Mediating factors in the relationship between sociodemographic factors and
      Chronic Lower Respiratory Diseases (CLRD) among adult ACBS respondents in
      the United States
Creators: name: Eyong, Ayuk
Publisher: name: Lancaster University
Year: 2018

description: Background: Chronic Lower Respiratory Diseases (CLRD), such as asthma,
      chronic obstructive pulmonary disease (COPD), chronic bronchitis and
      emphysema are preventable diseases that constitute a serious public health
      concern. Estimates indicate that there is an increased prevalence of
      mortality from these diseases worldwide. Low socio-economic positions
      (SEP) and poor indoor environmental conditions have been identified as
      risk factors for CLRD among adults. Given the public health burden of
      CLRD, there is increasing interest among researchers to identify all
      relevant factors associated with CLRD. However, many studies identified in
      the literature only controlled for individual or specific risk factors and
      most of these studies vary in their definition of risk factors. As a
      result, the evidence was contradictory. Some studies reported statistical
      associations while other studies reported no statistical association
      between specific risk factors and CLRD. Furthermore, questions remain on
      which risk factors mediate the relationships between socio-demographic
      factors and respiratory health outcomes. Given this, the study will
      examine if one or more indoor environmental factors and access to
      healthcare mediates the relationships between socio-demographic factors
      and CLRD among adult ACBS respondents in the United States (U.S). The
      study will further examine if the effects of socio-demographic factors on
      CLRD depend on indoor environmental factors and access to healthcare.
      
      Methods: This study examined three different years of secondary
      cross-sectional data collected from adults 18 years or older by the
      Behavioral Risk Factor Surveillance Survey (BRFSS) and Asthma Call-Back
      Survey (ACBS). 15,403 participants from 2009, 17,753 from 2010 and 16,693
      from 2011 were included in the study. Bivariate analyses were used to
      identify significant predictors, and logistic regression models were used
      to examine mediation and predictor-mediator interaction effects. CLRD was
      
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      the outcome of interest, socio-demographic factors were used as
      predictors, and indoor environmental factors and healthcare access were
      used as potential mediators.
      
      Results: The bivariate analyses revealed that gender, age, marital status,
      education, employment status, income, mold, pest infestation, smoking
      indoors, being a current or former smoker, occupational exposure and
      medical cost were significant predictors of CLRD. The mediation tests
      revealed that mold, mice presence, being a current smoker, smoke indoors
      and occupational exposure fully or partially mediated the relationship
      between age, education, employment, income and current asthma. Being a
      current or former smoker, smoking indoors, and occupational exposure fully
      or partially mediated the effects of age, marital status, education,
      employment, income on COPD, bronchitis and emphysema. Mold and medical
      cost were also identified as mediators for bronchitis and mold for
      emphysema. These findings indicate that indoor environmental factors and
      medical cost, fully or partially explain the effects of socio-demographic
      factors on the reporting of CLRD. The statistical significant
      predictor-mediator interaction effects that were identified revealed that
      the effects of gender, age, education, employment and income on the
      reporting of CLRD depends on mold, mice presence, being a current or
      former smoker, smoking indoors, occupational exposure and medical cost.
      
      Conclusion: This is the first study to use rich cross-sectional secondary
      data from three different years to demonstrate that poor indoor
      environmental conditions and inadequate access to healthcare play a
      significant role in explaining the reporting of CLRD among ACBS
      respondents in different social, economic and demographic groups. These
      findings have clear implications for related public health policies. These
      policies should focus on creating more resources in deprived
      neighborhoods, improving inadequate housing conditions through housing
      refurbishment and ensuring adequate access to healthcare for all groups
      regardless of their SEP.