Socioeconomic status associates with worse asthma morbidity among Black and Latinx adults.

Abstract

BACKGROUND:

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.

OBJECTIVE:

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.

METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

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.

• Authors: Juan Carlos Cardet, Ku-Lang Chang, Benjamin J Rooks, Jennifer K Carroll, Juan Carlos Celedón, Tamera Coyne-Beasley, Jing Cui, Brianna Ericson, Victoria E Forth, Maureen Fagan, Anne L Fuhlbrigge, Paulina Arias Hernandez, Jean Kruse, Margee Louisias, Nancy E Maher, Brian Manning, Wilson D Pace, Wanda Phipatanakul, Jacqueline Rodriguez-Louis, Joel B Shields, Elliot Israel, Juan P Wisnivesky
• Journal: The Journal of allergy and clinical immunology (J Allergy Clin Immunol) Vol. 150 Issue 4 Pg. 841-849.e4 (10 2022) ISSN: 1097-6825 [Electronic] United States
• PMID: 35597370 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2022 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Adrenal Cortex Hormones

Topics

• Adrenal Cortex Hormones
• Adult
• Black or African American
• Asthma (drug therapy, epidemiology)
• Humans
• Morbidity
• Social Class