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Association of socioeconomic deprivation with asthma care, outcomes, and deaths in Wales: A 5-year national linked primary and secondary care cohort study

Mohammad Al Sallakh Orcid Logo, Sarah Rodgers Orcid Logo, Ronan Lyons, Aziz Sheikh Orcid Logo, Gwyneth Davies Orcid Logo

PLOS Medicine, Volume: 18, Issue: 2, Start page: e1003497

Swansea University Authors: Mohammad Al Sallakh Orcid Logo, Sarah Rodgers Orcid Logo, Ronan Lyons, Gwyneth Davies Orcid Logo

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DOI (Published version): 10.1371/journal.pmed.1003497

Abstract

BackgroundSocioeconomic 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 pri...

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Published in: PLOS Medicine
ISSN: 1549-1676
Published: Public Library of Science (PLoS) 2021
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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 findingsWe 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&#x2013;0.99, p-value &lt; 0.001), slightly fewer routine asthma reviews (IRR = 0.98, 0.97&#x2013;0.99, p-value &lt; 0.001), lower controller-to-total asthma medication ratios (AMRs; 0.50 versus 0.56, p-value &lt; 0.001), more asthma-related accident and emergency (A&amp;E) attendances (IRR = 1.27, 1.10&#x2013;1.46, p-value = 0.001), more asthma emergency admissions (IRR = 1.56, 1.39&#x2013;1.76, p-value &lt; 0.001), longer asthma-related hospital stay (IRR = 1.64, 1.39&#x2013;1.94, p-value &lt; 0.001), and were at higher risk of asthma-related death (risk ratio of deaths with any mention of asthma 1.56, 1.18&#x2013;2.07, p-value = 0.002). Study limitations include the deprivation index being area based and the potential for residual confounders and mediators.ConclusionsIn this study, we observed that the most deprived asthma patients in Wales had different prescribing patterns, more A&amp;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.</abstract><type>Journal Article</type><journal>PLOS Medicine</journal><volume>18</volume><journalNumber>2</journalNumber><paginationStart>e1003497</paginationStart><paginationEnd/><publisher>Public Library of Science (PLoS)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1549-1676</issnElectronic><keywords/><publishedDay>12</publishedDay><publishedMonth>2</publishedMonth><publishedYear>2021</publishedYear><publishedDate>2021-02-12</publishedDate><doi>10.1371/journal.pmed.1003497</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>This work was funded by Health and Care Research Wales (https://www.healthandcareresearch.gov.wales) and Swansea Bay University Health Board (https://sbuhb.nhs.wales) (GAD, RAL, SER). We acknowledge the support of the Asthma UK Centre for Applied Research (AUKCAR) and Health Data Research UK. We also acknowledge the support of BREATHE - The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK.</funders><projectreference/><lastEdited>2025-07-10T12:41:16.5639831</lastEdited><Created>2025-06-04T11:56:11.5137198</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Mohammad</firstname><surname>Al Sallakh</surname><orcid>0000-0002-8333-7279</orcid><order>1</order></author><author><firstname>Sarah</firstname><surname>Rodgers</surname><orcid>0000-0002-4483-0845</orcid><order>2</order></author><author><firstname>Ronan</firstname><surname>Lyons</surname><order>3</order></author><author><firstname>Aziz</firstname><surname>Sheikh</surname><orcid>0000-0001-7022-3056</orcid><order>4</order></author><author><firstname>Gwyneth</firstname><surname>Davies</surname><orcid>0000-0003-1218-1008</orcid><order>5</order></author></authors><documents><document><filename>69623__34728__daaac72c309d419592d23270eddae868.pdf</filename><originalFilename>69623.VoR.pdf</originalFilename><uploaded>2025-07-10T12:38:29.2641821</uploaded><type>Output</type><contentLength>3507649</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; 2021 Alsallakh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2025-07-10T12:41:16.5639831 v2 69623 2025-06-04 Association of socioeconomic deprivation with asthma care, outcomes, and deaths in Wales: A 5-year national linked primary and secondary care cohort study 6efc53139ba1416418a6c6e584a25f2d 0000-0002-8333-7279 Mohammad Al Sallakh Mohammad Al Sallakh true false e81e94dea293640575619d15baf34a35 0000-0002-4483-0845 Sarah Rodgers Sarah Rodgers true false 83efcf2a9dfcf8b55586999d3d152ac6 Ronan Lyons Ronan Lyons true false 92d69cf8519a334ced3f55142c811d95 0000-0003-1218-1008 Gwyneth Davies Gwyneth Davies true false 2025-06-04 MEDS BackgroundSocioeconomic 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 findingsWe 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.ConclusionsIn 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. Journal Article PLOS Medicine 18 2 e1003497 Public Library of Science (PLoS) 1549-1676 12 2 2021 2021-02-12 10.1371/journal.pmed.1003497 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University This work was funded by Health and Care Research Wales (https://www.healthandcareresearch.gov.wales) and Swansea Bay University Health Board (https://sbuhb.nhs.wales) (GAD, RAL, SER). We acknowledge the support of the Asthma UK Centre for Applied Research (AUKCAR) and Health Data Research UK. We also acknowledge the support of BREATHE - The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. 2025-07-10T12:41:16.5639831 2025-06-04T11:56:11.5137198 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Mohammad Al Sallakh 0000-0002-8333-7279 1 Sarah Rodgers 0000-0002-4483-0845 2 Ronan Lyons 3 Aziz Sheikh 0000-0001-7022-3056 4 Gwyneth Davies 0000-0003-1218-1008 5 69623__34728__daaac72c309d419592d23270eddae868.pdf 69623.VoR.pdf 2025-07-10T12:38:29.2641821 Output 3507649 application/pdf Version of Record true © 2021 Alsallakh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License. true eng http://creativecommons.org/licenses/by/4.0/
title Association of socioeconomic deprivation with asthma care, outcomes, and deaths in Wales: A 5-year national linked primary and secondary care cohort study
spellingShingle Association of socioeconomic deprivation with asthma care, outcomes, and deaths in Wales: A 5-year national linked primary and secondary care cohort study
Mohammad Al Sallakh
Sarah Rodgers
Ronan Lyons
Gwyneth Davies
title_short Association of socioeconomic deprivation with asthma care, outcomes, and deaths in Wales: A 5-year national linked primary and secondary care cohort study
title_full Association of socioeconomic deprivation with asthma care, outcomes, and deaths in Wales: A 5-year national linked primary and secondary care cohort study
title_fullStr Association of socioeconomic deprivation with asthma care, outcomes, and deaths in Wales: A 5-year national linked primary and secondary care cohort study
title_full_unstemmed Association of socioeconomic deprivation with asthma care, outcomes, and deaths in Wales: A 5-year national linked primary and secondary care cohort study
title_sort Association of socioeconomic deprivation with asthma care, outcomes, and deaths in Wales: A 5-year national linked primary and secondary care cohort study
author_id_str_mv 6efc53139ba1416418a6c6e584a25f2d
e81e94dea293640575619d15baf34a35
83efcf2a9dfcf8b55586999d3d152ac6
92d69cf8519a334ced3f55142c811d95
author_id_fullname_str_mv 6efc53139ba1416418a6c6e584a25f2d_***_Mohammad Al Sallakh
e81e94dea293640575619d15baf34a35_***_Sarah Rodgers
83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
92d69cf8519a334ced3f55142c811d95_***_Gwyneth Davies
author Mohammad Al Sallakh
Sarah Rodgers
Ronan Lyons
Gwyneth Davies
author2 Mohammad Al Sallakh
Sarah Rodgers
Ronan Lyons
Aziz Sheikh
Gwyneth Davies
format Journal article
container_title PLOS Medicine
container_volume 18
container_issue 2
container_start_page e1003497
publishDate 2021
institution Swansea University
issn 1549-1676
doi_str_mv 10.1371/journal.pmed.1003497
publisher Public Library of Science (PLoS)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
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description BackgroundSocioeconomic 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 findingsWe 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.ConclusionsIn 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.
published_date 2021-02-12T05:30:36Z
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