Asthma and the socio-economic reality in Brazil

Abstract

BackgroundAsthma is a prevalent disease that is considered a health problem worldwide. The aim of this study was to analyze the clinical and socioeconomic characteristics of a cohort of asthmatics receiving specialized outpatient treatment in a tertiary/teaching public hospital in Brazil.MethodsPersistent asthmatics older than 5 years old were consecutively included. They received clinical treatment at 3- to 4-month intervals and were interviewed 2 times at 6-month intervals over a 12-month observation period. The data were collected directly from the patients or their parents by 2 researchers who did not participate in their clinical care. The primary variables were age, gender, education level, monthly family income, place of residence, number of lost days of school or work, BMI, the severity and control level of asthma, the number of scheduled and non-scheduled visits and hospitalization days and the best peak-flow measurement.ResultsOf the 117 participants, 108 completed the study. Of the participants, 73.8% were women, and 25.0% lived outside the county. Of those who lived within the county, 60.1% lived in areas far from the health care unit. The majority (83.3%) had associated rhinitis, and more than 50.0% were overweight or obese, in whom the prevalence of severe asthma was greater (p = 0.001). The median monthly income was US$ 536.58 and was greater among the patients with controlled asthma (p = 0.005 and p = 0.01 at the start and the end of the study, respectively). In the initial evaluation, 16 participants had severe asthma, and in the final evaluation, 8 out of 21 patients with uncontrolled asthma had improved. Three-quarters of the students and half of the workers had missed days of school or work, respectively. The asthmatic population in this study had medium to low socioeconomic status in Brazil and socioeconomic status was associated with overweigth/obesity and with poor control of asthma.ConclusionAsthma has a great impact on absenteeism in Brazil. Lower monthly family income and body weight above the ideal level were associated with greater severity and worse control of asthma.

Working while unwell: Workplace impairment in people with severe asthma

“…However, we did observe that a one‐point increase in ACQ6 almost doubled the chance of reporting absenteeism. Previous studies comparing absenteeism in severe or uncontrolled asthma with controlled asthma over periods longer than a week report even higher prevalence of absenteeism (36%‐43%) in severe patients than our study . Cost analyses show that differences in indirect costs to the economy due to lost workdays between uncontrolled and controlled asthma are striking (€466.86 vs €44.60/month, based on the ACT) .…”

“…Beyond presenteeism and absenteeism, people with severe asthma work less, switch jobs, are prevented from entering some professions, take disability leave and retire early, all of which may pose significant risks to their financial stability . They report lower earnings compared with controlled asthma . People with severe asthma worry about their work and non‐work activity limitations and their finances, reporting fear that health costs will be unmanageable due to restrictions on their ability to work .…”

“…Previous studies comparing absenteeism in severe or uncontrolled asthma with controlled asthma over periods longer than a week report even higher prevalence of absenteeism (36%-43%) in severe patients than our study. [34][35][36][37][38] Cost analyses show that differences in indirect costs to the economy due to lost workdays between uncontrolled and controlled asthma are striking (€466.86 vs €44.60/month, based on the ACT). 25 Taken together, substantial levels of absenteeism and work deficits show that there is an urgent need to achieve asthma control and reduce exacerbations in severe asthma to improve workplace participation.…”

“…3,[7][8][9]30,33,49 They report lower earnings compared with controlled asthma. 28,29,35,37 People with severe asthma worry about their work and non-work activity limitations and their finances, reporting fear that health costs will be unmanageable due to restrictions on their ability to work. 3 They report workplace discrimination and stigma due to asthma 7 and experience negative emotions of giving up work.…”

Particularities of allergy in the Tropics

“…Poverty has a negative impact for asthma development and management [ 13 , 14 ]. Elevated rates of uncontrolled asthma are found among the poorest [ 15 ]. Chronic asthma represents important out of pocket expenditures for families since access to health system is not universal, even though equality is the ultimate goal in health policies for most countries [ 16 ].…”