title: Asthma prescribing, ethnicity and risk of hospital admission: an analysis of 35,864 linked primary and secondary care records in East London.
abstract: Inappropriate prescribing in primary care was implicated in nearly half of asthma deaths reviewed in the UK's recent National Review of Asthma Deaths. Using anonymised EMIS-Web data for 139 ethnically diverse general practices (total population 942,511) extracted from the North and East London Commissioning Support Unit, which holds hospital Secondary Uses Services (SUS)-linked data, we examined the prevalence of over-prescribing of short-acting β2-agonist inhalers (SABA), under-prescribing of inhaled corticosteroid (ICS) inhalers and solo prescribing of long-acting β2-agonists (LABA) to assess the risk of hospitalisation for people with asthma for 1 year ending August 2015. In a total asthma population of 35,864, multivariate analyses in adults showed that the risk of admission increased with greater prescription of SABA inhalers above a baseline of 1-3 (4-12 SABA: odds ratio (OR) 1.71; 95% confidence interval (CI) 1.20-2.46, ⩾13 SABA: OR 3.22; 95% CI 2.04-5.07) with increasing British Thoracic Society step (Step 3: OR 2.90; 95% CI 1.79-4.69, Step 4/5: OR 9.42; 95% CI 5.27-16.84), and among Black (OR 2.30; 95% CI 1.64-3.23) and south Asian adult populations (OR 1.83; 95% CI 1.36-2.47). Results in children were similar, but risk of hospitalisation was not related to ethnic group. There is a progressive risk of hospital admission associated with the prescription of more than three SABA inhalers a year. Adults (but not children) from Black and South Asian groups are at an increased risk of admission. Further work is needed to target care for these at-risk groups.
authors.affiliation: Clinical Effectiveness Group, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK.
authors.forename: Sally A
authors.initials: SA
authors.lastname: Hull
authors.affiliation: Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK.
authors.forename: Shauna
authors.initials: S
authors.lastname: McKibben
authors.affiliation: Clinical Effectiveness Group, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Homer
authors.affiliation: Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK.
authors.forename: Stephanie Jc
authors.initials: SJ
authors.lastname: Taylor
authors.affiliation: Respiratory Critical Care and Anaesthesia Section, University College London, Institute of Child Health, London, UK.
authors.forename: Katy
authors.identifier: 0000-0003-4911-6082
authors.initials: K
authors.lastname: Pike
authors.affiliation: Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Griffiths
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D008131:London; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D063127:Secondary Health Care / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D018927:Anti-Asthmatic Agents