Abstract
Background: The prevalence and severity of asthma is believed to increase with increasing socioeconomic deprivation. The relationship between asthma diagnosis, symptoms, diagnostic accuracy, and socioeconomic deprivation as determined by Townsend scores was determined in Sheffield schoolchildren.
Methods: All 6021 schoolchildren aged 8–9 years in one school year in Sheffield were given a parent respondent survey based on International Survey of Asthma and Allergies in Childhood (ISAAC) questions.
Results: 5011/6021 (83.2%) questionnaires were returned. Postcode data were available in 4131 replies (82.4%) and were used to assign a composite deprivation score (Townsend score). Scores were divided into five quintiles, with group 1 being least and group 5 being most deprived. A positive trend was observed from group 1 to group 5 for the prevalence of wheeze in the previous 12 months, wheeze attacks ≥4/year, nocturnal wheeze and cough (all p<0.001), cough and/or wheeze "most times" with exertion (p<0.03), current asthma (p<0.001), and significant asthma symptoms (p<0.001). No significant trend was observed for lifetime wheeze or attacks of speech limiting wheeze. There were no significant trends in the prevalence of current asthmatic children without significant symptoms (overdiagnosis) or children with significant asthma symptoms but no current asthma diagnosis (underdiagnosis) across the social groups. There was a significant negative trend in the ratio of asthma medication to asthma diagnosis from least to most deprived groups (p<0.001).
Conclusions: Asthma morbidity and severity increase according to the level of socioeconomic deprivation. This may be due to differences in environment, asthma management, and/or symptom reporting. Diagnostic accuracy does not vary significantly across deprivation groups but children living in areas of least deprivation and taking asthma medication are less likely to be labelled as having asthma, suggesting diagnostic labelling bias.
Full Text
The Full Text of this article is available as a PDF (98.0 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Anderson H. R., Bailey P. A., Cooper J. S., Palmer J. C. Influence of morbidity, illness label, and social, family, and health service factors on drug treatment of childhood asthma. Lancet. 1981 Nov 7;2(8254):1030–1032. doi: 10.1016/s0140-6736(81)91225-3. [DOI] [PubMed] [Google Scholar]
- Apter A. J., Reisine S. T., Affleck G., Barrows E., ZuWallack R. L. Adherence with twice-daily dosing of inhaled steroids. Socioeconomic and health-belief differences. Am J Respir Crit Care Med. 1998 Jun;157(6 Pt 1):1810–1817. doi: 10.1164/ajrccm.157.6.9712007. [DOI] [PubMed] [Google Scholar]
- Cook D. G., Strachan D. P. Health effects of passive smoking. 3. Parental smoking and prevalence of respiratory symptoms and asthma in school age children. Thorax. 1997 Dec;52(12):1081–1094. doi: 10.1136/thx.52.12.1081. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Duran-Tauleria E., Rona R. J., Chinn S., Burney P. Influence of ethnic group on asthma treatment in children in 1990-1: national cross sectional study. BMJ. 1996 Jul 20;313(7050):148–152. doi: 10.1136/bmj.313.7050.148. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Duran-Tauleria E., Rona R. J. Geographical and socioeconomic variation in the prevalence of asthma symptoms in English and Scottish children. Thorax. 1999 Jun;54(6):476–481. doi: 10.1136/thx.54.6.476. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ernst P., Demissie K., Joseph L., Locher U., Becklake M. R. Socioeconomic status and indicators of asthma in children. Am J Respir Crit Care Med. 1995 Aug;152(2):570–575. doi: 10.1164/ajrccm.152.2.7633709. [DOI] [PubMed] [Google Scholar]
- Erzen D., Carriere K. C., Dik N., Mustard C., Roos L. L., Manfreda J., Anthonisen N. R. Income level and asthma prevalence and care patterns. Am J Respir Crit Care Med. 1997 Mar;155(3):1060–1065. doi: 10.1164/ajrccm.155.3.9116987. [DOI] [PubMed] [Google Scholar]
- Gergen P. J., Turkeltaub P. C., Kovar M. G. The prevalence of allergic skin test reactivity to eight common aeroallergens in the U.S. population: results from the second National Health and Nutrition Examination Survey. J Allergy Clin Immunol. 1987 Nov;80(5):669–679. doi: 10.1016/0091-6749(87)90286-7. [DOI] [PubMed] [Google Scholar]
- Halfon N., Newacheck P. W. Childhood asthma and poverty: differential impacts and utilization of health services. Pediatrics. 1993 Jan;91(1):56–61. [PubMed] [Google Scholar]
- Jones A. P., Bentham G. Health service accessibility and deaths from asthma in 401 local authority districts in England and Wales, 1988-92. Thorax. 1997 Mar;52(3):218–222. doi: 10.1136/thx.52.3.218. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Martinez F. D., Cline M., Burrows B. Increased incidence of asthma in children of smoking mothers. Pediatrics. 1992 Jan;89(1):21–26. [PubMed] [Google Scholar]
- Mielck A., Reitmeir P., Wjst M. Severity of childhood asthma by socioeconomic status. Int J Epidemiol. 1996 Apr;25(2):388–393. doi: 10.1093/ije/25.2.388. [DOI] [PubMed] [Google Scholar]
- Miller J. E. Predictors of asthma in young children: does reporting source affect our conclusions? Am J Epidemiol. 2001 Aug 1;154(3):245–250. doi: 10.1093/aje/154.3.245. [DOI] [PubMed] [Google Scholar]
- Mitchell E. A., Stewart A. W., Pattemore P. K., Asher M. I., Harrison A. C., Rea H. H. Socioeconomic status in childhood asthma. Int J Epidemiol. 1989 Dec;18(4):888–890. doi: 10.1093/ije/18.4.888. [DOI] [PubMed] [Google Scholar]
- Ng Man Kwong G., Proctor A., Billings C., Duggan R., Das C., Whyte M. K., Powell C. V., Primhak R. Increasing prevalence of asthma diagnosis and symptoms in children is confined to mild symptoms. Thorax. 2001 Apr;56(4):312–314. doi: 10.1136/thorax.56.4.312. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Payne J. N., Coy J., Milner P. C., Patterson S. Are deprivation indicators a proxy for morbidity? A comparison of the prevalence of arthritis, depression, dyspepsia, obesity and respiratory symptoms with unemployment rates and Jarman scores. J Public Health Med. 1993 Jun;15(2):161–170. doi: 10.1007/BF02959657. [DOI] [PubMed] [Google Scholar]
- Powell C. V., Primhak R. A. Asthma treatment, perceived respiratory disability, and morbidity. Arch Dis Child. 1995 Mar;72(3):209–213. doi: 10.1136/adc.72.3.209. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rona R. J. Asthma and poverty. Thorax. 2000 Mar;55(3):239–244. doi: 10.1136/thorax.55.3.239. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Salmond C., Crampton P., Hales S., Lewis S., Pearce N. Asthma prevalence and deprivation: a small area analysis. J Epidemiol Community Health. 1999 Aug;53(8):476–480. doi: 10.1136/jech.53.8.476. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Watson J. P., Cowen P., Lewis R. A. The relationship between asthma admission rates, routes of admission, and socioeconomic deprivation. Eur Respir J. 1996 Oct;9(10):2087–2093. doi: 10.1183/09031936.96.09102087. [DOI] [PubMed] [Google Scholar]
- Whincup P. H., Cook D. G., Strachan D. P., Papacosta O. Time trends in respiratory symptoms in childhood over a 24 year period. Arch Dis Child. 1993 Jun;68(6):729–734. doi: 10.1136/adc.68.6.729. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wissow L. S., Gittelsohn A. M., Szklo M., Starfield B., Mussman M. Poverty, race, and hospitalization for childhood asthma. Am J Public Health. 1988 Jul;78(7):777–782. doi: 10.2105/ajph.78.7.777. [DOI] [PMC free article] [PubMed] [Google Scholar]