Low socioeconomic position and neighborhood deprivation are associated with uncontrolled asthma in elderly. (October 2019)

• Record Type: Journal Article
• Authors: Temam, Sofia; Chanoine, Sébastien; Bédard, Annabelle; Dumas, Orianne; Sanchez, Margaux; Boutron-Ruault, Marie-Christine; Siroux, Valérie; Rican, Stéphane; Varraso, Raphaëlle; Le Moual, Nicole
• Is Part Of: Respiratory medicine. Volume 158(2019)
• Page Start: 70
• Page End: 77
• Publication Date: 2019-10
• Subjects: Asthma control -- Elderly -- Neighborhood deprivation -- Socioeconomic position; ACT Asthma control test -- GINA Global initiative for asthma -- ICS Inhaled corticosteroids -- SABA Short-acting b2 agonists -- SEP Socioeconomic position; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2019.09.010
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background: While uncontrolled asthma in adults is frequent in Europe, the impact of socioeconomic position (SEP) was little investigated. We aimed to investigate the respective association of individual- and area-level SEP with uncontrolled asthma among French elderly women. Methods: Analyses were conducted in the Asthma-E3N study, among participants with current asthma (i.e., asthma attacks, treatment, or symptoms in previous year). Asthma control was evaluated using Asthma Control Test (uncontrolled: score ≤19); SEP was defined at both individual- and area-level, using educational level (low, medium, high), the French Deprivation index (tertiles defined at national level), and by merging them in a combined-SEP index. Associations between SEP and asthma control were estimated for 2258 women by logistic regression adjusted for age. Analyses were stratified by asthma controller medication use estimated through a drug reimbursement database. Results: Women were 70 years on average and 24% had uncontrolled asthma. A low educational level (11%) was associated with an increased risk of uncontrolled asthma [odds ratio (95% confidence interval) = 1.9 (1.4, 2.6)], especially among women not using controller medication [3.1 (1.9, 5.1)]. Using the combined-SEP index, the highest risk of uncontrolled asthma was observed among women with the most disadvantaged socioeconomic profile (low educational level and low-SEP neighborhood) [2.5 (1.5, 4.2)]. Conclusions: Women with low SEP had more often uncontrolled asthma, which might be partly explained by inadequate asthma treatment. To achieve the best management of asthma for elderly patients, a specific attention should be given not only to disadvantaged population and neighborhoods, but also to disadvantaged populations in affluent neighborhoods. Highlights: Uncontrolled asthma in adults is frequent in Europe. Few studies investigated the role of socioeconomic position (SEP) on asthma control. Low SEP at individual- and at area-level are associated with uncontrolled asthma. Inappropriate treatment, care or health access could partly explain this result. Patients with low SEP at individual- and area-levels need better asthma management.