Determinants of longitudinal health-related quality-of-life change in children with asthma from low-income families: a report from the PROMIS®Pediatric Asthma Study.
BACKGROUND
How the longitudinal asthma control status and other socio-demographic factors influence the changes of health-related quality of life (HRQOL) among asthmatic children, especially from low-income families, has not been fully investigated.


OBJECTIVE
This study aimed to describe the trajectories of asthma-specific HRQOL over 15 months and examine the effect of asthma control status on HRQOL by taking socio-demographic factors into consideration.


METHODS
A total of 229 dyads of asthmatic children and their parents enroled in public insurance programs were recruited for assessing asthma control status and HRQOL over four time points of assessment. Asthma control status was measured using the Asthma Control and Communication Instrument, and asthma-specific HRQOL was assessed using the Patient-Reported Outcomes Measurement Information System's Pediatric Asthma Impact Scale. Latent growth models (LGMs) were applied to examine the trajectory of HRQOL and the factors contributing to the changes of HRQOL.


RESULTS
Unconditional LGM revealed that HRQOL was improved over time. Conditional LGM suggested that accounting for asthma control and participants' socio-demographic factors, the variation in the initial level of HRQOL was significant, yet the rate of change was not. Conditional LGM also revealed that poorly controlled asthma status was associated with poor HRQOL at each time point (P's < 0.05). Lower parental education was associated with lower baseline HRQOL (P < 0.05). Hispanic children had a larger increase in HRQOL over time (P < 0.01) than non-Hispanic White children.


CONCLUSIONS
Vulnerable socio-demographic characteristics and poorly controlled asthma status affect HRQOL in children. This finding encourages interventions to improve asthma control status and HRQOL in minority children.
College of Nursing and Health Professions, Valparaiso University, Valparaiso, IN, USA.
Z
Z
Li
School of Human Development and Organizational Studies in Education, College of Education, University of Florida, Gainesville, FL, USA.
W L
WL
Leite
Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA.
L A
LA
Thompson
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
H E
HE
Gross
Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA.
E A
EA
Shenkman
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
B B
BB
Reeve
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
D A
DA
DeWalt
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
I-C
IC
Huang
D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000453:epidemiology* / Q000517:prevention & control; D002648:Child; D005260:Female; D006306:Health Surveys; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D010290:Parents; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires
asthma control; children; health-related quality of life; latent growth models; patient-reported outcomes
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