Noreen Clark, PhD Molly Gong, MDMelissa Valerio, MPHSijian Wang, BSXihong Lin, PhDWilliam Bria, MD Timothy Johnson, MD

University of MichiganSchool of Public Health

Impact of Being Overweight in Women with Asthma

Background

Both asthma and obesity are common health problems and their prevalence continues to rise.

Recent studies indicate that asthma may be associated with overweight in women but not men (Guerra, et al. 2002,

Thomson, et al., 2003).

Purpose

To examine factors associated

with body mass index (BMI) and

related asthma problems for

women.

Study Participants

652 women 18 years and older Physician diagnosis Attending University of Michigan

Asthma & Airways Clinic and University of Michigan Health System

Data collection

Telephone interview

Demographics Asthma symptoms Health care utilization Gender-related management Co-morbidity Quality of life and self-esteem

Data Analyses

Multivariate linear regression models were conducted using BMI as dependent variable and adjusting for age.

Demographics: Age

13%

7% 9%

21%

26%

24%

18-30

31-40

41-50

51-60

61-70

>71

Demographics: Education

22%

2%

26%

21%29%

< High School

High School

2-year College

4-year College

Post Grad

Demographics: Income

5%6%

16%

18%

16%

13%

15%

11%<10,000

10,001-20,000

10,001-20,000

40,001-60,000

60,001-80,000

80,000-100,000

>100,000

Not reported

Demographics: Race/Ethnicity

2%1%2%

10%

2%

83%Caucasian/White

African American/Black

Asian/Pacific Islander

Hispanic/Latino

Native American

Other

Asthma Severity

Classified by NAEPP criteria, Guidelines and Diagnosis and Treatment of Asthma, 1997

Percent of Women

Mild intermittent 53%

Mild persistent 14%

Moderate persistent 18%

Severe persistent 15%

BMI Levels

Percent of Women

Underweight (BMI<19) 3%

Normal (BMI 19-25) 31%

Overweight (BMI 26-30) 26%

Obese (BMI 31-35) 20%

Over Obese (BMI >35) 20%

Association of BMI and Demographic Factors

Estimate Std Error P-Value

Age 0.04 0.02 0.0652

Income -2.6 0.71 0.0003

Education -2.98 0.68 0.0001

Marital status* -1.29 0.65 0.0471

Ethnicity** 5.14 1.02 0.0001

* 1=yes married, 0=otherwise**2=African American, 1=otherwise

Association of BMI and Health Care Utilization for Asthma

Number of timesin past 12months

Estimate Std Error P-Value

Hospitalization 1.13 0.26 0.0001

ED visits 0.25 0.08 0.0016

Unscheduledurgent visit to aclinic

0.09 0.06 0.1117

Regularlyscheduled visits

0.07 0.05 0.1506

Visits to follow-up an asthmaattack

0.06 0.04 0.1533

Association of BMI and Asthma Symptoms & Severity

Estimate Std Error P-Value

Days havingdaytimesymptoms

0.011 0.005 0.0332

Nightsymptomsinterferedsleep

0.018 0.006 0.0031

Severity 0.848 0.278 0.0024

Association of BMI and Other Health Problems

Ever suffered inpast 12 months

Estimate Std Error P-Value

Migraines 1.60 0.66 0.0156

Reflux 2.29 0.67 0.0007

Urinaryincontinence

3.48 0.64 0.0001

Association of BMI, Self-esteem, Quality of Life & Social Support

Estimate Std Error P-Value

Self-esteem -0.27 0.06 0.0001

Quality of Life -0.11 0.02 0.0001

Social Support 0.16 0.06 0.0001

Study Limitations

The study sample includes a number of women with high levels of education and income and an average age of 51 years.

Conclusions

1. Higher BMI among women with asthma was significantly associated with lower annual household income, a lower level of education, being unmarried, being African American, and being of older age.

2. Higher BMI was significantly associated with more asthma symptoms and severe disease.

Conclusions (con’t)

3. Women with higher BMI were more likely to have more hospital admissions and more emergency department visits for asthma.

4. Women with higher BMI were more likely to have other health problems such as migraines, reflux, and urinary incontinence.

Conclusions (con’t)

5. Higher BMI was significantly associated with lower self-esteem and quality of life, and with more social support.

6. Overweight and obese women with asthma confront more problems with asthma than women with the disease of normal weight.