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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
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Sarah Rodgers ,
Ronan Lyons,
Aziz Sheikh ,
Gwyneth Davies
PLOS Medicine, Volume: 18, Issue: 2, Start page: e1003497
Swansea University Authors:
Mohammad Al Sallakh , Sarah Rodgers , Ronan Lyons, Gwyneth Davies
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DOI (Published version): 10.1371/journal.pmed.1003497
Abstract
BackgroundSocioeconomic 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 pri...
| Published in: | PLOS Medicine |
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| ISSN: | 1549-1676 |
| Published: |
Public Library of Science (PLoS)
2021
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| Online Access: |
Check full text
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| URI: | https://cronfa.swan.ac.uk/Record/cronfa69623 |
| Abstract: |
BackgroundSocioeconomic 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 findingsWe 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.ConclusionsIn 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. |
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| College: |
Faculty of Medicine, Health and Life Sciences |
| Funders: |
This work was funded by Health and Care Research Wales (https://www.healthandcareresearch.gov.wales) and Swansea Bay University Health Board (https://sbuhb.nhs.wales) (GAD, RAL, SER). We acknowledge the support of the Asthma UK Centre for Applied Research (AUKCAR) and Health Data Research UK. We also acknowledge the support of BREATHE - The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. |
| Issue: |
2 |
| Start Page: |
e1003497 |