BMJ 1996;313:148-152 (20 July)

General practice

Influence of ethnic group on asthma treatment in children in 1990-1: national cross sectional study

Enric Duran-Tauleria, lecturer in public health medicine,a Roberto J Rona, reader in public health medicine,a Susan Chinn, reader in medical statistics,a Peter Burney, professor of public health medicine a

a Department of Public Health Medicine, United Medical and Dental Schools of Guy's and St Thomas's Hospitals, St Thomas's Hospital, London SE1 7EH

Correspondence to: Dr Duran-Tauleria.

Abstract

Objective: To examine the extent to which the prescription of drugs for asthma adhered to recommended guidelines in 1990-1 and to assess the influence of ethnic group on prescription.
Design: Cross sectional.
Setting: Primary schools in England and Scotland in 1990-1.
Subjects: Children aged mainly 5-11 years. The representative samples included 10 628 children. The inner city sample included 7049 children, 4866 (69%) from ethnic minority groups. For the prevalence estimation 14 490 children were included in the analysis (82% of the eligible children). For the treatment analysis a subgroup of 5494 children with respiratory symptoms was selected.
Main outcome measures: Prevalence of respiratory symptoms and drugs commonly prescribed for asthma, method of administration, inappropriate treatment, and odds ratios to assess the effect of ethnic group on rate of prescription and method of administration.
Results: Children with respiratory symptoms in the inner city sample were less likely to be diagnosed as having asthma. Of children with reported asthma attacks, those in inner city areas had a higher risk of not having been prescribed any drug for asthma (odds ratio 1.87 (95% confidence interval 1.26 to 2.77). Overall, 773 (75%) of these children had received a ß2 agonist, 259 (25%) had received steroids, 148 (14%) had received sodium cromoglycate, and 194 (19%) had received no drug treatment in the previous year. When prescribed, ß2 agonists were inhaled in 534 (69%) of cases, and this percentage was even lower in ethnic minority groups. Children of Afro-Caribbean and Indian subcontinent origin who had asthma were less likely to receive ß2 agonists, and those from the Indian subcontinent were less likely to receive anti-inflammatory drugs. Antibiotics were less prescribed and antitussives more prescribed in children from ethnic minority groups than in white children.
Conclusion: In 1990-1 the risk of underdiagnosis and undertreatment of asthma was higher in children from ethnic minority groups. The implementation of indicators and targets to monitor inequalities in the treatment of asthma in ethnic groups could improve equity and effectiveness in the NHS.

Key messages

  • In 1990-1 children with reported asthma attacks were more likely to be prescribed drugs for asthma and to use the appropriate method of administra- tion

  • In 1990-1 children with reported asthma attacks who were from ethnic minority groups were less likely to be prescribed drugs for asthma and to use the appropriate method of administration

  • The implementation of indicators and targets to monitor inequalities in the treatment of asthma in ethnic minority groups would help purchasers and providers to improve equity and effectiveness in the NHS


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Relevant Article

Study in London confirms influence of ethnic group on treatment for asthma
Patricia Sturdy, Jeannette Nash, Yvonne Carter, and Chris Griffiths
BMJ 1996 313: 1260. [Extract] [Full Text]

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