TY - JOUR

T1 - Impact of socioeconomic status on adult patients with asthma

T2 - A population-based cohort study from uk primary care

AU - Busby, John

AU - Price, David

AU - Al-Lehebi, Riyad

AU - Bosnic-Anticevich, Sinthia

AU - van Boven, Job F.M.

AU - Emmanuel, Benjamin

AU - Fitzgerald, J. Mark

AU - Gaga, Mina

AU - Hansen, Susanne

AU - Hew, Mark

AU - Iwanaga, Takashi

AU - Linnemann, Désirée Larenas

AU - Mahboub, Bassam

AU - Mitchell, Patrick

AU - Morrone, Daniela

AU - Pham, Jonathan

AU - Porsbjerg, Celeste

AU - Roche, Nicolas

AU - Wang, Eileen

AU - Eleangovan, Neva

AU - Heaney, Liam G.

N1 - Funding Information: Désirée Larenas Linnemann reports personal fees from Amstrong, AstraZeneca, Boehringer Ingelheim, Carnot., Chiesi, Circassia, DBV Technologies, Grunenthal, GSK, MEDA, Menarini, MSD, Novartis, Pfizer, Novartis, Sanofi, Siegfried, UCB, Viatris, Alakos, Gossamer, grants Funding Information: John Busby declares no relevant conflicts of interest. David Price has board membership with AstraZeneca, Boehringer Ingelheim, Chiesi, Mylan, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, Thermofisher; consultancy agreements with Airway Vista Secretariat, AstraZeneca, Boehringer Ingelheim, Chiesi, EPG Communication Holdings Ltd, FIECON Ltd, Fieldwork International, GlaxoSmithKline, Mylan, Mundipharma, Novartis, OM Pharma SA, PeerVoice, Phadia AB, Spirosure Inc, Strategic North Limited, Synapse Research Management Partners S.L., Talos Health Solutions, Theravance and WebMD Global LLC; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from AstraZeneca, Boehringer Ingelheim, Chiesi, Mylan, Novartis, Regeneron Pharmaceuticals, Respiratory Effectiveness Group, Sanofi Genzyme, Theravance and UK National Health Service; payment for lectures/speaking engagements from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Mylan, Mundipharma, Novartis, Regeneron Pharmaceuticals and Sanofi Genzyme; payment for travel/accommodation/meeting expenses from AstraZeneca, Boehringer Ingelheim, Mundipharma, Mylan, Novartis, Thermofisher; stock/ stock options from AKL Research and Development Ltd which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum Patient Care Ltd (Australia and UK) and 92.61% of Observational and Pragmatic Research Institute Pte Ltd (Singapore); 5% shareholding in Timestamp which develops adherence monitoring technology; is peer reviewer for grant committees of the UK Efficacy and Mechanism Evaluation programme, and Health Technology Assessment; and was an expert witness for GlaxoSmithKline. Riyad Al-Lehebi has given lectures at meetings supported by AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, and Sanofi and participated in advisory board fees from GlaxoSmithKline. Sinthia Bosnic-Anticevich has received honorarium for participation in expert advisory boards and given lectures for Teva Pharmaceuticals, AstraZeneca, Boehringer Ingelheim, GSK, Meda, Mundipharma, Sanofi, Mylan and received unrestricted research grants from Mylan, AstraZeneca, Teva and Mundipharma International. Job F.M. van Boven and/or his institution received grants and consultancy fees from AstraZeneca, Chiesi, GSK, Boehringer Ingelheim, Pill Connect, TEVA, Novartis, Trudell Medical, Menarini, European Commission (COST Action 19132), and Aardex. Benjamin Emmanuel is an employee of AstraZeneca, a co-funder of the International Severe Asthma Registry. J. Mark FitzGerald reports grants from AstraZeneca, GSK, Sanofi Regeneron, Novartis paid directly to UBC. Personal fees for lectures and attending advisory boards: Astra Zeneca, GSK, Sanofi Regeneron, Novartis, TEVA. Mina Gaga reports grants and personal fees from Novartis, BMS, and Menarini; grants from Galapagos and Elpen; and personal fees from MSD and Roche outside the submitted work. Susanne Hansen reports no conflict of interest. Mark Hew declares grants and other advisory board fees (made to his institutional employer) from AstraZeneca, GlaxoSmithKline, Novartis, Sanofi, and Seqirus, Teva, for unrelated projects. Takashi Iwanaga declares grants from Astellas, Boehringer Ingelheim, Daiichi-Sankyo, Kyorin, MeijiSeika Pharma, Novartis, Teijin Pharma, Ono, Otsuka Pharmaceutical Factory, and Taiho, and lecture fees from Kyorin, GlaxoSmithKline, and AstraZeneca. Funding Information: 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. Funding Information: from Sanofi, AstraZeneca, Novartis, UCB, GSK, TEVA, Boehringer Ingelheim, Chiesi, and Purina institute, outside the submitted work. Bassam Mahboub reports no conflict of interest. Patrick Mitchell has received speaker fees from GlaxoSmithKline, AstraZeneca, Teva, and Novartis, and has received grants from AstraZeneca and Teva. Daniela Morrone reports no relevant conflicts of interest. Jonathan Pham reports no relevant conflicts of interest. Celeste Porsbjerg has attended advisory boards for AstraZeneca, Novartis, TEVA, and Sanofi-Genzyme; has given lectures at meetings supported by AstraZeneca, Novartis, TEVA, Sanofi-Genzyme, and GlaxoSmithKline; has taken part in clinical trials sponsored by AstraZeneca, Novartis, MSD, Sanofi-Genzyme, GlaxoSmithKline, and Novartis; and has received educational and research grants from AstraZeneca, Chiesi, Novartis, TEVA, GlaxoSmithKline, ALK, and Sanofi-Genzyme. Nicolas Roche reports grants and personal fees from Boehringer Ingelheim, Novartis, and Pfizer, and personal fees from Teva, GSK, AstraZeneca, Chiesi, Sanofi, and Zambon. Eileen Wang has received honoraria from AstraZeneca, Clinical Care Options, Optimum Patient Care, and Sema4. She has been an investigator on clinical trials sponsored by AstraZeneca, GlaxoSmithKline, Genentech, Novartis, Teva, and National Institute of Allergy and Infectious Diseases (NIAID) for which her institution has received funding. Neva Eleangovan is an employee of the Observational and Pragmatic Research Institute, which conducted this study in collaboration with Optimum Patient Care and AstraZeneca. Liam G. Heaney declares he has received grant funding, participated in advisory boards and given lectures at meetings supported by Aerocrine and Vitalograph, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Evelo Biosciences, Hoffmann la Roche, GlaxoSmithKline, MedImmune, Napp Pharmaceuticals, Novartis, Sanofi, Theravance and Teva; he has taken part in asthma clinical trials sponsored by Boehringer Ingelheim, Hoffmann la Roche, and GlaxoSmithKline for which his institution received remuneration; he is the Academic Lead for the Medical Research Council Stratified Medicine UK Consortium in Severe Asthma which involves industrial partnerships with a number of pharmaceutical companies including Amgen, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Hoffmann la Roche, and Janssen. The authors report no other conflicts of interest in this work. Publisher Copyright: © 2021 Busby et al. This work is published and licensed by Dove Medical Press Limited.

PY - 2021

Y1 - 2021

N2 - 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; pinteraction=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; pinteraction=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.

AB - 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; pinteraction=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; pinteraction=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.

KW - Asthma

KW - Disparities

KW - Socioeconomic status

U2 - 10.2147/JAA.S326213

DO - 10.2147/JAA.S326213

M3 - Journal article

C2 - 34785911

AN - SCOPUS:85119131622

VL - 14

SP - 1375

EP - 1388

JO - Journal of Asthma and Allergy

JF - Journal of Asthma and Allergy

SN - 1178-6965

ER -