Physical and Social Environmental Factors in Adult Asthma Outcomes

描述（由申请人提供）：拟议的项目将前瞻性地调查物理和社会环境暴露作为成人哮喘和鼻炎的健康相关生活质量（HRQOL）的决定因素，重点是疾病严重程度作为物理和社会环境与HRQOL之间的主要媒介的作用。拟议的研究，一个R01接近完成的竞争性更新，建立在我们目前的研究阐明物理和社会环境风险的多因素模型。具体的研究目标是：1）。描述将身体和社会环境暴露与成人哮喘和鼻炎的疾病特异性和一般HRQOL联系起来的特定途径，包括通过随时间改变疾病状态进行调解; 2.]确定特定的风险因素，如个人社会经济地位，改变这些环境因素对疾病严重程度的影响或严重程度对成人哮喘和鼻炎HRQOL的影响。为了实现这些目标，我们将组建一个636名成年人的前瞻性队列，将我们正在进行的哮喘-鼻炎队列（当前R01的基础）与作为方法学相似研究的一部分建立的第二个严重哮喘成年人队列合并。受试者将在研究期间接受3波结构化电话访谈，以确定环境暴露、疾病严重程度和HRQOL。将在一个受试者子集（n = 380）中进行两次家庭访视，以评估家庭环境（包括粉尘抗原、空气颗粒和湿度的测量），测量肺功能和呼出的一氧化氮分数，并收集生物样本以测量二手烟暴露。我们还将进行地理编码，以便与美国人口普查信息，交通密度和环境空气污染物水平的外部数据集联系起来。我们将测试物理和社会环境因素的预测模型，包括室内空气质量，环境污染，邻里和社区状况的措施，估计这些因素对HRQOL的纵向影响。我们将评估疾病严重程度作为从环境暴露到HRQOL变化的因果途径中的中介因素的作用;我们还将评估可能是这种关系的影响因素的选定个体因素，特别是个人社会经济地位（SES）。公共卫生的重要性：为了从患者的角度了解影响气道疾病结局的复杂因素网络，迫切需要一种分析方法，可以测试多种组合环境风险因素对HRQOL的影响，评估疾病严重程度的中介作用，并考虑到个体效应修饰因子。我们研究的长期目标是确定可改变的因素和高危亚组，以改善成人哮喘患者的HRQOL。拟议的项目建立在我们在当前R01中的成功基础上，通过在我们迄今为止积累的经验的背景下测试更具体的途径。

DESCRIPTION (provided by applicant): The proposed project will prospectively investigate physical and social environmental exposures as determinants of Health-Related Quality of Life (HRQOL) in adult asthma and rhinitis, focusing on the role of severity of disease as a principal mediator between the physical and social environment and HRQOL. The proposed study, a competitive renewal of an R01 near completion, builds upon our current research elucidating multifactorial models of physical and social environmental risks. The specific study aims are: 1.] Delineate the specific pathways linking physical and social environmental exposures to disease-specific and general HRQOL in adult asthma and rhinitis, including mediation by changing disease status overtime; 2.] Identify specific risk factors, such as personal socioeconomic status, that modify the impact of these environmental factors on disease severity or the effect of severity on HRQOL in adult asthma and rhinitis. To accomplish these goals, we will assemble a prospective cohort of 636 adults, merging our ongoing asthma-rhinitis cohort (the basis of the current R01) with a second cohort of adults with severe asthma established as part of a methodologically similar study. Subjects will undergo 3 waves of structured telephone interviews over the study period to ascertain environmental exposures, disease severity, and HRQOL. Two home visits will be conducted in a subset of subjects (n=380) to assess the home environment (including measurements of dust antigen, airborne particulate, and dampness), measure pulmonary function and exhaled fraction of nitric oxide, and collect biological samples to measure secondhand smoke exposure. We will also carry out geocoding for linkage to external data sets for U.S. Census information, traffic density, and levels of ambient air pollutants. We will test predictive models of physical and social environmental factors, including measures of indoor air quality, ambient pollution, and neighborhood and community status, estimating the longitudinal effect of these factors on HRQOL. We will assess the role of disease severity as a mediating factor in the causal pathway leading from environmental exposures to changes in HRQOL; we will also assess selected individual factors that may be effect modifiers of this relationship, especially personal socioeconomic status (SES). Public Health Importance: In order to understand the complex web of factors influencing airway disease outcomes from the perspective of persons with disease, there is a critical need for an analytic approach that can test the effect of multiple combined environmental risk factors on HRQOL, assess the mediating role of disease severity, and take into account individual effect modifiers. The long- term goal of our study is to identify modifiable factors and subgroups at high risk in order to improve HRQOL among adults with asthma. The proposed project builds upon our success in the current R01 by testing more specific pathways in the context of our accumulated experience to date.