Usher Institute

People with asthma in deprived areas of Wales have worse outcomes and increased risk of death

Asthma patients living in the most deprived areas of Wales are more likely to suffer from increased asthma attacks, be admitted to hospital and are at a higher risk of death.

A new study, published in the journal PLOS Medicine, has discovered that people with asthma from socially and economically deprived areas of Wales have less control of their asthma, suffer from more asthma attacks and are at a higher risk of death. 

Linking datasets 

This study looked at over 100,000 people with treated asthma across Wales for 5 years. The research team analysed routinely collected primary and secondary care data from the Secure Anonymised Information Linkage (SAIL) Databank. SAIL Databank contains 100% of secondary and 80% of primary care data for the population of Wales, and is the primary Trusted Research Environment for BREATHE - Health Data Research Hub for Respiratory Health.  

The authors used SAIL Databank to link data for the period of 2013 to 2017. They wanted to investigate the link between GP care data, emergency hospital admissions, prescriptions and asthma deaths, together with geographical and socioeconomic measures for ranked areas of deprivation. 

Poorer asthma outcomes in more disadvantaged areas 

The researchers found that people living in more disadvantaged areas had worse asthma outcomes, particularly those with lower levels of wealth, employment, and education.  

In the most disadvantaged areas, people: 

  • Went to emergency departments for asthma more often 

  • Were approximately 50% more likely to be admitted to hospital and die from asthma 

  • Had lower ratios of control-to-total asthma medications 

  • Were three times more likely to take 12 or more reliever inhalers per year 

A lack of educational opportunities likely affects how well people manage their asthma and puts them at a higher risk of asthma attacks and death. This socioeconomic gap could be mitigated with GPs encouraging people to receive and take enough preventative medications and self-manage their asthma well, regardless of background. The researchers also encourage wider policies to provide equal educational opportunities across society. 

Health inequalities 

This study represents an important example of the value of linked datasets to broaden our understanding of respiratory conditions.

Lead author on the study, Dr Mohammad Al Sallakh, a member of both the Asthma UK Centre for Applied Research and BREATHE, believes this study identifies health inequalities within Wales. He said: 

This study demonstrates asthma burden is not evenly distributed within society, but it is affected by where people were born and live. We found that lower income and education levels are important drivers of socioeconomic inequalities in asthma.

Dr Mohammad Al SallakhAsthma UK Centre for Applied Research Member, and BREATHE Researcher

Professor Aziz Sheikh, Director of the Usher Institute, BREATHE and the Asthma UK Centre for Applied Research, believes this paper could have significance across the United Kingdom. He said:  

1 in 10 people in the UK are currently receiving treatment for asthma. This research clearly shows inequalities in the experiences of people living with asthma across Wales. Those in less affluent areas have more A&E attendances, hospitalisations, and deaths due to asthma. Developing targeted changes to the way asthma is treated and also opportunities for health education in Wales may reduce the gap for more deprived groups. This study could lead the way in identifying improvements for people with asthma living in more deprived areas that could be implemented across all four UK nations.

Professor Aziz SheikhDirector of BREATHE and the Asthma UK Centre for Applied Research

Commenting on the findings Joseph Carter, Head of Asthma UK & British Lung Foundation Wales, said:

These findings put the reality into stark contrast and clearly show the link between the environment people live in and their long-term health.  

Living in a disadvantaged area has a huge impact upon your life. Doing so means you are more likely to develop a serious condition, such as asthma, and are 50% more likely to be admitted to hospital or die because of that condition.  

More must be done to address this situation. We need more targeted investment, focused on the most disadvantaged communities, to deliver better healthcare services locally and diagnose conditions sooner.  

We also need to see a greater focus on tackling air pollution, and creating greener communities, to stop people developing a lung condition and ensure everyone can live a healthy and fulfilling life.

Joseph CarterHead of Asthma UK & British Lung Foundation Wales

The study was conducted by Swansea University’s Wales Asthma Observatory (WAO) in collaboration with the Asthma UK Centre for Applied Research, BREATHE, and Applied Research Collaboration North West Coast (ARC NWC) at the University of Liverpool. 

The Wales Asthma Observatory (WAO) is a platform for asthma research and surveillance with a cumulative cohort of asthma patients covering most of Wales and is based on electronic health records dating back to 1990. 

The research was jointly funded by Health and Care Research Wales and Swansea Bay University Health Board. 

Read the paper 

This publication is available from PLOS Medicine 

Cite as 

Alsallakh MA, Rodgers SE, Lyons RA, Sheikh A, Davies GA. Association of socioeconomic deprivation with asthma care, outcomes, and deaths in Wales: A 5-year national linked primary and secondary care cohort study. PLoS Med. 2021 Feb 12;18(2):e1003497. doi: 10.1371/journal.pmed.1003497. PMID: 33577558. 

Related links

BREATHE - Health Data Research Hub for Respiratory Health

Asthma UK Centre for Applied Research


Image credit: "Welsh flag" by Leo Reynolds is licensed under CC BY-NC-SA 2.0