Gender differences of health behaviors and quality of life of Koreans with asthma

doi:10.4236/ojn.2013.36057

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Open Journal of Nursing, 2013, 3, 420-425 OJN

http://dx.doi.org/10.4236/ojn.2013.36057 Published Online October 2013 (http://www.scirp.org/journal/ojn/)

Gender differences of health behaviors and quality of life

of Koreans wit h a s t hma

Yeonsoo Jang1, Hyera Yoo2*

1College of Nursing, Nursing Policy and Research Institute, Yonsei University, South Korea

2College of Nursing, Ajou Univeristy, South Korea

Email: *[email protected]

Received 21 July 2013; revised 22 August 2013; accepted 19 September 2013

cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Purpose: The purpose of this study was to explore

gender differences in health-behaviors and quality of

life (QOL) in Koreans with asthma. Methods: Par-

ticipants, selected from the 2009 Korean National

Health and Nutritional Examination Survey VI, in-

cluded 305 individuals (men = 128, women = 177)

with asthma and over 19 years old. Health behaviors

were measured by questions about disease manage-

ment, health choices, and functional and psychologi-

cal status. QOL was measured with the European

Quality of Life-5D (EQ-5D). Results: In health be-

haviors, 51.3% of women and 37.7% of men suffered

from wheezing at rest. About 41% of men and 10% of

women were smokers. One half of the participants

were not taking medication and this was not signifi-

cantly different by gender. The number of women

with symptoms of depression was significantly higher

than men. The EQ-5D index score of women was sig-

nificantly lower than that of men. Conclusion: W ome n

with asthma were more likely to have psychological

problems and discomfort than men. Understanding

gender differences in asthma is important to the de-

velopment of effective, tailored asthma management

strategies to cope with symptoms and improve health

behaviors and QOL for people with asthma.

Keywords: Asthma; Health Behavior; Quality of Life;

Gender; Korean

1. INTRODUCTION

Asthma is a chronic disease characterized by recurrent

attacks of breathlessness and wheezing, which vary in

severity and frequency. The World Health Organization

reported that 235 million people suffer from asthma

across the world [1]. In 2007, 34 million people were

diagnosed with asthma in the United States, and asthma

accounted for 3447 deaths. After the age of 20, asthma

death rates are higher among women than men in the

United States [2]. In Korea, the prevalence of asthma

was 7.7% among adults aged 19 years and older in 2009;

in comparison, the prevalence of type II diabetes mellitus

and cancer were 9.6% and 2.9%, respectively, in the

same year [3].

Asthma impairs the quality of life (QOL) and physical

and psychological health status such as depression, dis-

tress, or limited activities [4]. Patients with asthma have

reduced exercise capacity and may be limited in work

performance [5]. Koreans with asthma are likely to have

similar health outcomes as patients in other countries.

Previous studies report that Koreans with chronic ob-

structive lung disease engaged in poor health behaviors.

Moreover, the QOL of Koreans with asthma is lower

than that of Koreans with chronic obstructive lung dis-

ease [6,7].

The results of previous studies suggest that tailored

interventions, based on gender, may be needed because

there are gender-related differences among people with

asthma. It is known that the prevalence of asthma and the

rates of mortality and hospitalization in women are

higher than those in men [8,9]. In addition, it has been

reported that the QOL and health status of women with

asthma are lower than those of men [10,11]. However,

gender differences in health behaviors and QOL among

Koreans with asthma are poorly understood.

The purpose of this study was to examine gender dif-

ferences in disease management, health behaviors, and

QOL using data from the 2009 Korean National Health

and Nutritional Examination Survey (KNHANES IV).

2. METHODS

2.1. Participants

The KNHANES IV was a nation-wide study using a

*Corresponding author.

OPEN ACCESS

Y. Jang, H. Yoo / Open Journal of Nursing 3 (2013) 420-425 421

complex sample design for the selection of representative

household units (N = 24,871) of non-institutionalized

civilians in South Korea conducted by the Korean Center

for Disease Control and Prevention in 2009. KNHANES

IV consisted of three components: the Health Interview

Survey, the Health Examination Survey, and the Nutri-

tion Survey [12]. From the KNHANES IV database, 305

individuals (men = 128, women = 177) aged 19 years or

over and diagnosed with asthma by a physician were

selected for the present study.

2.2. Measurements

Demographic characteristics. Age, marital status, educa-

tion level, occupation, household income, and comorbid-

ity were collected to identify the demographic character-

istics of the sample.

Health behaviors. Health behaviors were measured by

questions about disease management, health choices, and

functional and psychological status. The disease man-

agement category included questions about current

treatment status, medication compliance, the status of

symptoms (wheezing), and asthma attacks. The health

choices category assessed the use of tobacco or alcohol,

and the frequency of exercise, health examinations, and

influenza vaccinations.

Functional health was assessed by activity limitations,

measured using a dichotomous scale (yes/no), and per-

ceived health status, which was represented by the choice

of good, fair, or poor. Psychological health was assessed

by symptoms of depression in the last two weeks, meas-

ured with a dichotomous scale (yes/no), and the level of

stress, which was measured with a 4-point Likert scale (1

= very much to 4 = very little).

Quality of life. The European Quality of Life-5D (EQ-

5D) scale was used to assess the quality of life. The EQ-

5D consists of questions about five items—mobility,

self-care, normal activities, pain, and anxiety/depression

—on a dichotomous scale (no problems/problems). In

addition, the EQ-5D assesses overall QOL using a visual

analysis scale of 0 to 100.

The EQ-5D index scores are calculated based on re-

sponses to the five-item questionnaire, preference weights,

and an algorithm. The weights and algorithm were de-

termined by a study with a UK population that used data

from the Measurement and Valuation of Health survey

[13]. The index score was used to evaluate the overall

QOL.

2.3. Ethical Considerations

This study is a retrospective study that used and analyzed

the data from the 2009 KNHANES survey; therefore,

approval from IRB was not required.

2.4. Data Analysis

Using PASW Statistics 18, a general linear model and

cross-tabulation analysis were used to explore demo-

graphic characteristics and gender differences in health

behaviors and QOL. All values were weighted.

3. RESULTS

3.1. Demographic Characteristics

The demographic characteristics of participants are pre-

sented in Tabl e 1. The mean age of men was 48.1 years

(SE = 1.97, ranging: 19 - 89) and the mean age of

Table 1. Demographic characteristics by gender (N = 305).

Total Men Women

Variables N = 305 (%†) n = 128 (%†) n = 177 (%†) t or x2 (p value)

Age, years, mean† (SE†) 55.9 (17.43) 48.1 (1.97) 52.2 (1.57) −1.595 (0.113)

Marital status 32.98 (0.000)

Married/living with spouse 201 (61.3) 102 (92.3) 99 (61.9)

Single/Divorced/Widowed 104 (34.7) 8 (7.7) 62 (38.1)

Education 26.57 (0.000)

Elementary or less 136 (34.5) 42 (21.1) 94 (46.1)

Middle school 36 (11.0) 14 (11.1) 22 (11.0)

High school 77 (32.3) 45 (44.9) 32 (21.6)

College or over 56 (21.1) 27 (22.9) 29 (21.4)

Occupation 33.90 (0.000)

Yes 156 (53.9) 85 (71.9) 71 (38.5)

No 149 (46.1) 43 (28.1) 106 (61.5)

Monthly income, won, mean* (SE*) 2,957,917 (41.9) 2,810,271 (25.0) 3,087,244 (75.0) −0.352 (0.725)

Comorbidity††

Hypertension 103 (33.8) 40 (26.4) 63 (32.7) 1.46 (0.292)

Arthritis 106 (34.8) 27 (20.3) 79 (35.5) 8.75 (0.012)

Diabetes Mellitus 39 (10.6) 15 (10.6) 24 (10.6) 0.00 (0.991)

†weighted values. ††Multiple response.

Y. Jang, H. Yoo / Open Journal of Nursing 3 (2013) 420-425

422

women was 52.2 years (SE = 1.57, range: 41 - 88 year).

There was no significant difference for mean age be-

tween men and women. The number of women who were

diagnosed with arthritis was significantly higher than that

of men (p = 0.012).

3.2. Health Behaviors

The mean age at diagnosis of asthma of men (31.3 ± 2.66)

was significantly younger than that of women (40.8 ±

1.71) (p = 0.005). Women were more likely than men to

have wheezing at rest (p = 0.027). One half of both men

and women had never taken medication for asthma, and

there was no gender difference on this variable (Table 2).

One half of the men (41.1%) smoked and number of

cigarettes was 15.3 per day. Twenty-six percent of

women reported drinking. About 51% of the men and

64% of the women did not exercise (Table 3).

The number of women with symptoms of depression

Table 2. Comparison of disease management by gender (N = 305).

Total Men Women

Variables N = 305 (%†) n = 128(%†) n = 17 7 ( %†) t or x2 (p value)

Age at diagnosis, years, mean† (SE†) 36.66 (1.53) 31.3 (2.66) 40.8 (1.71) −2.89 (0.005)

Current treatment 1.98 (0.222)

Yes 76 (22.3) 33 (18.6) 43 (25.4)

No 229 (77.7) 95 (81.4) 137 (74.6)

Wheezing

Rest 152 (45.0) 56 (37.7) 96 (51.3) 5.70 (0.027)

Exercise 107 (31.8) 43 (28.9) 64 (34.4) 2.21 (0.329)

Taking Medication 3.52 (0.478)

Always, regular 49 (14.6) 25 (12.2) 24 (16.5)

Often, or as needed 83 (26.1) 27 (22.9) 56 (28.9)

Never 154 (52.2) 68 (57.7) 86 (47.5)

Unknown 19 (7.2) 8 (7.2) 11 (7.1)

Asthma attack in the previous year 0.32 (0.882)

Yes 35 (10.3) 16 (9.3) 19 (11.2)

No 251 (82.5) 104 (83.5) 147 (81.6)

Unknown 19 (7.2) 8 (7.2) 11 (7.1)

†weighted values.

Table 3. Comparison of health choices by gender (N = 305).

Total Men Women

Variables N = 305 (%†) n = 128 (%†) n = 177 (%†) t or x2 (p value)

Smoking 99.0 (0.000)

Current 67 (24.6) 50 (41.1) 17 (10.5)

Quit 65 (21.3) 50 (35.5) 15 (9.1)

No 173 (54.1) 28 (23.5) 145 (80.4)

Smoking, cigarettes/day, mean† (SE†) 13.44 (0.754) 15.3 (0.983) 7.12 (0.754) 9.43 (0.000)

Drinking 16.35 (0.000)

Yes 63 (17.9) 12 (8.3) 51 (26.1)

No 242 (82.1) 116 (91.7) 126 (73.9)

Regular exercise (moderate) 5.01 (0.174)

Not at all 186 (58.0) 73 (51.2) 113 (63.8)

Less than 3 days 66 (23.8) 27 (27.2) 39 (20.8)

3 days or more 53 (18.2 28 (21.6) 25 (15.3)

Health Examination in last years 0.37 (0.597)

Yes 165 (48.9) 72 (47.0) 93 (50.5)

No 140 (51.1) 56 (53.0) 84 (49.5)

Influenza Vaccination 1.11 (0.444)

Yes 161 (46.9) 64 (43.7) 97 (49.7)

No 144 (53.1) 64 (56.3) 80 (50.3)

†weighted values.

Y. Jang, H. Yoo / Open Journal of Nursing 3 (2013) 420-425 423

in the last two weeks was significantly higher than the

number of men (p = 0.022). Approximately 26% of men

and 33% of women reported some limits on activity, but

there were no gender differences. Similarly, current

health status was not significantly different between men

and women (Table 4).

3.3. Quality of Life

The overall QOL of all subjects was moderate and there

was no gender difference. However, there were signifi-

cant differences on subscales of EQ-5D: women reported

more problems related to mobility (p = 0.001), usual

activity (p = 0.036), and pain/discomfort (p = 0.001) than

men. The EQ-5D index score of women was signifi-

cantly lower than that of men (p = 0.003) (Table 5).

4. DISCUSSION

This study was conducted to explore gender differences

Table 4. Comparison of functional and psychological health status by gender (N = 305).

Total Men Women

Variables N = 305 (%†) n = 128 (%†) n = 177 (%†) t or x2 (p value)

Stress 0.90 (0.881)

Very much 25 (9.6) 12 (10.6) 13 (8.7)

Much 91 (32.4) 38 (32.9) 53 (31.9)

Little 143 (46.1) 56 (43.5) 87 (48.3)

Very little 46 (12.0) 22 (13.0) 24 (11.1)

Depression in last two weeks 6.51 (0.022)

Yes 68 (21.2) 21 (14.7) 47 (26.7)

No 237 (78.8) 107 (85.3) 130 (73.3)

Activity limitation 1.45 (0.225)

Yes 108 (29.6) 42 (26.2) 66 (32.6)

No 197 (70.4) 86 (73.8) 111 (67.4)

Current Health Status 0.67 (0.788)

Good 78 (27.4) 38 (29.7) 40 (25.5)

Moderate 80 (26.8) 34 (28.1) 46 (29.0)

Poor 147 (44.0) 56 (42.3) 91 (45.4)

†weighted values.

Table 5. Comparison of quality of life by gender (N = 305).

Total Men Women

Variables N = 305 (%†) n = 128 (%†) n = 17 7 ( %†) t or x2 (p value)

Mobility 12.61 (0.001)

No Problems 205 (72.2) 96 (82.0) 109 (63.8)

Problems 100 (27.8) 32 (18.0) 68 (36.2)

Self-Care 1.24 (0.303)

No Problems 268 (90.8) 114 (92.8) 154 (89.1)

Problems 37 (9.2) 14 (7.2) 23 (10.9)

Usual Activity 6.06 (0.036)

No Problems 235 (79.7) 105 (85.8) 130 (74.4)

Problems 20.3 (70) 23 (14.2) 47 (25.6)

Pain/Discomfort 11.30 (0.001)

No Problems 190 (67.1) 93 (76.8) 97 (58.7)

Problems 32.9 (115) 35 (23.2) 80 (41.3)

Anxiety/Depression 0.31 (0.638)

No Problems 254 (80.7) 111 (82.0) 143 (79.5)

Problems 19.3 (51) 17 (18.0) 34 (20.5)

Overall QOL, VAS, mean† (SE†) 70.45 (2.6) 71.6 (1.82) 69.5 (1.72) 0.81 (0.419)

EQ-5D index 0.88 (0.02) 0.91 (0.01) 0.85 (0.02) 3.07 (0.003)

†weighted values.

Y. Jang, H. Yoo / Open Journal of Nursing 3 (2013) 420-425

424

in disease management, health behaviors, and QOL in

Koreans with asthma. The mean age at diagnosis among

men was significantly lower than that of women in this

study. This result is consistent with previous studies

[14,15], which reported that the incidence of asthma

among women 35 years or older was increasing, and that

the number of women with asthma was higher than that

of men in individuals over 40 years of age [14]. The age

at diagnosis of asthma seems to differ by gender.

Both men and women had poor health behaviors in

this study, and there were gender differences in asthma

symptoms. Manfreda and his colleges [16] reported that

women experienced more symptoms, such as dyspnea

and wheezing, than men; therefore, women received

more medical treatments. In this study, more women also

reported wheezing at rest than men. However, although

51% women reported wheezing at rest, only 25% of this

sample received asthma treatments. Adherence to asthma

medication schedules was moderate for both men and

women and there were no significant gender differences.

Therefore, effective interventions to improve self-man-

agement of their disease should be developed for Kore-

ans with asthma.

In psychological health status, the rate of women with

depression was significantly higher than that of men.

This result is consistent with the results of a previous

study that found women with mild asthma had more

episodes of anxiety and depression than men [17]. In

addition, Koreans women with asthma might be likely to

be more depressed than overall Korean populations even

though we did not compare depression between Korean

women with asthma and without asthma in this study.

However, Sung [18] reported that 13% of participants

were depressed in last two weeks and 3% of them were

diagnosed depression generally using national data,

while about 27% of women with asthma reported de-

pression in this sample. Interventions focusing on psy-

chological issues may need to be tailored more toward

women.

The overall QOL of this sample was moderate and a

gender difference was not observed. However, the EQ-

5D index score of women was significantly lower than

the score of men. The EQ-5D index scores of the par-

ticipants was lower than the scores of overall Koreans

aged 19 years or over and Koreans with osteoarthritis

and hypertension [19], and was similar to the scores of

Koreans with cancer and chronic obstructive pulmonary

disease [6]. The results of prior QOL studies are similar

to the results of this study; in those studies, the overall

QOL of patients with asthma was low, and women had a

lower QOL than men [10,20,21].

In the subscales of the EQ-5D, the number of women

reporting problems with mobility, usual activities, and

pain/discomfort was significantly higher than the number

of men. More women than men also reported problems

on the subscales of self-care and anxiety/depression,

even though there were no significant gender differences.

Sinclaire and Tolsma [21] found that women with asthma

were more likely to complain of discomfort, symptoms

of wheezing, and shortness of breath, which supports the

results of this study. Therefore, women with asthma

might need different symptom management and health

behavior strategies than men. Health care providers

should evaluate and address health status by gender for

individuals with asthma.

The study has some limitations. First, there is sam-

pling bias due to the use of the self-report instruments in

the KNHANES IV. Some of the information was subjec-

tive and might differ from a professional evaluation.

Second, the KNHANES IV used the EQ-5D to evaluate

QOL, which is useful when comparing QOL among peo-

ple with varying diseases and countries, but this instru-

ment lacks sensitivity in the assessment of specific issues

affecting people with asthma. Third, we did not compare

health status and health behaviors between Koreans with

asthma and without asthma. Because the differences s of

sample sizes between them was big, there was the lack of

statistical stability. Further study needs to examine the

difference between people with asthma and without asthma.

5. CONCLUSION

Although there are some limitations, this study found

gender differences in disease management, health status,

and QOL of Koreans with asthma. Women with asthma

were more likely to have psychological problems and

discomfort related to asthma symptoms than men. The

findings of this study are important for the development

of effective and gender-sensitive interventions aimed at

enhancing health status and QOL among patients with

asthma.

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