Socioeconomic inequalities in severe childhood asthma: results of a nationwide cohort.

Objectives: Emerging evidence shows that health disparities contribute to an increased risk of severe asthma. Therefore, the study objectives were to explore how socioeconomic disparities influence the risk of severe paediatric asthma in the Netherlands. Methods: In this nationwide cohort study, all children aged 2-17 years living in the Netherlands between 2018 and 2022 were included. Asthma definitions were based upon individually linked data from nonpublic Dutch registry databases on asthma-related health expenditures including hospital and paediatric intensive care unit (PICU) admissions. Geospatial analysis was used to identify hot spots based on the regions with the highest counts of severe asthma. Additionally, the impact of various socioeconomic variables ( Results: The total study population consisted of 4 538 020 children. Children from the lowest income class had twice the odds of severe asthma (p<0.001) and were 2.6 times more likely to be admitted to the PICU compared to the highest income class (p<0.001). Other socioeconomic disadvantage factors for severe (acute) asthma are, in order of level of association, living in a rental house, having a migration background and having a lower socioeconomic status score based on income, education and employment history. Conclusions: We identified several socioeconomic disparities that were increased in children with severe asthma and severe acute asthma at the PICU in the Netherlands. Comprehensive assessment and mitigation of these determinants may improve health equity in paediatric severe asthma and enhancement of asthma care.