Respira project: Humanistic and economic burden of asthma in Brazil

Figures & data

Table 1. Demographics by asthma diagnosis.

	Asthma
	Total	Asthma	Non-Asthma controls
N =	N = 11,981	N = 494	N = 11,487	P Value
Age (years)				<0.001
Mean ± SD	40.18 ± 15.38	36.29 ± 13.21	40.35 ± 15.44
Sex				<0.001
Male (%)	6,091 (50.8%)	198 (40.1%)	5,893 (51.3%)
Female (%)	5,890 (49.2%)	296 (59.9%)	5,594 (48.7%)
Race/Ethnicity^A				0.303
White (%)	7,537 (62.9%)	329 (66.6%)	7,208 (62.7%)
Black (%)	944 (7.9%)	31 (6.3%)	913 (7.9%)
Brown (%)	2,981 (24.9%)	113 (22.9%)	2,868 (25.0%)
Other (%)	519 (4.3%)	21 (4.3%)	498 (4.3%)
Marital status				0.601
Single (%)	5,230 (43.7%)	210 (42.5%)	5,020 (43.7%)
Married/living with partner (%)	6,751 (56.3%)	284 (57.5%)	6,467 (56.3%)
University education				0.025
Less than 4-year degree (%)	6,770 (56.5%)	255 (51.6%)	6,515 (56.7%)
4-year degree or more (%)	5,211 (43.5%)	239 (48.4%)	4,972 (43.3%)
Employed (FT/PT/SE)				0.001
No (%)	3,728 (31.1%)	121 (24.5%)	3,607 (31.4%)
Yes (%)	8,253 (68.9%)	373 (75.5%)	7,880 (68.6%)
Annual household income				0.873
R$ 1000 or less (%)	1,051 (8.8%)	44 (8.9%)	1,007 (8.8%)
R$ 1001–R$ 6500 (%)	5,182 (43.3%)	219 (44.3%)	4,963 (43.2%)
R$ 6501 or above (%)	4,430 (37.0%)	182 (36.8%)	4,248 (37.0%)
Declined to answer (%)	1,318 (11.0%)	49 (9.9%)	1,269 (11.0%)
Socioeconomic status^B				0.001
A (%)	1,582 (13.2%)	82 (16.6%)	1,500 (13.1%)
B (%)	7,163 (59.8%)	314 (63.6%)	6,849 (59.6%)
C (%)	3,019 (25.2%)	96 (19.4%)	2,923 (25.4%)
D (%)	200 (1.7%)	2 (0.4%)	198 (1.7%)
E (%)	17 (0.1%)	0 (0.0%)	17 (0.1%)
Insurance type				<0.001
Public (%)	5,871 (49.0%)	198 (40.1%)	5,673 (49.4%)
Private (%)	6,110 (51.0%)	296 (59.9%)	5,814 (50.6%)
BMI				0.143
Underweight [< 18.5] (%)	434 (3.6%)	20 (4.0%)	414 (3.6%)
Normal [18.5–24.9] (%)	5,274 (44.0%)	214 (43.3%)	5,060 (44.0%)
Overweight [25.0–29.9] (%)	3,985 (33.3%)	147 (29.8%)	3,838 (33.4%)
Obese [>30] (%)	2,122 (17.7%)	107 (21.7%)	2,015 (17.5%)
Declined to answer (%)	166 (1.4%)	6 (1.2%)	160 (1.4%)
Alcohol use				0.026
Do not drink alcohol (%)	4,672 (39.0%)	169 (34.2%)	4,503 (39.2%)
Drink alcohol (%)	7,309 (61.0%)	325 (65.8%)	6,984 (60.8%)
Smoking behavior				0.351
Non-smoker (%)	7,442 (62.1%)	297 (60.1%)	7,145 (62.2%)
Smoker (%)	4,539 (37.9%)	197 (39.9%)	4,342 (37.8%)
Days in the past month exercise				0.216
Mean ± SD	7.64 ± 9.00	8.13 ± 9.16	7.62 ± 8.99
Charlson comorbidity index (1987)				<0.001
Mean ± SD	0.32 ± 0.89	0.70 ± 1.25	0.30 ± 0.86

R$ = Brazilian Real, SD = SD: standard deviation. A: Self-declared ethnicity/race categories were defined based in the Brazilian Institute for Geography and Statistics (IBGE) definitions; B: Classification according Brazilian Institute for Geography and Statistics (IBGE).

Table 2. Health-related quality of life, labor force participation, WPAI, and healthcare resource use by asthma diagnosis.

	Asthma
	Total	Asthma DX	Non-Asthma controls
N =	N = 11,981	N = 494	11,487	P Value
SF-36v2: Mental component summary				<0.001
N	11,981	494	11,487
Mean ± SD	46.43 ± 10.60	42.11 ± 10.55	46.62 ± 10.56
SF-36v2: Physical component summary				<0.001
N	11,981	494	11,487
Mean ± SD	51.44 ± 7.81	47.73 ± 8.18	51.60 ± 7.75
SF6D: Health state utility score				<0.001
N	11,981	494	11,487
Mean ± SD	0.704 ± 0.13	0.639 ± 0.12	0.707 ± 0.13
Absenteeism %				<0.001
N	7,606	347	7,259
Mean ± SD	7.79 ± 18.75	13.12 ± 22.69	7.54 ± 18.51
Presenteeism %				<0.001
N	7,652	351	7,301
Mean ± SD	22.06 ± 28.24	35.21 ± 30.10	21.42 ± 27.99
Overall work impairment %				<0.001
N	7,606	347	7,259
Mean ± SD	25.99 ± 31.48	40.95 ± 33.03	25.27 ± 31.23
Activity impairment %				<0.001
N	11,981	494	11,487
Mean ± SD	24.75 ± 29.19	37.85 ± 29.94	24.19 ± 29.03
Healthcare provider visits in past 6 months				<0.001
N	11,981	494	11,487
Mean ± SD	4.58 ± 6.80	7.88 ± 11.09	4.44 ± 6.52
ER visits in the past 6 months				<0.001
N	11,981	494	11,487
Mean ± SD	0.62 ± 2.40	1.40 ± 3.73	0.59 ± 2.32
Hospitalizations in the past 6 months				<0.001
N	11,981	494	11,487
Mean ± SD	0.27 ± 1.55	0.67 ± 2.44	0.25 ± 1.50

SD = SD: standard deviation; ER = Emergency room.

Table 3. Descriptive for asthma-related variables for all respondents with asthma diagnosis.

	Asthma respondents
	N = 494
Years diagnosed with asthma
N	447
Mean ± SD	19.07 ± 15.01
Asthma Control Test (ACT) Score
N	494
Mean ± SD	18.48 ± 4.96
Asthma Control Test (ACT) Score (categorical)
19 or less (not well controlled) (%)	253 (51.2%)
20–24 (well controlled) (%)	180 (36.4%)
25 (total control) (%)	61 (12.3%)
Take asthma medications
No (%)	188 (38.1%)
Yes (%)	306 (61.9%)
Adherence to asthma medications (MGLS; 0 = non-adherent to 4 = fully adherent)
N	306
Mean ± SD	2.61 ± 1.23
Adherence to asthma medications (MGLS; categorical)
Not fully adherent (<4) (%)	207 (67.6%)
Fully adherent (4) (%)	99 (32.4%)
Medication class: SABA
No (%)	304 (61.5%)
Yes (%)	190 (38.5%)
Medication class: ICS
No (%)	433 (87.7%)
Yes (%)	61 (12.3%)
Medication class: LABA
No (%)	486 (98.4%)
Yes (%)	8 (1.6%)
Medication class: ICS/LABA
No (%)	409 (82.8%)
Yes (%)	85 (17.2%)
Medication class: SAMA
No (%)	428 (86.6%)
Yes (%)	66 (13.4%)
Medication class: SAMA/SABA
No (%)	439 (88.9%)
Yes (%)	55 (11.1%)
Medication class: Antileukotriene
No (%)	482 (97.6%)
Yes (%)	12 (2.4%)
Medication class: Methylxanthines
No (%)	465 (94.1%)
Yes (%)	29 (5.9%)
Medication class: LAMA
No (%)	486 (98.4%)
Yes (%)	8 (1.6%)
Medication class: IgE blocker
No (%)	489 (99.0%)
Yes (%)	5 (1.0%)

SD = SD: standard deviation; MGLS = Morisky Green Levine Medication Adherence Scale; SABA = Short-Acting Beta Agonists; LABA = Long-Acting Beta-Agonists; ICS = Inhaled Corticosteroids; SAMA = Short-Acting Muscarinic Agonists; LAMA = Long-Acting Muscarinic-Agonists.

Table 4. Health-related quality of life, healthcare resource use, WPAI, and labor force participation by asthma diagnosis, after controlling for covariates.

Dependent variable	Asthma DX	Adjusted mean	SE	95% LCL	95% UCL	P Value
SF-36v2: Mental component summary	Asthma DX	43.76	0.451	42.88	44.65	<0.0001
SF-36v2: Mental component summary	Non-Asthma DX	46.55	0.093	46.37	46.73
SF-36v2: Physical component summary	Asthma DX	48.17	0.343	47.49	48.84	<0.0001
SF-36v2: Physical component summary	Non-Asthma DX	51.58	0.071	51.44	51.72
SF6D: Health state utility score	Asthma DX	0.66	0.006	0.65	0.67	<0.0001
SF6D: Health state utility score	Non-Asthma DX	0.71	0.001	0.70	0.71
Healthcare provider visits in past 6 months	Asthma DX	6.11	0.378	5.41	6.89	<0.0001
Healthcare provider visits in past 6 months	Non-Asthma DX	4.16	0.055	4.06	4.27
ER visits in the past 6 months	Asthma DX	1.03	0.168	0.75	1.42	<0.0001
ER visits in the past 6 months	Non-Asthma DX	0.54	0.020	0.50	0.58
Hospitalizations in the past 6 months	Asthma DX	0.42	0.096	0.27	0.66	0.0047
Hospitalizations in the past 6 months	Non-Asthma DX	0.22	0.012	0.20	0.24
Absenteeism %^*	Asthma DX	11.51	1.582	8.79	15.07	0.0015
Absenteeism %^*	Non-Asthma DX	7.37	0.226	6.94	7.83
Presenteeism %^*	Asthma DX	30.41	2.200	26.39	35.04	<0.0001
Presenteeism %^*	Non-Asthma DX	20.88	0.338	20.23	21.55
Overall work impairment %^*	Asthma DX	36.03	2.462	31.52	41.20	<0.0001
Overall work impairment %^*	Non-Asthma DX	24.75	0.377	24.03	25.50
Activity impairment %	Asthma DX	33.20	1.841	29.78	37.01	<0.0001
Activity impairment %	Non-Asthma DX	23.55	0.269	23.03	24.09

Included all covariates that are significant at 0.10 level in Table 1 demographics for all participants by asthma diagnosis (Age, Sex, University Education, Employment status, Socioeconomic status, Insurance type, Alcohol use, and Charlson comorbidity index).

^* Questions only applicable to those working full-time, part-time, or self-employed: Asthma dx = 347 and non-asthma controls = 7,259.

Note: Socioeconomic status C1, C2, D, and E were collapsed into one group for all analyses due to relatively small sample sizes in the D (n = 200) and E (n = 17) groups.

Ministério da Saúde MS, Instituto Brasileiro de Geografia e Estatística IBGE. Pesquisa Nacional de Saúde (PNS) 2015. [accessed May 2017]. http://www.pns.icict.fiocruz.br/.

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