Socioeconomic disparities in asthma healthcare utilization, exacerbations and mortality: A systematic review and meta-analysis

Charlene Redmond, Abdul Qadr Akinoso-Imran, Liam Heaney, Aziz Sheikh, Frank Kee, John Busby*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Citations (Scopus)
172 Downloads (Pure)


Introduction Prior studies investigating the effect of socio-economic status (SES) on asthma healthcare outcomes have been heterogeneous in their populations studied and methodologies employed.

Objectives: To systematically synthesize evidence investigating the impact of SES on asthma healthcare utilization, exacerbations and mortality.

Methods We searched Embase, Medline and Web of Science for studies reporting differences in primary care attendance, exacerbations, emergency department (ED) attendance, hospitalization, ventilation / intubation, readmission and asthma mortality by SES. Study quality was assessed using the Newcastle Ottawa Scale and meta-analyses conducted using random-effects models. We conducted several pre-specified subgroup analyses, including by healthcare system (insurance-based vs. universal government funded) and time-period (pre-2010 vs. post-2010).

Results 61 studies, comprising 1,145,704 patients, were included. Lower SES was consistently associated with increased secondary healthcare utilization including ED attendance (OR: 1.61; 95%CI: 1.40-1.84), hospitalization (OR: 1.63; 95%CI 1.34-1.99) and readmission (OR: 1.31; 95%CI 1.19-1.44). Substantial associations were also found between SES and ventilation / intubation (OR: 1.76; 95%CI: 1.13-2.73) although there was no association with primary care attendances (OR: 0.79; 95%CI: 0.51-1.24). We found evidence of borderline significance for increased exacerbations (OR: 1.18; 95%CI: 0.98-1.42) and mortality (OR: 1.12; 95%CI: 0.92-1.37) among more deprived groups. There was no convincing evidence that disparities were associated with country-level healthcare funding models, or that disparities have narrowed over time.

Conclusions Patients with a lower SES have substantially increased secondary care healthcare utilization. We found evidence suggestive of increased exacerbations and mortality risk although confidence intervals were wide. These disparities have been consistently reported worldwide, including within countries offering universally funded healthcare systems.
Original languageEnglish
JournalJournal of Allergy and Clinical Immunology
Early online date18 Oct 2021
Publication statusEarly online date - 18 Oct 2021


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