Asthma outcomes, inhaled corticosteroid adherence and socio‐economic deprivation in English regions

data-produ cts/ epact2/ dashb oards - and-speci ficat ions/ respi rator y-dashb oard .


R E S E A R C H L E T T E R Asthma outcomes, inhaled corticosteroid adherence and socioeconomic deprivation in English regions
To the Editor, Socio-economic deprivation is known to be associated with adverse asthma outcomes, 1,2 although the precise mechanisms of this have not been determined.We hypothesised that poor adherence to inhaled corticosteroids (ICS) may account for some of the regional variability in asthma outcomes that exists throughout England.We aimed to investigate the associations between adverse asthma out- deprivation.The number of asthma admissions per year and the total number of prednisolone prescriptions were normalised to the number of asthma patients in each CCG.These were analysed as admissions per 1000 asthma patients, and prednisolone courses per asthma patient, respectively.We used the proportion of asthma patients receiving five or fewer ICS inhalers per year as our measure of ICS non-adherence, accepting that there is not a precise correspondence between ICS issues and actual ICS use.Since most ICS inhalers require 12 issues per year, this corresponds to the proportion of patients picking up less than 50% of their prescribed ICS dose.
Statistical analysis was performed using IBM SPSS V28, with a p value of <.05 as the threshold for statistical significance.Individual with IMD also being a significant positive predictor.
In summary, we observed that ICS adherence was better in CCG regions with greater socio-economic deprivation, with these areas also having worse asthma outcomes.This suggests that while ICS non-adherence may lead to worse asthma outcomes at an individual level, it is not the primary mediator of the population-level association between socio-economic deprivation and poor asthma outcomes.Previous studies have revealed a complex relationship between ICS adherence and asthma outcomes.There is evidence that poor adherence to ICS can lead to an increased risk of exacerbations and hospital admissions. 3,4e ratio of salbutamol to ICS prescriptions is positively associated with asthma admission rates at a population level. 57][8] This may explain our observation that CCG regions with worse asthma outcomes had better levels of ICS adherence.
In conclusion, we observed that socio-economic deprivation remains an important determinant of adverse asthma outcomes at a population level, but we did not find evidence that this association is primarily mediated by ICS non-adherence.Further studies using population or individual patient data are needed to investigate alternative mechanisms by which socio-economic deprivation may lead to adverse asthma outcomes, including the potential role of air pollution, smoking prevalence, poor quality housing and occupational exposures.
comes [hospital admissions, rescue prednisolone courses, and high short-acting β 2 -agonist (SABA) use], socio-economic deprivation and ICS adherence, at a population level in England.We obtained data at the level of the 106 individual Clinical Commissioning Group (CCG) regions (as they existed on 1 April 2021) from the following publicly available data sources: Public Health England (https:// finge rtips.phe.org.uk): Population size and asthma prevalence (2019/2020), number of hospital admissions for asthma (2020/2021), Index of Multiple Deprivation (IMD, 2019); Office for National Statistics (https:// www.ons.gov.uk): Median age (Mid-2020); NHS Business Services Authority Respiratory Dashboard (https:// www.nhsbsa.nhs.uk/ acces s-our-data-produ cts/ epact2/ dashb oards -and-speci ficat ions/ respi rator y-dashb oard): Proportion of asthma patients receiving five or fewer ICS inhalers per year (ICS non-adherence), proportion of patients receiving six or more SABA inhalers per year (high SABA use) and total number of prednisolone prescriptions (Aug 2021-July 2022).Data were extracted in October 2022, and in each case, the most recent available data were used.Index of Multiple Deprivation is a composite index of socio-economic deprivation, comprising domains of Income, Employment, Education, skills and Training, Health and Disability, Crime, Barriers to Housing and Services, and Living environment.A larger score indicates greater socio-economic

Standardised coefficient (95% confidence interval) p value
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.© 2024 The Authors.Clinical & Experimental Allergy published by John Wiley & Sons Ltd.