A NEW systematic review and meta-analysis has confirmed that individuals with lower incomes are significantly more likely to experience asthma exacerbations, adding weight to the argument that socioeconomic disadvantage is a key driver of poor respiratory health.
Health inequalities remain one of the most persistent challenges in public health, particularly for chronic conditions like asthma. To assess how income and employment, two major dimensions of deprivation, affect asthma outcomes, researchers conducted a systematic review and meta-analysis of studies published between January 2010–April 2025. Searches were performed using Medline and Embase, focusing on studies that examined the relationship between income and/or employment status and asthma-related outcomes, including exacerbations, hospital admissions, and mortality. Risk of bias was evaluated using the ROBINS-E and other validated tools. For quantitative synthesis, the team used the restricted maximum likelihood method to meta-analyse the rate of exacerbations and stratified findings by age group (children and adults).
Of 4,153 potential studies, 30 met inclusion criteria, with most demonstrating a low risk of bias. Nineteen studies examined income as a primary exposure in relation to asthma exacerbations, and ten were eligible for meta-analysis. The pooled data showed that people in the lowest income bracket had a 25% higher odds of experiencing asthma exacerbations compared to those in the highest income group (odds ratio [OR]: 1.25; 95% CI: 1.13–1.37). When analysed by age, the association was even stronger in children (OR: 1.36; 95% CI: 1.23–1.50), while adults also showed a significant association (OR: 1.19; 95% CI: 1.05–1.33). Only three studies explored the impact of unemployment, which was linked to higher emergency care use but yielded mixed evidence for predicting exacerbation rates.
These findings highlight income as a clear and consistent predictor of asthma exacerbations across age groups. Interventions that address upstream socioeconomic inequalities, particularly income disparity, may be crucial to reducing asthma-related health disparities.
Reference
Gassasse Z et al. Association between income, employment status, and asthma outcomes: a systematic review and meta-analysis. Lancet Reg Health Eur. 2025;56:101367.
