Risk factors for hospitalization among adults with asthma: the influence of sociodemographic factors and asthma severity

M D Eisner, P P Katz, E H Yelin, S C Shiboski, P D Blanc, M D Eisner, P P Katz, E H Yelin, S C Shiboski, P D Blanc

Abstract

Background: The morbidity and mortality from asthma have markedly increased since the late 1970s. The hospitalization rate, an important marker of asthma severity, remains substantial.

Methods: In adults with health care access, we prospectively studied 242 with asthma, aged 18-50 years, recruited from a random sample of allergy and pulmonary physician practices in Northern California to identify risk factors for subsequent hospitalization.

Results: Thirty-nine subjects (16%) reported hospitalization for asthma during the 18-month follow-up period. On controlling for asthma severity in multiple logistic regression analysis, non-white race (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.1-8.8) and lower income (OR, 1.1 per $10,000 decrement; 95% CI, 0.9-1.3) were associated with a higher risk of asthma hospitalization. The severity-of-asthma score (OR, 3.4 per 5 points; 95%, CI 1.7-6.8) and recent asthma hospitalization (OR, 8.3; 95%, CI, 2.1-33.4) were also related to higher risk, after adjusting for demographic characteristics. Reliance on emergency department services for urgent asthma care was also associated with a greater likelihood of hospitalization (OR, 3.2; 95% CI, 1.0-9.8). In multivariate analysis not controlling for asthma severity, low income was even more strongly related to hospitalization (OR, 1.2 per $10,000 decrement; 95% CI, 1.02-1.4).

Conclusion: In adult asthmatics with access to health care, non-white race, low income, and greater asthma severity were associated with a higher risk of hospitalization. Targeted interventions applied to high-risk asthma patients may reduce asthma morbidity and mortality.

References

    1. Woodwell D. Advance data, number 286. National Ambulatory Medical Care Survey: 1995 Summary Washington, DC: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 1997.
    1. Mannino DM, Homa DM, Pertowski CA, Ashizawa A, Nixon LL, Johnson CA, Ball LB, Jack E, Kang DS. Surveillance for asthma — United States, 1960-1995. MMWR. 1998;47:1–27.
    1. Smith DH, Malone DC, Lawson KA, Okamoto LJ, Battista C, Saunders WB. A national estimate of the economic costs of asthma. Am J Respir Crit Care Med. 1997;156:787–793.
    1. Carr W, Zeitel L, Weiss K. Variations in asthma hospitalizations and deaths in New York City. Am J Public Health. 1992;82:59–65.
    1. Ray NF, Thamer M, Fadillioglu B, Gergen PJ. Race, income, urbanicity, and asthma hospitalization in California: a small area analysis. Chest. 1998;113:1277–1284.
    1. Gottlieb DJ, Beiser AS, O'Connor GT. Poverty, race, and medication use are correlates of asthma hospitalization rates. A small area analysis in Boston. Chest. 1995;108:28–35.
    1. De Palo VA, Mayo PH, Friedman P, Rosen MJ. Demographic influences on asthma hospital admission rates in New York City. Chest. 1994;106:447–451.
    1. Skobeloff EM, Spivey WH, St Clair SS, Schoffstall JM. The influence of age and sex on asthma admissions. JAMA. 1992;268:3437–3440. doi: 10.1001/jama.268.24.3437.
    1. Osborne ML, Vollmer WM, Linton KL, Buist AS. Characteristics of patients with asthma within a large HMO: a comparison by age and gender. Am J Respir Crit Care Med. 1998;157:123–128.
    1. Zoratti EM, Havstad S, Rodriguez J, Robens-Paradise Y, Lafata JE, McCarthy B. Health service use by African Americans and Caucasians with asthma in a managed care setting. Am J Respir Crit Care Med. 1998;158:371–377.
    1. Wissow LS, Gittelsohn AM, Szklo M, Starfield B, Mussman M. Poverty, race, and hospitalization for childhood asthma. Am J Public Health. 1988;78:777–782.
    1. Mayo PH, Richman J, Harris HW. Results of a program to reduce admissions for adult asthma. Ann Intern Med. 1990;112:864–871.
    1. Lozano P, Connell FA, Koepsell TD. Use of health services by African–American children with asthma on Medicaid. JAMA. 1995;274:469–473. doi: 10.1001/jama.274.6.469.
    1. Haas JS, Cleary PD, Guadagnoli E, Fanta C, Epstein AM. The impact of socioeconomic status on the intensity of ambulatory treatment and health outcomes after hospital discharge for adults with asthma. J Gen Int Med. 1994;9:121–126.
    1. Komaromy M, Lurie N, Osmond D, Vranizan K, Keane D, Bindman AB. Physician practice style and rates of hospitalization for chronic medical conditions. Med Care. 1996;34:594–609. doi: 10.1097/00005650-199606000-00009.
    1. Targonski PV, Persky VW, Kelleher P, Addington W. Characteristics of hospitalization for asthma among persons less than 35 years of age in Chicago. J Asthma. 1995;32:365–372.
    1. Mitchell EA, Borman B. Demographic characteristics of asthma admissions to hospitals. NZ Med J. 1986;99:576–579.
    1. Jackson RT, Mitchell EA. Trends in hospital admission rates and drug treatment of asthma in New Zealand. NZ Med J. 1983;96:728–730.
    1. Griffiths C, Sturdy P, Naish J, Omar R, Dolan S, Feder G. Hospital admissions for asthma in east London: associations with characteristics of local general practices, prescribing, and population. BMJ(Clin Res Ed) 1997;314:482–486.
    1. Legorreta AP, Christian-Herman J, O'Connor RD, Hasan MM, Evans R, Leung KM. Compliance with national asthma management guidelines and specialty care: a health maintenance organization experience. Arch Intern Med. 1998;158:457–464. doi: 10.1001/archinte.158.5.457.
    1. Li D, German D, Lulla S, Thomas RG, Wilson SR. Prospective study of hospitalization for asthma. A preliminary risk factor model. Am J Respir Crit Care Med. 1995;151:647–655.
    1. Prescott E, Lange P, Vestbo J. Effect of gender on hospital admissions for asthma and prevalence of self-reported asthma: a prospective study based on a sample of the general population. Copenhagen City Heart Study Group. Thorax. 1997;52:287–289.
    1. Blanc PD, Cisternas M, Smith S, Yelin EH. Asthma, employment status, and disability among adults treated by pulmonary and allergy specialists. Chest. 1996;109:688–696.
    1. Blanc PD, Katz PP, Henke J, Smith S, Yelin EH. Pulmonary and allergy subspecialty care in adults with asthma. Treatment, use of services, and health outcomes. West J Med. 1997;167:398–407.
    1. Eisner MD, Katz PP, Yelin EH, Henke J, Smith S, Blanc PD. Assessment of asthma severity in adults with asthma treated by family practitioners, allergists, and pulmonologists. Med Care. 1998;36:1567–1577. doi: 10.1097/00005650-199811000-00006.
    1. Blanc P. Correction to the scientific record [letter]. Chest. 2000;118:564. doi: 10.1378/chest.118.2.564.
    1. Eisner MD, Yelin EH, Katz PP, Shiboski SC, Henke J, Blanc PD. Predictors of cigarette smoking and smoking cessation among adults with asthma. Am J Public Health. 2000;90:1307–1311.
    1. Centers for Disease Control: Cigarette smoking among adults — United States, 1997. MMWR. 1999;48:993–996.
    1. Picado C, Castillo JA, Montserrat JM, Agusti-Vidal A. Aspirin-intolerance as a precipitating factor of life-threatening attacks of asthma requiring mechanical ventilation. Eur Respir J. 1989;2:127–129.
    1. Levin TR, Sperling RM, McQuaid KR. Omeprazole improves peak expiratory flow rate and quality of life in asthmatics with gastroesophageal reflux. Am J Gastrol. 1998;93:1060–1063. doi: 10.1016/S0002-9270(98)00210-X.
    1. Bousquet J, Knani J, Dhivert H, Richard A, Chicoye A, Ware JE. Quality of life in asthma. I. Internal consistency and validity of the SF-36 questionnaire. Am J Respir Crit Care Med. 1994;149:371–375.
    1. Ware JE, Jr, Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A. Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care. 1995;33:AS264–AS279.
    1. Weiss KB, Wagener DK. Changing patterns of asthma mortality. Identifying target populations at high risk. JAMA. 1990;264:1683–1687. doi: 10.1001/jama.264.13.1683.
    1. Lang DM, Polansky M. Patterns of asthma mortality in Philadelphia from 1969 to 1991. N Engl J Med. 1994;331:1542–1546. doi: 10.1056/NEJM199412083312302.
    1. Marder D, Targonski P, Orris P, Persky V, Addington W. Effect of racial and socioeconomic factors on asthma mortality in Chicago. Chest. 1992;101:426S–429S.
    1. Blendon RJ, Scheck AC, Donelan K, Hill CA, Smith M, Beatrice D, Altman D. How white and African Americans view their health and social problems. Different experiences, different expectations. JAMA. 1995;273:341–346. doi: 10.1001/jama.273.4.341.
    1. Donahue JG, Weiss ST, Livingston JM, Goetsch MA, Greineder DK, Platt R. Inhaled steroids and the risk of hospitalization for asthma. JAMA. 1997;277:887–891. doi: 10.1001/jama.277.11.887.
    1. Menon P, Menon V, Hilman B, Stankus R, Lehrer SB. Skin test reactivity to whole body and fecal extracts of American (Periplaneta americana) and German (Blatella germanica) cockroaches in atopic asthmatics. Ann Allergy. 1991;67:573–577.
    1. Sippel JM, Pedula KL, Vollmer WM, Buist AS, Osborne ML. Associations of smoking with hospital-based care and quality of life in patients with obstructive airway disease. Chest. 1999;115:691–696. doi: 10.1378/chest.115.3.691.
    1. Schenker MB, Gold EB, Lopez RL, Beaumont JJ. Asthma mortality in California, 1960–1989. Demographic patterns and occupational associations. Am Rev Respir Dis. 1993;147:1454–1460.
    1. David MM, Hanrahan JP, Carey V, Speizer FE, Tager IB. Respiratory symptoms in urban Hispanic and non-Hispanic white women. Am J Respir Crit Care Med. 1996;153:1285–1291.
    1. Coultas DB, Gong H, Jr, Grad R, Handler A, McCurdy SA, Player R, Rhoades ER, Samet JM, Thomas A, Westley M. Respiratory diseases in minorities of the United States [published erratum appears in Am J Respir Crit Care Med 150:290]. Am J Respir Crit Care Med. 1994;149:S93–S131.
    1. Crane J, Pearce N, Burgess C, Woodman K, Robson B, Beasley R. Markers of risk of asthma death or readmission in the 12 months following a hospital admission for asthma. Int J Epidemiol. 1992;21:737–744.
    1. Adams RJ, Smith BJ, Ruffin RE. Factors associated with hospital admissions and repeat emergency department visits for adults with asthma. Thorax. 2000;55:566–573. doi: 10.1136/thorax.55.7.566.
    1. Becklake MR, Lalloo U. The 'healthy smoker': a phenomenon of health selection? Respiration. 1990;57:137–144.
    1. Richter JE. Gastroesophageal reflux disease and asthma: the two are directly related. Am J Med. 2000;108 (suppl 4a):153S–158S. doi: 10.1016/S0002-9343(99)00356-3.
    1. Kiljander TO, Salomaa ER, Hietanen EK, Terho EO. Gastroesophageal reflux in asthmatics: a double-blind, placebo-controlled crossover study with omeprazole. Chest. 1999;116:1257–1264. doi: 10.1378/chest.116.5.1257.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever