TY - JOUR T1 - Ethnic variation in asthma healthcare utilisation and exacerbation: systematic review and meta-analysis JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00591-2022 SP - 00591-2022 AU - AbdulQadr Akin-Imran AU - Achint Bajpai AU - Dáire McCartan AU - Liam G. Heaney AU - Frank Kee AU - Charlene Redmond AU - John Busby Y1 - 2023/01/01 UR - http://openres.ersjournals.com/content/early/2023/02/16/23120541.00591-2022.abstract N2 - Background Patients from ethnic minority groups (EMGs) frequently report poorer asthma outcomes, however a broad synthesises summarizing ethnic disparities is yet to be undertaken.Objective What is the magnitude of ethnic disparities in asthma healthcare utilisation, exacerbations and mortality?Methods MEDLINE, EMBASE and Web of Science databases were searched for studies reporting ethnic variation in asthma healthcare outcomes (primary care attendance, exacerbation, emergency department [ED] visit, hospitalisation, hospital readmission, ventilation/intubation, and mortality) between White and EMGs. Estimates were displayed using forest plots and random-effects models were used to calculate pooled estimates.‏ We conducted subgroup analyses to explore heterogeneity, including by specific ethnicity (Black, Hispanic, Asian, and Other).Results 65 studies, comprising 699 882 patients, were included. Most studies (92.3%) were conducted in the U.S.A. Patients from EMGs had evidence suggestive of lower levels of primary care attendances (OR:0.72, 95%CI:0.48–1.09), but substantially higher ED visits (OR:1.74, 95%CI:1.53–1.98), hospitalisations (OR:1.63, 95%CI:1.48–1.79) and ventilation / intubation (OR:2.67, 95%CI:1.65–4.31) when compared to White patients. We also found evidence suggestive of increased hospital readmissions (OR:1.19, 95%CI:0.90–1.57) and exacerbation rates (OR:1.10, 95%CI:0.94–1.28) among EMGs. No eligible studies explored disparities in mortality. ED attendances were much higher among Black and Hispanic patients, while Asian and other ethnicities had similar rates to White patients.Conclusions EMGs had higher secondary care utilisation and exacerbations. Despite the global importance of this issue, the majority of studies were performed in the U.S.A. Further research into the causes of these disparities, including whether these vary by specific ethnicity, is required to aid the design of effective interventions.Systematic review registration: The review was registered on PROSPERO (registration number: CRD42020200392).FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: A. Akinoso-Imran reports a grant from Health Data Research UK (Grant Number: JHR1157-100/1230). A. Bajpai was on a studentship placement programme at the Centre for Public Health, Queen's University Belfast. C. Redmond reports a PhD stipend alongside the payment of university fees, from the Department for the Economy, Northern Ireland. L. Heaney (LH) reports grant funding from Medimmune, Novartis UK, Roche/Genentech Inc, Glaxo Smith Kline, Amgen, Genentech / Hoffman la Roche, Astra Zeneca, Aerocrine and Vitalograph. LH has given lectures supported by Novartis, Hoffman la Roche/Genentech Inc, Sanofi, Glaxo Smith Kline, Astra Zeneca, Teva and Circassia. LH reports support for attending meetings from Astra Zeneca, Boehringer Ingelheim, Chiesi, Glaxo Smith Kline and Napp Pharmaceuticals. LH has taken part in advisory boards supported by Novartis, Hoffman la Roche/Genentech Inc, Sanofi, Evelo Biosciences, Glaxo Smith Kline, Astra Zeneca, Teva, Theravance and Circassia. The rest of the authors declare that they have no relevant conflicts of interest. ER -