Living in the inner city brings with it a host of problems, such as crime, poor housing, lack of access to needed services, and unemployment. These and other factors create a lot of stress for residents in these areas. On top of this, asthma is a major medical problem in the inner city, where its prevalence, morbidity, and mortality are higher than other areas. A new study has found a direct link between the level of stress and how much worse the asthma of inner-city adults is. Those who perceived higher stress levels were more likely to have increased asthma-related problems compared with persons with low stress levels.
Juan P. Wisnivesky, M.D., Dr.P.H., of the Mount Sinai School of Medicine, and colleagues recruited adults with asthma being treated at two large urban internal medicine practices in Harlem, New York, and New Brunswick, New Jersey. All had moderate-to-severe asthma. Each patient was given a standardized questionnaire at the start of the study and then again at 1, 3, and 12 months after they enrolled. Items included questions about their asthma control, medication use, personal information, quality of life, and measurements of perceived stress.
The study's findings are based on 326 participants, the majority of whom were either black or Hispanic of low socioeconomic status. They also had various conditions in addition to asthma, such as hypertension (46.8 percent) and diabetes (24.6 percent). A participant's perceived stress level was associated with increased asthma problems and a poorer quality of life. Those with the highest stress levels displayed decreased adherence to their asthma medications.
According to the researchers, this resulting suboptimal self-management of asthma may partially explain the connection between increased stress and worse asthma outcomes. Given these findings, asthma programs aimed at inner-city populations should assess stress levels and consider management and coping techniques, as well as appropriate referrals, for some patients with poorly controlled asthma, suggest the study authors. Their study was supported in part by the Agency for Healthcare Research and Quality (HS13312).
See "The relationship between perceived stress and morbidity among adult inner-city asthmatics," by Dr. Wisnivesky, Jessica Lorenzo, M.P.H., Jonathan M. Feldman, Ph.D., and others in the Journal of Asthma 47, pp. 100-104, 2010.