Impact of sex, socioeconomic deprivation, ethnicity and region on exacerbation rates and mortality of chronic respiratory diseases in England: population-based cohorts

BACKGROUND: Inequalities in chronic respiratory diseases persist, yet up-to-date evidence on outcomes remains limited. We described national mortality and exacerbation rates in people with asthma and chronic obstructive pulmonary disease (COPD) since the beginning of the COVID-19 pandemic and assessed variation by inequalities. METHODS: England primary care records from the General Practice Extraction Service data for Pandemic Planning and Research were linked to Hospital Episode Statistics and Office for National Statistics mortality data. Cohorts of primary care diagnosed asthma and COPD were defined prior to 1 November 2019. Monthly age-sex-standardised exacerbation rates (Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) and Internationl Classification of Diseases (ICD) 10 codes) and mortality rates (ICD-10 codes) were calculated from 1 November 2019 to 31 March 2025, stratified by sex, Index of Multiple Deprivation (IMD), ethnicity and region. RESULTS: The study included 7644 510 people with asthma and 1 211 975 with COPD. Mean monthly exacerbation rates were higher in females than males (33% and 30% higher for asthma and COPD, respectively), while mean monthly all-cause mortality rates were 13% and 15% higher in males than females. Mean monthly exacerbation and all-cause mortality rates were higher in IMD-1 compared with IMD-10 across all conditions (asthma: 123% and 100% higher, COPD: 68% and 41% higher, respectively). Mean monthly all-cause mortality and exacerbation rates were higher in the northeast than the southwest (asthma: 22% and 69% COPD: 15% and 42% higher, respectively). Outcome rates varied by ethnicity across conditions. CONCLUSIONS: Inequalities in chronic respiratory disease outcomes persist across England despite sustained policy focus on reducing health inequalities.