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Impact of Being

Overweight in Women
with Asthma
Noreen Clark, PhD
Molly Gong, MD
Melissa Valerio, MPH
Sijian Wang, BS
Xihong Lin, PhD
William Bria, MD
Timothy Johnson, MD

University of Michigan
School of Public Health
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
7% 9%

13%

21% 18-30
31-40
41-50
51-60
24%
61-70
>71
26%
Demographics: Education
2%
22%
26%

< High School

High School

2-year College

4-year College

Post Grad
29%
21%
Demographics: Income

11% 5%
6% <10,000
10,001-20,000
15% 16% 10,001-20,000
40,001-60,000
60,001-80,000

13% 80,000-100,000
18% >100,000
Not reported
16%
Demographics: Race/Ethnicity

83%
2% Caucasian/White

1% African American/Black
2%
Asian/Pacific Islander
2%
Hispanic/Latino
10%
Native American

Other
Asthma Severity

Percent of Women
Mild intermittent 53%

Mild persistent 14%

Moderate persistent 18%

Severe persistent 15%

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

* 1=yes married, 0=otherwise


**2=African American, 1=otherwise

Ethnicity** 5.14 1.02 0.0001


Association of BMI and
Health Care Utilization for Asthma
Number of times
in past 12 Estimate Std Error P-Value
months
Hospitalization 1.13 0.26 0.0001

ED visits 0.25 0.08 0.0016


Unscheduled
urgent visit to a 0.09 0.06 0.1117
clinic
Regularly
0.07 0.05 0.1506
scheduled visits
Visits to follow-
up an asthma 0.06 0.04 0.1533
attack
Association of BMI and
Asthma Symptoms & Severity

Estimate Std Error P-Value

Days having
daytime 0.011 0.005 0.0332
symptoms
Night
symptoms
0.018 0.006 0.0031
interfered
sleep

Severity 0.848 0.278 0.0024


Association of BMI and
Other Health Problems
Ever suffered in
Estimate Std Error P-Value
past 12 months

Migraines 1.60 0.66 0.0156

Reflux 2.29 0.67 0.0007

Urinary
3.48 0.64 0.0001
incontinence
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.