An examination of adverse asthma outcomes in U.S. Adults with multiple morbidities

Ann Am Thorac Soc. 2013 Oct;10(5):426-31. doi: 10.1513/AnnalsATS.201302-032OC.


Rationale: More Americans are managing multiple chronic conditions. Little is known regarding combinations of multiple chronic conditions with asthma.

Objectives: To examine the prevalence and demographic distribution of five common chronic conditions (arthritis, heart disease, cancer, diabetes, and hypertension) in adults with and without asthma and the adverse asthma outcomes associated with multiple chronic conditions.

Methods: Cross-sectional interview data from the National Health and Nutrition Examination Survey were analyzed (n = 22,172) between 2003 and 2010. Bivariate analysis methods and multivariate generalized linear regression were used to examine associations.

Measurements and main results: Of the 10% of subjects with asthma, 54% had one or more coexisting health condition(s). The prevalence of two or three or more other chronic conditions was greater among those with asthma compared with those without (P < 0.001). Common comorbidities with asthma were hypertension (34%) and arthritis (31%). For every additional comorbid chronic condition, there was an increase in the prevalence of reported asthma symptom episodes (prevalence ratio [PR], 1.06; 95% confidence interval [CI], 1.00-1.13), frequent activity limitation (PR, 1.14; 95% CI, 1.04-1.25), sleep disturbances (PR, 1.22; 95% CI, 1.04-1.43), and emergency department visit for asthma (PR, 1.45; 95% CI, 1.19-1.76) when adjusted for socioeconomic and demographic factors and body mass index. The population-attributable risk for emergency department visits for asthma among individuals with asthma who have other chronic comorbidities was 19.5%.

Conclusions: Half of the adult population with asthma in the United States suffers from comorbid conditions, which are associated with adverse asthma-related outcomes and account for up to 20% of emergency room visits for asthma.

MeSH terms

  • Activities of Daily Living
  • Adult
  • Arthritis / epidemiology*
  • Asthma / epidemiology*
  • Asthma / physiopathology
  • Case-Control Studies
  • Chronic Disease
  • Comorbidity
  • Cross-Sectional Studies
  • Diabetes Mellitus / epidemiology*
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Heart Diseases / epidemiology*
  • Humans
  • Hypertension / epidemiology*
  • Likelihood Functions
  • Male
  • Middle Aged
  • Neoplasms / epidemiology*
  • Poisson Distribution
  • Prevalence
  • Regression Analysis
  • Severity of Illness Index
  • Sleep Wake Disorders / epidemiology
  • United States / epidemiology
  • Young Adult