Factors associated with health-related quality of life in adults with asthma in Jordan: the roles of asthma control and asthma-related numeracy

Background Health-related quality of life (HRQoL) is an important outcome in asthma care. Evidence from Middle Eastern settings remains limited regarding the relative contribution of clinical, treatment-related, sociodemographic, and self-management factors to generic HRQoL.Objective To identify factors independently associated with HRQoL among adults with asthma in Jordan, focusing on asthma-related numeracy and asthma control, and to test the robustness of findings in a sensitivity analysis.Methods This cross-sectional study included 396 adults with asthma. The EQ−5D−3L index was modelled using hierarchical ordinary least squares regression with HC3 robust standard errors. Predictors included sociodemographic characteristics, medication use, Ar-ANQ score, medication adherence, and asthma-control status. A sensitivity model used a three-level treatment-intensity and adherence-based clinical-status proxy.Results Partly controlled and uncontrolled asthma were associated with lower EQ−5D−3L index values than well-controlled asthma; the adjusted difference for uncontrolled asthma was −0.225 (95% CI −0.271 to −0.179). Each one-point higher Ar-ANQ score was associated with a 0.024-point higher index (95% CI 0.005 to 0.043). Older age and oral corticosteroid use were also associated with lower HRQoL, whereas high adherence was not independently associated with the outcome. In the sensitivity analysis, both difficult-to-treat and severe-asthma proxy groups had lower HRQoL than the non-severe group.Conclusion Asthma control was the strongest independent correlate of generic HRQoL. Asthma-related numeracy showed a smaller positive association, while adherence was not independently associated after adjustment. These findings support a multifactorial interpretation of asthma HRQoL and do not imply causality.