Håkansson KEJ, Backer V, Ulrik CS. Socioeconomic status is associated with healthcare seeking behaviour and disease burden in young adults with asthma - A nationwide cohort study.
Chron Respir Dis 2022;
19:14799731221117297. [PMID:
35938497 PMCID:
PMC9364195 DOI:
10.1177/14799731221117297]
[Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction
Specialist management of asthma has been shown to associate with
socioeconomic status (SES). However, little is known about the influence of
SES on care burden in universal healthcare settings.
Methods
Patients aged 18–45 years using inhaled corticosteroids (ICS) were followed
in national databases. Impact of asthma was investigated using negative
binomial regression adjusted for age, sex, comorbidity, and GINA 2020 Step.
Uncontrolled asthma was defined as >600 annual SABA puffs, ≥2
prednisolone courses and/or ≥1 hospitalization.
Results
A total of 60,534 (55% female, median age 33 (IQR 25–39)) patients were
followed for 10.1 years (IQR 5.2–14.3)). Uncontrolled asthma resulted in 6.5
and 0.51 additional annual contacts to primary care and pulmonologists,
respectively.
Unscheduled and primary care burden was dependent on SES, increasing with
rural residence, lower education, income and receiving welfare. Differences
in planned respiratory care were slight, only seen among divorced, low
income- or welfare recipients. Lower SES was consistently associated with an
increased utilization of SABA and prednisolone. No dose–response
relationship between ICS use and SES could be identified.
Conclusion
Lower SES in asthma is a risk factor for a predominance of unscheduled care
and adverse outcomes, warranting further attention to patients’ background
when assessing asthma care.
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