Socioeconomic disadvantage and emergency treatment for asthma

Introduction: To determine the impact of socioeconomic disadvantage on emergency asthma treatment we have reviewed data from two Nottingham hospitals. Methods: All visits to hospital for acute asthma over a 12 month period for persons between the ages of 5 and 59 years were identified by review of daily hospital admission data. Data on age, sex, postcode, treatment and subsequent admission were extracted from the case records of patients diagnosed as having asthma. Postcode derived Townsend Scores were obtained for the patient's home electoral ward (EWTS) and home address (HATS). Using 1991 census data, age and sex adjusted incidence rates (SIR) for attendance at hospital with asthma were calculated for each electoral ward using indirect standardisation (Nottingham as a whole was used as the reference population). To investigate the association between SIR and EWTS we used Spearman Rank Correlation. To investigate the impact of socioeconomic disadvantage on subsequent admission we used HATS and logistic regression. Only the first hospital attendance was analysed for each individual. Results: Data were available for 671 individuals from 99 electoral wards. The median age was 20 years, 50% male and 321(48%) were subsequently admitted to hospital. At initial assessment 52 (8%) were taking oral steroids, 77 (11%) a long acting beta-agonist and 410 (61%) an inhaled steroid. A strong positive correlation was present between SIR and EWTS (0.50, p<0.0001). In contrast the risk of subsequent admission decreased with increasing HATS (Odds ratio per quartile of HATS 0.84, 95%CI 0.74 to 0.97, p=0.015) and this effect remained after adjustment for age, sex and treatment (OR 0.83, 95%CI 0.72 to 0.96, p=0.011). Conclusions: Electoral wards in Nottingham with higher levels of socioeconomic disadvantage have higher rates of hospital visits for emergency treatment of asthma, but socioecomically disadvantaged individuals are less likely to be admitted.