Association between socioeconomic deprivation, ethnicity and health outcomes in preschool children with recurrent wheeze in England: a retrospective cohort study.

IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Thorax Pub Date : 2024-10-16 DOI:10.1136/thorax-2023-221210
David Lo, Claire Lawson, Clare Gillies, Sharmin Shabnam, Erol A Gaillard, Hilary Pinnock, Jennifer K Quint
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Abstract

Background: Preschool-aged children have among the highest burden of acute wheeze. We investigated differences in healthcare use, treatment and outcomes for recurrent wheeze/asthma in preschoolers from different ethno-socioeconomic backgrounds.

Methods: Retrospective cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics in England. We reported number of acute presentations and hospitalisations stratified by index of multiple deprivation (IMD) and ethnicity; and factors associated with treatment non-escalation, and hospitalisation rates using multivariable logistic and Poisson regression models.

Results: 194 291 preschool children were included. In children not trialled on asthma preventer medications, children from the most deprived IMD quintile (adjusted OR 1.67; 95% CI 1.53 to 1.83) and South Asian (1.77; 1.64 to 1.91) children were more likely to have high reliever usage and where specialist referral had not occurred, the odds of referral being indicated was higher in the most deprived quintile (1.39; 1.28 to 1.52) and South Asian (1.86; 1.72 to 2.01) children compared with the least deprived quintile and white children, respectively.Hospitalisation rates for wheeze/asthma were significantly higher in children from the most deprived quintile (adjusted IRR 1.20; 95% CI 1.13 to 1.27) compared with the least, and in South Asian (1.57; 1.44 to 1.70) and black (1.32; 1.22 to 1.42) compared with white children.

Conclusions: We identified inequalities in wheeze/asthma treatment and morbidity in preschool children from more deprived, and non-white backgrounds. A multifaceted approach to tackle health inequality at both the national and local levels, which includes a more integrated and standardised approach to treatment, is needed to improve health outcomes in children with preschool wheeze/asthma.

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英格兰反复喘息学龄前儿童的社会经济贫困、种族和健康结果之间的关系:一项回顾性队列研究。
背景:学龄前儿童是急性喘息负担最重的人群之一。我们调查了来自不同种族-社会经济背景的学龄前儿童在复发性喘息/哮喘的医疗保健使用、治疗和结果方面的差异:回顾性队列研究使用的数据来自与英格兰医院病例统计相关联的临床实践研究数据链。我们报告了按多重贫困指数(IMD)和种族分层的急性发病人数和住院人数;并使用多变量逻辑回归模型和泊松回归模型报告了与未升级治疗和住院率相关的因素:共纳入 194 291 名学龄前儿童。在未试用哮喘预防药物的儿童中,来自最贫困IMD五分位数(调整后OR值为1.67;95% CI为1.53至1.83)和南亚裔(1.77;1.64至1.91)的儿童更有可能大量使用缓解剂,在未进行专家转诊的情况下,最贫困五分位数(1.39;1.28至1.52)和南亚裔(1.与最贫困的五分之一儿童和白人儿童相比,最贫困的五分之一儿童的喘息/哮喘住院率明显更高(调整后的IRR为1.20;95% CI为1.13至1.27),南亚儿童(1.57;1.44至1.70)和黑人儿童(1.32;1.22至1.42)的住院率也明显更高:我们发现,来自贫困地区和非白人背景的学龄前儿童在喘息/哮喘治疗和发病率方面存在不平等现象。为了改善学龄前喘息/哮喘儿童的健康状况,需要在国家和地方层面采取多方面的方法来解决健康不平等问题,其中包括更加综合和标准化的治疗方法。
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来源期刊
Thorax
Thorax 医学-呼吸系统
CiteScore
16.10
自引率
2.00%
发文量
197
审稿时长
1 months
期刊介绍: Thorax stands as one of the premier respiratory medicine journals globally, featuring clinical and experimental research articles spanning respiratory medicine, pediatrics, immunology, pharmacology, pathology, and surgery. The journal's mission is to publish noteworthy advancements in scientific understanding that are poised to influence clinical practice significantly. This encompasses articles delving into basic and translational mechanisms applicable to clinical material, covering areas such as cell and molecular biology, genetics, epidemiology, and immunology.
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