Parental socioeconomic status, access to specialist care, and childhood asthma severity, control, and exacerbations

Abstract

<b>Background:</b> Pediatric asthma has lifelong consequences among those with poor control. Specialist care is recommended for uncontrolled and severe asthma, yet little is known about impact of socioeconomic status (SES) on specialist care. <b>Objective:</b> Using a Danish nationwide cohort, we aimed to elucidate the prevalence of severe pediatric asthma, and the impact of parental SES on disease control and specialist management. <b>Methods:</b> Children aged 0-17 years using inhaled corticosteroids (n=40,798) were followed from birth to 2018. Severity was classified using GINA 2020 guidelines. Poor control was defined as 400/600 (ages 0-11/12+) annual doses of short-acting bronchodilator. Impact of SES and specialist care on asthma outcomes was investigated using logistic regression. <b>Results:</b> Severe asthma prevalence (11.0-3.2%) was lower than poor control (57-10%); both declined from childhood to adolescence. 4.3-8.0% of children with well-controlled, mild-to-moderate asthma experienced exacerbations. Severity, poor control, and exacerbations were associated with rural residence and low income. Poor control was additionally predicted by parental welfare recipiency and shorter education. 59-74% of uncontrolled and/or exacerbating patients were managed in primary care, although few socioeconomic barriers to specialist care were found. Associations between SES and adverse outcomes were mostly attenuated by specialist care. <b>Conclusion:</b> Throughout childhood, there was a high prevalence of severe asthma and poor control. We demonstrate an unmet need for specialist care among poorly controlled and/or exacerbating children, despite&nbsp;few socioeconomic barries to specialist care.