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: 4.55). 12/2012; 103(2). DOI: 10.2105/AJPH.2012.300938
Source: PubMed


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.

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.

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).

Differences in home and neighborhood environments partially explained associations of SES with adult asthma and rhinitis outcomes.

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