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Wide variety in asthma outcomes across England despite better care

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Falling numbers of asthma deaths, hospital admissions and prevalence have not changed regional and socio-economic variations in the condition, according to researchers.

They said asthma outcomes still varied widely across England and appeared to be influenced by region and affluence, despite falling rates of asthma deaths, emergency admissions and prevalence.

“England still experiences significant socio-economic status and regional variations2

Study authors

They highlighted that, for high-income countries, the UK had among the highest rates of asthma symptoms and mortality in younger patients and the highest asthma admission rates in Europe.

Socio-economic status was generally accepted as playing a significant role in reported asthma symptoms, diagnosis, hospital admission rates and mortality, they noted in the journal Thorax.

The researchers, from St George’s, University of London, and the University of Edinburgh, updated and extended earlier reviews to consider trends by deprivation and region.

They used data on asthma deaths in England during the period 2002-15 obtained from national deaths registers, emergency asthma admissions from Hospital Episode Statistics for England, and prevalence of asthma from the Health Survey for England.

Results showed there were more than 14,800 recorded asthma deaths between 2002 and 2015. There were 1,424 in five- to 44-year-olds, 3,993 in 45-74-year-olds and 9,388 in those over 75.

“Those lower down the social hierarchy are more likely to experience and die from respiratory disease”

Michael Marmot

There were 542,877 emergency asthma admissions over the age of five during 2001-11. Meanwhile, out of 12,077 people over the age of five, 1,156 reported having been diagnosed and treated for asthma and 721 reported severe symptoms of asthma in the last year.

Analysis of the results showed that asthma mortality fell among more deprived groups at younger ages – among five- to 44-year-olds, people in the most deprived areas had a 19% lower mortality rate than people in the most affluent areas.

However, in older adults, this pattern was reversed with 45–74-year-olds in the poorest areas having a 37% higher asthma mortality rate than people in the richest areas, and people aged over 75 in the most deprived regions having a 30% higher death rate than people in the most affluent areas.

There were significant regional variations for all outcomes, with the highest mortality rates seen in the West Midlands for both males and females, which was about a third higher than the England average. The highest emergency admission rates occurred in the North West.

In the under 45-year-old age group, there was a more than threefold increase in asthma admissions in the most deprived areas compared with the most affluent, a doubling in the 45-74-year-olds and a 43% increase in the oldest age-band.

Differences in the prevalence of diagnosed and treated asthma as well as severe asthma showed similar patterns though these were smaller than that for admissions and greater than that for mortality.

The study authors said: “Despite asthma mortality, emergency admissions and prevalence decreasing over recent decades, England still experiences significant socio-economic status and regional variations.

“The previously undocumented inverse relation between deprivation and mortality in the young requires further investigation,” they added.

In an accompanying editorial, public health expert Dr Michael Marmot, from University College London, said: “Improvements in air quality, relief of crowded living conditions with ample promotion of infection and declines in smoking could all have contributed to the marked decline in mortality from respiratory conditions.

“What we are left with, though, are clear social inequalities in mortality; those lower down the social hierarchy are more likely to experience and die from respiratory disease,” he said.

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