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Association of socioeconomic deprivation with asthma care, outcomes, and deaths in Wales: A 5-year national linked primary and secondary care cohort study.
PLoS Med. 2021 02; 18(2):e1003497.PM

Abstract

BACKGROUND

Socioeconomic deprivation is known to be associated with worse outcomes in asthma, but there is a lack of population-based evidence of its impact across all stages of patient care. We investigated the association of socioeconomic deprivation with asthma-related care and outcomes across primary and secondary care and with asthma-related death in Wales.

METHODS AND FINDINGS

We constructed a national cohort, identified from 76% (2.4 million) of the Welsh population, of continuously treated asthma patients between 2013 and 2017 using anonymised, person-level, linked, routinely collected primary and secondary care data in the Secure Anonymised Information Linkage (SAIL) Databank. We investigated the association between asthma-related health service utilisation, prescribing, and deaths with the 2011 Welsh Index of Multiple Deprivation (WIMD) and its domains. We studied 106,926 patients (534,630 person-years), 56.3% were female, with mean age of 47.5 years (SD = 20.3). Compared to the least deprived patients, the most deprived patients had slightly fewer total asthma-related primary care consultations per patient (incidence rate ratio [IRR] = 0.98, 95% CI 0.97-0.99, p-value < 0.001), slightly fewer routine asthma reviews (IRR = 0.98, 0.97-0.99, p-value < 0.001), lower controller-to-total asthma medication ratios (AMRs; 0.50 versus 0.56, p-value < 0.001), more asthma-related accident and emergency (A&E) attendances (IRR = 1.27, 1.10-1.46, p-value = 0.001), more asthma emergency admissions (IRR = 1.56, 1.39-1.76, p-value < 0.001), longer asthma-related hospital stay (IRR = 1.64, 1.39-1.94, p-value < 0.001), and were at higher risk of asthma-related death (risk ratio of deaths with any mention of asthma 1.56, 1.18-2.07, p-value = 0.002). Study limitations include the deprivation index being area based and the potential for residual confounders and mediators.

CONCLUSIONS

In this study, we observed that the most deprived asthma patients in Wales had different prescribing patterns, more A&E attendances, more emergency hospital admissions, and substantially higher risk of death. Interventions specifically designed to improve treatment and outcomes for these disadvantaged groups are urgently needed.

Authors+Show Affiliations

Swansea University Medical School, Swansea, United Kingdom. Health Data Research UK, Swansea and Edinburgh, United Kingdom. Asthma UK Centre for Applied Research, Edinburgh, United Kingdom.Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom.Swansea University Medical School, Swansea, United Kingdom. Health Data Research UK, Swansea and Edinburgh, United Kingdom.Health Data Research UK, Swansea and Edinburgh, United Kingdom. Asthma UK Centre for Applied Research, Edinburgh, United Kingdom. Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom.Swansea University Medical School, Swansea, United Kingdom. Asthma UK Centre for Applied Research, Edinburgh, United Kingdom.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33577558

Citation

Alsallakh, Mohammad A., et al. "Association of Socioeconomic Deprivation With Asthma Care, Outcomes, and Deaths in Wales: a 5-year National Linked Primary and Secondary Care Cohort Study." PLoS Medicine, vol. 18, no. 2, 2021, pp. e1003497.
Alsallakh MA, Rodgers SE, Lyons RA, et al. Association of socioeconomic deprivation with asthma care, outcomes, and deaths in Wales: A 5-year national linked primary and secondary care cohort study. PLoS Med. 2021;18(2):e1003497.
Alsallakh, M. A., Rodgers, S. E., Lyons, R. A., Sheikh, A., & Davies, G. A. (2021). Association of socioeconomic deprivation with asthma care, outcomes, and deaths in Wales: A 5-year national linked primary and secondary care cohort study. PLoS Medicine, 18(2), e1003497. https://doi.org/10.1371/journal.pmed.1003497
Alsallakh MA, et al. Association of Socioeconomic Deprivation With Asthma Care, Outcomes, and Deaths in Wales: a 5-year National Linked Primary and Secondary Care Cohort Study. PLoS Med. 2021;18(2):e1003497. PubMed PMID: 33577558.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of socioeconomic deprivation with asthma care, outcomes, and deaths in Wales: A 5-year national linked primary and secondary care cohort study. AU - Alsallakh,Mohammad A, AU - Rodgers,Sarah E, AU - Lyons,Ronan A, AU - Sheikh,Aziz, AU - Davies,Gwyneth A, Y1 - 2021/02/12/ PY - 2020/04/29/received PY - 2021/01/15/accepted PY - 2021/2/12/entrez PY - 2021/2/13/pubmed PY - 2021/2/13/medline SP - e1003497 EP - e1003497 JF - PLoS medicine JO - PLoS Med VL - 18 IS - 2 N2 - BACKGROUND: Socioeconomic deprivation is known to be associated with worse outcomes in asthma, but there is a lack of population-based evidence of its impact across all stages of patient care. We investigated the association of socioeconomic deprivation with asthma-related care and outcomes across primary and secondary care and with asthma-related death in Wales. METHODS AND FINDINGS: We constructed a national cohort, identified from 76% (2.4 million) of the Welsh population, of continuously treated asthma patients between 2013 and 2017 using anonymised, person-level, linked, routinely collected primary and secondary care data in the Secure Anonymised Information Linkage (SAIL) Databank. We investigated the association between asthma-related health service utilisation, prescribing, and deaths with the 2011 Welsh Index of Multiple Deprivation (WIMD) and its domains. We studied 106,926 patients (534,630 person-years), 56.3% were female, with mean age of 47.5 years (SD = 20.3). Compared to the least deprived patients, the most deprived patients had slightly fewer total asthma-related primary care consultations per patient (incidence rate ratio [IRR] = 0.98, 95% CI 0.97-0.99, p-value < 0.001), slightly fewer routine asthma reviews (IRR = 0.98, 0.97-0.99, p-value < 0.001), lower controller-to-total asthma medication ratios (AMRs; 0.50 versus 0.56, p-value < 0.001), more asthma-related accident and emergency (A&E) attendances (IRR = 1.27, 1.10-1.46, p-value = 0.001), more asthma emergency admissions (IRR = 1.56, 1.39-1.76, p-value < 0.001), longer asthma-related hospital stay (IRR = 1.64, 1.39-1.94, p-value < 0.001), and were at higher risk of asthma-related death (risk ratio of deaths with any mention of asthma 1.56, 1.18-2.07, p-value = 0.002). Study limitations include the deprivation index being area based and the potential for residual confounders and mediators. CONCLUSIONS: In this study, we observed that the most deprived asthma patients in Wales had different prescribing patterns, more A&E attendances, more emergency hospital admissions, and substantially higher risk of death. Interventions specifically designed to improve treatment and outcomes for these disadvantaged groups are urgently needed. SN - 1549-1676 UR - https://www.unboundmedicine.com/medline/citation/33577558/Association_of_socioeconomic_deprivation_with_asthma_care_outcomes_and_deaths_in_Wales:_A_5_year_national_linked_primary_and_secondary_care_cohort_study_ L2 - https://dx.plos.org/10.1371/journal.pmed.1003497 DB - PRIME DP - Unbound Medicine ER -