Abstract
Background Although socioeconomic impact on asthma control has been investigated, little is known about its relation to specialist referral of patients with possible severe asthma, especially in a public healthcare setting. The present study aims to identify socioeconomic patterns in disease control and referral of patients with asthma in a nationwide cohort of adult patients treated with inhaled corticosteroid (ICS).
Methods Asthma patients fulfilling the following: aged 18–45 and redeeming ≥2 prescriptions of ICS during 2014–18 based on data from Danish national registers were included. Possible severe asthma was defined as GINA 2020 Step 4 (with either ≥2 courses of systemic steroids or ≥1 hospitalisation) or Step 5 treatment. Findings presented as odds ratio (OR) (95% confidence intervals).
Results Of 60 534 patients (median age 34, 55% female), 3275 (5.7%) were deemed as having possible severe asthma, of whom 61% were managed in primary care alone.
Odds of specialist management for possible severe asthma decreased with age (OR 0.66 (0.51–0.85)), 36–45 versus 18–25 years), male sex (OR 0.75 (0.64–0.87)), residence outside the Capital Region (OR 0.70 (0.59–0.82)) and with receiving unemployment or disability benefits OR 0.75 (0.59–0.95)).
Having completed higher education increased odds of specialist referral (OR 1.28 (1.03–1.59)), when compared to patients with basic education.
Conclusion Even in settings with nationally available free access to specialist care, the majority of patients with possible severe asthma are managed in primary care. Referral of at-risk asthma patients differs across socioeconomic parameters, calling for initiatives to identify and actively refer these patients.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Håkansson reports personal fees from AstraZeneca, personal fees from Chiesi, personal fees from TEVA, outside the submitted work.
Conflict of interest: Dr. Backer reports personal fees from AstraZeneca, personal fees from GSK, personal fees from TEVA, personal fees from Sanofi Genzyme, personal fees from MSD, personal fees from Chiesi, personal fees from Novartis, personal fees from ALK-Abello, personal fees from Mundipharma , personal fees from Boehringer-Ingelheim, from Pharmaxis, outside the submitted work.
Conflict of interest: Dr. Suppli Ulrik reports personal fees from AstraZeneca, personal fees from GSK, personal fees from TEVA, personal fees from Sanofi Genzyme, personal fees from Boehringer-Ingelheim, personal fees from Orion Pharma, personal fees from Novartis, personal fees from ALK-Abello, personal fees from Mundipharma , personal fees from Actelion, outside the submitted work;.
- Received March 12, 2021.
- Accepted May 3, 2021.
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