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Age and African-American race impact the validity and reliability of the asthma control test in persistent asthmatics.

ABSTRACT: BACKGROUND:The Asthma Control Test (ACT) is widely used to assess asthma control, yet the validity and reliability of the test have not been specifically evaluated in adolescents or African-Americans. We conducted a prospective psychometric study of the ACT in African-American (AA) and non-African-American (nAA) adolescents with persistent asthma, with emphasis on the clinical utility of the test for medical decision making. METHODS:Participants completed the ACT and performed spirometry. A physician conducted a guidelines-based assessment of asthma control, blinded to the ACT score. Study procedures were repeated 6-8 weeks later. The ACT-based asthma control assessment was compared to physician assessment. RESULTS:For baseline and follow-up visits, internal consistency, as measured using Cronbach's alpha, was 0.80 and 0.81 in AA teens and 0.80 and 0.83 in nAA teens. Intraclass correlation coefficients were 0.59 and 0.76 in AA and nAA teens, respectively, with stable asthma control over time. Agreement between ACT and physician assessment was moderate in AA teens and fair in nAA teens. An ACT score of ?19 showed reduced sensitivity for not well controlled asthma in both groups, while a score of ?21 had the greatest area under the ROC curve. ACT scores were marginally responsive to change in control status. CONCLUSIONS:Concerns for the ACT's ability to detect uncontrolled asthma in adolescents emphasizes the need for a more comprehensive evaluation of asthma control in clinical settings. A higher threshold ACT score to define not well controlled asthma may be needed if the ACT is to be used for medical decision making. TRIAL REGISTRATION:ClinicalTrials.gov: NCT02671643 , NCT02662413 .

SUBMITTER: Burbank AJ

PROVIDER: S-EPMC6094875 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Age and African-American race impact the validity and reliability of the asthma control test in persistent asthmatics.

Burbank Allison J AJ Todoric Krista K Steele Pamela P Rosen Jonathan J Zhou Haibo H Frye Marcia M Loughlin Ceila E CE Ivins Sally S Mills Katherine K Massey Lauren Dembnicki LD Reeve Bryce B BB Hernandez Michelle L ML

Respiratory research 20180815 1

<h4>Background</h4>The Asthma Control Test (ACT) is widely used to assess asthma control, yet the validity and reliability of the test have not been specifically evaluated in adolescents or African-Americans. We conducted a prospective psychometric study of the ACT in African-American (AA) and non-African-American (nAA) adolescents with persistent asthma, with emphasis on the clinical utility of the test for medical decision making.<h4>Methods</h4>Participants completed the ACT and performed spi ...[more]

PMID: 30111326

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Project description:BACKGROUND:In the general population, compared wtih their White peers, African Americans suffer premature all-cause and cardiovascular (CV) deaths, attributed in part to reduced access to care and lower socioeconomic status. Prior reports indicated younger (aged 35 to 44 years) African Americans had a signficantly greater age-adjusted risk of death. Recent studies suggest that in a more egalitarian health care structure than typical United States (US) health care structures, African Americans may have similar or even better CV outcomes, but the impact of age is less well-known. METHODS:We examined age stratified all-cause mortality, and incident coronary heart disease (CHD) and ischemic stroke in 3,072,966 patients (547,441 African American and 2,525,525 White) with an estimated glomerular filtration rate (eGFR)>60 mL/min/1.73m(2) receiving care from the US Veterans Health Administration. Outcomes were examined in Cox models adjusted for demographics, comorbidities, kidney function, blood pressure, socioeconomics and indicators of the quality of health care delivery. RESULTS:African Americans had an overall 30% lower all-cause mortality (P<.001) and 29% lower incidence of CHD (P<.001) and higher incidence of ischemic stroke (aHR, 95%CI: 1.16, 1.13-1.18, P<.001). The lower rates of mortality and CHD were strongest in younger African Americans and attenuated across patients aged ?70 years. Stroke rates did not differ by race in persons aged <70 years. CONCLUSIONS:Among patients with normal eGFR and receiving care in the Veterans Health Administration, younger African Americans had lower all-cause mortality and incidence of CHD and similar rates of stroke, independent of demographic, comorbidity and socioeconomic differences. The lower all-cause mortality persisted but attenuated with increasing age and the lower incidence of CHD ended at aged ?80 years. The higher incidence of ischemic stroke in African Americans was driven by increasing risk in patients aged ?70 years suggesting that the improved cardiovascular outcomes were most dramatic for younger African Americans.

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Age and African-American race impact the validity and reliability of the asthma control test in persistent asthmatics.

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Age and African-American race impact the validity and reliability of the asthma control test in persistent asthmatics.

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