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Ethnic differences in severe asthma clinical care and outcomes: An analysis of United Kingdom primary and specialist care

Ethnic differences in severe asthma clinical care and outcomes: An analysis of United Kingdom primary and specialist care
Ethnic differences in severe asthma clinical care and outcomes: An analysis of United Kingdom primary and specialist care

BACKGROUND: Understanding the effects of ethnicity in severe asthma is important for optimal personalized patient care.

OBJECTIVE: To assess ethnic differences in disease control, exacerbations, biological phenotype, and treatment in severe asthma in the United Kingdom.

METHODS: We compared demographics, type 2 biomarkers, lung function, asthma control, medications, and health care use between White and underrepresented ethnic group patients in the UK Severe Asthma Registry (UKSAR) and Optimum Patient Care Research Database (OPCRD).

RESULTS: A total of 3637 patients (665 from the underrepresented ethnic group) were included from UKSAR and 10,549 (577 from the underrepresented ethnic group) from OPCRD. Patients in the underrepresented ethnic group had higher levels of uncontrolled disease when measurements were made using the asthma control questionnaire in UKSAR (odds ratio [OR] = 1.47; 95% confidence interval [CI], 1.12-1.93) and the Royal College of Physicians 3 Questions in OPCRD (OR = 1.82; 95% CI, 1.27-2.60). Although exacerbation rates were similar, patients in the underrepresented ethnic group were more likely to have recently attended the emergency department (OR = 1.55; 95% CI, 1.26-1.92) or to have been hospitalized (OR = 1.31; 95% CI, 1.07-1.59) owing to asthma. Inflammatory biomarkers were consistently higher in the underrepresented ethnic group, including blood eosinophils in OPCRD (ratio = 1.12; 95% CI, 1.05-1.20) and in UKSAR blood eosinophils (ratio = 1.16; 95% CI, 1.06-1.27), FeNO (ratio = 1.14; 95% CI, 1.04-1.26), and IgE (ratio = 1.70; 95% CI, 1.47-1.97). Patients in the underrepresented ethnic group were more likely to be atopic in the UKSAR (OR = 1.32; 95% CI, 1.07-1.63) and OPCRD (OR = 1.67; 95% CI, 1.26-2.21), and less likely to be using maintenance oral corticosteroids at referral (OR = 0.75; 95% CI, 0.61-0.92).

CONCLUSIONS: Severe asthma patients from underrepresented ethnic groups presented with a higher disease burden and were more likely to attend the emergency department. They had a distinct phenotypic presentation and differences in medicine use, with higher levels of type 2 biomarkers.

Asthma, Disparities, Ethnicity
2213-2198
Busby, John
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Heaney, Liam G
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Brown, Thomas
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Chaudhuri, Rekha
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Dennison, Paddy
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Gore, Robin
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Jackson, David J
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Mansur, Adel H
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Menzies-Gow, Andrew
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Message, Simon
8b35aee9-fc2a-4b08-ae8b-fa27b0d5e82b
Niven, Rob
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Patel, Mitesh
b537128d-b665-442f-80d3-8e9e76512e29
Price, David
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Siddiqui, Salman
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Stone, Robert
99c192c2-1254-4189-9617-5208c20f16d7
Pfeffer, Paul E
20afcc06-2295-4870-b559-fa70d5b85369
et al.,
96c90377-641f-4276-9d09-6968e3f36258
UK Severe Asthma Registry
Busby, John
5e0b8623-b8be-4216-83e9-7c9854329844
Heaney, Liam G
80e8956f-63cb-4637-b916-9b13f3420761
Brown, Thomas
3caafb17-8988-47af-b3a5-cfdaafb5f4bc
Chaudhuri, Rekha
25061dc1-b61f-40d5-a6b0-40840d701aea
Dennison, Paddy
837dcc21-e806-4c76-92f6-c5b6c0a8e4d9
Gore, Robin
0aaa0df8-113e-437f-b340-3f0ced71050f
Jackson, David J
5f2430c7-b548-42d0-bc1a-54c933ccf6c1
Mansur, Adel H
041b5d7b-7822-4d58-a471-bacb21673fef
Menzies-Gow, Andrew
2ad51ccd-38dd-4916-b08a-cc7f6551d37a
Message, Simon
8b35aee9-fc2a-4b08-ae8b-fa27b0d5e82b
Niven, Rob
954ee9be-258a-47c5-8dfe-c3793310f362
Patel, Mitesh
b537128d-b665-442f-80d3-8e9e76512e29
Price, David
5c9e8609-7731-4225-b3e7-1e1f72e39800
Siddiqui, Salman
d14ac91e-dc87-4384-acff-54ee646c05fc
Stone, Robert
99c192c2-1254-4189-9617-5208c20f16d7
Pfeffer, Paul E
20afcc06-2295-4870-b559-fa70d5b85369
et al.,
96c90377-641f-4276-9d09-6968e3f36258

Busby, John, Heaney, Liam G, Brown, Thomas and et al., , UK Severe Asthma Registry (2021) Ethnic differences in severe asthma clinical care and outcomes: An analysis of United Kingdom primary and specialist care. Journal of Allergy and Clinical Immunology: In Practice. (doi:10.1016/j.jaip.2021.09.034).

Record type: Article

Abstract

BACKGROUND: Understanding the effects of ethnicity in severe asthma is important for optimal personalized patient care.

OBJECTIVE: To assess ethnic differences in disease control, exacerbations, biological phenotype, and treatment in severe asthma in the United Kingdom.

METHODS: We compared demographics, type 2 biomarkers, lung function, asthma control, medications, and health care use between White and underrepresented ethnic group patients in the UK Severe Asthma Registry (UKSAR) and Optimum Patient Care Research Database (OPCRD).

RESULTS: A total of 3637 patients (665 from the underrepresented ethnic group) were included from UKSAR and 10,549 (577 from the underrepresented ethnic group) from OPCRD. Patients in the underrepresented ethnic group had higher levels of uncontrolled disease when measurements were made using the asthma control questionnaire in UKSAR (odds ratio [OR] = 1.47; 95% confidence interval [CI], 1.12-1.93) and the Royal College of Physicians 3 Questions in OPCRD (OR = 1.82; 95% CI, 1.27-2.60). Although exacerbation rates were similar, patients in the underrepresented ethnic group were more likely to have recently attended the emergency department (OR = 1.55; 95% CI, 1.26-1.92) or to have been hospitalized (OR = 1.31; 95% CI, 1.07-1.59) owing to asthma. Inflammatory biomarkers were consistently higher in the underrepresented ethnic group, including blood eosinophils in OPCRD (ratio = 1.12; 95% CI, 1.05-1.20) and in UKSAR blood eosinophils (ratio = 1.16; 95% CI, 1.06-1.27), FeNO (ratio = 1.14; 95% CI, 1.04-1.26), and IgE (ratio = 1.70; 95% CI, 1.47-1.97). Patients in the underrepresented ethnic group were more likely to be atopic in the UKSAR (OR = 1.32; 95% CI, 1.07-1.63) and OPCRD (OR = 1.67; 95% CI, 1.26-2.21), and less likely to be using maintenance oral corticosteroids at referral (OR = 0.75; 95% CI, 0.61-0.92).

CONCLUSIONS: Severe asthma patients from underrepresented ethnic groups presented with a higher disease burden and were more likely to attend the emergency department. They had a distinct phenotypic presentation and differences in medicine use, with higher levels of type 2 biomarkers.

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More information

Accepted/In Press date: 20 September 2021
e-pub ahead of print date: 7 October 2021
Keywords: Asthma, Disparities, Ethnicity

Identifiers

Local EPrints ID: 453929
URI: http://eprints.soton.ac.uk/id/eprint/453929
ISSN: 2213-2198
PURE UUID: 60175cbc-0112-4b77-abc9-6ec3980490c0

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Date deposited: 25 Jan 2022 18:20
Last modified: 16 Mar 2024 15:07

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Contributors

Author: John Busby
Author: Liam G Heaney
Author: Thomas Brown
Author: Rekha Chaudhuri
Author: Paddy Dennison
Author: Robin Gore
Author: David J Jackson
Author: Adel H Mansur
Author: Andrew Menzies-Gow
Author: Simon Message
Author: Rob Niven
Author: Mitesh Patel
Author: David Price
Author: Salman Siddiqui
Author: Robert Stone
Author: Paul E Pfeffer
Author: et al.
Corporate Author: UK Severe Asthma Registry

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