Abstract
BackgroundWheezing among children below the age of six (pre-schoolers) is common and often triggered by environmental factors. Moreover, evidence on which to base recommendations for its management is limited, resulting in high numbers of prescriptions and costs. This study aims to describe the spatial differences in asthma medication sales for children aged 0 to 5 years in Belgium, and to evaluate the correlations with socio-economic and environmental factors..MethodsThis ecological study includes information on prescribed and sold asthma medication (R03 ATC code) for all the pre-schoolers registered in Belgium, aggregated at the municipality and smaller administrative levels, in 2014. A case was defined as a pre-schooler having purchased prescribed R03 medication at least once in 2014. We mapped the number of cases, the prevalence of medication purchase (n cases/n registered pre-schoolers) and the costs per case (€) at different administrative levels. We used symbol maps for the number of cases and choropleth maps for prevalence and costs per case using Jenks discretization at the municipal level, and standard deviation at finer scales. Finally, we calculated Pearson correlations of medication prevalence and costs per case with socio-economic (population density and area median income), and environmental (PM10, pig density and green spaces) factors.ResultsThe number of medication purchases was large in cities. The prevalence of purchase was higher in the French- than in the Flemish-speaking region, showing a sharp linguistic border. The cost per case was concentrated in one specific region in the north-west of Belgium. We found inverse correlations of prevalence of purchase with area median income and PM10 concentrations, and positive moderate correlations with green spaces and pig density. The costs per case were weakly but positively correlated with PM10 concentrations and green spaces, and moderately with pig density.ConclusionsIn Belgium, the geographical distribution of purchases of prescribed asthma medication for pre-schoolers is only weakly correlated with some environmental factors. The existence of clear differences in prevalence of purchase between Flemish and French-speaking regions suggests that the observed geographical distribution is strongly driven by regional differences in medical practice.
Highlights
Wheezing among children below the age of six is common and often triggered by environmental factors
Wheezing can be a manifestation of many diseases, including respiratory infections and asthma, and it can be triggered by environmental factors such as air pollution, allergens or tobacco smoke [3, 4], some of them very much dependent on the geographical location of the residence
Except for Brussels Capital Region, mobility of workers between regions in Belgium is limited [23] and only very few medical doctors practice in another Region than the one where they obtained their degree
Summary
Wheezing among children below the age of six (pre-schoolers) is common and often triggered by environmental factors. Living in rural areas may imply poor access to health care [15] and high exposure to other pollutants (e.g. pesticides) [16] or pro-inflammatory agents like endotoxins [17]. In this regard, previous research suggests that the prevalence of pre-school wheezing, the risk of asthma diagnosis, and that of the use of medication for airway-related symptoms may differ between urban and rural environments. A potential explanation for these inconsistencies may be the differences in health care access or in medical practice across countries or regions
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