Geographical and socioeconomic variation in the prevalence of asthma symptoms in English and Scottish children.

BACKGROUND: There has been controversy over the relation between poverty and asthma in the community. The aim of this analysis was to disentangle geographical and socioeconomic variation in asthma symptoms. METHODS: The analysis is based on parental reports of symptoms from data collected in 1990 and 1991. Children aged 5-11 years from three populations (English representative sample, Scottish representative sample, and an English inner city sample) were included. Of 17 677 eligible children, between 14 490 (82.0%) and 15 562 (88.0%) children were available for analysis according to symptom group. RESULTS: Wheezy symptoms were less prevalent in the Scottish sample than in the English samples and asthma attacks were most prevalent in the English representative sample. Asthma attacks were less prevalent in inner city areas than in the English representative sample (OR 0.79, 95% CI 0.66 to 0.95), but persistent wheeze and other respiratory symptoms were more prevalent (OR 1.95, 95% CI 1.65 to 2.32 and OR 1.67, 95% CI 1.52 to 1.84, respectively). The prevalence of persistent wheeze was higher in children whose father's social class was low and in those living in areas with a high Townsend score (an index of poverty) than in other children (p<0.001). Of the 14 areas with the highest Townsend score, 13 had an OR above 1 and six had an OR significantly higher than the reference area. CONCLUSIONS: Persistent wheeze is more prevalent in poor areas than in less deprived areas. This may indicate that poverty is associated with severe asthma or that a high percentage of persistent asthma symptoms in inner city areas are unrecognised and untreated.