A new study published in The Lancet Regional Health – Europe has highlighted links between income inequality and asthma exacerbations in both children and adults, renewing calls for urgent policy action to address the social determinants of health. Led by researchers from the HDR UK-funded Inflammation and Immunity Driver Programme, the systematic review and meta-analysis examined studies from 2010 to 2025 that looked at the role of income and employment in asthma outcomes. The analysis found that people in the lowest income groups were 25% more likely to experience asthma exacerbations compared to wealthier groups. For children, the odds were even higher: they were 36% more likely to suffer an asthma attack.An asthma exacerbation occurs when a person’s asthma symptoms suddenly get much worse. Symptoms can include severe breathlessness, wheezing, chest tightness, and coughing. These episodes often require urgent treatment with medication, and in more serious instances, may lead to hospital visits or even be life-threatening.“We expected to see a link between poverty and asthma,” said lead author Zakariah Gassasse, a PhD student at Imperial College London. “But we were surprised by how strong that link was, especially in children. Children living in poverty face compounding odds, from poor-quality housing and indoor pollution to chronic stress and limited access to care." He added that the findings may also reflect the generational effects of deprivation on children, where the impact of poverty accumulates over time and across generations, impacting children’s health before they are even born.While a strong link was found between low income and poor asthma outcomes, the picture for unemployment was less clear, as only three studies met the criteria for inclusion. These studies suggested a potential connection between joblessness and higher emergency care use, but evidence on exacerbation rates remains inconclusive. This study highlights the complex and multi-layered ways that poverty affects health, through poor housing, polluted environments, limited access to care, and the chronic stress of deprivation.“Those who are most deprived are more likely to work in precarious employment, with zero-hour contracts and less favourable working arrangements,” said Zak. “If they are in poor health, they will have to forgo work and their income to get treatment. It becomes an impossible choice.”The authors call for upstream interventions to reduce income inequality, such as improved housing, better employment opportunities, and targeted healthcare for the most deprived communities. According to Zak, the wider issue isn’t just one of income, but how financial insecurity cascades into every area of life. “We need policies focusing on wider forms of deprivation to enable people to manage their conditions better,” he said. “We want policy interventions to improve people’s living conditions, amenities, employment, and financial prospects order to better manage their health and wellbeing.”Asthma is a considerable public health issue in the UK, affecting 5.4 million people, with some of the highest death rates among young people in Europe. Socioeconomic status (SES) is known to influence asthma outcomes, but no prior review has focused specifically on income and employment, the two most heavily weighted domains of the Index of Multiple Deprivation (IMD).The study’s findings add urgency to initiatives like the NHS’s Core20PLUS5 programme, which aims to reduce health disparities in the UK’s most deprived populations. The approach defines a target population (the most deprived 20% of the national population as identified by the national Index of Multiple Deprivation) and identifies five focus clinical areas requiring accelerated improvement (maternity, severe mental illness, chronic respiratory disease, early cancer diagnosis, and hypertension case-finding and optimal management and lipid optimal management).The research team is based at leading UK institutions, including Imperial College London, the University of Oxford, the University of Liverpool, and Swansea University. Click here to read the full study: Gassasse, Z., Khan, I. D., Mok, E., Asick, A. M., Tan, A., Sheikh, A., Sinha, I., Davies, G. A., Whittaker, H., Kallis, C., & Quint, J. K. (2025). Association between income, employment status, and asthma outcomes: A systematic review and meta-analysis. The Lancet Regional Health – Europe, 56, 101367. https://doi.org/10.1016/j.lanepe.2025.101367 Publication date 04 Jul, 2025
