Psychological, social and health behaviour risk factors for deaths certified as asthma: a national case-control study
- P M Sturdy1,
- C R Victor1,
- H R Anderson1,
- J M Bland1,
- B K Butland1,
- B D W Harrison2,
- C Peckitt1,
- J C Taylor1,
- on behalf of the Mortality and Severe Morbidity Working Group of the National Asthma Task Force
- 1Department of Public Health Sciences, St George’s Hospital Medical School, London SW17 0RE, UK
- 2Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Trust, Norwich NR1 3SE, UK
- Correspondence to:
Professor H R Anderson, Department of Public Health Sciences, St. George’s Hospital Medical School, London SW17 0RE, UK;
- Accepted 2 August 2002
- Revised 22 July 2002
Background: Uncontrolled studies suggest that psychosocial factors and health behaviour may be important in asthma death.
Methods: A community based case-control study of 533 cases, comprising 78% of all asthma deaths under age 65 years and 533 hospital controls individually matched for age, district and asthma admission date corresponding to date of death was undertaken in seven regions of Britain (1994–98). Data were extracted blind from anonymised copies of primary care records for the previous 5 years and non-blind for the earlier period.
Results: 60% of cases and 63% of controls were female. The median age in both groups was 53. Cases had an earlier age of asthma onset, more chronic obstructive lung disease, and were more obese. 48% of cases and 42% of controls had a health behaviour problem; repeated non-attendance/poor inhaler technique was related to increased risk of death. Overall, 85% and 86%, respectively, had a psychosocial problem. Four psychosocial factors were associated with increased risk of death (psychosis, alcohol/drug abuse, financial/employment problems, learning difficulties) and two with reduced risk (anxiety/prescription of antidepressant drugs and sexual problems). While alcohol/drug abuse lost significance after adjustment for psychosis, other associations appeared independent of each other and of indicators of severity and co-morbidity. None of the remaining 13 factors including family problems, domestic abuse, bereavement, and social isolation were significantly related to risk of asthma death.
Conclusion: There was an apparently high burden of psychosocial problems in both cases and controls. The associations between health behaviour, psychosocial factors, and asthma death are varied and complex with a limited number of factors showing positive relationships.
The study was funded jointly between the National Research and Development Asthma Management Programme (contract number AM1/05/002) and the National Asthma Campaign through a grant from Glaxo Wellcome (now GlaxoSmithKline).