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

John Busby; David Price; Riyad Al-Lehebi; Sinthia Bosnic-Anticevich; Job F M 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; Eileen Wang; Neva Eleangovan; Liam G Heaney

doi:10.2147/JAA.S326213

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

J Asthma Allergy. 2021 Nov 10:14:1375-1388. doi: 10.2147/JAA.S326213. eCollection 2021.

Authors

John Busby¹, David Price^{2

3

4}, Riyad Al-Lehebi⁵, Sinthia Bosnic-Anticevich^{6

7

8}, Job F M van Boven⁹, Benjamin Emmanuel¹⁰, J Mark FitzGerald¹¹, Mina Gaga¹², Susanne Hansen^{13

14}, Mark Hew^{15

16}, Takashi Iwanaga¹⁷, Désirée Larenas Linnemann¹⁸, Bassam Mahboub^{19

20}, Patrick Mitchell²¹, Daniela Morrone²², Jonathan Pham^{15

23}, Celeste Porsbjerg¹⁴, Nicolas Roche^{24

25}, Eileen Wang^{26

27}, Neva Eleangovan^{2

3}, Liam G Heaney²⁸

Affiliations

¹ Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
² Optimum Patient Care, Cambridge, UK.
³ Observational and Pragmatic Research Institute, Singapore, Singapore.
⁴ Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
⁵ Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia.
⁶ Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
⁷ Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.
⁸ Central Sydney Local Area Health District, Sydney, Australia.
⁹ Department of Clinical Pharmacy & Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
¹⁰ BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA.
¹¹ Department of Medicine, The University of British Columbia, Vancouver, Canada.
¹² 7th Respiratory Medicine Department and Asthma Centre, Athens Chest Hospital, Athens, Greece.
¹³ Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
¹⁴ Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark.
¹⁵ Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Australia.
¹⁶ Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
¹⁷ Center for General Medical Education and Clinical Training, Kindai University Hospital, Osakasayama, Japan.
¹⁸ Directora Centro de Excelencia en Asma y Alergia, Hospital Médica Sur, Ciudad de México, Mexico.
¹⁹ College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.
²⁰ Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
²¹ Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
²² Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.
²³ Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Australia.
²⁴ Respiratory Medicine, Cochin Hospital, APHP.Centre, Paris, France.
²⁵ University of Paris, Cochin Institute (UMR1016), Paris, France.
²⁶ Division of Allergy & Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, USA.
²⁷ Division of Allergy & Clinical Immunology, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
²⁸ Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland.

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; p_interaction=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; p_interaction=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.

Keywords: asthma; disparities; socioeconomic status.

Grants and funding

This research study was funded and delivered by the Observational & Pragmatic Research Institute Pte Ltd (OPRI). Optimum Patient Care Global received partial funding from AstraZeneca Ltd to support dataset creation.