A new study by researchers at St George’s, University of London shows that asthma outcomes still vary widely across England and seem to be influenced by region and affluence despite falling rates of asthma deaths, emergency hospital admissions and prevalence.

calendar-icon 15 May 2018

However in a surprising finding, the research revealed that amongst younger people, asthma deaths rates are lower in the poorest parts of the population compared with the wealthiest.

The UK has among the highest asthma mortality rates of high-income countries globally in younger age-groups (people aged 5–34 years), the highest asthma admission rates in Europe and the highest rates of asthma symptoms globally in children. Socio-economic status is generally accepted as playing a significant role in reported asthma symptoms, doctor-diagnosis, hospital admission rates and mortality.

Following the National Review of Asthma Deaths in 2014, which found that many deaths from asthma were preventable, a team of researchers from St George’s, University of London and Edinburgh University looked at additional data to consider trends by deprivation and region.

The researchers used data on asthma deaths in England during the period 2002–2015 obtained from national deaths registers, emergency asthma admissions from Hospital Episode Statistics for England, and prevalence of asthma from the Health Survey for England.

Analysis of the results showed that asthma mortality fell among more deprived groups at younger ages. Among 5–44 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.

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.

There were significant regional variations for all outcomes (deaths and admissions) 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.

Ramyani Gupta, Honorary Senior Research Fellow and the lead author of the research, said: “The scale and persistence of inequality in asthma outcomes, particularly admissions, highlighted in this paper should raise concerns. The highly unusual finding in deaths in younger people needs investigation to see if it is caused by an overlap with allergies, by a specific asthma phenotype or another cause.”

In an editorial accompanying the research in Thorax, Sir Michael Marmot, Professor of Epidemiology and Public Health at University College London, commented: “We are left with clear social inequalities in mortality; those lower down the social hierarchy are more likely to experience and die from respiratory disease”

“Persistent variations in national asthma mortality, hospital admissions and prevalence by socioeconomic status and region in England” is published in the journal Thorax.