Article

Mediators of the Socioeconomic Gradient in Outcomes of Adult Asthma and Rhinitis.

At the time the work for this article was conducted, all authors were with the Department of Medicine, University of California, San Francisco. John R. Balmes was also affiliated with the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, and Paul D. Blanc with the Cardiovascular Research Institute, University of California, San Francisco.
American Journal of Public Health (Impact Factor: 4.23). 12/2012; DOI: 10.2105/AJPH.2012.300938
Source: PubMed

ABSTRACT Objectives. We estimated the extent to which socioeconomic status (SES) gradients in adult asthma and rhinitis outcomes can be explained by home and neighborhood environmental factors. Methods. Using survey data for 515 adults with either asthma or rhinitis, or both, we examined environmental mediators of SES associations with disease severity, using the Severity of Asthma Scale, and health-related quality of life (HRQL), using the Rhinasthma Scale. We defined SES on the basis of education and household income. Potential environmental mediators included home type and ownership, exposures to allergens and irritants, and a summary measure of perceived neighborhood problems. We modeled each outcome as a function of SES, and controlled for age, gender, and potential mediators. Results. Gradients in SES were apparent in disease severity and HRQL. Living in a rented house partially mediated the SES gradient for both severity and HRQL (P < .01). Higher perceived levels of neighborhood problems were associated with poorer HRQL and partially mediated the income-HRQL relationship (P < .01). Conclusions. Differences in home and neighborhood environments partially explained associations of SES with adult asthma and rhinitis outcomes.(Am J Public Health. Published online ahead of print December 13, 2012: e1-e8. doi:10.2105/AJPH.2012.300938).

0 Followers
 · 
93 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Higher values of the environmental relative moldiness index (ERMI), a DNA-based method for quantifying indoor molds, have been associated with asthma in children. In this study, settled dust samples were collected from the homes of adults with asthma, rhinitis, or both conditions (n=139 homes) in Northern California. The ERMI values for these samples were compared to those from dust collected in homes from the same geographic region randomly selected as part of the 2006 American Healthy Home Survey (n=44). The median ERMI value in homes of adult with airway disease (6) was significantly greater than median ERMI value (2) in the randomly selected homes (p<0.0001). In this study in Northern California, the homes of adults with asthma had ERMI values consistent with a heavier burden of indoor mold than that measured in other homes from the same region.
    Environmental Research 02/2013; 122. DOI:10.1016/j.envres.2013.01.002
  • [Show abstract] [Hide abstract]
    ABSTRACT: The present review addresses recent advances and especially challenging aspects regarding the role of environmental risk factors in adult-onset asthma, for which the causes are poorly established. In the first part of the review, we discuss aspects regarding some environmental risk factors for adult-onset asthma: air pollution, occupational exposures with a focus on an emerging risk represented by exposure to cleaning agents (both at home and in the workplace), and lifestyle and nutrition. The second part is focused on perspectives and challenges, regarding relevant topics on which research is needed to improve the understanding of the role of environmental factors in asthma. Aspects of exposure assessment, the complexity of multiple exposures, the interrelationships of the environment with behavioral characteristics and the importance of studying biological markers and gene-environment interactions to identify the role of the environment in asthma are discussed. We conclude that environmental and lifestyle exposures play an important role in asthma or related phenotypes. The changes in lifestyle and the environment in recent decades have modified the specific risk factors in asthma even for well-recognized risks such as occupational exposures. To better understand the role of the environment in asthma, the use of objective (quantitative measurement of exposures) or modern tools (bar code, GPS) and the development of multidisciplinary collaboration would be very promising. A better understanding of the complex interrelationships between socio-economic, nutritional, lifestyle and environmental conditions might help to study their joint and independent roles in asthma.
    La Presse Médicale 09/2013; DOI:10.1016/j.lpm.2013.06.010
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients with interstitial lung disease (ILD) have poor health-related quality of life (HRQL). However, whether HRQL differs among different subtypes of ILD is unclear. The aim of this study was to determine whether HRQL was different among patients with idiopathic pulmonary fibrosis (IPF) and chronic hypersensitivity pneumonitis (CHP). We identified patients from an ongoing longitudinal cohort of ILD patients. HRQL was assessed using the SF-36v2 medical outcomes form. Regression analysis was used to determine the association between clinical co-variates and HRQL, primarily the physical component summary (PCS) and mental component summary (MCS) score. A multivariate regression model was created to identify potential co-variates that could help explain the association between the ILD subtype and HRQL. IPF patients (n=102) were older, more likely to be men, and to have smoked. Pulmonary function was similar between the groups. The CHP patients (n=69) had worse HRQL across all eight domains of the SF-36, as well as the PCS and MCS, compared to IPF (p-value <0.01-0.09). This pattern remained after controlling for age and pulmonary function (p-value <0.01-0.02). Co-variates explaining part of the relationship between disease subtype and PCS score included severity of dyspnea (p-value <0.01) and fatigue (p-value 0.01). Co-variates explaining part of the relationship between disease subtype and MCS score included severity of dyspnea (p-value <0.01), female sex (p-value 0.02), and fatigue (p-value 0.02). HRQL is worse in CHP compared to IPF. HRQL differences between ILD subtypes are explained in part by differences in gender, dyspnea, and fatigue.
    Chest 01/2014; 145(6). DOI:10.1378/chest.13-1984
Show more