Reports of wheezing and of diagnosed asthma are associated with impaired social functioning: Secondary analysis of the cross-sectional World Health Survey data

Objective: We sought to investigate whether there are associations between asthma and social functioning in adults from Western and non-Western countries. Methods: We analyzed data on individuals (94% aged 20 +, 52% female) from 50 countries participating in the cross-sectional World Health Survey. We used information on self-reports of wheezing and an asthma diagnosis. Social functioning was defined by reports of severe or extreme difficulties related to personal relationships or participation in the community. Logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results: Wheezing was associated with impaired social functioning both in the overall sample (OR = 2.40, 95%CI = 2.09-2.75) and in Africa, South America and Asia (ORs >= 2.47), but not in Europe (aOR = 1.26, 95%CI = 0.90-1.77). Analyses with self-reports of diagnosed asthma yielded similar, albeit weaker, associations (e.g. OR for the overall sample = 1.63, 95%CI = 1.38-1.92). We also combined asthma and wheezing into a single variable (reference group: no asthma diagnosis/no wheezing). We observed that in particular reports of wheezing were associated with impaired social functioning regardless of whether a concomitant asthma diagnosis was reported (OR = 2.19, 95%CI = 1.81-2.64) or not (OR = 2.50, 95%CI = 2,09-2.99). Conclusion: Self-reports of wheezing and of diagnosed asthma are associated with impaired social functioning among adults in Africa, South America and Asia, but less so in Europe. These relationships are mainly driven by the experience of respiratory symptoms (i.e. wheezing). Our findings may partly be explained by regional variations in asthma control. Further research should elucidate the determinants and mechanisms of asthma related impaired social functioning.