OBJECTIVES:

Asthma is a global public health issue affecting millions of people in the UK. However, prevalence and outcomes may differ between socio-economic groups because of inequalities in care, non-adherence to medication, socio-economic circumstances, etc. Our research aims to: (i) assess the relationship between asthma outcomes, including asthma severity steps, asthma reviews, inhaler technique, management plan, exacerbations and emergency visits/admission, with deprivation (as a proxy for socioeconomic status), ethnicity or other demographic characteristics and (ii) understand how this relationship evolves across the care pathway.

METHODS:

We use routinely collected data in three East London Clinical Commission Groups (CCGs) of East London: Tower Hamlets, City & Hackney and Newham, including more than 139 ethnically diverse general practices (with over-represented Black or South Asian ethnicities) to identify all patients with diagnosed asthma and actively receiving medication in the study period (1/1/2010-31/12/2019). All records on medication and contacts with primary care services were then extracted. A multinomial logit regression or a multilevel mixed-effects logistic regression was used to estimate the respective association between outcome variables and the multi-deprivation index. Models were adjusted for all other covariates and corrected using two-way clustered standard errors.

RESULTS:

We found that patients from the most deprived groups are more likely to have asthma reviews but poorer inhaler techniques and less controlled asthma and are more likely in more severe states of asthma. Ethnic groups like Asians or Asian British are more likely to have asthma reviews, better inhaler techniques, and better-controlled asthma. A significant amount of variation exists in outcomes (even after checking for all the covariates) among GP practices in these 3 CCGs.

CONCLUSIONS:

Our results show that increasing asthma care for the deprived population does not necessarily lead to better outcomes and calls for more attention to the interlinks between asthma care indicators and outcomes.