Why the new Health Secretary should prioritise tackling health inequalities
As the NHS faces another challenging winter the case for taking action to address disparities in respiratory care has never been more urgent.
Severe asthma is associated with high levels of healthcare utilisation, and the healthcare costs of patients with severe uncontrolled asthma are four times those with well controlled asthma1.
At Sanofi we recognise that tackling some of the biggest ills in our society requires true collaboration. The COVID-19 pandemic threw into sharp relief deep health inequalities within our society; as well as what can be achieved through close collaboration between industry and the health service.
The UK has some of the worst asthma outcomes in Europe2. There are stark inequalities in treatment and outcomes based on gender3, race4, and, socioeconomic status and geography5. Studies have shown that people on lower incomes are more likely to have uncontrolled asthma, and suffer more asthma attacks, and income disparities were identified as having a significant impact on asthma outcomes6.
To build on this evidence and further understand the impact of health inequalities on people living with respiratory conditions, Sanofi commissioned a study to explore whether a relationship existed between social deprivation and the treatment that asthma and Chronic Obstructive Pulmonary Disease (COPD) patients received. We worked with York Health Economics Consortium to investigate the link between deprivation (as measured by the Index of Multiple Deprivation) and the prescribing of oral corticosteroids (OCS) for patients with asthma and COPD.
Oral corticosteroids are used for the management of asthma and COPD, however long-term use of OCS is associated with debilitating side effects including osteoporosis, arterial hypertension, diabetes and metabolic syndrome, dyslipidemia, obesity, cataracts, glaucoma, gastrointestinal bleeds/ulcers, tuberculosis, depression, herpes, and sepsis7. There is now widespread recognition that maintenance use of OCS should be minimised in asthma and other respiratory patients8.
Our new study found there is a nearly 50% difference in prescribing of OCS for patients with asthma or COPD in GP surgeries located in the most deprived areas prescribing more OCS, versus those located in the least deprived areas9.
Each year in the UK there are around 1400 deaths due to severe asthma2, over two-thirds of which may be preventable10. Asthma has been estimated to cause around 113,000 ambulance trips, 120,000 A&E attendances, and account for 195,000 days of in patient and day-case hospital stays per year11.
Additionally, new research has highlighted the negative impact of the cost of living crisis on people’s lung health. A survey of 3600 patients with lung conditions, including asthma, found that for half, their condition had worsened since the cost of living crisis began12. Concerningly, this survey was carried out in August, before the winter months which are the most difficult season for patients with respiratory conditions12. As we go into a challenging winter, the cost of living crisis threatens to further compound health inequalities.
My ask of the new Health Secretary is to prioritise investigating and tackling these inequalities and to ensure that patients living with respiratory conditions such as asthma are accessing the most appropriate treatment and care. Similarly, the NHS should ensure that all areas – regardless of levels of deprivation – are following the latest guidance around OCS prescribing.
Sanofi will continue with our commitment to improving the lives of people living with respiratory conditions and reducing the health inequalities which affect them. I hope we can collaborate to achieve these goals, easing the burden on the health service during this challenging winter, and improving the long-term health of the nation.
1 Accelerated Access Collaborative, AAC Consensus Pathway: Management of Uncontrolled Asthma in Adults, June 2021. Available at: https://www.oxfordahsn.org/wp-content/uploads/2022/06/AAC-Pathway-16.9_FINAL-No-NHS.pdf
2 ALUK. UK asthma death rates among worst in Europe, 2022. Available at: https://www.asthma.org.uk/about/media/news/press-release-uk-asthma-death-rates-among-worst-in-europe/
3 ALUK. Women almost twice as likely to die from asthma than men, 2022. Available at: https://www.asthmaandlung.org.uk/women-almost-twice-as-likely-to-die-from-asthma-than-men/
4 Busby J et al. UK Severe Asthma Registry. Ethnic Differences in Severe Asthma Clinical Care and Outcomes: An Analysis of United Kingdom Primary and Specialist Care. J Allergy Clin Immunol Pract. 2022 Feb;10(2):495-505.e2. doi: 10.1016/j.jaip.2021.09.034.
5 Gupta, R. P., Mukherjee, M., Sheikh, A., & Strachan, D. P. (2018). Persistent variations in national asthma mortality, hospital admissions and prevalence by socioeconomic status and region in England. Thorax, 73(8), 706–712. https://doi.org/10.1136/thoraxjnl-2017-210714
6 The Great Asthma Divide – The Annual Asthma Survey (2019) Asthma UK – found at https://www.asthma.org.uk/58a0ecb9/globalassets/campaigns/publications/The-Great-Asthma-Divide.pdf (accessed 04/10/2022) - p25
7 Sullivan PW, et al. Oral corticosteroid exposure and adverse effects in asthmatic patients. Journal of Allergy and Clinical Immunology. 2017;141(1):110–6
8 Menzies-Gow A, Canonica G, Winders TA. et al. A Charter to Improve Patient Care in Severe Asthma. Adv Ther. 2018;35:1485-9.
9 York Health Economics Consortium (2022) – Data held on file
10 Asthma UK press release, data from Royal College of Physicians, The National Review of Asthma Deaths (NRAD): Why Asthma Still Kills. full report 2014 https://www.asthma.org.uk/293597ee/globalassets/campaigns/nrad-full-report.pdf, PP42
11 Mukherjee, M., Stoddart, A., Gupta, R.P. et al. The epidemiology, healthcare and societal burden and costs of asthma in the UK and its member nations: analyses of standalone and linked national databases. BMC Med 14, 113 (2016). https://doi.org/10.1186/s12916-016-0657-8
12 Asthma and Lung UK Cost of Living Survey 2022 This survey received 3,657 responses in total, 2,820 from people with asthma, and was open between 9 August and 26 August 2022. Available at: https://www.asthmaandlung.org.uk/cost-of-living-crisis-1-in-5-people-with-asthma-surveyed-say-price-hikes-causing-asthma-attacks-as-they-cut-back-on-life-saving-medicine-food-and-electricity/
Job N. MAT-XU-2300039 (V1.0) January 2023
You may also like to read our article by Chris Green MP, Vice-Chair of the Life Sciences APPG, and Nicole Farmer, General Manager, UK&Ire at Sanofi as they assess the impact of the Government's Life Sciences Vision and how we can unlock the benefits for patients and the wider economy.
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