Year of Publication

2021

College

Public Health

Date Available

5-3-2023

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Timothy Scott Prince

Committee Member

Steven Browning

Committee Member

Wayne Sanderson

Committee Member

Susan Spengler

Abstract

Background: Central Appalachia residents have one of the highest rates of serious respiratory diseases in the nation. Appalachian Kentuckians are 50% more likely to be diagnosed with adult asthma compared to the overall U.S. population. Yet, few epidemiologic studies have assessed risk factors for respiratory disease in this population. Using a community-based approach, the investigators of the Mountain Air Project (MAP), one of the largest adult cohorts from two disadvantaged communities in Central Kentucky, collected data to estimate the prevalence of asthma and assess various socioeconomic and environmental risk factors to determine their effect on asthma.

Methods: A cross-sectional epidemiologic study was undertaken of 1,190 individuals of which 972 individuals (67%) completed all requirement of the study. The inclusion criteria for participants included: 21 years and older residing in one of the two targeted counties for three years, being an English speaker, and being of any race or ethnicity. The study required the completion of an interviewer–administered questionnaire and spirometry test. Prevalence ratios and 95% confidence intervals for self-reported asthma episodes were computed for the entire cohort and then stratified by multiple characteristics including gender, income, housing type, exposure to mold, and several exposure metrics to roadway traffic, coal haul routes, coal mining, and oil and gas operations.

Results: Age, socioeconomics and environmental factors are major risk factors for asthma exacerbations. Living within a road density metric greater than 2.76 square miles was identified as a significant risk factor compared to those living less than 1.79 square miles road density (adjusted OR: 4.39, 95% CI: 1.78-10.81). Additional risks factors were identified such as living in an apartment vs. single family home (adjusted OR: 4.13, 95% CI: 1.91-8.92), younger age with those in their 40’s at a higher risk than those in their 60’s (adjusted OR: 3.26, 95% CI: 1.54-6.88). History of allergies and exposure to mold in the past 12 months were also found to be significant risk factors (adjusted OR: 2.34, 95% CI: 1.35-4.06 and adjusted OR 1.96, 95% CI: 1.05-3.67 respectively) based on a multivariable logistic regression model. The link between smoking and asthma exacerbation although present was not statistically significant. Asthma is a heterogenous condition and exacerbated as a consequence of a complex interaction between the environment, socioeconomics and genes; such interaction can cause airway inflammation and remodeling in susceptible individuals.

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