Level of education and asthma control in adult-onset asthma

Abstract

Objective

Education in itself and as a proxy for socioeconomic status, may influence asthma control, but remains poorly studied in adult-onset asthma. Our aim was to study the association between the level of education and asthma control in adult-onset asthma.

Methods

Subjects with current asthma with onset >15 years were examined within the Obstructive Lung Disease in Northern Sweden study (OLIN, n = 593), Seinäjoki Adult Asthma Study (SAAS, n = 200), and West Sweden Asthma Study (WSAS, n = 301) in 2009–2014 in a cross-sectional setting. Educational level was classified as primary, secondary and tertiary. Uncontrolled asthma was defined as Asthma Control Test (ACT) score ≤19. Altogether, 896 subjects with complete data on ACT and education were included (OLIN n = 511, SAAS n = 200 and WSAS n = 185).

Results

In each cohort and in pooled data of all cohorts, median ACT score was lower among those with primary education than in those with secondary and tertiary education. Uncontrolled asthma was most common among those with primary education, especially among daily ICS users (42.6% primary, 28.6% secondary and 24.2% tertiary; p = 0.001). In adjusted analysis, primary education was associated with uncontrolled asthma in daily ICS users (OR 1.92, 95% CI 1.15–3.20). When stratified by atopy, the association between primary education and uncontrolled asthma was seen in non-atopic (OR 3.42, 95% CI 1.30–8.96) but not in atopic subjects.

Conclusions

In high-income Nordic countries, lower educational level was a risk factor for uncontrolled asthma in subjects with adult-onset asthma. Educational level should be considered in the management of adult-onset asthma.

Keywords:

• Asthma
• adult-onset asthma
• education
• socioeconomic status
• asthma control
• ACT
• non-atopic asthma
• inhaled corticosteroids
• treatment

Acknowledgements

Acknowledgement is given to all the participants in the specific cohorts and all in the research team of the Nordic EpiLung are acknowledged for their excellent work. In the OLIN-studies and the WSAS especially acknowledgement is given to the research nurses Britt-Marie Eklund, Ann-Christine Jonsson, Helén Törnqvist, Maryanne Raneklint, Lina Rönnebjerg and Lotte Edvardsson. Furthermore, Aino Sepponen, RN (Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland) is gratefully acknowledged for her help through all the stages of Seinäjoki Adult Asthma Study.

Additional information

Funding

Financial support for the Nordic Epilung project was received from Nordforsk. Financial support for creating the Obstructive Lung Diseases in Northern Sweden (OLIN) asthma cohort was received from the Swedish Heart-Lung Foundation, the Swedish Asthma and Allergy foundation, ALF-a regional agreement between Umeå university and Norrbotten Council, Visare Norr, Norrbotten County Council, and the Swedish Research Council. Financial support for Seinäjoki Adult Asthma Study was received from the Tampere Tuberculosis Foundation, the Finnish Anti- Tuberculosis Foundation, the Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital, and the Medical Research Fund of Seinäjoki Central Hospital, the Research Foundation of the Pulmonary Diseases, the Ida Montini Foundation, the Pirkanmaa Regional Fund of the Finnish Cultural Foundation and Allergy Research Foundation. West Sweden Asthma Study was supported by the VBG Group Herman Krefting Foundation on Asthma and Allergy, the Swedish Heart-Lung Foundation, the Swedish Research Council, the Research Foundation of the Swedish Asthma and Allergy Association, and the Swedish government under the ALF agreement between the Swedish government and the county councils. None of the sponsors had any involvement in the planning, execution, drafting or write-up of this study.