Abstract
Background: Understanding the effects of ethnicity in severe asthma is important for optimal personalized patient care. Objective: To assess ethnic differences in disease control, exacerbations, biological phenotype, and treatment in severe asthma in the United Kingdom. Methods: We compared demographics, type 2 biomarkers, lung function, asthma control, medications, and health care use between White and underrepresented ethnic group patients in the UK Severe Asthma Registry (UKSAR) and Optimum Patient Care Research Database (OPCRD). Results: A total of 3637 patients (665 from the underrepresented ethnic group) were included from UKSAR and 10,549 (577 from the underrepresented ethnic group) from OPCRD. Patients in the underrepresented ethnic group had higher levels of uncontrolled disease when measurements were made using the asthma control questionnaire in UKSAR (odds ratio [OR] = 1.47; 95% confidence interval [CI], 1.12-1.93) and the Royal College of Physicians 3 Questions in OPCRD (OR = 1.82; 95% CI, 1.27-2.60). Although exacerbation rates were similar, patients in the underrepresented ethnic group were more likely to have recently attended the emergency department (OR = 1.55; 95% CI, 1.26-1.92) or to have been hospitalized (OR = 1.31; 95% CI, 1.07-1.59) owing to asthma. Inflammatory biomarkers were consistently higher in the underrepresented ethnic group, including blood eosinophils in OPCRD (ratio = 1.12; 95% CI, 1.05-1.20) and in UKSAR blood eosinophils (ratio = 1.16; 95% CI, 1.06-1.27), FeNO (ratio = 1.14; 95% CI, 1.04-1.26), and IgE (ratio = 1.70; 95% CI, 1.47-1.97). Patients in the underrepresented ethnic group were more likely to be atopic in the UKSAR (OR = 1.32; 95% CI, 1.07-1.63) and OPCRD (OR = 1.67; 95% CI, 1.26-2.21), and less likely to be using maintenance oral corticosteroids at referral (OR = 0.75; 95% CI, 0.61-0.92). Conclusions: Severe asthma patients from underrepresented ethnic groups presented with a higher disease burden and were more likely to attend the emergency department. They had a distinct phenotypic presentation and differences in medicine use, with higher levels of type 2 biomarkers.
| Original language | English |
|---|---|
| Journal | Journal of Allergy and Clinical Immunology: In Practice |
| Early online date | 6 Oct 2021 |
| DOIs | |
| Publication status | E-pub ahead of print - 6 Oct 2021 |
Keywords
- Asthma
- Disparities
- Ethnicity
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In: Journal of Allergy and Clinical Immunology: In Practice, 06.10.2021.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Ethnic Differences in Severe Asthma Clinical Care and Outcomes
T2 - An Analysis of United Kingdom Primary and Specialist Care
AU - UK Severe Asthma Registry
AU - Busby, John
AU - Heaney, Liam G.
AU - Brown, Thomas
AU - Chaudhuri, Rekha
AU - Dennison, Paddy
AU - Gore, Robin
AU - Jackson, David J.
AU - Mansur, Adel H.
AU - Menzies-Gow, Andrew
AU - Message, Simon
AU - Niven, Rob
AU - Patel, Mitesh
AU - Price, David
AU - Siddiqui, Salman
AU - Stone, Robert
AU - Pfeffer, Paul E.
N1 - Funding Information: Conflicts of interest: L.G. Heaney is Academic Lead for the Medical Research Council Stratified Medicine UK Consortium in Severe Asthma, which involves industrial partnerships with a number of pharmaceutical companies. T. Brown reports grants from Asthma UK and Innovate UK ; grants, personal fees, and nonfinancial support from AstraZeneca and GlaxoSmithKline ; personal fees and nonfinancial support from Teva ; nonfinancial support from Napp Pharmaceuticals ; and personal fees and nonfinancial support from Novartis , outside the submitted work. R. Gore declares speaking fees in the past 12 months for AstraZeneca and GSK; speaking fees in the past 24 months for Novartis UK; and personal fees from GSK UK, AstraZeneca UK, and Novartis UK, outside the submitted work. R. Chaudhuri reports grants, personal fees, and nonfinancial support from AstraZeneca ; personal fees from GSK and Novartis; personal fees and nonfinancial support from Teva and Chiesi ; and nonfinancial support from Napp Pharmaceuticals , outside the submitted work. P. Dennison reports personal fees for lecturing and nonfinancial support from AstraZeneca , GlaxoSmithKline , and Teva ; consultancy fees from Teva and AstraZeneca; and grants from Novartis , GlaxoSmithKline , and AstraZeneca , all outside of or unrelated to the submitted work. D.J. Jackson has received advisory board and speaker fees from AstraZeneca plc, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline plc, Napp Pharmaceuticals Limited, and Novartis International. A.H. Mansur received personal and department funds for talks and advisory board meetings and was sponsored to attend national and international conferences from pharmaceutical companies including GlaxoSmithKline , AstraZeneca , Novartis , NAPP , Boehringer Ingelheim , Roche , and Chiesi . A. Menzies-Gow has consultancy agreements with AstraZeneca, Vectura, and Sanofi; is participating in research funded by AstraZeneca ; has received lecture fees from Teva, AstraZeneca, Novartis, and Sanofi; attended advisory boards for Novartis, Sanofi, GlaxoSmithKline, AstraZeneca, and Teva; and attended international conferences with Teva. R. Niven has received an unrestricted grant of £10,000 from Novartis in 2010 toward development of clinical services at the University Hospital of South Manchester. He has run preceptorship programs in 2015 and 2016. These programs have resulted in payment to the University Hospital of South Manchester for amounts not exceeding £10,000. He has also lectured at pharmaceutically sponsored meetings in the past 3 years for AstraZeneca (<£1000), Boehringer Ingelheim (<£2000), Boston Scientific (<£5000), Chiesi (<£1000), Novartis (<£10,000), Napp (<£2000), and Teva (<£2000). He has sat on advisory boards in the past 3 years for AstraZeneca, Boehringer Ingelheim, Boston Scientific, Chiesi, GSK, Novartis Vectura, and Teva, receiving reimbursement not exceeding £5000 per company. He has received sponsorship support to attend international academic meetings from AstraZeneca , Boehringer Ingelheim , Novartis , GSK , Chiesi , and Teva . Neither R. Niven nor any members of his family has shares or any pecuniary interest in any pharmaceutical industry and or shareholdings or dividends, and is not a paid consultant for any company. D. Price has board membership with Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Mylan, Mundipharma, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, Teva Pharmaceuticals, and Thermo Fisher; consultancy agreements with Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mylan, Mundipharma, Novartis, Pfizer, Teva Pharmaceuticals, and Theravance; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from AstraZeneca , Boehringer Ingelheim , Chiesi , Circassia , Mylan , Mundipharma , Novartis , Pfizer , Regeneron Pharmaceuticals , Respiratory Effectiveness Group , Sanofi Genzyme , Teva Pharmaceuticals , Theravance , and UK National Health Service ; payment for lectures/speaking engagements from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Mylan, Mundipharma, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, and Teva Pharmaceuticals; payment for the development of educational materials from Mundipharma, Novartis; payment for travel/accommodation/meeting expenses from AstraZeneca, Boehringer Ingelheim, Mundipharma, Mylan, and Novartis, Thermo Fisher; funding for patient enrollment or completion of research from Novartis; and stock/stock options from AKL Research and Development Ltd, which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum Patient Care Ltd (Australia and UK) and 74% of Observational and Pragmatic Research Institute Pte Ltd (Singapore); 5% shareholding in Timestamp, which develops adherence monitoring technology; is peer reviewer for grant committees of the Efficacy and Mechanism Evaluation program , and Health Technology Assessment; and was an expert witness for GlaxoSmithKline . S. Siddiqui has received fees from consultancy agreements/other services from AstraZeneca, GSK, Boehringer Ingelheim, Napp, Mundipharma, Chiesi, ERT Medical, and Owlstone Medical. R. Stone has received presentation fees from AstraZeneca. P.E. Pfeffer has attended an advisory board for Novartis; has given lectures at meetings with or without lecture honoraria supported by AstraZeneca and GlaxoSmithKline ; has taken part in clinical trials sponsored by AstraZeneca , GlaxoSmithKline , and Novartis ; and is conducting research funded by GlaxoSmithKline , for which his institution receives remuneration. The rest of the authors declare that they have no relevant conflicts of interest. Funding Information: Conflicts of interest: L.G. Heaney is Academic Lead for the Medical Research Council Stratified Medicine UK Consortium in Severe Asthma, which involves industrial partnerships with a number of pharmaceutical companies. T. Brown reports grants from Asthma UK and Innovate UK; grants, personal fees, and nonfinancial support from AstraZeneca and GlaxoSmithKline; personal fees and nonfinancial support from Teva; nonfinancial support from Napp Pharmaceuticals; and personal fees and nonfinancial support from Novartis, outside the submitted work. R. Gore declares speaking fees in the past 12 months for AstraZeneca and GSK; speaking fees in the past 24 months for Novartis UK; and personal fees from GSK UK, AstraZeneca UK, and Novartis UK, outside the submitted work. R. Chaudhuri reports grants, personal fees, and nonfinancial support from AstraZeneca; personal fees from GSK and Novartis; personal fees and nonfinancial support from Teva and Chiesi; and nonfinancial support from Napp Pharmaceuticals, outside the submitted work. P. Dennison reports personal fees for lecturing and nonfinancial support from AstraZeneca, GlaxoSmithKline, and Teva; consultancy fees from Teva and AstraZeneca; and grants from Novartis, GlaxoSmithKline, and AstraZeneca, all outside of or unrelated to the submitted work. D.J. Jackson has received advisory board and speaker fees from AstraZeneca plc, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline plc, Napp Pharmaceuticals Limited, and Novartis International. A.H. Mansur received personal and department funds for talks and advisory board meetings and was sponsored to attend national and international conferences from pharmaceutical companies including GlaxoSmithKline, AstraZeneca, Novartis, NAPP, Boehringer Ingelheim, Roche, and Chiesi. A. Menzies-Gow has consultancy agreements with AstraZeneca, Vectura, and Sanofi; is participating in research funded by AstraZeneca; has received lecture fees from Teva, AstraZeneca, Novartis, and Sanofi; attended advisory boards for Novartis, Sanofi, GlaxoSmithKline, AstraZeneca, and Teva; and attended international conferences with Teva. R. Niven has received an unrestricted grant of ?10,000 from Novartis in 2010 toward development of clinical services at the University Hospital of South Manchester. He has run preceptorship programs in 2015 and 2016. These programs have resulted in payment to the University Hospital of South Manchester for amounts not exceeding ?10,000. He has also lectured at pharmaceutically sponsored meetings in the past 3 years for AstraZeneca (<?1000), Boehringer Ingelheim (<?2000), Boston Scientific (<?5000), Chiesi (<?1000), Novartis (<?10,000), Napp (<?2000), and Teva (<?2000). He has sat on advisory boards in the past 3 years for AstraZeneca, Boehringer Ingelheim, Boston Scientific, Chiesi, GSK, Novartis Vectura, and Teva, receiving reimbursement not exceeding ?5000 per company. He has received sponsorship support to attend international academic meetings from AstraZeneca, Boehringer Ingelheim, Novartis, GSK, Chiesi, and Teva. Neither R. Niven nor any members of his family has shares or any pecuniary interest in any pharmaceutical industry and or shareholdings or dividends, and is not a paid consultant for any company. D. Price has board membership with Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Mylan, Mundipharma, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, Teva Pharmaceuticals, and Thermo Fisher; consultancy agreements with Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mylan, Mundipharma, Novartis, Pfizer, Teva Pharmaceuticals, and Theravance; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Mylan, Mundipharma, Novartis, Pfizer, Regeneron Pharmaceuticals, Respiratory Effectiveness Group, Sanofi Genzyme, Teva Pharmaceuticals, Theravance, and UK National Health Service; payment for lectures/speaking engagements from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Mylan, Mundipharma, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, and Teva Pharmaceuticals; payment for the development of educational materials from Mundipharma, Novartis; payment for travel/accommodation/meeting expenses from AstraZeneca, Boehringer Ingelheim, Mundipharma, Mylan, and Novartis, Thermo Fisher; funding for patient enrollment or completion of research from Novartis; and stock/stock options from AKL Research and Development Ltd, which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum Patient Care Ltd (Australia and UK) and 74% of Observational and Pragmatic Research Institute Pte Ltd (Singapore); 5% shareholding in Timestamp, which develops adherence monitoring technology; is peer reviewer for grant committees of the Efficacy and Mechanism Evaluation program, and Health Technology Assessment; and was an expert witness for GlaxoSmithKline. S. Siddiqui has received fees from consultancy agreements/other services from AstraZeneca, GSK, Boehringer Ingelheim, Napp, Mundipharma, Chiesi, ERT Medical, and Owlstone Medical. R. Stone has received presentation fees from AstraZeneca. P.E. Pfeffer has attended an advisory board for Novartis; has given lectures at meetings with or without lecture honoraria supported by AstraZeneca and GlaxoSmithKline; has taken part in clinical trials sponsored by AstraZeneca, GlaxoSmithKline, and Novartis; and is conducting research funded by GlaxoSmithKline, for which his institution receives remuneration. The rest of the authors declare that they have no relevant conflicts of interest. Publisher Copyright: © 2021 American Academy of Allergy, Asthma & Immunology
PY - 2021/10/6
Y1 - 2021/10/6
N2 - Background: Understanding the effects of ethnicity in severe asthma is important for optimal personalized patient care. Objective: To assess ethnic differences in disease control, exacerbations, biological phenotype, and treatment in severe asthma in the United Kingdom. Methods: We compared demographics, type 2 biomarkers, lung function, asthma control, medications, and health care use between White and underrepresented ethnic group patients in the UK Severe Asthma Registry (UKSAR) and Optimum Patient Care Research Database (OPCRD). Results: A total of 3637 patients (665 from the underrepresented ethnic group) were included from UKSAR and 10,549 (577 from the underrepresented ethnic group) from OPCRD. Patients in the underrepresented ethnic group had higher levels of uncontrolled disease when measurements were made using the asthma control questionnaire in UKSAR (odds ratio [OR] = 1.47; 95% confidence interval [CI], 1.12-1.93) and the Royal College of Physicians 3 Questions in OPCRD (OR = 1.82; 95% CI, 1.27-2.60). Although exacerbation rates were similar, patients in the underrepresented ethnic group were more likely to have recently attended the emergency department (OR = 1.55; 95% CI, 1.26-1.92) or to have been hospitalized (OR = 1.31; 95% CI, 1.07-1.59) owing to asthma. Inflammatory biomarkers were consistently higher in the underrepresented ethnic group, including blood eosinophils in OPCRD (ratio = 1.12; 95% CI, 1.05-1.20) and in UKSAR blood eosinophils (ratio = 1.16; 95% CI, 1.06-1.27), FeNO (ratio = 1.14; 95% CI, 1.04-1.26), and IgE (ratio = 1.70; 95% CI, 1.47-1.97). Patients in the underrepresented ethnic group were more likely to be atopic in the UKSAR (OR = 1.32; 95% CI, 1.07-1.63) and OPCRD (OR = 1.67; 95% CI, 1.26-2.21), and less likely to be using maintenance oral corticosteroids at referral (OR = 0.75; 95% CI, 0.61-0.92). Conclusions: Severe asthma patients from underrepresented ethnic groups presented with a higher disease burden and were more likely to attend the emergency department. They had a distinct phenotypic presentation and differences in medicine use, with higher levels of type 2 biomarkers.
AB - Background: Understanding the effects of ethnicity in severe asthma is important for optimal personalized patient care. Objective: To assess ethnic differences in disease control, exacerbations, biological phenotype, and treatment in severe asthma in the United Kingdom. Methods: We compared demographics, type 2 biomarkers, lung function, asthma control, medications, and health care use between White and underrepresented ethnic group patients in the UK Severe Asthma Registry (UKSAR) and Optimum Patient Care Research Database (OPCRD). Results: A total of 3637 patients (665 from the underrepresented ethnic group) were included from UKSAR and 10,549 (577 from the underrepresented ethnic group) from OPCRD. Patients in the underrepresented ethnic group had higher levels of uncontrolled disease when measurements were made using the asthma control questionnaire in UKSAR (odds ratio [OR] = 1.47; 95% confidence interval [CI], 1.12-1.93) and the Royal College of Physicians 3 Questions in OPCRD (OR = 1.82; 95% CI, 1.27-2.60). Although exacerbation rates were similar, patients in the underrepresented ethnic group were more likely to have recently attended the emergency department (OR = 1.55; 95% CI, 1.26-1.92) or to have been hospitalized (OR = 1.31; 95% CI, 1.07-1.59) owing to asthma. Inflammatory biomarkers were consistently higher in the underrepresented ethnic group, including blood eosinophils in OPCRD (ratio = 1.12; 95% CI, 1.05-1.20) and in UKSAR blood eosinophils (ratio = 1.16; 95% CI, 1.06-1.27), FeNO (ratio = 1.14; 95% CI, 1.04-1.26), and IgE (ratio = 1.70; 95% CI, 1.47-1.97). Patients in the underrepresented ethnic group were more likely to be atopic in the UKSAR (OR = 1.32; 95% CI, 1.07-1.63) and OPCRD (OR = 1.67; 95% CI, 1.26-2.21), and less likely to be using maintenance oral corticosteroids at referral (OR = 0.75; 95% CI, 0.61-0.92). Conclusions: Severe asthma patients from underrepresented ethnic groups presented with a higher disease burden and were more likely to attend the emergency department. They had a distinct phenotypic presentation and differences in medicine use, with higher levels of type 2 biomarkers.
KW - Asthma
KW - Disparities
KW - Ethnicity
UR - http://www.scopus.com/inward/record.url?scp=85118149769&partnerID=8YFLogxK
U2 - 10.1016/j.jaip.2021.09.034
DO - 10.1016/j.jaip.2021.09.034
M3 - Article
AN - SCOPUS:85118149769
SN - 2213-2198
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
ER -