Longitudinal trends in fatal and life-threatening asthma in children and young people in England – a retrospective cohort study. (ID 734)
University of Leicester
Abstract
Introduction
Despite available treatments, the number of asthma deaths in children and young people (CYP) in the UK is unacceptably high. Previous attacks and uncontrolled symptoms are known risk factors. Temporal trends in fatal and life-threatening asthma are unknown.
Aim
To describe longitudinal trends in fatal and life-threatening asthma (defined as an ICU-admission) over the past 20 years in CYP in England, stratified by socioeconomic and ethnic groups.
Methods
We conducted a retrospective cohort study using routinely collected linked primary and secondary care, and administrative data from the Clinical Practice Research Datalink (CPRD), Hospital Episode Statistics (HES), Office for National Statistics (ONS) mortality data, and the Index of Multiple Deprivation (IMD). We included CYP aged 5-21 between 2002-2022, with an asthma code as the reason for an ICU-admission, or underlying cause of death. We estimated the incidence rate (IR) of asthma deaths and life-threatening attacks for each year. We explored temporal trends through generalised linear model (GLM) regression.
Results
Between 2002-2022, there were 113 CYP asthma deaths; 21% CYP were non-white, and 39% were from the most-deprived areas (compared to 12% and 24% in the general asthma-cohort, respectively). Mean IR was 0.25 (95%CI 0.23-0.26) deaths/100,000/year. While the GLM regression indicated that asthma death trends remained broadly stable, with only minor fluctuations over time, the mortality incidence rate fell from 0.27 in 2002 to 0.08/100,000/per year in 2022.
1,955 CYP had ICU-admission between 2008-2022; 33% were non-white, and 34% were from the most-deprived areas. The mean IR was 4.25 (95%CI 2.99-5.50)/100,000/year. The spline terms indicated an increase in trends until 2017 and a decrease thereafter
Conclusions
While asthma mortality remained broadly stable in England during the study period, the IR decreased from 0.27 to 0.08/100,000/year between 2002 and 2022, representing a relative reduction of approximately 70%. Life-threatening asthma IR has improved over time. Our data highlighted that children from non-white ethnic backgrounds and the most deprived areas appear to be disproportionately affected by adverse asthma outcomes. More research exploring the causes of the disparities and introducing targeted interventions is recommended.
Funding: This study is part of a PhD programme jointly funded by the Midlands Asthma and Allergy Research Association (MAARA)(Charity number: 257131), Asthma & Lung UK (HPPB/8), and a matched PhD studentship from NIHR (NIHR302205).
Conflicts of interest: A Gawlik-Lipinski received honoraria for lectures and support for attending meetings from AstraZeneca and Chiesi and does consultancy for GLG, she also holds the position of Clinical Fellow for CYP asthma at the National Respiratory Audit Programme UK, Vice-Chair Research and Education Sub-Committee at Association of Respiratory Nurses. EA Gaillard has received research grants from Wellcome Trust, NIHR Programme Development grant, UKRI – SBRI, European Respiratory Society, University of Leicester, Midlands Asthma and Allergy Research Association, Leicester, Leicestershire and Rutland ICB; and payment or honoraria for lectures/presentations from Circassia, Sanofi, and Thorasys. He also holds the position of Chair of the Paediatric Asthma and Allergy Assembly. JK Quint received research grants from UKRI, NIHR, Health Data Research UK, BI, AZ, Insmed and consulting fees from GlaxoSmithKline, BI, Chiesi. DKH Lo received research grants to directly support this manuscript from NIHR, research grants from Midlands Asthma and Allergy Research Association (MAARA) and SBRI. He holds a position of Associate Director HDR UK Midlands and Associate Editor at Thorax. There are no other relationships or activities that could appear to have influenced the submitted work.