1. Noreen Clark, PhD Molly Gong, MD Melissa Valerio, MPH Sijian Wang, BS Xihong Lin, PhD William Bria, MD Timothy Johnson, MD University of Michigan School of Public Health Impact of Being Overweight in Women with Asthma

2. Background Both asthma and obesity are common health problems and their prevalence continues to rise. Recent studies indicate that asthma may be associated with overweight in women but not men (Guerra, et al. 2002, Thomson, et al., 2003).

3. Purpose To examine factors associated with body mass index (BMI) and related asthma problems for women.

4. Study Participants 652 women 18 years and older Physician diagnosis Attending University of Michigan Asthma & Airways Clinic and University of Michigan Health System

5. Data collection Telephone interview Demographics Asthma symptoms Health care utilization Gender-related management Co-morbidity Quality of life and self-esteem

6. Data Analyses Multivariate linear regression models were conducted using BMI as dependent variable and adjusting for age.

7. Demographics: Age

8. Demographics: Education

9. Demographics: Income

10. Demographics: Race/Ethnicity

11. Asthma Severity  Classified by NAEPP criteria, Guidelines and Diagnosis and Treatment of Asthma, 1997 Percent of Women Mild intermittent53% Mild persistent14% Moderate persistent18% Severe persistent15%

12. BMI Levels Percent of Women Underweight (BMI<19)3% Normal (BMI 19-25)31% Overweight (BMI 26-30)26% Obese (BMI 31-35)20% Over Obese (BMI >35)20%

13. Association of BMI and Demographic Factors Estimate Std Error P-Value Age0.040.020.0652 Income-2.60.710.0003 Education-2.980.680.0001 Marital status*-1.290.650.0471 Ethnicity**5.141.020.0001 * 1=yes married, 0=otherwise **2=African American, 1=otherwise

14. Association of BMI and Health Care Utilization for Asthma

15. Association of BMI and Asthma Symptoms & Severity

16. Association of BMI and Other Health Problems

17. Association of BMI, Self-esteem, Quality of Life & Social Support

18. Study Limitations The study sample includes a number of women with high levels of education and income and an average age of 51 years.

19. Conclusions 1. Higher BMI among women with asthma was significantly associated with lower annual household income, a lower level of education, being unmarried, being African American, and being of older age. 2. Higher BMI was significantly associated with more asthma symptoms and severe disease.

20. Conclusions (con’t) 3. Women with higher BMI were more likely to have more hospital admissions and more emergency department visits for asthma. 4. Women with higher BMI were more likely to have other health problems such as migraines, reflux, and urinary incontinence.

21. Conclusions (con’t) 5. Higher BMI was significantly associated with lower self-esteem and quality of life, and with more social support. 6. Overweight and obese women with asthma confront more problems with asthma than women with the disease of normal weight.