Socioeconomic deprivation and inequalities in asthma care in Wales

Abstract Background Area-based deprivation indices are widely used to study health inequalities. We explored whether inequality exists for asthma care across socioeconomic deprivation levels in Wales. Methods Using the Wales-wide Secure Anonymised Information Linkage databank, we accessed anonymised data on patients with a general practitioner (GP) diagnosis of asthma in or before 2009 and continuous GP registration between 2009 and 2014, and linked these data to the 2011 Welsh Index of Multiple Deprivation quintiles. The primary outcome variables were numbers of asthma-related GP visits, annual reviews, emergency department visits, and hospital admissions between 2010 and 2014. Statistical analysis included zero-inflated negative binomial regression adjusted for age and sex. No ethics approval was needed for use of anonymised data. Findings We analysed data from 209 887 patients with asthma. Over 5 years, there were 8·2% more asthma-related GP visits per patient in the most deprived areas than in the least deprived areas (4·0 vs 3·7; incidence rate ratio 1·082, 95% CI 1·071–1·094), 3·7% more asthma annual reviews (2·35 vs 2·26; 1·037, 1·026–1·049), 31·1% more asthma emergency department visits (0·021 vs 0·016; 1·311, 1·151–1·494), and 123·3% more asthma inpatient admissions (0·074 vs 0·033; 2·233, 1·983–2·515) (all p Interpretation Higher health-care utilisation in the most deprived group indicates worse asthma control. Despite an 8·2% excess of primary care contacts in this group, outcomes are poorer in terms of much higher emergency department visits and hospital admissions. Disease severity, quality of primary care, self-management, or wider non-health-care-related determinants may be contributing factors, indicating further potential to reduce inequality in the impact of disease. Funding Health and Care Research Wales, Abertawe Bro Morgannwg University Health Board, Asthma UK Centre for Applied Research (AUK-AC-2012-01), Farr Institute of Health Informatics Research (CIPHER MR/K006525/1, Scotland MR/K007017/1).