Demographic and socioeconomic patterns in healthcare-seeking behaviour for respiratory symptoms in England: a comparison with non-respiratory symptoms and between three healthcare services

Morrison, Kirsty; Colón‐González, Felipe J.; Morbey, Roger; Hunter, Paul R.; Rutter, Judith; Stuttard, Gareth; Lusignan, Simon de; Yeates, A; Pebody, Richard; Smith, Gillian; Elliot, Alex J; Lake, Iain

doi:10.1136/bmjopen-2020-038356

Cited by 12 publications

(8 citation statements)

References 37 publications

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“…Furthermore, DAVIDSEN et al [21] highlight higher persistence of ICS use in females, potentially explaining the increased odds of excessive SABA use associated with male sex. Our findings are in line with previous studies [20]; however, confounders such as differences in healthcare-seeking behaviour for respiratory symptoms between sexes [22] cannot be excluded, as female sex was a risk factor for exacerbations in the present study.…”

Section: Discussionsupporting

confidence: 93%

Socioeconomic biases in asthma control and specialist referral of possible severe asthma

2021

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BackgroundAlthough socioeconomic impact on asthma control has been investigated, little is known about its relation to specialist referral of patients with possible severe asthma, especially in a public healthcare setting. The present study aims to identify socioeconomic patterns in disease control and referral of patients with asthma in a nationwide cohort of adult patients treated with inhaled corticosteroid (ICS).MethodsAsthma patients fulfilling the following: aged 18–45 and redeeming ≥2 prescriptions of ICS during 2014–18 based on data from Danish national registers were included. Possible severe asthma was defined as GINA 2020 Step 4 (with either ≥2 courses of systemic steroids or ≥1 hospitalisation) or Step 5 treatment. Findings presented as odds ratio (OR) (95% confidence intervals).ResultsOf 60 534 patients (median age 34, 55% female), 3275 (5.7%) were deemed as having possible severe asthma, of whom 61% were managed in primary care alone.Odds of specialist management for possible severe asthma decreased with age (OR 0.66 (0.51–0.85)), 36–45 versus 18–25 years), male sex (OR 0.75 (0.64–0.87)), residence outside the Capital Region (OR 0.70 (0.59–0.82)) and with receiving unemployment or disability benefits OR 0.75 (0.59–0.95)).Having completed higher education increased odds of specialist referral (OR 1.28 (1.03–1.59)), when compared to patients with basic education.ConclusionEven in settings with nationally available free access to specialist care, the majority of patients with possible severe asthma are managed in primary care. Referral of at-risk asthma patients differs across socioeconomic parameters, calling for initiatives to identify and actively refer these patients.

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Section: Discussionsupporting

confidence: 93%

Socioeconomic biases in asthma control and specialist referral of possible severe asthma

2021

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“…The four complicated cases managed over a three-year period in our facility, located in an urban centre, all belonged to the Ogunlesi socioeconomic classes IV and V, which are the lower socioeconomic class (20). Low socioeconomic factors have been identified by several authors as an adverse predictor of health and disease outcome (21)(22)(23). It is not surprising that this is a major factor considering the rising level of poverty and cost of living in Nigeria, (24,25) even though there seem to be increasing number of health facilities.…”

Section: Discussionmentioning

confidence: 99%

Traditional Uvulectomy: A common and potentially life-threatening practice in a developing country

et al. 2022

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Objective: uvula. It is usually performed by non-medical personnel using mostly unsterile instruments. Notwithstanding the increasing number of health facilities, it is surprising that this aged-long crude practice with significant complications is still rampant in the 21st century. Material and Methods: This is a case series of four males with the age range of 5-months to four years who had traditional uvulectomy following febrile illnesses but with no improvement of symptoms. Thereafter, all presented late to our facility with diverse complications, including haemorrhage, infections, and convulsions. Three recovered fully following prompt treatment, however, one mortality was recorded. Conclusion: These cases highlight the life-threatening complications associated with traditional uvulectomy and the need for drastic measures to curtail the practice.

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“…The very high values of aRR for older ages (≥ 60 years) in comparison with other risk factors can be explained by the very low case fatality observed in the reference age group 0–49 years irrespective of comorbidities, which are less frequent in this group. There is potentially a higher under-estimation in men, as with other diseases where health-seeking behaviour differs, namely for respiratory symptoms [ 16 ]. This, in turn, might have led to an overestimation of the risk.…”

Section: Discussionmentioning

confidence: 99%

Determinants for hospitalisations, intensive care unit admission and death among 20,293 reported COVID-19 cases in Portugal, March to April 2020

et al. 2021

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Background Determinants of hospitalisation, intensive care unit (ICU) admission and death are still unclear for COVID-19. Few studies have adjusted for confounding for different clinical outcomes including all reported cases within a country. Aim We used routine surveillance data from Portugal to identify risk factors for severe COVID-19 outcomes, and to support risk stratification, public health interventions, and planning of healthcare resources. Methods We conducted a retrospective cohort study including 20,293 laboratory-confirmed cases of COVID-19 reported between 1 March and 28 April 2020 through the national epidemiological surveillance system. We calculated absolute risk, relative risk (RR) and adjusted relative risk (aRR) to identify demographic and clinical factors associated with hospitalisation, ICU admission and death using Poisson regressions. Results Increasing age (≥ 60 years) was the major determinant for all outcomes. Age ≥ 90 years was the strongest determinant of hospital admission (aRR: 6.1), and 70–79 years for ICU (aRR: 10.4). Comorbidities of cardiovascular, immunodeficiency, kidney and lung disease (aRR: 4.3, 2.8, 2.4, 2.0, respectively) had stronger associations with ICU admission, while for death they were kidney, cardiovascular and chronic neurological disease (aRR: 2.9, 2.6, 2.0). Conclusions Older age was the strongest risk factor for all severe outcomes. These findings from the early stages of the COVID-19 pandemic support risk-stratified public health measures that should prioritise protecting older people. Epidemiological scenarios and clinical guidelines should consider this, even though under-ascertainment should also be considered.

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Demographic and socioeconomic patterns in healthcare-seeking behaviour for respiratory symptoms in England: a comparison with non-respiratory symptoms and between three healthcare services

Cited by 12 publications

References 37 publications

Socioeconomic biases in asthma control and specialist referral of possible severe asthma

Socioeconomic biases in asthma control and specialist referral of possible severe asthma

Traditional Uvulectomy: A common and potentially life-threatening practice in a developing country

Determinants for hospitalisations, intensive care unit admission and death among 20,293 reported COVID-19 cases in Portugal, March to April 2020

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