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Association between income, employment status, and asthma outcomes: a systematic review and meta-analysis

Zakariah Gassasse Orcid Logo, Isaa D. Khan Orcid Logo, Elliot Mok, Ayyash M. Asick, Andrew Tan Orcid Logo, Aziz Sheikh, Ian Sinha, Gwyneth Davies Orcid Logo, Hannah Whittaker, Constantinos Kallis, Jennifer K. Quint Orcid Logo

The Lancet Regional Health - Europe, Volume: 56, Start page: 101367

Swansea University Author: Gwyneth Davies Orcid Logo

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DOI (Published version): 10.1016/j.lanepe.2025.101367

Abstract

Background: Health inequalities are deeply entrenched in society, and finding ways to reduce these, therefore, represents a major health policy challenge. Focusing on the two highest weighted Index of Multiple Deprivation domains, namely income and employment, we sought to synthesise the evidence on...

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Published in: The Lancet Regional Health - Europe
ISSN: 2666-7762
Published: Elsevier Ltd 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa69851
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Methods: In this systematic review and meta-analysis, we searched key concepts related to employment, income, and asthma outcomes using Medline and Embase for studies published between January 1, 2010 and April 3, 2025. Studies were eligible for inclusion if they were in English and described an association between income and/or employment and asthma outcomes, including exacerbations, hospital admissions and mortality, in people with asthma. Risk Of Bias In Non-randomized Studies&#x2013;of Exposures (ROBINS-E), Risk of Bias (RoB) and adapted RoB tools were used to assess the risk of bias in the included studies. Using the restricted maximum likelihood method, we meta-analysed the rate of exacerbations and explored heterogeneity between age-related population groups: children (under 18 years) and adults (18 years and older). This study was registered with PROSPERO, CRD42024527300. Findings: We identified 4153 potentially eligible studies, of which 3141 were screened. 30 studies met the inclusion criteria, with most having a low risk of bias. 19 studies reported income as the exposure and exacerbation as the outcome, of which ten were included in the meta-analysis. People in the lowest income group were more likely to experience an asthma exacerbation than those in the highest income group: OR 1.25; 95% CI 1.13&#x2013;1.37 overall and when stratified by age: children (1.36 [1.23&#x2013;1.50]) and adults (1.19 [1.05&#x2013;1.33]). Only three studies investigated the role of unemployment and were narratively synthesised. While unemployment was associated with increased emergency care visits, its role in predicting exacerbations was less clear. Interpretation: There is a need for upstream interventions aiming to reduce income inequalities and to investigate their impact on reducing asthma inequalities. 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spelling 2025-06-30T13:22:48.0532339 v2 69851 2025-06-30 Association between income, employment status, and asthma outcomes: a systematic review and meta-analysis 92d69cf8519a334ced3f55142c811d95 0000-0003-1218-1008 Gwyneth Davies Gwyneth Davies true false 2025-06-30 MEDS Background: Health inequalities are deeply entrenched in society, and finding ways to reduce these, therefore, represents a major health policy challenge. Focusing on the two highest weighted Index of Multiple Deprivation domains, namely income and employment, we sought to synthesise the evidence on the association between these major determinants of socioeconomic status and asthma outcomes. Methods: In this systematic review and meta-analysis, we searched key concepts related to employment, income, and asthma outcomes using Medline and Embase for studies published between January 1, 2010 and April 3, 2025. Studies were eligible for inclusion if they were in English and described an association between income and/or employment and asthma outcomes, including exacerbations, hospital admissions and mortality, in people with asthma. Risk Of Bias In Non-randomized Studies–of Exposures (ROBINS-E), Risk of Bias (RoB) and adapted RoB tools were used to assess the risk of bias in the included studies. Using the restricted maximum likelihood method, we meta-analysed the rate of exacerbations and explored heterogeneity between age-related population groups: children (under 18 years) and adults (18 years and older). This study was registered with PROSPERO, CRD42024527300. Findings: We identified 4153 potentially eligible studies, of which 3141 were screened. 30 studies met the inclusion criteria, with most having a low risk of bias. 19 studies reported income as the exposure and exacerbation as the outcome, of which ten were included in the meta-analysis. People in the lowest income group were more likely to experience an asthma exacerbation than those in the highest income group: OR 1.25; 95% CI 1.13–1.37 overall and when stratified by age: children (1.36 [1.23–1.50]) and adults (1.19 [1.05–1.33]). Only three studies investigated the role of unemployment and were narratively synthesised. While unemployment was associated with increased emergency care visits, its role in predicting exacerbations was less clear. Interpretation: There is a need for upstream interventions aiming to reduce income inequalities and to investigate their impact on reducing asthma inequalities. Funding: Health Data Research UK, Inflammation and Immunity Driver Programme. Journal Article The Lancet Regional Health - Europe 56 101367 Elsevier Ltd 2666-7762 Asthma; Income; Employment; Exacerbations; Admissions; Mortality; Inequalities; Socioeconomic status; Deprivation; Index of multiple deprivation; Domains; Material disadvantage 1 9 2025 2025-09-01 10.1016/j.lanepe.2025.101367 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee This study was funded by Health Data Research UK, Inflammation and Immunity Driver Programme, through the provision of PhD funding to ZG (HDRUK2023.0027). 2025-06-30T13:22:48.0532339 2025-06-30T12:40:06.3350706 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Zakariah Gassasse 0000-0003-3079-1563 1 Isaa D. Khan 0009-0002-2443-2994 2 Elliot Mok 3 Ayyash M. Asick 4 Andrew Tan 0009-0004-1741-0687 5 Aziz Sheikh 6 Ian Sinha 7 Gwyneth Davies 0000-0003-1218-1008 8 Hannah Whittaker 9 Constantinos Kallis 10 Jennifer K. Quint 0000-0003-0149-4869 11 69851__34625__1085d3bd9db04da891b2a077fd4915f7.pdf 69851.VOR.pdf 2025-06-30T12:54:57.0730295 Output 1801426 application/pdf Version of Record true © 2025 The Authors. This is an open access article under the CC BY license. true eng http://creativecommons.org/licenses/by/4.0/
title Association between income, employment status, and asthma outcomes: a systematic review and meta-analysis
spellingShingle Association between income, employment status, and asthma outcomes: a systematic review and meta-analysis
Gwyneth Davies
title_short Association between income, employment status, and asthma outcomes: a systematic review and meta-analysis
title_full Association between income, employment status, and asthma outcomes: a systematic review and meta-analysis
title_fullStr Association between income, employment status, and asthma outcomes: a systematic review and meta-analysis
title_full_unstemmed Association between income, employment status, and asthma outcomes: a systematic review and meta-analysis
title_sort Association between income, employment status, and asthma outcomes: a systematic review and meta-analysis
author_id_str_mv 92d69cf8519a334ced3f55142c811d95
author_id_fullname_str_mv 92d69cf8519a334ced3f55142c811d95_***_Gwyneth Davies
author Gwyneth Davies
author2 Zakariah Gassasse
Isaa D. Khan
Elliot Mok
Ayyash M. Asick
Andrew Tan
Aziz Sheikh
Ian Sinha
Gwyneth Davies
Hannah Whittaker
Constantinos Kallis
Jennifer K. Quint
format Journal article
container_title The Lancet Regional Health - Europe
container_volume 56
container_start_page 101367
publishDate 2025
institution Swansea University
issn 2666-7762
doi_str_mv 10.1016/j.lanepe.2025.101367
publisher Elsevier Ltd
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description Background: Health inequalities are deeply entrenched in society, and finding ways to reduce these, therefore, represents a major health policy challenge. Focusing on the two highest weighted Index of Multiple Deprivation domains, namely income and employment, we sought to synthesise the evidence on the association between these major determinants of socioeconomic status and asthma outcomes. Methods: In this systematic review and meta-analysis, we searched key concepts related to employment, income, and asthma outcomes using Medline and Embase for studies published between January 1, 2010 and April 3, 2025. Studies were eligible for inclusion if they were in English and described an association between income and/or employment and asthma outcomes, including exacerbations, hospital admissions and mortality, in people with asthma. Risk Of Bias In Non-randomized Studies–of Exposures (ROBINS-E), Risk of Bias (RoB) and adapted RoB tools were used to assess the risk of bias in the included studies. Using the restricted maximum likelihood method, we meta-analysed the rate of exacerbations and explored heterogeneity between age-related population groups: children (under 18 years) and adults (18 years and older). This study was registered with PROSPERO, CRD42024527300. Findings: We identified 4153 potentially eligible studies, of which 3141 were screened. 30 studies met the inclusion criteria, with most having a low risk of bias. 19 studies reported income as the exposure and exacerbation as the outcome, of which ten were included in the meta-analysis. People in the lowest income group were more likely to experience an asthma exacerbation than those in the highest income group: OR 1.25; 95% CI 1.13–1.37 overall and when stratified by age: children (1.36 [1.23–1.50]) and adults (1.19 [1.05–1.33]). Only three studies investigated the role of unemployment and were narratively synthesised. While unemployment was associated with increased emergency care visits, its role in predicting exacerbations was less clear. Interpretation: There is a need for upstream interventions aiming to reduce income inequalities and to investigate their impact on reducing asthma inequalities. Funding: Health Data Research UK, Inflammation and Immunity Driver Programme.
published_date 2025-09-01T05:29:44Z
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