Socioeconomic, Behavioural, and Environmental Determinants of Asthma Inequalities in Europe: A Cross-Sectional Study...

Asthma is a chronic respiratory disease with uneven prevalence across population groups. This study investigated the associations between socioeconomic status, health behaviours, and environmental exposures and asthma prevalence across European countries. We conducted a cross-sectional analysis using data from the European Health Interview Survey (EHIS) covering wave III (2019). The sample included 223,453 adults aged 20 or older from 26 European countries. Asthma prevalence was self-reported. Socioeconomic variables included education and employment status, while behavioural factors included smoking and overweight status. Environmental exposures encompassed urbanisation and air pollution. Multilevel logistic regression models examined associations between asthma prevalence and its socioeconomic, behavioural, and environmental factors. Asthma prevalence was higher among individuals with lower educational attainment (OR = 1.30; 95% CI: 1.20-1.40), those who were unable to work due to long-standing health problems (OR = 2.27; 95% CI: 2.04-2.52), and retired individuals (1.44; 95% CI: 1.31-1.57). Individuals with pre-obesity and obesity had increased odds of asthma (OR = 1.13; 95%CI: 1.07-1.19, and OR = 1.76; 95%CI: 1.66-1.86, respectively). Urbanisation (OR = 1.13; 95%CI: 1.07-1.19) and exposure to air pollution (CO₂ and PM_2.5) were both significantly associated with higher asthma prevalence. Six countries exhibited a significant deviation from the average asthma prevalence. Inequalities in asthma prevalence in Europe were linked to socioeconomic disadvantage, unhealthy behaviours, and adverse environmental conditions. Some variability in asthma prevalence was independent of individual characteristics. These findings highlight the need for integrated public health policies that address the structural, behavioural, and environmental determinants of respiratory health.