Impact of Socioeconomic Status on Adult Patients with Asthma: A Population-Based Cohort Study from UK Primary Care

John Busby, David Price, Riyad Al-Leheb, Sinthia Z Bosnic-Anticevich, Job FM van Boven, Benjamin Emmanuel, J. Mark FitzGerald, Mina Gaga, Susanne Hansen, Mark Hew, Takashi Iwanaga, Désirée Larenas-Linnemann, Bassam Mahboub, Patrick Mitchell, Daniela Morrone, Jonathan Pham, Celeste Porsbjerg, Nicolas Roche, Elleen Wang, Nevaashni EleangovanLiam G Heaney

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Abstract

Introduction: Asthma morbidity and health-care utilization are known to exhibit a steep socioeconomic gradient. Further investigation into the modulators of this effect is required to identify potentially modifiable factors.
Methods: We identified a cohort of patients with asthma from the Optimum Patient Care Research Database (OPCRD). We compared demographics, clinical variables, and health-care utilization by quintile of the UK 2011 Indices of Multiple Deprivation based on the location of the patients’ general practice. Multivariable analyses were conducted using generalized linear models adjusting for year, age, and sex. We conducted subgroup analyses and interaction tests to
investigate the impact of deprivation by age, sex, ethnicity, and treatment step.
Results: Our analysis included 127,040 patients with asthma. Patients from the most deprived socio-economic status (SES) quintile were more likely to report uncontrolled disease (OR: 1.54, 95% CI: 1.16, 2.05) and to have an exacerbation during follow-up (OR: 1.27, 95% CI: 1.13, 1.42) than the least deprived quintile. They had higher blood eosinophils (ratio: 1.03; 95% CI: 1.00, 1.06) and decreased peak flow (ratio: 0.95, 95% CI: 0.94, 0.97) when compared to those in the least deprived quintile. The effect of deprivation on asthma control was greater among those aged over 75 years (OR = 1.81, 95% CI: 1.20, 2.73) compared to those aged less than 35 years (OR: 1.22, 95% CI: 0.85, 1.74; pinteraction=0.019). Similarly, socioeconomic disparities in exacerbations were larger among those from ethnic minority groups (OR: 1.94, 95% CI: 1.40, 2.68) than white patients (OR: 1.24, 95% CI: 1.10, 1.39; pinteraction=0.012).
Conclusion: We found worse disease control and increased exacerbation rates among patients with asthma from more deprived areas. There was evidence that the magnitude of socioeconomic disparities was elevated among older patients and those from ethnic minority groups. The drivers of these differences require further exploration
Original languageEnglish
Pages (from-to)1375—1388
Number of pages14
JournalJournal of Asthma and Allergy
Volume2021
Issue number14
Early online date10 Nov 2021
DOIs
Publication statusPublished - 10 Nov 2021

Keywords

  • asthma
  • socioeconomic status
  • disparities

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