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PEDIATRICS Vol. 110 No. 1 July 2002, pp. e6-e6

ELECTRONIC ARTICLE

Relationship of Adherence to Pediatric Asthma Morbidity Among Inner-City Children

Laurie J. Bauman, PhD*, Elizabeth Wright, PhD{ddagger}, Frederick E. Leickly, MD§, Ellen Crain, MD, PhD*, Deanna Kruszon-Moran, MS||, Shari L. Wade, PhD and Cynthia M. Visness, MA#

* Department of Pediatrics, Albert Einstein College of Medicine and the Children’s Hospital at Montefiore, Bronx, New York
{ddagger} New England Research Institute, Watertown, Massachusetts
§ Department of Pediatrics, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana
|| National Center for Health Statistics, Hyattsville, Maryland
Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
# Rho Federal Systems Division, Inc, Chapel Hill, North Carolina

Objectives. Morbidity from asthma among children is one of the most important US health concerns. This study examines the relationship of baseline nonadherence to subsequent asthma morbidity among inner-city children.

Methods. A multisite, prospective, longitudinal panel study was conducted of 1199 children who were aged 4 to 9 years and had asthma and their caregivers, most of whom were parents, in emergency departments and clinics at 8 research centers in 7 US metropolitan inner-city areas. Nine morbidity indicators were collected at 3, 6, and 9 months after baseline, including hospitalizations, unscheduled visits, days of wheeze/cough, and days of reduced activities.

Results. Children whose caregivers scored high on a new measure, Admitted Nonadherence, experienced significantly worse morbidity on 8 of the 9 measures. Children who scored high on a new Risk for Nonadherence measure experienced significantly worse morbidity on all 9 morbidity measures. Multiple and logistic regressions found that the adherence measures had independent significant effects on morbidity. Combining the measures improved estimates of morbidity: children whose caregivers were poor on either adherence measure had worse morbidity than those with good adherence on both, eg, rate of hospitalization was twice as high, they missed more than twice as much school, had poorer overall functioning, and experienced more days of wheezing and more restricted days of activity.

Conclusions. Risk for Nonadherence and Admitted Nonadherence independently and jointly predicted subsequent asthma morbidity. Targeting risks for nonadherence may be an effective intervention strategy. Most risks can be controlled by physicians through reducing the complexity of asthma regimens, communicating effectively with caregivers about medication use, and correcting family misconceptions about asthma medication side effects.

Key Words: adherence • asthma • morbidity • inner-city • child

Abbreviations: ED, emergency department • BSI, Brief Symptom Inventory • SD, standard deviation

Received for publication Mar 12, 2001; Accepted Mar 18, 2002.


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