The Role of Socioeconomic Factors in Severity, Diagnosis and Management of Childhood Asthma: A Scoping Review

Vollständiger Abstract

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Abstract Background Socioeconomic status (SES) has been proposed as a determining factor in asthma severity and management, independent of its role as a confounder. This scoping review aims to systematically map the existing literature on the relationship between parental education, income, occupation, insurance status, and residential environment, and various aspects of asthma, including diagnostic delay, severity, treatment adherence, and environmental exposure. Methods Following the Arksey and O’Malley framework and the PRISMA-ScR reporting guideline, a comprehensive search was conducted across Scopus, web of Science, Google Scholar and PubMed. The search encompassed studies published between 2013 and 2025, focusing on the interaction between SES and childhood asthma (aged 0–18 years). Eighteen studies met the predefined eligibility criteria and were subsequently analysed based on exposure, outcome, population characteristics, and study design. Results Analysis of the 17 studies identified a consistent association between lower SES and increased asthma severity, frequent exacerbations, and higher rates of emergency and intensive care unit (ICU) admissions. Furthermore, a “diagnostic paradox” was observed in several studies, where children from lower SES reported fewer subjective symptoms despite showing poorer outcomes and experiencing longer delays in formal diagnosis. Conversely, higher parental income and education were consistently linked to improved asthma control and treatment adherence. Nevertheless, there was substantial variability in the concerning casual pathways and outcome definitions across the studies. Conclusion The synthesized results suggests that socioeconomic disadvantage is linked with a cumulative burden that could hinder early diagnosis and treatment adherence in childhood asthma. Given the scoping nature of this review, these association should be viewed as a indicative of a significant research and policy gap than definitive proof of causal mechanisms. In future, longitudinal and mechanistic studies is essential before specific clinical or policy interventions can be confidently recommended.