Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Fla.
Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville, Fla.
J Allergy Clin Immunol. 2022 Oct;150(4):841-849.e4. doi: 10.1016/j.jaci.2022.04.030. Epub 2022 May 18.
Asthma disproportionately affects African American/Black (AA/B) and Hispanic/Latinx (H/L) patients and individuals with low socioeconomic status (SES), but the relationship between SES and asthma morbidity within these racial/ethnic groups is inadequately understood.
To determine the relationship between SES and asthma morbidity among AA/B and H/L adults with moderate to severe asthma using multidomain SES frameworks and mediation analyses.
We analyzed enrollment data from the PeRson EmPowered Asthma RElief randomized trial, evaluating inhaled corticosteroid supplementation to rescue therapy. We tested for direct and indirect relationships between SES and asthma morbidity using structural equation models. For SES, we used a latent variable defined by poverty, education, and unemployment. For asthma morbidity, we used self-reported asthma exacerbations in the year before enrollment (corticosteroid bursts, emergency room/urgent care visits, or hospitalizations), and Asthma Control Test scores. We tested for mediation via health literacy, perceived stress, and self-reported discrimination. All models adjusted for age, sex, body mass index, ethnicity, and comorbidities.
Among 990 AA/B and H/L adults, low SES (latent variable) was directly associated with hospitalizations (β = 0.24) and worse Asthma Control Test scores (β = 0.20). Stress partially mediated the relationship between SES and increased emergency room/urgent care visits and worse asthma control (β = 0.03 and = 0.05, respectively). Individual SES domains were directly associated with asthma morbidity. Stress mediated indirect associations between low educational attainment and unemployment with worse asthma control (β = 0.05 and = 0.06, respectively).
Lower SES is directly, and indirectly through stress, associated with asthma morbidity among AA/B and H/L adults. Identification of stressors and relevant management strategies may lessen asthma-related morbidity among these populations.
哮喘在非裔美国人/黑人（AA/B）和西班牙裔/拉丁裔（H/L）患者以及社会经济地位较低的个体中发病率不成比例，但在这些种族/族裔群体中，社会经济地位与哮喘发病率之间的关系尚未得到充分理解。
使用多领域社会经济地位框架和中介分析，确定 AA/B 和 H/L 中重度哮喘成人中社会经济地位与哮喘发病率之间的关系。
我们分析了评估吸入性皮质类固醇补充治疗作为抢救疗法的 PeRson EmPowered Asthma RElief 随机试验的入组数据。我们使用结构方程模型来检验社会经济地位与哮喘发病率之间的直接和间接关系。对于社会经济地位，我们使用了一个由贫困、教育和失业定义的潜在变量。对于哮喘发病率，我们使用了入组前一年自我报告的哮喘加重情况（皮质类固醇爆发、急诊/紧急护理就诊或住院）和哮喘控制测试评分。我们通过健康素养、感知压力和自我报告的歧视来检验中介作用。所有模型均调整了年龄、性别、体重指数、种族和合并症。
在 990 名 AA/B 和 H/L 成年人中，低社会经济地位（潜在变量）与住院（β=0.24）和哮喘控制测试评分较差（β=0.20）直接相关。压力部分中介了社会经济地位与急诊/紧急护理就诊增加和哮喘控制恶化之间的关系（β=0.03 和β=0.05）。个体社会经济地位领域与哮喘发病率直接相关。压力介导了低教育程度和失业与哮喘控制恶化之间的间接关联（β=0.05 和β=0.06）。
较低的社会经济地位与 AA/B 和 H/L 成年哮喘患者的哮喘发病率直接相关，通过压力间接相关。识别压力源和相关管理策略可能会降低这些人群中与哮喘相关的发病率。
