Asthma and Social Class. 2000/3

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Introduction

Social class, based on occupation (see footnote) reflects a wide range of factors that can influence the occurrence and severity of disease and its medical care. This factsheet presents data on prevalence, GP consultations and mortality for asthma, by social class.

Prevalence of asthma and wheeze

Figure 1:Prevalence of doctor-diagnosed asthma ever and recent wheeze by social class in children

The Health Survey for England measured the prevalence of ever having had doctor-diagnosed asthma and of self-reported wheeze in the last 12 months in children aged 2 to 15 years and in adults aged 16+ adjusting for age. In children there is little difference by social class in the prevalence of diagnosed asthma or of wheeze. In adults there is no class trend for asthma but for wheeze there is clear evidence of a gradient with a third more wheeze in classes IV/V than in I/II. It should be noted that wheeze can be associated with COPD in older adults. COPD is linked with smoking, a class related behaviour.

GP attendance for asthma

The fourth National Morbidity Study in General Practice (MSGP4) gives the proportion of patients consulting for asthma in one year.

Figure 2:Patients consulting GPs for asthma by social class

There is a gradient towards the manual classes in all age groups except the 65+ group.

Figure 3:GP consultations per patient for asthma by social class

This figure shows the number of consultations for asthma per patient per year. In all ages combined there is a slight class gradient in asthmatics from 2.15 consultations in classes I/II to 2.36 in classes IV/V. This effect is only apparent in the 15-44 age groups.

Figure 4:Patients consulting GPs for asthma by current smoking status

Overall, slightly more non-smokers consult GPs for asthma than do current smokers. This is most apparent in the older-age groups. Possible explanations for this are that asthmatics are less likely to smoke, older smokers might be diagnosed with COPD and that smokers might consult less often than non-smokers.

Figure 5:Patients consulting GPs for asthma by smoking status and social class

Though smoking is associated with social class, this figure shows that the class gradients in patients consulting GPs for asthma is evident in both non-smokers and smokers in the 45-64 year olds.

Mortality

Figure 6:Asthma mortality by social class in men

Comparisons of mortality rates by social class bring together occupation recorded on the death certificate with data from the census. This figure shows Standardised Mortality Ratios (SMR) for deaths due to asthma in 20-64 year old men in Great Britain during 1979-80 and 1991-93. An SMR of less than 100 means numbers of deaths are lower than expected in that class. At both times there was a trend of higher SMRs in the manual social classes and there appears to be a widening in class differences over this period. If real, this might be due to asthma attacks being more frequent or more severe (or both) in social class V as a result of more exposure to aggravating factors or to less adequate medical care. There is no information published on women dying from asthma by social class.

Summary

• There is little difference in prevalence of asthma by social class though there is a class trend in adult wheezing.

• More people from manual than non-manual classes consult GPs for asthma and they consult more often.

• The social class gradient in GP consultations in middle age is independent of current smoking habit.

• Class differentials are greater for mortality than for other indicators of asthma.

Footnote

Registrar General's Social Class

Sources and notes

(1) Health Survey for England 1996, Health of Young People, England 1995-97. The surveys aimed to provide a representative sample of population of England living in private households. The data presented cover 31,000 adults and 13,000 children.
(2) Morbidity Statistics from General Practice, Fourth National Study 1991-92. Sixty NHS volunteer practices in England and Wales took part in the study, covering ½ million patients.
(3) Health Inequalities 1997. Most deaths occur in the over 65s but many retired people are unclassified with respect to social class in the census and in the deaths registration.