Predictors of asthma-related health care utilization and quality of life among inner-city patients with asthma

Background

Asthma morbidity and mortality are highest among minority inner-city populations.

Objective

To identify factors associated with acute health care resource utilization and asthma-related quality of life among high-risk, minority patients with asthma.

Methods

We interviewed a prospective cohort of 198 adults hospitalized for asthma in an inner city hospital over a period of 1 year. Detailed information about sociodemographics, asthma history, access to care, asthma medications, and self-reported allergy to aeroallergens was collected at baseline. Data on resource utilization (emergency department visits and hospital admissions for asthma) and asthma-related quality of life were obtained at 6 months after discharge. Multivariate analyses were used to identify predictors of resource utilization and quality of life.

Results

The mean age of patients was 49.9 ± 17.4 years, 78% were women, and 97% were nonwhite. At 6 months, 49% of patients had an emergency department visit or hospitalization. In multivariate analysis, adjusting for age, sex, medication regimen, and asthma severity, patients with a physician in charge of their asthma care had lower odds of resource utilization (odds ratio, 0.4; P=.03). Conversely, a self-reported history of cockroach allergy was associated with greater utilization (odds ratio, 2.3; P=.05). Asthma-related quality of life was worse among patients who spoke mostly Spanish or who reported allergy to cockroaches (P < .004).

Conclusion

Lack of an established asthma care provider, language barriers, and self-reported allergy to cockroaches are associated with higher resource utilization and worse quality of life among minority, inner-city patients with asthma. Interventions targeting these factors may lead to better outcomes among these patients.

Key words: Asthma, hospitalization, quality of life, predictors, allergic sensitization

Abbreviations used: AQLQ, Asthma Quality of Life Questionnaire, ED, Emergency department, OR, Odds ratio