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Asthma in Women of Color and/or Low Income

Noreen M. Clark, PhD, Molly Gong, MD, Sijian Wang, MS, Melissa Valerio, MPH, William Bria, MD,
Xihong Lin, PhD, Timothy Johnson, MD
University of Michigan - School of Public Health

ABSTRACT FINDINGS Comparison of Medication Use


Minority & low White & not low Odds Ratio
RATIONALE: The purpose of this study was to compare management income income
problems of women with asthma of different races and socioeconomic status. Demographics:
(N=151) (N=422) p-value
METHODS: Telephone interview data were collected from 590 participants Education Level
Age 9% 8% 2% Inhaled anti- 51% 63% 0.68
attending asthma clinics within the University of Michigan Health System. 37% inflammatory
21%
(n=160) were women of color and/or from low income families (less than medications
17%
17% 26% .042
$20,000). Poisson and Logistic regression models were conducted to ascertain 18-30 < High School
group differences. 31-40 Inhaled corticosteroids 52% 62% 0.65
High School
RESULTS: Women of color were 4 times more likely to be at the low income 41-50 .025
2-year College
level than white women (OR=4.0, p=.0001). Women of color and/or from low 51-60 Long-acting inhaled 44% 55% 0.64
income families were 1.6 times more likely to have persistent disease (OR=1.6, 61-70 4-year College bronchodilators .019
p=.016), 4.9 hospitalizations (RR=4.9, p=.0001), 1.8 ED visits (RR=1.8, 24% 30%
25% >71 Post Grad
21% Home remedies 5% 3% 1.66 0..3
p=.002), 1.3 unscheduled urgent office visits (RR=1.3, p=.0007), and 1.5
follow-up visits for an asthma episode (RR=1.5, p=.006) compared to non-
minority women and/or those of higher income. They used less inhaled
corticosteroid medicine (OR=0.7, p=.025) and less long-acting inhaled Annual Household Income Race/Ethnicity
Comparison of quality of life, asthma knowledge, and self-esteem
bronchodilators (OR=0.6, p=.02). Although not statistically significant, they 4% 6%
11% 1 = Minority & low income Quality of life Asthma Knowledge Self-esteem
also used more oral steroids (OR=1.5, p=.1) and more home remedies (OR=1.7, <10,000
0 = White & not low income
2% Caucasian/White
p=.3). They also were more likely to have lower levels of self-esteem (p=.05), 10,001-20,000 85%
asthma knowledge (p=.01), and asthma-related quality of life (p=.02). 16% 1% African American/Black
17% 10,001-20,000
2%
Significantly more women of color and/or from low income families reported 40,001-60,000 Asian/Pacific Islander
that they had never visited a specialist for asthma (OR=.06, p=.006) and were 60,001-80,000
2%
Hispanic/Latino Estimation 0.1779 -0.1407 -0.09
not satisfied with the medical care they received (OR=0.3, p=.05). 80,000-100,000 8%
Native American p-value 0.0219 0.05 0.049
CONCLUSION: Women of color and/or from low income families confront 12% >100,000
20%
more asthma management difficulties and bear greater burden of the disease. refusal
Other
14%

BACKGROUND & METHODS


Women of Color and/or low income versus White, not low income: Comparison of Healthcare Providers:
Background: Significantly more Women of Color and/or low income reported that:
Asthma Continues to be an extensive problem in the Unites States. Women • They had never visited a specialist for asthma (OR=0.06, p=.006)
• 27% of the participants were Women of Color and/or low income (<$20,000 annual family income)
predominate among adults with asthma and confront particular problems in • Women of Color were 4 times more likely to be at the low income level than White women
managing the disease. Studies indicate that women of color, especially from • They were not satisfied with the medical care they received
(OR=4.0, p<.0001)
low income families, bear a significantly greater burden of asthma. (OR=0.3, p=.05)

Purpose: Comparison of Symptoms & Severity


The purpose of this study was to compare management problems of women with Minority and/ or low White & not low income p-value
asthma of different socioeconomic status income (N=433) CONCLUSIONS
(N=156)

Data Collection: Telephone interview data collected: Yearly average days of daytime 6.1 (SD=5.9) 4.6 (SD=5.5) <.05
Demographic Medication use symptoms Women of Color were more likely:
Disease severity Health care utilization Yearly Average nights of nighttime 4.3 (SD=4.9) 3.1 (SD=4.1) <.05
Quality of life and self-esteem symptoms • To have more severe disease and use more health care.
56% 45% OR=1.6 • To use less controller medication.
Persistent Asthma (%) .016 • To have lower levels of self esteem, asthma knowledge, and perceptions of
Data Analysis: quality of life.
Poisson and Logistic regression models controlling for age and disease severity
and Chi-square or t-tests were performed to compare differences in outcomes Comparison of health care use
between minority and/or low income women with non minority, non low Women of Color and/or low income bear a greater asthma burden.
1 = Minority & low Hospital admission ED visits Unscheduled Visits
income women. income
0 = White & not low Follow-up visits
Study Participants: income Supported by NHLBI grant 1R18 HL60884
•806 women Estimation 1.59 0.61 0.29 0.38
•18 years and older S.E. 0.30 0.20 0.09 0.14
•Physician diagnosis of asthma
•Cared for in the University of Michigan Health System Relative Risk 4.90 1.84 1.34 1.46
p-value <.0001 .0019 .0007 .0055
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