0
Clinical Investigations: ASTHMA |

Reconcilable Differences*: A Cross-sectional Study of the Relationship Between Socioeconomic Status and the Magnitude of Short-Acting β-Agonist Use in Asthma

Larry D. Lynd, PhD; Andrew J. Sandford, PhD; Erin M. Kelly; Peter D. Paré, MD; Tony R. Bai, MD; J. Mark FitzGerald, MD, FCCP; Aslam H. Anis, PhD
Author and Funding Information

*From the Faculty of Pharmaceutical Sciences (Dr. Lynd), and the Department of Health Care and Epidemiology (Dr. Anis), University of British Columbia, Vancouver, BC, Canada; iCAPTURE Centre (Drs. Sandford, Parè, and Bai, and Ms. Kelly), Providence Health Care, Vancouver, BC, Canada; and the Centre for Clinical Epidemiology and Evaluation (Dr. FitzGerald), Vancouver General Hospital, Vancouver, BC, Canada.

Correspondence to: Aslam H. Anis, PhD, Centre for Health Evaluation and Outcome Sciences, 620–1081 Burrard St, Vancouver, BC, Canada; e-mail: aslam.anis@ubc.ca



Chest. 2004;126(4):1161-1168. doi:10.1378/chest.126.4.1161
Text Size: A A A
Published online

Study objective: To assess the association between socioeconomic status (SES) and short-acting (SA) β-agonist use, controlling for asthma severity.

Design: Cross-sectional study.

Setting: Vancouver, BC, Canada.

Participants: Two hundred two asthmatics between 19 years and 50 years of age and residing in the greater Vancouver regional district.

Measurements: The quantity of SA β-agonist used in the previous year was collected by self-report; pulmonary function and β-receptor genotype were measured on each participant. SES was measured at both the individual and population levels. Five methods of adjustment for asthma severity were used, as follows: the Canadian Asthma Consensus Guidelines, three previously developed asthma-severity scores, and forward stepwise multiple regression modeling. Polychotomous logistic regression was used to assess all relationships.

Results: Independent of the method used to measure SES or adjust for asthma severity, lower SES was consistently and significantly associated with the use of greater amounts of SA β-agonist. Adjusting for severity using the multivariate model explained the most variance of SA β-agonist use (R2 adjusted, 0.35 to 0.37). In this model, social assistance recipients were more likely to use greater amounts of SA β-agonist (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.7 to 6.5). An inverse relationship between SA β-agonist use and both annual household income (> $50,000; OR, 0.28; 95% CI, 0.13 to 0.60; and $20,000 to $50,000; OR, 0.44; 95% CI, 0.21 to 0.96; relative to <$20,000) and education (completing a bachelor’s degree vs no formal education; OR, 0.25; 95% CI, 0.14 to 0.71). Participants living in a neighborhood with higher median household income (OR, 0.91; 95% CI, 0.84 to 0.98 per $1,000 increase) or a higher prevalence of having attainted a bachelor’s degree (OR, 0.96; 95% CI, 0.84 to 0.98 per 1% increase) were also less likely use greater amounts of SA β-agonist. Results were consistent for neighborhood unemployment rate.

Conclusions: The social gradient in asthma-related outcomes may be at least partially attributable to poorer asthma control in lower-SES asthmatics.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543