PMID- 33577558 OWN - NLM STAT- MEDLINE DCOM- 20210625 LR - 20231110 IS - 1549-1676 (Electronic) IS - 1549-1277 (Print) IS - 1549-1277 (Linking) VI - 18 IP - 2 DP - 2021 Feb TI - Association of socioeconomic deprivation with asthma care, outcomes, and deaths in Wales: A 5-year national linked primary and secondary care cohort study. PG - e1003497 LID - 10.1371/journal.pmed.1003497 [doi] LID - e1003497 AB - BACKGROUND: Socioeconomic deprivation is known to be associated with worse outcomes in asthma, but there is a lack of population-based evidence of its impact across all stages of patient care. We investigated the association of socioeconomic deprivation with asthma-related care and outcomes across primary and secondary care and with asthma-related death in Wales. METHODS AND FINDINGS: We constructed a national cohort, identified from 76% (2.4 million) of the Welsh population, of continuously treated asthma patients between 2013 and 2017 using anonymised, person-level, linked, routinely collected primary and secondary care data in the Secure Anonymised Information Linkage (SAIL) Databank. We investigated the association between asthma-related health service utilisation, prescribing, and deaths with the 2011 Welsh Index of Multiple Deprivation (WIMD) and its domains. We studied 106,926 patients (534,630 person-years), 56.3% were female, with mean age of 47.5 years (SD = 20.3). Compared to the least deprived patients, the most deprived patients had slightly fewer total asthma-related primary care consultations per patient (incidence rate ratio [IRR] = 0.98, 95% CI 0.97-0.99, p-value < 0.001), slightly fewer routine asthma reviews (IRR = 0.98, 0.97-0.99, p-value < 0.001), lower controller-to-total asthma medication ratios (AMRs; 0.50 versus 0.56, p-value < 0.001), more asthma-related accident and emergency (A&E) attendances (IRR = 1.27, 1.10-1.46, p-value = 0.001), more asthma emergency admissions (IRR = 1.56, 1.39-1.76, p-value < 0.001), longer asthma-related hospital stay (IRR = 1.64, 1.39-1.94, p-value < 0.001), and were at higher risk of asthma-related death (risk ratio of deaths with any mention of asthma 1.56, 1.18-2.07, p-value = 0.002). Study limitations include the deprivation index being area based and the potential for residual confounders and mediators. CONCLUSIONS: In this study, we observed that the most deprived asthma patients in Wales had different prescribing patterns, more A&E attendances, more emergency hospital admissions, and substantially higher risk of death. Interventions specifically designed to improve treatment and outcomes for these disadvantaged groups are urgently needed. FAU - Alsallakh, Mohammad A AU - Alsallakh MA AUID- ORCID: 0000-0002-8333-7279 AD - Swansea University Medical School, Swansea, United Kingdom. AD - Health Data Research UK, Swansea and Edinburgh, United Kingdom. AD - Asthma UK Centre for Applied Research, Edinburgh, United Kingdom. FAU - Rodgers, Sarah E AU - Rodgers SE AUID- ORCID: 0000-0002-4483-0845 AD - Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom. FAU - Lyons, Ronan A AU - Lyons RA AUID- ORCID: 0000-0001-5225-000X AD - Swansea University Medical School, Swansea, United Kingdom. AD - Health Data Research UK, Swansea and Edinburgh, United Kingdom. FAU - Sheikh, Aziz AU - Sheikh A AUID- ORCID: 0000-0001-7022-3056 AD - Health Data Research UK, Swansea and Edinburgh, United Kingdom. AD - Asthma UK Centre for Applied Research, Edinburgh, United Kingdom. AD - Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom. FAU - Davies, Gwyneth A AU - Davies GA AD - Swansea University Medical School, Swansea, United Kingdom. AD - Asthma UK Centre for Applied Research, Edinburgh, United Kingdom. LA - eng GR - MC_PC_19004/MRC_/Medical Research Council/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20210212 PL - United States TA - PLoS Med JT - PLoS medicine JID - 101231360 SB - IM MH - Adult MH - Asthma/*rehabilitation MH - Cohort Studies MH - Female MH - Hospitalization/*statistics & numerical data MH - Humans MH - *Incidence MH - Longitudinal Studies MH - Male MH - Middle Aged MH - Odds Ratio MH - Secondary Care/*statistics & numerical data MH - Socioeconomic Factors MH - Wales/epidemiology PMC - PMC7880491 COIS- I have read the journal's policy and the authors of this manuscript have the following competing interests: RAL is supported by Health Data Research UK (HDR-9006), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, National Institute for Health Research (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation and Wellcome. AS is an Academic Editor on PLOS Medicine's editorial board and declares support from the Asthma UK Centre for Applied Research. EDAT- 2021/02/13 06:00 MHDA- 2021/06/29 06:00 PMCR- 2021/02/12 CRDT- 2021/02/12 17:13 PHST- 2020/04/29 00:00 [received] PHST- 2021/01/15 00:00 [accepted] PHST- 2021/02/12 17:13 [entrez] PHST- 2021/02/13 06:00 [pubmed] PHST- 2021/06/29 06:00 [medline] PHST- 2021/02/12 00:00 [pmc-release] AID - PMEDICINE-D-20-01743 [pii] AID - 10.1371/journal.pmed.1003497 [doi] PST - epublish SO - PLoS Med. 2021 Feb 12;18(2):e1003497. doi: 10.1371/journal.pmed.1003497. eCollection 2021 Feb.