Abstract
This thesis explores inequalities in asthma care and outcomes through the analysis of routinely collected data from the UK Severe Asthma Registry and UK Biobank.The thesis begins with a systematic review and meta-analysis of inequalities in asthma healthcare utilisation, exacerbations and mortality by socio-economic status (SES). My findings indicate that patients with a lower SES have substantially increased secondary healthcare utilisation, although there was limited evidence of differences in exacerbations or mortality.
The next chapter investigates the benefits of specialist care in a UK cohort of patients with severe asthma, which prior to this study had not been evaluated within the biologic era of UK severe asthma treatment. This study was therefore the first of its kind to describe the benefits of specialist care in a real-world cohort of patients with severe asthma, demonstrating that specialist assessment and management leads to substantial benefits for the majority of patients.
Chapter 4 of this thesis explores asthma healthcare outcomes in UK Biobank participants with doctor diagnosed asthma. This study found that participants of low socioeconomic status had greater odds of experiencing poor lung function or hospital admission for asthma, compared to those of high socio-economic status. These results were only slightly attenuated when lifestyle, environmental, and health factors were included in the analysis.
The final analytical chapter of this thesis assesses the concordance of the composite socio-economic measure used in the analysis of the UK Biobank cohort, against each of the three individual measures of household income, employment and education. Although some variation was noted between these measures, household income was identified as the most concordant, demonstrating substantial agreement, with subsequent sensitivity analysis producing results similar to those seen using the composite measure, thereby demonstrating its suitability.
Thesis is embargoed 31 July 2025.
| Date of Award | Jul 2024 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | John Busby (Supervisor) & Liam Heaney (Supervisor) |