Persistent variations in national asthma mortality, hospital admissions and prevalence by socioeconomic status and region in England

Abstract

BackgroundThe UK-wide National Review of Asthma Deaths sought to identify avoidable factors from the high numbers of deaths, but did not examine variation by socioeconomic status (SES) or region.MethodsWe used asthma deaths in England over the period 2002–2015 obtained from national deaths registers, summarised by quintiles of Index of Multiple Deprivation (IMD) and Government Office Region. Emergency asthma admissions were obtained from Hospital Episode Statistics for England 2001–2011. The prevalence of asthma was derived from the Health Survey for England 2010. Associations of mortality, admissions and prevalence with IMD quintile and region were estimated cross-sectionally using incidence rate ratios (IRRs) adjusted for age and sex and, where possible, smoking.ResultsAsthma mortality decreased among more deprived groups at younger ages. Among 5–44 year olds, those in the most deprived quintile, mortality was 19% lower than those in the least deprived quintile (IRR 0.81 (95% CI 0.69 to 0.96). In older adults, this pattern was reversed (45–74 years: IRR 1.37 (1.24–1.52), ≥75 years: IRR 1.30 (1.22–1.39)). In 5–44 year olds the inverse trend with asthma mortality contrasted with large positive associations for admissions (IRR 3.34 (3.30–3.38)) and prevalence of severe symptoms (IRR 2.38 (1.70–3.33)). Prevalence trends remained after adjustment for smoking. IRRs for asthma mortality, admissions and prevalence showed significant heterogeneity between English regions.ConclusionsDespite asthma mortality, emergency admissions and prevalence decreasing over recent decades, England still experiences significant SES and regional variations. The previously undocumented inverse relation between deprivation and mortality in the young requires further investigation.

Protein S protects against allergic bronchial asthma by modulating Th1/Th2 balance

“…Bronchial asthma is a chronic respiratory disease associated with high mortality and morbidity worldwide despite substantial advances in its therapeutic management 1‐3. The disease can affect populations of any age and of any geographical region 3‐6. Epidemiological data suggest that there are globally more than 300 millions bronchial asthma patients with an annual number of deaths of more than 200 thousands 7,8.…”

Structural and Social Determinants of Health in Asthma in Developed Economies: a Scoping Review of Literature Published Between 2014 and 2019

“…A register-based cohort study in Sweden found incident asthma in children was associated with lower parental income in the first year of life and lower parental education levels regardless of child age [34]. Lower SES was also associated with asthma admissions in Canada [35] and England [36]. The role of occupation, with detrimental exposure risk often correlating with SES, should be studied further for asthma disparities [37].…”

Individual and neighbourhood socioeconomic status increase risk of avoidable hospitalizations among Canadian adults: A retrospective cohort study of linked population health data

“…Prior studies have demonstrated that individual and neighbourhood SES separately increase risk of avoidable hospitalizations for aggregate and disease-specific conditions, [9,[13][14][15][16][17][18][30][31][32] while others found non-significant attenuated effects after full adjustment of their models [33][34][35]. Differential selection and control of confounding variables, heterogeneity in exposure and outcome definitions, and use of various modelling approaches may all contribute to variation in findings from prior studies.…”