Ethnic differences in severe asthma clinical care and outcomes: an analysis of United Kingdom primary and specialist care

John Busby, Liam G Heaney, Thomas Brown, Rekha Chaudhuri, Paddy Dennison, Robin Gore, David J Jackson, Adel H Mansur, Andrew Menzies-Gow, Simon Message, Rob Niven, Mitesh Patel, David Price, Salman Siddiqui, Robert A Stone, Paul E Pfeffer, UK Severe Asthma Registry

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Understanding the effects of ethnicity in severe asthma is important for optimal personalised patient care.

Objective: To assess ethnic differences in disease control, exacerbations, biological phenotype and treatment in UK severe asthma.

Methods: We compared demographics, type-2 biomarkers, lung function, asthma control, medications and healthcare utilisation between White and ethnic minority group [EMG] patients in the UK Severe Asthma Registry (UKSAR) and Optimum Patient Care Research Database (OPCRD).

Results: 3,637 patients (665 EMG) were included from UKSAR and 10,549 (577 EMG) from OPCRD. EMG patients had higher levels of uncontrolled disease when measured using the asthma control questionnaire in UKSAR (OR:1.47, 95%CI: 1.12-1.93) and the Royal College of Physicians 3 Questions in OPCRD (OR:1.82, 95%CI: 1.27-2.60). Although exacerbation rates were similar, EMG patients were more likely to have recently attended ED (OR:1.55, 95%CI: 1.26-1.92) or been hospitalised (OR:1.31, 95% CI: 1.07-1.59) due to their asthma. Inflammatory biomarkers were consistently higher in EMG severe asthma including blood eosinophils in OPCRD (Ratio:1.12, 95%CI: 1.05-1.20) and in UKSAR blood eosinophils (Ratio:1.16, 95%CI: 1.06-1.27), FeNO (Ratio:1.14, 95%CI: 1.04-1.26) and IgE (Ratio:1.70, 95%CI: 1.47-1.97). EMG patients were more likely to be atopic in the UKSAR (OR:1.32; 95%CI: 1.07-1.63) and OPCRD (OR:1.67; 95%CI: 1.26-2.21), and less likely to be using maintenance oral corticosteroids at referral (OR:0.75 [95%CI: 0.61-0.92]).

Conclusions: Severe asthma patients from EMGs presented with higher disease burden and were more likely to attend ED. They had a distinct phenotypic presentation, and differences in medicine utilisation, with higher levels of type-2 biomarkers.
Original languageEnglish
JournalThe Journal of Allergy and Clinical Immunology: In Practice
Publication statusAccepted/In press - 23 Sep 2021

Keywords

  • asthma
  • disparities
  • ethnicity

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