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Authorship↗
Biomedical subjects
Edward H Yelin
Publications and source records attributed to Edward H Yelin.
Directly measured secondhand smoke exposure and COPD health outcomes.
BACKGROUND: Although personal cigarette smoking is the most important cause and modulator of chronic obstructive pulmonary disease (COPD), secondhand smoke (SHS) exposure could influence the course of the disease. Despite the importance of this question, the impact of SHS exposure on COPD health outcomes remains unknown. METHODS: We used data from two waves of a population-based multiwave U.S. cohort study of adults with COPD. 77 non-smoking respondents with a diagnosis of COPD completed direct SHS monitoring based on urine cotinine and a personal badge that measures nicotine. We evaluated the longitudinal impact of SHS exposure on validated measures of COPD severity, physical health status, quality of life (QOL), and dyspnea measured at one year follow-up. RESULTS: The highest level of SHS exposure, as measured by urine cotinine, was cross-sectionally associated with poorer COPD severity (mean score increment 4.7 pts; 95% CI 0.6 to 8.9) and dyspnea (1.0 pts; 95% CI 0.4 to 1.7) after controlling for covariates. In longitudinal analysis, the highest level of baseline cotinine was associated with worse COPD severity (4.7 points; 95% CI -0.1 to 9.4; p = 0.054), disease-specific QOL (2.9 pts; -0.16 to 5.9; p = 0.063), and dyspnea (0.9 pts; 95% CI 0.2 to 1.6 pts; p < 0.05), although the confidence intervals did not always exclude the no effect level. CONCLUSION: Directly measured SHS exposure appears to adversely influence health outcomes in COPD, independent of personal smoking. Because SHS is a modifiable risk factor, clinicians should assess SHS exposure in their patients and counsel its avoidance. In public health terms, the effects of SHS exposure on this vulnerable subpopulation provide a further rationale for laws prohibiting public smoking.
Aged↗
Perceived neighborhood problems and quality of life, physical functioning, and depressive symptoms among adults with asthma.
OBJECTIVES: We investigated associations between perceived neighborhood problems and quality of life (QOL), physical functioning, and depressive symptoms among adults with asthma. METHODS: Using cross-sectional data from adults with asthma in northern California (n=435), we examined associations between 5 types of perceived neighborhood problems (traffic, noise, trash, smells, and fires) and asthma-specific QOL (Marks instrument), physical functioning (Short Form-12 physical component summary), and depressive symptoms (Center for Epidemiological Studies-Depression). We used multivariate regression analysis. RESULTS: When asthma severity and sociodemographics were taken into account, people reporting a score of 8 or higher on a scale of 0 to 25 for serious problems (the top quartile of seriousness) in their neighborhoods had significantly poorer QOL scores (mean difference=5.91; standard error [SE]=1.63), poorer physical functioning (mean difference=-3.04; SE=1.27), and almost a fivefold increase in depressive symptoms (odds ratio=4.79; 95% confidence interval=2.41, 9.52). CONCLUSIONS: A high level of perceived neighborhood problems was associated with poorer QOL, poorer physical functioning, and increased depressive symptoms among people with asthma when disease severity and sociodemographic factors were taken into account.
Adult↗
Journal policies on authorship and disclosures.
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Risk factors for work disability in severe adult asthma.
PURPOSE: We aimed to elucidate the prevalence of and risk factors for work disability in severe adult asthma and to evaluate the impact of work disability on downstream health outcomes. METHODS: We used data from a prospective cohort study of 465 adults with severe asthma. Structured telephone interviews ascertained asthma status and employment history. A job exposure matrix (JEM) was used to characterize the likelihood of workplace exposure to "asthmagens." RESULTS: The prevalence of asthma-related complete work disability was 14% among working-age adults with severe asthma (95% confidence interval, 11%-18%). Among those who were currently employed, the prevalence of partial work disability was 38% (95% confidence interval, 31%-45%). Sociodemographic (P = .027) and medical factors (P = .020) were related to the risk of complete work disability. Both sociodemographic characteristics (P = .06) and work exposures based on the JEM (P = .012) were related to partial work disability. In additional models, poorer asthma severity, physical health status, and mental health status were all associated with a higher risk of complete and partial work disability. CONCLUSIONS: Work disability is common among adults with severe asthma. There are three sets of risk factors for work disability that are potentially modifiable: smoking, workplace exposures, and asthma severity.
Absenteeism↗
Evaluating medical effectiveness for the california health benefits review program.
An important aspect of the mandate assessments requested by the California legislature is a review of the scientific and medical literature on the medical effectiveness of the proposed health insurance benefit mandate. Although such a review bears many similarities to effectiveness reviews that might be undertaken for publication as research studies, several important differences arise from the requirements of the California legislation. Our reviews are intended to assist the legislators in deciding whether to support a specific mandate to modify health insurance benefits in a particular way. Thus, our assessments focus on how the scientific literature bears on the proposed mandate, which may involve a complicated chain of potential effects leading from altered coverage to ultimate impact on health. Evidence may be available for only some of the links in the chain. Furthermore, not all the evidence may be directly applicable to the diverse population of California or the subpopulation affected by the mandate. The mandate reviews, including the medical effectiveness analyses, may be used in a potentially contentious decision making setting. The legislative calendar requires that they need to be timely, yet they must be as valid, credible, and based on the best information available as possible. The focus on applicability also implies the need for informed, technical decisions concerning the relevance of the articles for the report, and these decisions need to be made as transparent as possible. These goals and constraints yield an approach that differs somewhat from an investigator-initiated review of the literature.
California↗
Measuring disease-specific quality of life in obstructive airway disease: validation of a modified version of the airways questionnaire 20.
BACKGROUND: The Airways Questionnaire 20 (AQ20) is a concise measure of health-related quality of life (HRQL) in obstructive airway disease; however, its original format may underestimate impairment due to the complete cessation of certain activities. METHODS: We revised seven items of the original AQ20 (revised AQ20 [AQ20-R]), adding response options for inability to perform certain activities. We assessed the performance of the AQ20-R among 352 adults with various airway conditions identified through a random telephone sample. Concurrent validity of the AQ20-R was assessed relative to the Short Form-12 (SF-12) physical component summary (PCS), FEV(1), and medication use. Predictive validity was assessed relative to health-care utilization among 278 subjects studied longitudinally. RESULTS: Twenty-one of 352 subjects were unable to perform at least one activity. These subjects demonstrated higher AQ20-R scores (p < 0.001) indicating worse HRQL. Mean (+/- SD) AQ20-R scores differed significantly (p < 0.001) among subjects with COPD (8.9 +/- 5.2), asthma (6.7 +/- 5.0), and chronic bronchitis (4.7 +/- 4.2). At baseline, the AQ20-R correlated with the SF-12 PCS (r = - 0.55, p < 0.001) and FEV(1) (r = - 0.43, p < 0.001), and was associated with the use of respiratory-specific therapies (p </= 0.001). In multivariate models, the AQ20-R was an independent predictor of outpatient visits (odds ratio, 2.2; 95% confidence interval, 1.6 to 3.1), emergency department visits (odds ratio, 2.9; 95% confidence interval, 1.9 to 4.6), hospitalization (odds ratio, 2.8; 95% confidence interval, 1.6 to 4.9), and ICU admission (odds ratio, 3.0; 95% confidence interval, 1.2 to 7.3) during the following year. CONCLUSIONS: The AQ20-R is a valid respiratory-specific HRQL measure that accounts for activity cessation among the most impaired and can be used across various airway conditions.
Aged↗
The influence of perceived control of asthma on health outcomes.
BACKGROUND: Psychosocial factors play an important role in outcomes of asthma. Perceived control, a measure of patients' beliefs about their ability to control their disease, has not been studied in association with asthma health outcomes METHODS: We used data from a prospective cohort study of patients who were hospitalized for asthma (n = 865). After hospital discharge, we conducted structured telephone interviews to obtain demographic characteristics, asthma history, and psychological variables. Interviews included administration of the Perceived Control of Asthma Questionnaire (PCAQ). We then prospectively measured emergency department (ED) visits and hospitalizations for asthma over time, with a median follow-up time of 1.9 years RESULTS: Greater perceived control was associated with better physical health status (mean score increment per 2-point change in PCAQ score, 1.13; 95% confidence interval [CI], 0.79 to 1.47), better asthma-related quality of life (mean score increment, -2.24; 95% CI, -2.6 to -1.83), fewer days of restricted activity due to asthma (mean increment, -1.23; 95% CI, -1.62 to -0.83), and lower asthma severity scores (mean score increment, -0.40; 95% CI, -0.53 to -0.27). In a multivariate model, greater perceived control was associated with a significantly decreased prospective risk of ED visits (hazard ratio [HR], 0.92; 95% CI, 0.86 to 0.98; p = 0.008) and hospitalizations for asthma (HR, 0.84; 95% CI, 0.78 to 0.90; p < 0.0001). There was no association found between perceived control and most aspects of preventive care or self-management CONCLUSIONS: Greater perceived control is associated with improved asthma-related health status as well as with a decreased prospective risk of severe asthma attacks resulting in emergency health-care utilization. This difference does not appear to be mediated by changes in preventive care or asthma self-management practices.
Adult↗
Impact of managed care on the use of biologic agents for rheumatoid arthritis.
OBJECTIVE: To compare the use of biologic agents among persons with rheumatoid arthritis (RA) in managed care and fee-for-service settings. METHODS: The present study uses data from the University of California, San Francisco RA Panel Study in which 529 patients with RA from a random sample of northern California rheumatologists were interviewed annually between 1999 and 2002 using a structured survey instrument. Linear and logistic regression were used to compare current utilization, initiation, and cessation of biologic agents and other treatments among patients with RA in managed care and fee-for-service settings, with and without adjustment for differences in demographic and health characteristics. RESULTS: After adjustment, patients with RA in health maintenance organizations (HMOs) were significantly less likely to use biologic agents than those in other managed care settings (difference of -6.6%; 95% confidence interval [95% CI] -11.4%, -1.7%) or than those in fee-for-service settings (difference of -12.5%; 95% CI -19.0%, -5.9%); patients in other managed care settings and fee-for-service did not differ significantly in their use of biologic agents. Patients with RA in HMOs were significantly less likely than those in other managed care settings to initiate the use of biologic agents (difference of -7.3%; 95% CI -11.5%, -3.1%); there were no other differences between patients in HMOs and those in other managed care and fee-for-service settings in rates of initiation or cessation of these agents. Patients with RA in HMOs were less likely to use methotrexate, cyclooxygenase 2 (COX-2) inhibitors, and corticosteroids than those in other managed care settings; they were also less likely to use COX-2 inhibitors than those in fee-for-service settings. CONCLUSION: Patients with RA in HMOs were significantly less likely to use biologic agents than those in other managed care and fee-for-service settings, primarily due to lower rates of initiation.
Adrenal Cortex Hormones↗
Lifetime environmental tobacco smoke exposure and the risk of chronic obstructive pulmonary disease.
BACKGROUND: Exposure to environmental tobacco smoke (ETS), which contains potent respiratory irritants, may lead to chronic airway inflammation and obstruction. Although ETS exposure appears to cause asthma in children and adults, its role in causing COPD has received limited attention in epidemiologic studies. METHODS: Using data from a population-based sample of 2,113 U.S. adults aged 55 to 75 years, we examined the association between lifetime ETS exposure and the risk of developing COPD. Participants were recruited from all 48 contiguous U.S. states by random digit dialing. Lifetime ETS exposure was ascertained by structured telephone interview. We used a standard epidemiologic approach to define COPD based on a self-reported physician diagnosis of chronic bronchitis, emphysema, or COPD. RESULTS: Higher cumulative lifetime home and work exposure were associated with a greater risk of COPD. The highest quartile of lifetime home ETS exposure was associated with a greater risk of COPD, controlling for age, sex, race, personal smoking history, educational attainment, marital status, and occupational exposure to vapors, gas, dusts, or fumes during the longest held job (OR 1.55; 95% CI 1.09 to 2.21). The highest quartile of lifetime workplace ETS exposure was also related to a greater risk of COPD (OR 1.36; 95% CI 1.002 to 1.84). The population attributable fraction was 11% for the highest quartile of home ETS exposure and 7% for work exposure. CONCLUSION: ETS exposure may be an important cause of COPD. Consequently, public policies aimed at preventing public smoking may reduce the burden of COPD-related death and disability, both by reducing direct smoking and ETS exposure.
Aged↗
Exposure to vapors, gas, dust, or fumes: assessment by a single survey item compared to a detailed exposure battery and a job exposure matrix.
BACKGROUND: Occupational exposure assessment often relies upon subject report. We examined the characteristics of self-reported exposure in respondents' longest held job to vapors, gas, dust, or fumes (VGDF) compared to other measures of exposure risk. METHODS: We analyzed data from 1,876 respondents from a national US population-based telephone survey designed to estimate the association between occupational factors and chronic disease of the airways. We tested a single VGDF item against responses to a 16-item battery assessing specific inhalation exposures and against a job exposure matrix (JEM). We analyzed all of these measures for their association with adult-onset asthma after excluding subjects with COPD or asthma with onset before age 18. RESULTS: VDGF (single item) was reported by 744 (40%) subjects; any of the 16 exposures by 899 (48%); and an intermediate or high exposure likelihood job by JEM was assigned to 682 (36%). The sensitivity of the VGDF item measured against the 16-item battery was 69%; the specificity was 88%; (classification agreement kappa=0.58); against the JEM classification the sensitivity was 64% and specificity 74% (kappa=0.37). The relative odds (OR) for adult-onset asthma associated with various measures of exposure were: VGDF, 1.7 (95% Confidence Interval [CI] 1.0-2.8; P=0.04); any of the 16 exposures, 1.6 (95% CI 1.0-2.7; P=0.06), and intermediate or high by JEM, 1.2 (0.7-2.1; P>0.50). CONCLUSIONS: A single VGDF survey item appears to delineate exposure risk at least as well as a multiple-item battery assessing such exposures; it has modest agreement with a JEM-based exposure categorization.
Aged↗
New journal policy regarding registration of clinical trials.
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Clinical Trials as Topic↗
Functioning and psychological status among individuals with COPD.
BACKGROUND: We examined the link between functioning and psychological status among persons with chronic obstructive pulmonary disease (COPD), using measures of both general functional status and performance of life activities. METHODS: 334 persons with COPD were interviewed by telephone. Functioning was assessed with two measures of difficulty with specific types of activities (self-care, recreational activities/hobbies) and a general measure of functional status (SF-12 Physical Component Score (PCS)). RESULTS: About 16.2% of the sample had SF-12 Mental Component Score (MCS) scores indicative of psychological distress (MCS < 35). In separate regression models, difficulty with self-care and recreational activities was associated with an increased likelihood of distress (self-care: OR=2.9, 95%CI 1.3, 6.6; recreation: OR=7.5 [2.4, 23.7]), while PCS scores were not. In a model including all three predictors, difficulty with recreation was strongly associated with distress (OR=7.7 [2.1, 29.2]), difficulty with self-care was less strongly associated with distress (OR=2.1 [0.8, 5.5]), and PCS did not contribute significantly to the predictive ability of the model. However, low functioning as measured by the PCS was a significant risk factor for difficulty performing activities. CONCLUSIONS: Measures of activity difficulty were independent predictors of psychological distress, while general physical function was not. Poor general physical function was a risk factor for activity difficulties, suggesting an indirect relationship between low PCS and psychological distress, with activity difficulties as the intermediate variable.
Activities of Daily Living↗
Impact of the home indoor environment on adult asthma and rhinitis.
OBJECTIVE: We sought to study the combined effects of multiple home indoor environmental exposures in adult asthma and rhinitis. METHODS: We studied 226 adults with asthma and rhinitis by structured interviews and home assessments. Environmental factors included dust allergen, endotoxin and glucan concentrations, and indoor air quality (IAQ) variables. Outcomes included forced expiratory volume in 1 second (FEV1) percent predicted, Severity of Asthma Score (SAS), Short-Form (SF)-12 Physical Component Scale (PCS), and asthma Quality of Life (QOL) score. RESULTS: House dust-associated exposures together with limited IAQ variables were related to FEV1 % predicted (R = 0.24; P = 0.0001) and SAS (R = 0.18; P = 0.007). IAQ and limited dust variables were associated with SF-12 PCS (R = 0.15; P = 0.02), but not QOL (R = 0.13; P = 0.16). CONCLUSIONS: The home environment is strongly linked to lung function, health status, and disease severity in adult asthma and rhinitis.
Air Pollution, Indoor↗
Development and validation of a survey-based COPD severity score.
OBJECTIVE: To develop a comprehensive disease-specific COPD severity instrument for survey-based epidemiologic research. STUDY DESIGN AND SETTING: Using a population-based sample of 383 US adults with self-reported physician-diagnosed COPD, we developed a disease-specific COPD severity instrument. The severity score was based on structured telephone interview responses and included five overall aspects of COPD severity: respiratory symptoms, systemic corticosteroid use, other COPD medication use, previous hospitalization or intubation, and home oxygen use. We evaluated concurrent validity by examining the association between the COPD severity score and three health status domains: pulmonary function, physical health-related quality of life (HRQL), and physical disability. Pulmonary function was available for a subgroup of the sample (FEV1, n = 49; peak expiratory flow rate [PEFR], n = 93). RESULTS: The COPD severity score had high internal consistency reliability (Cronbach alpha = 0.80). Among the 49 subjects with FEV1 data, higher COPD severity scores were associated with poorer percentage of predicted FEV1 (r = - 0.40, p = 0.005). In the 93 subjects with available PEFR measurements, greater COPD severity was also related to worse percentage of predicted PEFR (r = - 0.35, p < 0.001). Higher COPD severity scores were strongly associated with poorer physical HRQL (r = - 0.58, p < 0.0001) and greater restricted activity attributed to a respiratory condition (r = 0.59, p < 0.0001). Higher COPD severity scores were also associated with a greater risk of difficulty with activities of daily living (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.8 to 3.0) and inability to work (OR, 4.2; 95% CI, 3.0 to 5.8). CONCLUSION: The COPD severity score is a reliable and valid measure of disease severity, making it a useful research tool. The severity score, which does not require pulmonary function measurement, can be used as a study outcome or to adjust for disease severity.
Activities of Daily Living↗
Leukotriene modifier use and asthma severity: how is a new medication being used by adults with asthma?
BACKGROUND: The introduction of leukotriene modifiers, the first novel class of medications for asthma in more than 2 decades, provided an opportunity to evaluate the clinical context in which patients receive new treatments. Because milder asthma is usually controllable with more familiar medications, we hypothesized that adults with asthma would receive leukotriene modifiers for more severe disease. METHODS: We conducted a prospective, longitudinal, 18-month cohort study of 349 patients with asthma. We evaluated the association of baseline self-reported medication use and measures of asthma severity. We also examined the impact of baseline measurement of asthma severity on incident leukotriene modifier use at follow-up. RESULTS: At baseline, 39 (11%) of 349 patients reported leukotriene modifier use during the previous 2 weeks (95% confidence interval [CI], 8%-15%). Adults with asthma who reported recent use of leukotriene modifiers were more likely to indicate use of other long-term controller medications for asthma, such as inhaled corticosteroids (80% vs 57%;P =.007). Leukotriene modifier use was also associated with poorer severity-of-asthma scores (mean score difference, 3.6 points; 95% CI, 1.7-5.2 points) and asthma-specific health-related quality of life (mean score difference, 8.1 points; 95% CI, 3.4-12.8 points). Leukotriene modifier users were also more likely to indicate a recent emergency department visit (odds ratio [OR], 2.3; 95% CI, 0.9-5.6) or hospitalization for asthma (OR, 4.1; 95% CI, 1.4-11.4). Greater baseline asthma severity was associated with an increased probability of new-onset leukotriene modifier use during 18-month follow-up. Poorer baseline severity-of-asthma scores and asthma-specific quality-of-life scores were related to a greater likelihood of leukotriene modifier use at follow-up (OR per SD-sized score increment, 2.0; 95% CI, 1.4-2.7; OR, 1.8; 95% CI, 1.3-2.5; respectively). Recent hospitalization for asthma at baseline was also associated with a greater likelihood of leukotriene modifier use at follow-up (OR, 4.9; 95% CI, 1.6-14.8). CONCLUSIONS: Adults with asthma who receive leukotriene modifiers have more severe asthma.
Acetates↗
Health-related quality of life in adult rhinitis: the role of perceived control of disease.
BACKGROUND: Factors affecting health-related quality of life (HRQOL) in adult rhinitis have not been well described. OBJECTIVE: To understand how symptom severity, physical functioning, psychological distress, and perceived control of disease relate to HRQOL in a population-based sample of adults with rhinitis. METHODS: We conducted telephone interviews in 109 adults with rhinitis recruited via random digit dialing. We assessed HRQOL by using the Rhinosinusitis Disability Index, physical functioning by using the physical component score of the Short Form-12, and psychological distress by using the Center for Epidemiologic Studies Depression Scale. To evaluate the role of patient-perceived control of disease in rhinitis, we developed a new 8-item instrument, the Perceived Control of Rhinitis Questionnaire. RESULTS: Lower HRQOL correlated with greater symptom severity ( r=0.57), poorer physical functioning ( r=-0.41), greater psychological distress ( r=0.44), and less perceived control ( r=-0.53). In a multivariate model, symptom severity ( P < .001), psychological distress ( P <.001), and perceived control ( P <.001) were all independent predictors of HRQOL. Adding functional and psychosocial measures to a base model with demographics and disease severity explained an additional 26% of variance in HRQOL. CONCLUSIONS: Although disease severity is an important factor in HRQOL, psychosocial factors, such as perceived control of disease, explain a substantial amount of the variability in HRQOL among adults with rhinitis.
Adolescent↗
Performance of valued life activities reflected asthma-specific quality of life more than general physical function.
OBJECTIVE: We examined the prevalence of disability in valued life activities (VLAs) among a group of adults with asthma and the impact of general physical function and performance of VLAs on asthma-specific quality of life (QOL). STUDY DESIGN AND SETTING: Interview data collected from two waves of a longitudinal cohort study were used to examine the prevalence of disability in VLAs, the cross-sectional association of general function and performance of VLAs with QOL, and the longitudinal association of changes in general function and changes in performance of VLAs with changes in QOL. General function was assessed with the SF-12; VLAs were assessed with a newly developed measure. RESULTS: A substantial portion of subjects reported disability in VLAs. VLA function was a stronger predictor of QOL than general physical function in cross-sectional and longitudinal analyses. CONCLUSION: Performance of VLAs is more closely tied to asthma-specific QOL than is general physical function.
Activities of Daily Living↗