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A national survey of asthma prevalence, severity, and treatment in Great Britain
D P Strachan1, H R Anderson, E S Limb
1Department of Public Health Sciences, St George's Hospital Medical School, London.
Insights
Childhood asthma prevalence in Britain shows socioeconomic disparities in outcomes, not just diagnosis or treatment. Poorer families experience greater wheezing severity despite similar medical care access.
Area of Science:
- Pediatric Pulmonology
- Public Health
- Epidemiology
Background:
- Childhood asthma affects a significant portion of children, with varying severity and impact.
- Socioeconomic status (SES) is a known determinant of health outcomes, but its specific role in childhood asthma care in Britain requires examination.
Purpose of the Study:
- To investigate the prevalence of wheezing and diagnosed asthma in British children.
- To assess the relationship between socioeconomic status and childhood asthma morbidity, diagnosis, and treatment.
- To evaluate the equity of medical care for childhood asthma across different socioeconomic groups.
Main Methods:
- Nationwide household survey involving parents of 5472 children aged 5-17 years from 3209 families.
- Data collection on wheezing episodes, asthma attacks, sleep disturbances, doctor diagnoses, and antiasthmatic drug prescriptions.
- Analysis of prevalence and severity indices stratified by age and socioeconomic status.
Main Results:
- In the past year, 15.0% of children experienced wheezing, with 2.2% having >12 attacks and 2.3% experiencing speech-limiting attacks.
- Doctor-diagnosed asthma (13.1%) and antiasthmatic drug prescriptions (13.6%) were reported. Morbidity declined with age, more than prevalence.
- While wheeze prevalence showed little SES variation, severity indices (attacks, sleep disturbance) increased in poorer families. Diagnosis and treatment were similar across SES groups.
Conclusions:
- A degree of socioeconomic equality exists in the diagnostic labeling and drug treatment processes for childhood asthma in Britain.
- Despite equitable access to medical care, socioeconomic disparities persist, leading to unequal health outcomes in childhood asthma.
- Further interventions are needed to address the socioeconomic determinants impacting asthma severity and outcomes in children.
Abstract:
Parents of 5472 children aged 5-17 years from 3209 families were interviewed in a nationwide household survey. In the past year, 15.0% of children had wheezed, 2.2% had more than 12 attacks, and 2.3% had experienced a speech limiting attack. Altogether 4.3% were woken more than once a week by wheezing, 13.1% had doctor diagnosed asthma, and 13.6% had been prescribed antiasthmatic drugs in the past year. With increasing age, morbidity related to wheezing declined to a greater extent than annual period prevalence. The prevalence of wheeze varied little by socioeconomic group, but there were marked trends in all three indices of severity towards increased morbidity in poorer families. Diagnostic labelling and drug treatment of wheezy children did not differ substantially with socioeconomic status. Thus, a degree of socioeconomic equality exists in the process of medical care for childhood asthma in Britain. This does not appear to have resulted in equality of outcome.