.
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.
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.
社会经济地位（SES）与观察性研究中的哮喘发病率有关，但这种关联的背后因素尚不确定。
我们研究了 SES 的三个相关因素（低收入、低教育程度和高感知压力）是否是随机对照试验中治疗失败和哮喘恶化的独立危险因素。
通过泊松回归模型分析了 381 名参与者中 SES 低（家庭收入<50000 美元/年，家庭教育程度低于学士学位）和高感知压力（感知压力量表得分>20）对哮喘发病率的影响。主要结局是治疗失败（试验方案中定义为显著的临床或气流恶化），次要结局是需要全身皮质类固醇治疗的哮喘恶化。
54%的参与者收入低，40%的参与者教育程度低，17%的参与者感知压力水平高。即使在调整种族和其他重要混杂因素后，收入较低的参与者治疗失败的发生率更高（比率比，1.6；95%置信区间，1.1-2.3；P=.03），哮喘恶化的发生率也更高（比率比，1.9；95%置信区间，1.1-3.3；P=.02）。两种收入水平的患者吸入皮质类固醇的依从性均较高。教育程度和感知压力与任何结局均无显著相关性。
在随机对照试验的背景下，收入较低的参与者更有可能出现不良哮喘结局，而与教育程度、感知压力、种族和药物依从性无关。
