Psychosocial factors and incident asthma hospital admissions in the EPIC-Norfolk cohort study

BACKGROUND: Case series and case-control studies have shown high rates of psychosocial and behavioural risk factors amongst patients admitted to hospital with severe asthma. General population studies have shown associations between psychosocial factors and prevalent asthma but few have investigated incident asthma outcomes. METHODS: Data on psychosocial factors and asthma hospital admissions were available for 20 854 participants, aged 41-80 years, in the Norfolk cohort of the European Prospective Investigation into Cancer study. Postal assessments included details of physical functioning, mood disorder history, social adversity and social support. RESULTS: A total of 686 asthma hospital admissions were recorded. Psychosocial factors present at baseline, including current mood disorders, adverse circumstances in childhood, the impact of life events experienced during adulthood and negative perceived support from a close confidant, were associated with increased rates of hospital admission independent of age, sex, indicators of socio-economic status, physical functional health, and obesity. Restricted to those participants who reported lifetime doctor-diagnosed asthma at baseline, the reported impact of adverse life events experienced in adulthood, and both confiding and negative aspects of support quality, were associated with asthma hospital admission. The magnitude of these associations was comparable to those involving indicators of socio-economic status and physical health. CONCLUSIONS: These results show that psychosocial factors are associated with incident asthma hospital admissions and highlight the potential importance of taking account of psychosocial factors, including availability and quality of support networks, in guiding long-term asthma management.