Association between socioeconomic deprivation, ethnicity, and health outcomes in preschool children with recurrent wheeze in England: a retrospective cohort study

Background Preschool-aged children have amongst the highest burden of acute wheeze. We investigated differences in healthcare use, treatment, and outcomes for recurrent wheeze/asthma inpre-schoolers from different ethno-socioeconomic backgrounds.  Methods Retrospective cohort studyusing data from the Clinical Practice Research Datalink linked toHospital Episode Statistics in England. We reported number of acute presentations, and hospitalisations stratified by index of multiple deprivation (IMD), and ethnicity; and factors associated with treatment non-escalation, and hospitalisation rates using multivariable logistic and Poisson regression models.  Results 194,291 preschool children were included. In children not trialled on asthma preventer medications, 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; and where specialist referral had not occurred, the odds of referral being indicated 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 compared with the least deprived quintile and White children respectively. Hospitalisation rates for wheeze/asthma were significantly higher in children from the most deprived quintile (adjusted IRR 1.20; 95%CI 1.13-to-1.27) compared with the least, and in South Asian (1.57; 1.44-to-1.70) and Black (1.32; 1.22-to-1.42) compared with White children. ConclusionsWe identified inequalities in wheeze/asthma treatment and morbidity in preschool children from more deprived, and non-White backgrounds. A multifaceted approach to tackle healthinequality at both the national and local level, which includes a more integrated and standardised approach to treatment, is needed to improve health outcomes in children with preschool wheeze/asthma.