Abstract
Objectives
Home environmental exposures are a primary source of asthma exacerbation. There is a gap in decision support models that efficiently aggregate the home exposure assessment scores for focused and tailored interventions. Three development methods of a home environment allergen exposure scale for persons with asthma (weighted by dimension reduction, unweighted, precision biomarker-based) were compared, and racial disparity tested.
Methods
Baseline measures from a longitudinal cohort of 187 older adults with asthma were analyzed using humidity and particulate matter sensors, allergy testing, and a home environment checklist. Weights for the dimension reduction scale were obtained from factor analysis, applied for loadings > 0.35. Scales were tested in linear regression models with asthma control and asthma quality of life outcomes. Racial disparities were tested using t tests. Scale performance was tested using unadjusted regression analyses with asthma control and asthma quality of life outcomes, separately.
Results
The 7-item empirically weighted scale demonstrated best performance with asthma control associations (F = 4.65, p = 0.03, R2 = .02) and quality of life (F = 6.45, p = 0.01, R2 = .03) as follows: evidence of roach/mice, dust, mold, tobacco smoke exposure, properly venting bathroom fan, self-report of roach/mice/rats, and access to a HEPA filter vacuum. Pets indoors loaded on a separate scale. Racial differences were observed (t = − 3.09, p = 0.004).
Conclusion
The Home Environment Allergen Exposure Scale scores were associated with racial disparities. Replicating these methods in populations residing in high-risk/low-income housing may generate a clinically meaningful, tailored assessment of asthma triggers. Further consideration for variables that address allergic reactivity and biomarker results is indicated to enhance the potential for a precision prevention score.
Résumé
Objectifs
Les expositions environnementales à domicile sont une source principale d’exacerbation de l’asthme. Il existe une lacune dans les modèles de soutien à la décision qui regroupent efficacement les scores d’évaluation de l’exposition à domicile pour des interventions ciblées et adaptées. Trois méthodes de développement d’une échelle d’exposition aux allergènes de l’environnement domestique pour les personnes atteints d’asthme (pondérée par réduction de dimension, non pondérée, basée sur un biomarqueur de précision) ont été comparées et la disparité raciale testée.
Méthodes
Les mesures de base d’une cohorte longitudinale de 187 personnes âgées asthmatiques ont été analysées à l’aide de capteurs d’humidité et de particules, de tests d’allergie et d’une liste de contrôle de l’environnement domestique. Les poids pour l’échelle de réduction des dimensions ont été obtenus à partir de l’analyse factorielle, appliquée aux charges > 0,35. Les échelles ont été testées dans des modèles de régression linéaire avec contrôle de l’asthme et résultats de la qualité de vie avec asthme. Les disparités raciales ont été testées à l’aide de tests t. La performance de l’échelle a été testée à l’aide d’analyses de régression non pondérées avec contrôle de l’asthme et résultats de la qualité de vie avec asthme, séparément.
Résultats
L’échelle pondérée empiriquement en 7 éléments a démontré les meilleures performances avec les associations de contrôle de l’asthme (F = 4,65, p = 0,03, R2 = 0,02) et la qualité de vie (F = 6,45, p = 0,01, R2 = 0,03) comme suit : preuve d’exposition aux cafards/souris, à la poussière, à la moisissure, à la fumée de tabac, ventilateur de salle de bain correctement aéré, auto-déclaration des cafards/souris/rats et accès à un aspirateur à filtre HEPA. Les animaux de compagnie à l'intérieur ont été mesurés sur une échelle séparée. Des différences raciales ont été observées (t = -3,09, p = 0,004).
Conclusion
Les scores de l’échelle d’exposition aux allergènes de l’environnement domestique étaient associés à des disparités raciales. La reproduction de ces méthodes dans des populations résidant dans des logements à haut risque/à faible revenu peut générer une évaluation cliniquement significative et adaptée des déclencheurs de l’asthme. Un examen plus approfondi des variables qui traitent de la réactivité allergique et des résultats des biomarqueurs est indiqué pour améliorer le potentiel d’un score de prévention de précision.
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Acknowledgements
The authors gratefully acknowledge Diane Endicott, RN (University of Louisville School of Nursing, Louisville, KY), Carol Norton, MUP (University of Louisville School of Nursing, Louisville, KY), Bryan Beatty, RRT, CPFT (Clinical Program Manager, Division of Pulmonary, Critical Care & Sleep Disorders Medicine, University of Louisville, Louisville, KY), Zena Ntiranyibagira, PhD (Assistant Professor of French at SUNY Erie Community College), and Olive Ndayishimiye, BSN, RN.
Funding
This research was supported by the National Institute on Aging at the National Institutes of Health, Award NIH/NIA no. 3 R01 AG047297-04S1.
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Castner, J., Barnett, R., Moskos, L.H. et al. Home environment allergen exposure scale in older adult cohort with asthma. Can J Public Health 112, 97–106 (2021). https://doi.org/10.17269/s41997-020-00335-0
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DOI: https://doi.org/10.17269/s41997-020-00335-0