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Asthma deaths linked to national level of financial inequality and not overall wealth

Gaps between the rich and poor are linked to an increase in asthma deaths according to an international study of 32 countries.

The research, presented at the British Thoracic Society Winter Meeting today, suggests that financial inequality at a national level is far more significant than the wealth of a country.

There is no association between asthma mortality and a country’s GDP or GNP, according to the findings by researchers at the University Hospital Southampton, which included country’s with a low GDP or GNP.

Professor Gary Connett, consultant respiratory paediatrician said: ‘We know from previous studies that hospital admissions for acute asthma attacks are related to socioeconomic factors. Those from the most deprived areas of the UK are almost twice as likely to be admitted as those from the wealthiest parts.

‘Previously identified risk factors for poor outcomes amongst people from deprived areas include delayed presentation to emergency services, and increased exposure to tobacco smoke and air pollution. What this study additionally suggests is that relative inequality at a national level might also be important – acting independently of the absolute wealth of the countries studied.’

The UK, which was ranked sixth highest for financial inequality in the research, currently has 5.4 million people receiving treatment for asthma. More than 1,400 people died from an asthma attack in England and Wales last year.

Previous studies have shown that death rates for asthma in the UK, Australia, New Zealand and the USA – where all four countries have high levels of social inequality – are three times higher than most European countries.

‘Asthma is a challenging health care problem with complex interacting factors determining the risk of severe and life-threatening attacks. These data provide some support for the hypothesis that at a national level – high levels of financial inequality are associated with fatal asthma,’ added Professor Connett.

The study, mapped asthma death rates in children (aged 5-14 years) and young adults (aged 15-49 years) against markers of financial inequality.

In a population about the size of the UK the data suggests that an increase in the GINI index of 0.1 (on a scale of 0 to 1 where 1 indicates maximum inequality and 0 indicates everyone having the same income), is associated with 37 additional deaths amongst children aged 5-14 years and 81 amongst adults aged 15-49 years.

Of the 32 countries in the study the UK had the sixth worst GINI index at 0.351 and was only out ranked by Costa Rica, Mexico, USA, Lithuania and South Korea.

Professor Jon Bennett, consultant respiratory physician and chair of the British Thoracic Society board, said: ‘We know that many lung diseases are highly linked to financial and social deprivation – they play a major part in the widening life expectancy gap between rich and poor in this country. It is unacceptable and we must tackle it.

‘The good news is that the NHS long term plan in England aims to tackle health inequality and innovative lung teams in some parts of the country are targeting work at specific populations and areas of need – preventing lung disease and managing it earlier and more effectively. It is making a real difference. However, we do need more resources and investment to scale this good practice right across the nation.’

Figures released by NHS Digital yesterday revealed the proportion of adults with asthma in England varied by income, especially among women.

Those in the lowest income households were more likely to have asthma (10% of men and 15% of women) than those in the highest income households (9% of men and 8% of women) according to the 2018 Health Survey for England report.