Socioeconomic deprivation, ethnicity, and health outcomes in preschool children with wheeze in England: a retrospective cohort study

Background: Preschool children have a high burden of acute wheeze and asthma attacks. We identified differences in healthcare use, treatment, and health outcomes for preschool wheeze/asthma in children from different ethnic and socioeconomic backgrounds.

Methods: In this retrospective cohort study, we used data from the Clinical Practice Research Datalink (primary care database) to report the number of acute presentations, and hospitalisations stratified by ethnicity and index of multiple deprivation (IMD), and factors associated with treatment non-escalation, and hospitalisation rates using multivariable regression models.

Results: We included 194,291 preschool children. Rates of hospitalisation were higher in children from the most deprived IMD quintile (adjusted IRR 1.20; 95%CI 1.17 to 1.23), and from South Asian (1.57; 1.53 to 1.60) and Black (1.32; 1.27 to 1.37) ethnic backgrounds compared with children from the least deprived IMD quintile and White ethnic backgrounds respectively.

Children from the most deprived IMD quintile (adjusted OR 1.67; 95%CI 1.53 to 1.83), and South Asian (1.77; 1.64 to 1.91) children were more likely to have high reliever usage despite not being trialled on a regular preventer.

The odds of a specialist referral being indicated in children who had not been referred despite poor control was higher in the most deprived quintile (1.39; 1.28 to 1.52), and South Asian (1.86; 1.72 to 2.01) children.

Conclusion: Preschool children in England from more deprived and non-White ethnic backgrounds have a higher burden of illness and evidence of delayed escalation of treatment for preschool wheeze/asthma.