Gassasse Zakariah, Khan Isaa D, Mok Elliot, Asick Ayyash M, Tan Andrew, Sheikh Aziz, Sinha Ian, Davies Gwyneth A, Whittaker Hannah, Kallis Constantinos, Quint Jennifer K
Imperial College London, School of Public Health, 90 Wood Lane, London, W12 0BZ, United Kingdom.
Imperial College London, Sir Alexander Fleming Building, South Kensington Campus, London, United Kingdom.
Lancet Reg Health Eur. 2025 Jun 26;56:101367. doi: 10.1016/j.lanepe.2025.101367. eCollection 2025 Sep.
Health inequalities are deeply entrenched in society, and finding ways to reduce these, therefore, represents a major health policy challenge. Focusing on the two highest weighted Index of Multiple Deprivation domains, namely income and employment, we sought to synthesise the evidence on the association between these major determinants of socioeconomic status and asthma outcomes.
In this systematic review and meta-analysis, we searched key concepts related to employment, income, and asthma outcomes using Medline and Embase for studies published between January 1, 2010 and April 3, 2025. Studies were eligible for inclusion if they were in English and described an association between income and/or employment and asthma outcomes, including exacerbations, hospital admissions and mortality, in people with asthma. Risk Of Bias In Non-randomized Studies-of Exposures (ROBINS-E), Risk of Bias (RoB) and adapted RoB tools were used to assess the risk of bias in the included studies. Using the restricted maximum likelihood method, we meta-analysed the rate of exacerbations and explored heterogeneity between age-related population groups: children (under 18 years) and adults (18 years and older). This study was registered with PROSPERO, CRD42024527300.
We identified 4153 potentially eligible studies, of which 3141 were screened. 30 studies met the inclusion criteria, with most having a low risk of bias. 19 studies reported income as the exposure and exacerbation as the outcome, of which ten were included in the meta-analysis. People in the lowest income group were more likely to experience an asthma exacerbation than those in the highest income group: OR 1.25; 95% CI 1.13-1.37 overall and when stratified by age: children (1.36 [1.23-1.50]) and adults (1.19 [1.05-1.33]). Only three studies investigated the role of unemployment and were narratively synthesised. While unemployment was associated with increased emergency care visits, its role in predicting exacerbations was less clear.
There is a need for upstream interventions aiming to reduce income inequalities and to investigate their impact on reducing asthma inequalities.
Health Data Research UK, Inflammation and Immunity Driver Programme.
健康不平等在社会中根深蒂固，因此，寻找减少这些不平等的方法是一项重大的卫生政策挑战。我们聚焦于多重剥夺指数中权重最高的两个领域，即收入和就业，试图综合分析社会经济地位的这些主要决定因素与哮喘结局之间关联的证据。
在这项系统评价和荟萃分析中，我们使用Medline和Embase检索了与就业、收入和哮喘结局相关的关键概念，以查找2010年1月1日至2025年4月3日期间发表的研究。如果研究为英文且描述了哮喘患者的收入和/或就业与哮喘结局（包括病情加重、住院和死亡率）之间的关联，则符合纳入标准。使用非随机暴露研究中的偏倚风险（ROBINS-E）、偏倚风险（RoB）和改编后的RoB工具来评估纳入研究中的偏倚风险。我们采用限制最大似然法对病情加重率进行荟萃分析，并探讨不同年龄人群组（儿童（18岁以下）和成人（18岁及以上））之间的异质性。本研究已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42024527300。
我们识别出4153项潜在符合条件的研究，其中3141项经过筛选。30项研究符合纳入标准，大多数研究的偏倚风险较低。19项研究将收入作为暴露因素，病情加重作为结局，其中10项纳入了荟萃分析。最低收入组的人比最高收入组的人更易出现哮喘病情加重：总体比值比为1.25；95%置信区间为1.13 - 1.37，按年龄分层时：儿童为1.36（1.23 - 1.50），成人为1.19（1.05 - 1.33）。仅有三项研究调查了失业的作用，并进行了叙述性综合分析。虽然失业与急诊就诊次数增加有关，但其在预测病情加重方面的作用尚不清楚。
需要采取上游干预措施，旨在减少收入不平等，并研究其对减少哮喘不平等的影响。
英国健康数据研究、炎症与免疫驱动计划。
