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a specific programme for the management of children and adolescents with asthma was launched in the region of Castilla y Le&#243;n in Spain&#44; including health care quality criteria&#44; a written asthma action plan for the management of exacerbations&#44; the evaluation of inhaler technique and assessment of lung function at regular intervals&#46; However&#44; there is variation in the actual capacity of the health care system to implement these practices&#44; especially at the primary care &#40;PC&#41; level&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Socioeconomic inequality &#40;SEI&#41; may preclude the achievement of favourable health care outcomes&#44; and low socioeconomic status &#40;SES&#41; has been consistently identified as a risk factor for poor asthma control&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#8211;14</span></a> Some studies have also found an association between low SES and a decreased quality of the care received by children with asthma&#44;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;18</span></a> which in turn increases the risk of poor asthma control&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> In Spain&#44; one of the mission statements of the National Health System is to guarantee health care equity and quality&#44; thereby reducing the potential deleterious effects of SEI on health&#44; including differences in asthma control among children with different SES&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The degree of asthma control at the population level can serve as a health care quality indicator&#44; with a high prevalence of poorly controlled asthma indicating inadequacy or inappropriate use of the existing health care resources&#46; In Spain&#44; it has yet to be established whether SEI is associated with health care quality and asthma control in the paediatric population&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of our study was to identify the association of SEI with asthma control measures&#44; caregiver quality of life and health care quality in school-age children and adolescents in Castilla y Le&#243;n&#44; an autonomous region in Spain with a population of 2&#46;5 million people&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Sample</span><p id="par0030" class="elsevierStylePara elsevierViewall">We conducted a cross-sectional study between March and April of 2022&#46; The study universe comprised all school-age children and adolescents &#40;age 6&#8211;14 years&#41; with active asthma managed by the public health care system of the region of Castilla y Le&#243;n&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">We selected patients by stratified random sampling&#46; First&#44; we established 3 strata defined by the 3 tertiles of the &#8220;at risk of poverty rate&#8221; &#40;ARPR&#41; distribution by census section in Castilla y Le&#243;n&#46; The ARPR is the percentage of the population aged less than 18 years residing in households with incomes of less than 60&#37; of the median equivalent income &#40;income per consumption unit&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> We obtained the ARPR distribution of each census section from the Household Income Distribution Map developed by the national institute of statistics of Spain&#44; the Instituto Nacional de Estad&#237;stica &#40;INE&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> which combines data from 2 sources<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#58; &#40;1&#41; fiscal data from the Spanish tax administration agency &#40;Agencia Estatal de Administraci&#243;n Tributaria&#41; and &#40;2&#41; data from the INE on the population residing in the area as of January 1st the year after the period covered by the income tax data&#46; In our study&#44; we used the most recently published data &#40;2018 fiscal year&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">To identify patients with asthma in each stratum&#44; we revised the health records of the primary care centres &#40;PCCs&#41; that provide health care services in each census section&#46; We established the geographical boundaries of each census section through the Cartociudad<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> application &#40;Ministry of Transport&#44; Mobility and Urban Planning of Spain&#41; and determined how they corresponded to the catchment area of each PCC using the Health Care Organization Guide of the Department of Health of Castilla y Le&#243;n&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> We randomly selected PCCs within each stratum &#40;ARPR&#41; in proportion to the population of children aged 6&#8211;14 years of each province in the region &#40;data from the INE as of July 2020&#41;&#46; We excluded PCCs that included census sections with different ARPR levels&#46; After&#44; we invited the paediatricians who worked in the selected PCCs to participate in the study&#46; If they did not respond or declined to participate&#44; they were replaced by other paediatricians in the same province and ARPR stratum&#44; who were also selected at random&#46; The collaborating paediatricians identified all children managed in their respective PCCs who met the inclusion criteria&#44; contacted their parents and invited them to participate in the study&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The inclusion criteria were&#58; documentation in the electronic health record&#44; as of 1&#47;1&#47;2022&#44; of an asthma-related condition for which the patient had received health services in 2021 &#40;at the PCC or hospital level&#41; or prescription of any asthma medication &#40;inhaled corticosteroids or leukotriene receptor antagonists&#41; in order to include only cases of currently or recently active asthma&#46; We excluded children whose families had language barriers precluding effective written communication&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables</span><p id="par0050" class="elsevierStylePara elsevierViewall">After consenting to participation&#44; the main caregivers of the patients completed questionnaires from which data for the variables of interest were retrieved&#44; which concerned&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0055" class="elsevierStylePara elsevierViewall">Sociodemographic characteristics&#46; Age&#44; sex&#44; residential setting &#40;urban&#47;rural municipality&#44; defined by the threshold of 20 000 inhabitants&#41;&#44; number of members in the household&#44; exposure to tobacco smoke &#40;smoker in the household&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0060" class="elsevierStylePara elsevierViewall">Asthma control&#46; We assessed the components of <span class="elsevierStyleItalic">impairment</span> and <span class="elsevierStyleItalic">risk</span>&#46; Impairment&#44; defined by the current level of control &#40;at the time of the survey in 2022&#41;&#44; was assessed with the parent proxy version of the CAN questionnaire &#40;<span class="elsevierStyleItalic">Control del Asma en Ni&#241;os</span>&#44; or asthma control in children&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> This instrument is used to assess asthma control in the past 4 weeks and comprises 9 items rated on a Likert scale ranging from 0 to 4 points &#40;total possible score&#44; 0&#8211;36 points&#41;&#44; with higher scores indicating poorer asthma control&#46; Poorly controlled asthma was defined as a CAN score of 8 or higher&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> We assessed risk through 3 variables in reference to year 2021&#58; on-demand or urgent visits to PCC or hospital&#44; having received at least 1 course of oral corticosteroids&#44; hospital admission due to asthma&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0065" class="elsevierStylePara elsevierViewall">Parent&#47;caregiver asthma-related quality of life&#46; This was assessed with the IFABI-R &#40;revised version of the <span class="elsevierStyleItalic">Impacto Familiar del Asma Bronquial Infantil</span>&#44; or Family Impact of Childhood Bronchial Asthma questionnaire&#41;&#44; specifically designed to measure the impact on the quality of life of the primary caregivers of children with asthma in the past 3 months&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> It consists of 15 items rated on a Likert scale exploring the functional&#44; emotional and socio-occupational dimensions of quality of life&#46; The scores range from 1 to 4&#44; and higher scores represent a greater impact of asthma and a poorer quality of life in caregivers&#46; The minimum clinically important difference is of 0&#46;3 points&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4</span><p id="par0070" class="elsevierStylePara elsevierViewall">Health care-related variables&#46; Use &#40;or not&#41; of daily maintenance treatment&#44; and number of drugs used&#44; physician chiefly responsible for managing asthma in the child &#40;only PC physician&#44; involvement of allergologist&#41;&#44; previous allergy testing &#40;in vivo or in vitro&#41;&#44; previous lung function testing with spirometry &#40;ever and in 2021&#41;&#44; verification by a health care professional of correct inhaler technique &#40;ever and in 2021&#41;&#44; having a written asthma action plan for management of exacerbations&#44; having received guidance to avoid tobacco exposure&#44; scheduled follow-up visit in 2021&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5</span><p id="par0075" class="elsevierStylePara elsevierViewall">Other social and family-related aspects&#58; parental educational attainment &#40;having completed at least secondary education or a higher education degree&#41; and whether the parents lived with the child&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Sample size</span><p id="par0080" class="elsevierStylePara elsevierViewall">We calculated the sample size necessary to estimate the prevalence of poorly controlled asthma&#44; assuming a prevalence of asthma of 7&#37; and a prevalence of poorly controlled asthma of 30&#37;&#44; with a precision of 5&#37; and a confidence level of 95&#37;&#44; and found that we needed 313 patients evenly distributed through the 3 ARPR strata&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0085" class="elsevierStylePara elsevierViewall">The main outcomes under study were asthma control &#40;poor control in 2022 based on the CAN questionnaire and 3 risk indicators in reference to 2021&#58; on demand&#47;urgent visits&#44; hospital admission&#44; use of oral corticosteroids&#41; and caregiver quality of life in 2022&#46; We assessed their association with the ARPR stratum&#44; other sociodemographic variables &#40;urban&#47;rural setting&#44; parental educational attainment&#44; exposure to tobacco smoke at home&#41; and with health care-related variables &#40;management exclusively at PC level&#41; with bivariate tests &#40;&#967;<span class="elsevierStyleSup">2</span> test&#44; Mantel&#8211;Haenzsel statistic&#44; Pearson correlation&#44; Student <span class="elsevierStyleItalic">t</span> test and analysis of variance&#44; as applicable&#41; and multivariate regression methods &#40;logistic regression and multiple regression&#41;&#46; We adjusted the multivariate models for age&#44; sex&#44; ARPR stratum&#44; urban&#47;rural setting&#44; exclusive PC management&#44; presence of smoker in the household and paternal and maternal educational attainment&#46; The models of asthma control in 2022 and of caregiver quality of life were also adjusted for the history of on demand&#47;urgent visits in 2021&#46; We defined statistical significance as a probability of &#945; error of less than 0&#46;05&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical considerations</span><p id="par0090" class="elsevierStylePara elsevierViewall">The study was approved by the Clinical Research Ethics Committee of the Hospital Universitario R&#237;o Hortega&#46; The parents of the participants received written information about the study and signed an informed consent form&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0095" class="elsevierStylePara elsevierViewall">W contacted a total of 108 paediatricians&#44; of who 40 &#40;37&#46;0&#37;&#41; agreed to collaborate&#46; There were no significant differences in the percentage of paediatricians that agreed to collaborate between ARPR strata &#40;41&#46;0&#37;&#44; 28&#46;6&#37; and 41&#46;2&#37;&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;971&#41;&#46; We did not obtain data for one of the 9 provinces because no paediatrician in the province was included in the study&#46; The collaborating paediatricians identified 586 patients who met the inclusion criteria&#44; of who 80 &#40;13&#46;7&#37;&#41; could not be reached and 349 &#40;59&#46;6&#37;&#41; agreed to participate&#46; We also found no significant differences in the participation of patients between ARPR strata &#40;54&#46;2&#37;&#44; 68&#46;6&#37; and 58&#46;1&#37;&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;418&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the demographic and clinical characteristics of the sample&#44; which were evenly distributed between the ARPR strata&#46; Of the total patients&#44; 32&#46;2&#37; had poorly controlled asthma in 2022&#44; and in 2021&#44; 52&#46;0&#37; made on demand&#47;urgent visits&#44; 54&#46;8&#37; received oral corticosteroids and 4&#46;0&#37; were hospitalised&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Low SES &#40;the high ARPR category&#41; was significantly associated with residing in a rural area&#44; the father and mother living with the patient&#44; a higher likelihood of exposure to tobacco smoke in the home&#44; lower paternal educational attainment&#44; a lower likelihood of management exclusively at the PC level&#44; a greater likelihood of polypharmacy&#44; greater frequency of spirometry &#40;ever and in 2021&#41;&#44; having a written asthma action plan and having had a scheduled follow-up visit in 2021&#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; WE found no differences in variables related to asthma control or quality of life&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Exclusive management at the PC level was associated with a lower frequency of several care quality criteria&#58; scheduled follow-up visit in 2021 &#40;17&#46;7&#37; vs 67&#46;6&#37;&#59; <span class="elsevierStyleItalic">P</span> &#60; &#46;001&#41;&#44; having undergone spirometry for lung function testing at any point in the past &#40;30&#46;5&#37; vs 69&#46;5&#37;&#59; <span class="elsevierStyleItalic">P</span> &#60; &#46;001&#41; and in 2021 &#40;10&#46;4&#37; vs 29&#46;5&#37;&#59; <span class="elsevierStyleItalic">P</span> &#60; &#46;001&#41;&#44; having a written asthma action plan &#40;41&#46;0&#37; vs 66&#46;5&#37;&#59; <span class="elsevierStyleItalic">P</span> &#60; &#46;001&#41;&#44; knowing what to do in the case of an exacerbation &#40;78&#46;1&#37; vs 95&#46;2&#37;&#59; <span class="elsevierStyleItalic">P</span> &#60; &#46;001&#41; and assessment of inhaler technique in 2021 &#40;28&#46;4&#37; vs 40&#46;0&#37;&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;028&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Some social and family variables were significantly associated with some of the outcomes&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0115" class="elsevierStylePara elsevierViewall">In patients who lived with a smoker&#44; the frequency of on demand&#47;urgent visits in 2021 was higher &#40;62&#46;1&#37; vs 47&#46;1&#37;&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;009&#41;&#44; as was the frequency of poorly controlled asthma in 2022 &#40;39&#46;3&#37; vs 28&#46;6&#37;&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;044&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0120" class="elsevierStylePara elsevierViewall">In patients whose mothers completed secondary&#47;higher education&#44; the frequency of on demand&#47;urgent visits in 2021 was lower &#40;46&#46;7&#37; vs 67&#46;4&#37;&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;001&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0125" class="elsevierStylePara elsevierViewall">In patients whose fathers completed secondary&#47;higher education&#44; the frequency of poorly controlled asthma in 2022 was lower &#40;26&#46;2&#37; vs 40&#46;0&#37;&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;013&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0130" class="elsevierStylePara elsevierViewall">The quality of life assessed by means of the IFABI-R was somewhat poorer &#40;higher score&#41; in urban vs rural settings &#40;mean&#44; 1&#46;68 &#91;standard deviation &#91;SD&#93; 0&#46;63&#93; vs 1&#46;55 &#91;SD&#44; 0&#46;56&#93;&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;045&#41; and improved with increasing patient age &#40;r&#8239;&#61;&#8239;&#8722;0&#46;177&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;001&#41;&#46;</p></li></ul></p><p id="par0135" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> presents the results of the multivariate analysis&#46; The probability of on demand&#47;urgent visits in 2021 was lower if the mother had completed secondary education or a higher education degree&#46; The probability of poor asthma control in 2022 was lower if the patient was managed exclusively at the PC level and if the father had completed secondary education or a higher education degree&#44; but poor asthma control was most strongly associated with the history of on demand&#47;urgent visits in 2021&#46; The quality of life of caregivers was better &#40;lower score on the IFABI-R&#41; when the patient was followed up exclusively at the PC level and with increasing patient age&#44; but the only variable associated with a clinically important difference in quality of life &#40;difference &#62;0&#46;3 points in the IFABI-R&#41; was the history on demand&#47;urgent visits in 2021&#46; None of the multivariate models evinced an independent association of SEI with the outcome variables&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Findings</span><p id="par0140" class="elsevierStylePara elsevierViewall">In this study&#44; we did not find evidence that lower SES is associated with differences in asthma control in children in our population nor with a poorer quality of life in caregivers or poorer quality of the care received&#46; A higher parental educational attainment seems to be associated with better asthma control&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Limitations</span><p id="par0145" class="elsevierStylePara elsevierViewall">There are several limitations to this study that may have reduced the observed effect of SEI&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">1</span><p id="par0150" class="elsevierStylePara elsevierViewall">The identification of the income level based on the place of residence is considered an efficient method with a low risk of bias that generates results in the same direction as measures at the individual level&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a> However&#44; there is a risk of incorrect classification&#44; which could have diluted the actual impact of SEI&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">2</span><p id="par0155" class="elsevierStylePara elsevierViewall">The fact that census sections and the catchment areas of PCCs do not match may have resulted in contamination bias&#46; Although we excluded PCCs with catchment areas across census sections in different ARPR categories&#44; we cannot rule out the possibility of contamination&#44; which would also reduce the apparent effect of SES&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">3</span><p id="par0160" class="elsevierStylePara elsevierViewall">The census section income data correspond to 2018&#44; but we collected data on asthma control variables in 2022&#46; If there were changes in the income distribution&#44; they would have hindered the detection of an association between income and asthma control&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">4</span><p id="par0165" class="elsevierStylePara elsevierViewall">The COVID pandemic affected both the health care services provided to children with asthma as well as asthma control at the global level&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> which may have also affected the association between SEI and asthma control&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">5</span><p id="par0170" class="elsevierStylePara elsevierViewall">Spain is very diverse in certain socioeconomic and health care aspects&#44; so our results cannot be generalised without carrying out similar studies in other regions&#46; Our region is sparsely urbanised&#44; there are no large cities and no large economically depressed areas&#44; which are the main targets of studies conducted in countries such as the United States&#46; Thus&#44; the impact of urban poverty&#44; which may be substantial&#44; is not adequately represented in our sample&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">6</span><p id="par0175" class="elsevierStylePara elsevierViewall">We used instruments &#40;CAN&#44; IFABI-R&#41; validated in Spanish&#44; so we excluded families with language barriers&#46; As a result&#44; our study is not representative of the immigrant population with language barriers&#44; which may be particularly socioeconomically vulnerable&#46;</p></li></ul></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Interpretation</span><p id="par0180" class="elsevierStylePara elsevierViewall">The Beveridge health care system model &#40;National Health Service model&#44; such as the systems found in Spain&#44; United Kingdom&#44; Denmark&#44; Portugal&#44; Sweden and other European countries&#41; aims at providing universal coverage for health care services in order to decrease the impact of SEI on health&#46; It is important to confirm that this objective is achieved&#44; but in Spain the evidence on socioeconomic health determinants is scarce&#44; especially in relation child health&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> As for asthma&#44; most of the evidence comes from countries with other types of health care systems &#40;especially the United States&#41; and studies in adults&#46; A recent metanalysis &#40;61 studies&#44; most conducted in the USA&#44; only 2 including paediatric participants&#41;&#44; found that a lower SES was associated with adverse events during asthma follow-up &#40;emergency visits&#44; hospital admission&#44; readmission&#44; need of ventilation&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> However&#44; there is also recent evidence in Europe of an adverse impact of SEI on asthma control in children and adolescents&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> Our findings were not in agreement with those results&#44; which could be due to several reasons&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">1</span><p id="par0185" class="elsevierStylePara elsevierViewall">Some studies found an association between lower SES and less frequent use of asthma medication&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> which could contribute to poorer asthma control&#46; In our study&#44; however&#44; we found a higher frequency of polypharmacy in patients who resided in low-income areas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">2</span><p id="par0190" class="elsevierStylePara elsevierViewall">The impact of SEI on asthma-related outcomes is chiefly mediated by factors like social and family support&#44; caregiver stress and self-management education&#44; while factors such as access to the health care system&#44; individual behaviour and lifestyle habits are less important&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;34</span></a> This may explain why standardised management has been found not to eliminate the effect of SEI in asthma control in the United States&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> while interventions aimed at reducing social risks do achieve this goal&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> Social and family-related variables and stress may differ significantly in our population compared to the populations of these other studies&#46;</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">3</span><p id="par0195" class="elsevierStylePara elsevierViewall">Particularities of the Spanish health care system&#44; with a high number of paediatricians on staff in the PC network&#44; which is not the case of other European countries&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> Furthermore&#44; while other studies found that patients of lower SES were less frequently managed by specialists&#44;<span class="elsevierStyleSup">37</span> the opposite was observed in our sample&#58; exclusive follow-up in the PC system was less frequent with decreasing SES&#46; We found that management exclusively at the PC level was associated with lower adherence to certain care quality standards&#44; but at the same time was associated with better asthma control and caregiver quality of life&#44; which we attributed to the lower severity of asthma cases managed exclusively at the PC level&#46;</p></li></ul></p><p id="par0200" class="elsevierStylePara elsevierViewall">In conclusion&#44; we found that in the population of our region&#44; SEI was not associated with relevant outcomes of asthma in children&#44; nor with differences in health care quality&#46; We consider that this evinces the effectiveness of the National Health System in reducing the health care disparities that may result from SEI&#46; Nevertheless&#44; the quality of health care should improve&#44; especially at the PC level&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Funding</span><p id="par0205" class="elsevierStylePara elsevierViewall">The study was funded by a research grant of the <span class="elsevierStyleGrantSponsor" id="gs0005">Gerencia Regional de Salud de Castilla and Le&#243;n</span> &#40;<span class="elsevierStyleGrantNumber" refid="gs0005">GRS 2349&#47;A&#47;21</span>&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicts of interest</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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    "fechaAceptado" => "2022-12-29"
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            1 => "Health inequalities"
            2 => "Asthma"
            3 => "Health services"
            4 => "Cross-sectional studies"
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            0 => "Factores socioecon&#243;micos"
            1 => "Desigualdades en salud"
            2 => "Asma"
            3 => "Servicios de salud"
            4 => "Estudios transversales"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Socioeconomic inequality &#40;SEI&#41; can adversely affect asthma control&#46; The aim of this study was to establish the association of SEI with asthma control in children and caregiver quality of life&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">We assessed socioeconomic status based on the area of residence&#44; according to the at risk of poverty rate &#40;ARPR&#41;&#46; After stratifying the paediatric population of Castilla y Le&#243;n &#40;Spain&#41; in ARPR tertiles&#44; we selected participants by stratified random sampling&#44; and identified children with asthma aged 6&#8211;14 years from the health records of primary care centres&#46; We collected data through questionnaires completed by parents&#46; The primary outcomes were asthma control and caregiver quality of life&#46; We assessed their association with SEI&#44; health care quality measures and individual factors &#40;such as parental educational attainment&#41; by means of multivariate regression models&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Result</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The ARPR tertile was not associated with asthma control&#44; quality of life or health care quality&#46; A medium or high maternal educational attainment was associated with a lower risk of making an unscheduled or urgent visit &#40;OR&#8239;&#61;&#8239;&#46;50&#59; 95&#37; CI&#44; &#46;27&#8211;&#46;95&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;034&#41; and paternal educational attainment was associated with a lower risk of uncontrolled asthma &#40;OR&#8239;&#61;&#8239;0&#46;51&#59; 95&#37; CI&#44; &#46;28&#8211;&#46;94&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;030&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">In the sample under study&#44; SEI assessed at the local level was not associated with asthma control in children&#46; Other factors&#44; such as parental educational attainment&#44; may have a protective effect&#46;</p></span>"
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            "titulo" => "Introduction"
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            "identificador" => "abst0015"
            "titulo" => "Methods"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">La desigualdad socioecon&#243;mica &#40;DSE&#41; puede afectar negativamente al control del asma&#46; El objetivo de este estudio fue identificar la relaci&#243;n de la DSE con el control del asma y la calidad de vida de los cuidadores&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">M&#233;todos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">El nivel socioecon&#243;mico se determin&#243; por &#225;rea de residencia&#44; seg&#250;n la tasa de riesgo de pobreza &#40;TRP&#41;&#46; La poblaci&#243;n pedi&#225;trica de la comunidad aut&#243;noma se estratific&#243; en terciles de TRP&#44; y se seleccion&#243; una muestra mediante muestreo aleatorio estratificado&#44; identificando a los ni&#241;os &#40;6&#8211;14 a&#241;os&#41; con asma activa en los registros cl&#237;nicos de centros de atenci&#243;n primaria&#46; La informaci&#243;n se obtuvo mediante cuestionarios cumplimentados por los padres&#46; Las variables primarias fueron el control del asma y la calidad de vida de los cuidadores&#46; Se analiz&#243; su relaci&#243;n con la DSE&#44; la calidad de la atenci&#243;n sanitaria y factores individuales &#40;como el nivel educativo de los padres&#41; mediante modelos multivariantes de regresi&#243;n&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">El tercil de TRP no se relacion&#243; con ninguna medida de control del asma&#44; calidad de vida ni calidad de la asistencia&#46; El nivel educativo de la madre &#40;educaci&#243;n media o superior&#41; se asociaba a menor riesgo de consulta no programada&#47;urgente &#40;OR&#8239;&#61;&#8239;0&#44;50&#44; IC 95&#37;&#58; 0&#44;27&#8722;0&#44;95&#44; p&#8239;&#61;&#8239;0&#44;034&#41; y el del padre a menor riesgo de asma mal controlada &#40;OR&#8239;&#61;&#8239;0&#44;51&#44; IC 95&#37;&#58; 0&#44;28&#8722;0&#44;94&#44; p&#8239;&#61;&#8239;0&#44;030&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusi&#243;n</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">En la poblaci&#243;n que hemos estudiado&#44; no se encuentra asociaci&#243;n entre DSE&#44; medida por &#225;rea de residencia&#44; y el control del asma en ni&#241;os&#46; Otros factores&#44; como la educaci&#243;n de los padres&#44; pueden ser factores protectores&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">The members of the CANDAS Group are presented in Appendix A&#46;</p>"
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            "apendice" => "<p id="par0215" class="elsevierStylePara elsevierViewall">Ana Bel&#233;n Camina Guti&#233;rrez &#40;Centro de Salud &#91;CS&#93; Casa del Barco&#44; Valladolid&#41;&#59; Ana Rodr&#237;guez Gonz&#225;lez &#40;CS Lerma&#44; Burgos&#41;&#59; Ana Libr&#225;n Pe&#241;a &#40;CS Circunvalaci&#243;n&#44; Valladolid&#41;&#59; David Garc&#237;a Vaquero &#40;CS Villarcayo&#44; Burgos&#41;&#59; Elena Gonz&#225;lez Garc&#237;a &#40;CS Eras de Renueva&#44; Leon&#41;&#59; Francisco Fern&#225;ndez Pastor &#40;CS Santa Elena&#44; Zamora&#41;&#59; Ignacio Ledesma Ben&#237;tez &#40;CS Trobajo del Camino&#44; Leon&#41;&#59; Isabel Redondo D&#237;ez &#40;CS Pe&#241;afiel&#44; Valladolid&#41;&#59; Jos&#233; Francisco Colinas Herrero &#40;CS Jardinillos&#44; Palencia&#41;&#59; Jos&#233; Francisco Garc&#237;a de la Fuente &#40;CS Ponferrada I&#44; Leon&#41;&#59; Jos&#233; Jorge Mart&#237;n Mart&#237;n &#40;CS Alba de Tormes&#44; Salamanca&#41;&#59; Jos&#233; Luis Urquiza F&#237;sico &#40;CS Huelgas&#44; Burgos&#41;&#59; Juncal Reguera Bernardino &#40;CS Astorga I&#44; Leon&#41;&#59; Leyre L&#243;pez Villanueva &#40;CS Miranda Este&#44; Burgos&#41;&#59; Mar&#237;a Isabel G&#243;mez Martin &#40;CS Tudela de Duero&#44; Valladolid&#41;&#59; Mar&#237;a Jes&#250;s Alonso Ballesteros &#40;CS Medina del Campo&#44; Valladolid&#41;&#59; Mar&#237;a Jes&#250;s Vaquerizo Pollino &#40;CS Circular&#44; Valladolid&#41;&#59; Mar&#237;a Jos&#233; D&#237;ez Huerga &#40;CS Salda&#241;a&#44; Palencia&#41;&#59; Mar&#237;a Jos&#233; Mart&#237;n Sierra &#40;CS Tudela de Duero&#44; Valladolid&#41;&#59; Mar&#237;a Montserrat Rodr&#237;guez Fern&#225;ndez &#40;CS Jos&#233; Aguado I&#44; Leon&#41;&#59; Mar&#237;a Romero Calvo D&#237;az &#40;CS Miranda Este&#44; Burgos&#41;&#59; Mar&#237;a Dom&#237;nguez Villoria &#40;CS Casto Prieto&#44; Salamanca&#41;&#59; Mar&#237;a Polo de Dios &#40;CS Zamora Sur&#44; Zamora&#41;&#59; Mar&#237;a Rodr&#237;guez Rodr&#237;guez &#40;CS Aguilar de Campo&#243;&#44; Palencia&#41;&#59; Mar&#237;a Teresa S&#225;nchez V&#233;lez &#40;CS B&#233;jar&#44; Salamanca&#41;&#59; Marta Esther V&#225;zquez Fern&#225;ndez &#40;CS Circunvalaci&#243;n&#44; Valladolid&#41;&#59; Marta Pascual S&#225;nchez &#40;CS Estaci&#243;n&#44; Avila&#41;&#59; Miriam Mata Jorge &#40;CS Magdalena&#44; Valladolid&#41;&#59; Montserrat Piriz Veloso &#40;CS Pe&#241;afiel&#44; Valladolid&#41;&#59; Nieves San Jos&#233; Calleja &#40;CS Huelgas&#44; Burgos&#41;&#59; Olga Garc&#237;a Bodega &#40;CS Soria Rural&#44; Soria&#41;&#59; Patricia Gonz&#225;lez Ildefonso &#40;CS Estaci&#243;n&#44; Avila&#41;&#59; Pedro Florencio Mart&#237;nez &#40;CS Miranda Oeste&#44; Burgos&#41;&#59; Pilar &#193;lvarez Mingorance &#40;CS Medina del Campo&#44; Valladolid&#41;&#59; Pilar G&#243;mez Sorrigueta &#40;CS Eras de Renueva&#44; Le&#243;n&#41;&#59; Rafael Pe&#241;alver Penedo &#40;CS Almaz&#225;n&#44; Soria&#41;&#59; Raquel Roll&#243;n Casillas &#40;CS Estaci&#243;n&#44; &#193;vila&#41;&#59; Sara Anibarro P&#233;rez &#40;CS Tordesillas&#44; Valladolid&#41;&#59; Soledad L&#243;pez Palacios &#40;CS Alba de Tormes&#44; Salamanca&#41;&#59; Susana Alberola L&#243;pez &#40;CS Jardinillos&#44; Palencia&#41; y Teresa Centeno Robles &#40;CS Rondilla I&#44; Valladolid&#41;&#46;</p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Members of the CANDAS group"
            "identificador" => "sec0075"
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                  \t\t\t\t">70&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">At risk of poverty rate &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mother completed secondary&#47;higher ed &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Father completed secondary&#47;higher ed &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smoker in household &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Managed only by primary care paediatrician &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Daily maintenance treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number of daily drugs in combination &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Allergy testing &#40;ever&#41; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spirometry &#40;ever&#41; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spirometry in 2021 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Written asthma action plan &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Know what to do in exacerbation &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inhaler technique assessed &#40;ever&#41; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inhaler technique assessed in 2021 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Counselled to avoid exposure to tobacco smoke &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hospitalization due to asthma &#40;ever&#41; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Attended scheduled follow-up in 2021 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">On demand&#47;urgent visit in 2021 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hospitalization due to asthma in 2021 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral corticosteroids in 2021 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IFABI-R score &#40;mean&#8239;&#177;&#8239;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;61&#8239;&#177;&#8239;0&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poor control &#40;CAN&#8239;&#8805;&#8239;8&#41; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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      1 => array:8 [
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Table "
            "rol" => "short"
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        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">ARPR&#44; at risk of poverty rate&#59; SD&#44; standard deviation&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">At risk of poverty rate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Medium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">High&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ARPR as &#37; &#40;range&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;1&#8722;22&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;6&#8722;29&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;6&#8722;38&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age in years &#40;mean&#8239;&#177;&#8239;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;1&#8239;&#177;&#8239;2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;9&#8239;&#177;&#8239;2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Person completing questionnaire &#40;&#37;&#41;</span></td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Number of other household members&#44; &#40;mean&#8239;&#177;&#8239;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Smoker in household &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mother cohabitant &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Father cohabitant &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mother completed secondary&#47;higher ed &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Father completed secondary&#47;higher ed &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Physician in charge &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Only primary care paediatrician&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Involvement of allergologist&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#46;135&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Daily maintenance treatment</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">40&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;62&#8239;&#177;&#8239;0&#46;52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Variables in model&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Oral corticosteroids &#40;2021&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">IFABI-R &#40;2022&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Medium risk&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;86 &#40;0&#46;46&#8722;1&#46;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;07 &#40;0&#46;56&#8722;2&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;37 &#40;0&#46;66&#8722;2&#46;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00 &#40;&#8722;0&#46;18&#8722;0&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;645&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;839&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;396&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;990&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>High risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;09 &#40;0&#46;59&#8722;2&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;45 &#40;0&#46;12&#8722;1&#46;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;66 &#40;0&#46;36&#8722;1&#46;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;11 &#40;0&#46;56&#8722;2&#46;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8722;0&#46;02 &#40;&#8722;0&#46;20&#8722;0&#46;15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#46;06 &#40;&#8722;0&#46;20&#8722;0&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Age in years</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#46;04 &#40;&#8722;0&#46;06&#8722;0&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#46;03 &#40;&#8722;0&#46;18&#8722;0&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Father with secondary&#47;higher education</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#46;14 &#40;&#8722;0&#46;30&#8722;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
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Original Article
Asthma control in children, socioeconomic inequality and health care
Control del asma en niños, desigualdad socioeconómica y asistencia sanitaria
Miguel Antoñóna, Juan Ventura Pernía-Sáncheza, Teresa Cancho-Sotoa, Inés Segovia-Molinaa, Nuria Díez-Mongea,b, Alfredo Canoa,b,
Corresponding author
acanog@saludcastillayleon.es

Corresponding author.
, grupo CANDAS 1
a Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain
b Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Asthma is the most frequent chronic disease in the paediatric population&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> with a prevalence of approximately 10&#37; in school-age children in Spain&#44; although with some variation between geographical areas &#40;6&#37;&#8211;8&#37; in Castilla y Le&#243;n&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The goals of asthma management are to achieve <span class="elsevierStyleItalic">symptom control</span> and <span class="elsevierStyleItalic">reduce the risk</span> of exacerbations so that patients can lead normal lives for their age&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However&#44; in developed countries&#44; 30&#37;&#8211;50&#37; of school-age children and adolescents with asthma have poor asthma control&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In a large proportion of cases&#44; poor asthma control is due to factors modifiable through health care&#44; such as poor inhaler technique<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> or low adherence to treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Therefore&#44; education on asthma self-management is crucial to achieve adequate control and an efficient use of health care resources&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> and clinical guidelines recommend it as one of the cornerstones of asthma management&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;10</span></a> In 2004&#44; a specific programme for the management of children and adolescents with asthma was launched in the region of Castilla y Le&#243;n in Spain&#44; including health care quality criteria&#44; a written asthma action plan for the management of exacerbations&#44; the evaluation of inhaler technique and assessment of lung function at regular intervals&#46; However&#44; there is variation in the actual capacity of the health care system to implement these practices&#44; especially at the primary care &#40;PC&#41; level&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Socioeconomic inequality &#40;SEI&#41; may preclude the achievement of favourable health care outcomes&#44; and low socioeconomic status &#40;SES&#41; has been consistently identified as a risk factor for poor asthma control&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#8211;14</span></a> Some studies have also found an association between low SES and a decreased quality of the care received by children with asthma&#44;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;18</span></a> which in turn increases the risk of poor asthma control&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> In Spain&#44; one of the mission statements of the National Health System is to guarantee health care equity and quality&#44; thereby reducing the potential deleterious effects of SEI on health&#44; including differences in asthma control among children with different SES&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The degree of asthma control at the population level can serve as a health care quality indicator&#44; with a high prevalence of poorly controlled asthma indicating inadequacy or inappropriate use of the existing health care resources&#46; In Spain&#44; it has yet to be established whether SEI is associated with health care quality and asthma control in the paediatric population&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of our study was to identify the association of SEI with asthma control measures&#44; caregiver quality of life and health care quality in school-age children and adolescents in Castilla y Le&#243;n&#44; an autonomous region in Spain with a population of 2&#46;5 million people&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Sample</span><p id="par0030" class="elsevierStylePara elsevierViewall">We conducted a cross-sectional study between March and April of 2022&#46; The study universe comprised all school-age children and adolescents &#40;age 6&#8211;14 years&#41; with active asthma managed by the public health care system of the region of Castilla y Le&#243;n&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">We selected patients by stratified random sampling&#46; First&#44; we established 3 strata defined by the 3 tertiles of the &#8220;at risk of poverty rate&#8221; &#40;ARPR&#41; distribution by census section in Castilla y Le&#243;n&#46; The ARPR is the percentage of the population aged less than 18 years residing in households with incomes of less than 60&#37; of the median equivalent income &#40;income per consumption unit&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> We obtained the ARPR distribution of each census section from the Household Income Distribution Map developed by the national institute of statistics of Spain&#44; the Instituto Nacional de Estad&#237;stica &#40;INE&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> which combines data from 2 sources<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#58; &#40;1&#41; fiscal data from the Spanish tax administration agency &#40;Agencia Estatal de Administraci&#243;n Tributaria&#41; and &#40;2&#41; data from the INE on the population residing in the area as of January 1st the year after the period covered by the income tax data&#46; In our study&#44; we used the most recently published data &#40;2018 fiscal year&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">To identify patients with asthma in each stratum&#44; we revised the health records of the primary care centres &#40;PCCs&#41; that provide health care services in each census section&#46; We established the geographical boundaries of each census section through the Cartociudad<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> application &#40;Ministry of Transport&#44; Mobility and Urban Planning of Spain&#41; and determined how they corresponded to the catchment area of each PCC using the Health Care Organization Guide of the Department of Health of Castilla y Le&#243;n&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> We randomly selected PCCs within each stratum &#40;ARPR&#41; in proportion to the population of children aged 6&#8211;14 years of each province in the region &#40;data from the INE as of July 2020&#41;&#46; We excluded PCCs that included census sections with different ARPR levels&#46; After&#44; we invited the paediatricians who worked in the selected PCCs to participate in the study&#46; If they did not respond or declined to participate&#44; they were replaced by other paediatricians in the same province and ARPR stratum&#44; who were also selected at random&#46; The collaborating paediatricians identified all children managed in their respective PCCs who met the inclusion criteria&#44; contacted their parents and invited them to participate in the study&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The inclusion criteria were&#58; documentation in the electronic health record&#44; as of 1&#47;1&#47;2022&#44; of an asthma-related condition for which the patient had received health services in 2021 &#40;at the PCC or hospital level&#41; or prescription of any asthma medication &#40;inhaled corticosteroids or leukotriene receptor antagonists&#41; in order to include only cases of currently or recently active asthma&#46; We excluded children whose families had language barriers precluding effective written communication&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables</span><p id="par0050" class="elsevierStylePara elsevierViewall">After consenting to participation&#44; the main caregivers of the patients completed questionnaires from which data for the variables of interest were retrieved&#44; which concerned&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0055" class="elsevierStylePara elsevierViewall">Sociodemographic characteristics&#46; Age&#44; sex&#44; residential setting &#40;urban&#47;rural municipality&#44; defined by the threshold of 20 000 inhabitants&#41;&#44; number of members in the household&#44; exposure to tobacco smoke &#40;smoker in the household&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0060" class="elsevierStylePara elsevierViewall">Asthma control&#46; We assessed the components of <span class="elsevierStyleItalic">impairment</span> and <span class="elsevierStyleItalic">risk</span>&#46; Impairment&#44; defined by the current level of control &#40;at the time of the survey in 2022&#41;&#44; was assessed with the parent proxy version of the CAN questionnaire &#40;<span class="elsevierStyleItalic">Control del Asma en Ni&#241;os</span>&#44; or asthma control in children&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> This instrument is used to assess asthma control in the past 4 weeks and comprises 9 items rated on a Likert scale ranging from 0 to 4 points &#40;total possible score&#44; 0&#8211;36 points&#41;&#44; with higher scores indicating poorer asthma control&#46; Poorly controlled asthma was defined as a CAN score of 8 or higher&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> We assessed risk through 3 variables in reference to year 2021&#58; on-demand or urgent visits to PCC or hospital&#44; having received at least 1 course of oral corticosteroids&#44; hospital admission due to asthma&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0065" class="elsevierStylePara elsevierViewall">Parent&#47;caregiver asthma-related quality of life&#46; This was assessed with the IFABI-R &#40;revised version of the <span class="elsevierStyleItalic">Impacto Familiar del Asma Bronquial Infantil</span>&#44; or Family Impact of Childhood Bronchial Asthma questionnaire&#41;&#44; specifically designed to measure the impact on the quality of life of the primary caregivers of children with asthma in the past 3 months&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> It consists of 15 items rated on a Likert scale exploring the functional&#44; emotional and socio-occupational dimensions of quality of life&#46; The scores range from 1 to 4&#44; and higher scores represent a greater impact of asthma and a poorer quality of life in caregivers&#46; The minimum clinically important difference is of 0&#46;3 points&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4</span><p id="par0070" class="elsevierStylePara elsevierViewall">Health care-related variables&#46; Use &#40;or not&#41; of daily maintenance treatment&#44; and number of drugs used&#44; physician chiefly responsible for managing asthma in the child &#40;only PC physician&#44; involvement of allergologist&#41;&#44; previous allergy testing &#40;in vivo or in vitro&#41;&#44; previous lung function testing with spirometry &#40;ever and in 2021&#41;&#44; verification by a health care professional of correct inhaler technique &#40;ever and in 2021&#41;&#44; having a written asthma action plan for management of exacerbations&#44; having received guidance to avoid tobacco exposure&#44; scheduled follow-up visit in 2021&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5</span><p id="par0075" class="elsevierStylePara elsevierViewall">Other social and family-related aspects&#58; parental educational attainment &#40;having completed at least secondary education or a higher education degree&#41; and whether the parents lived with the child&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Sample size</span><p id="par0080" class="elsevierStylePara elsevierViewall">We calculated the sample size necessary to estimate the prevalence of poorly controlled asthma&#44; assuming a prevalence of asthma of 7&#37; and a prevalence of poorly controlled asthma of 30&#37;&#44; with a precision of 5&#37; and a confidence level of 95&#37;&#44; and found that we needed 313 patients evenly distributed through the 3 ARPR strata&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0085" class="elsevierStylePara elsevierViewall">The main outcomes under study were asthma control &#40;poor control in 2022 based on the CAN questionnaire and 3 risk indicators in reference to 2021&#58; on demand&#47;urgent visits&#44; hospital admission&#44; use of oral corticosteroids&#41; and caregiver quality of life in 2022&#46; We assessed their association with the ARPR stratum&#44; other sociodemographic variables &#40;urban&#47;rural setting&#44; parental educational attainment&#44; exposure to tobacco smoke at home&#41; and with health care-related variables &#40;management exclusively at PC level&#41; with bivariate tests &#40;&#967;<span class="elsevierStyleSup">2</span> test&#44; Mantel&#8211;Haenzsel statistic&#44; Pearson correlation&#44; Student <span class="elsevierStyleItalic">t</span> test and analysis of variance&#44; as applicable&#41; and multivariate regression methods &#40;logistic regression and multiple regression&#41;&#46; We adjusted the multivariate models for age&#44; sex&#44; ARPR stratum&#44; urban&#47;rural setting&#44; exclusive PC management&#44; presence of smoker in the household and paternal and maternal educational attainment&#46; The models of asthma control in 2022 and of caregiver quality of life were also adjusted for the history of on demand&#47;urgent visits in 2021&#46; We defined statistical significance as a probability of &#945; error of less than 0&#46;05&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical considerations</span><p id="par0090" class="elsevierStylePara elsevierViewall">The study was approved by the Clinical Research Ethics Committee of the Hospital Universitario R&#237;o Hortega&#46; The parents of the participants received written information about the study and signed an informed consent form&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0095" class="elsevierStylePara elsevierViewall">W contacted a total of 108 paediatricians&#44; of who 40 &#40;37&#46;0&#37;&#41; agreed to collaborate&#46; There were no significant differences in the percentage of paediatricians that agreed to collaborate between ARPR strata &#40;41&#46;0&#37;&#44; 28&#46;6&#37; and 41&#46;2&#37;&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;971&#41;&#46; We did not obtain data for one of the 9 provinces because no paediatrician in the province was included in the study&#46; The collaborating paediatricians identified 586 patients who met the inclusion criteria&#44; of who 80 &#40;13&#46;7&#37;&#41; could not be reached and 349 &#40;59&#46;6&#37;&#41; agreed to participate&#46; We also found no significant differences in the participation of patients between ARPR strata &#40;54&#46;2&#37;&#44; 68&#46;6&#37; and 58&#46;1&#37;&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;418&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the demographic and clinical characteristics of the sample&#44; which were evenly distributed between the ARPR strata&#46; Of the total patients&#44; 32&#46;2&#37; had poorly controlled asthma in 2022&#44; and in 2021&#44; 52&#46;0&#37; made on demand&#47;urgent visits&#44; 54&#46;8&#37; received oral corticosteroids and 4&#46;0&#37; were hospitalised&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Low SES &#40;the high ARPR category&#41; was significantly associated with residing in a rural area&#44; the father and mother living with the patient&#44; a higher likelihood of exposure to tobacco smoke in the home&#44; lower paternal educational attainment&#44; a lower likelihood of management exclusively at the PC level&#44; a greater likelihood of polypharmacy&#44; greater frequency of spirometry &#40;ever and in 2021&#41;&#44; having a written asthma action plan and having had a scheduled follow-up visit in 2021&#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; WE found no differences in variables related to asthma control or quality of life&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Exclusive management at the PC level was associated with a lower frequency of several care quality criteria&#58; scheduled follow-up visit in 2021 &#40;17&#46;7&#37; vs 67&#46;6&#37;&#59; <span class="elsevierStyleItalic">P</span> &#60; &#46;001&#41;&#44; having undergone spirometry for lung function testing at any point in the past &#40;30&#46;5&#37; vs 69&#46;5&#37;&#59; <span class="elsevierStyleItalic">P</span> &#60; &#46;001&#41; and in 2021 &#40;10&#46;4&#37; vs 29&#46;5&#37;&#59; <span class="elsevierStyleItalic">P</span> &#60; &#46;001&#41;&#44; having a written asthma action plan &#40;41&#46;0&#37; vs 66&#46;5&#37;&#59; <span class="elsevierStyleItalic">P</span> &#60; &#46;001&#41;&#44; knowing what to do in the case of an exacerbation &#40;78&#46;1&#37; vs 95&#46;2&#37;&#59; <span class="elsevierStyleItalic">P</span> &#60; &#46;001&#41; and assessment of inhaler technique in 2021 &#40;28&#46;4&#37; vs 40&#46;0&#37;&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;028&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Some social and family variables were significantly associated with some of the outcomes&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0115" class="elsevierStylePara elsevierViewall">In patients who lived with a smoker&#44; the frequency of on demand&#47;urgent visits in 2021 was higher &#40;62&#46;1&#37; vs 47&#46;1&#37;&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;009&#41;&#44; as was the frequency of poorly controlled asthma in 2022 &#40;39&#46;3&#37; vs 28&#46;6&#37;&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;044&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0120" class="elsevierStylePara elsevierViewall">In patients whose mothers completed secondary&#47;higher education&#44; the frequency of on demand&#47;urgent visits in 2021 was lower &#40;46&#46;7&#37; vs 67&#46;4&#37;&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;001&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0125" class="elsevierStylePara elsevierViewall">In patients whose fathers completed secondary&#47;higher education&#44; the frequency of poorly controlled asthma in 2022 was lower &#40;26&#46;2&#37; vs 40&#46;0&#37;&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;013&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0130" class="elsevierStylePara elsevierViewall">The quality of life assessed by means of the IFABI-R was somewhat poorer &#40;higher score&#41; in urban vs rural settings &#40;mean&#44; 1&#46;68 &#91;standard deviation &#91;SD&#93; 0&#46;63&#93; vs 1&#46;55 &#91;SD&#44; 0&#46;56&#93;&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;045&#41; and improved with increasing patient age &#40;r&#8239;&#61;&#8239;&#8722;0&#46;177&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;001&#41;&#46;</p></li></ul></p><p id="par0135" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> presents the results of the multivariate analysis&#46; The probability of on demand&#47;urgent visits in 2021 was lower if the mother had completed secondary education or a higher education degree&#46; The probability of poor asthma control in 2022 was lower if the patient was managed exclusively at the PC level and if the father had completed secondary education or a higher education degree&#44; but poor asthma control was most strongly associated with the history of on demand&#47;urgent visits in 2021&#46; The quality of life of caregivers was better &#40;lower score on the IFABI-R&#41; when the patient was followed up exclusively at the PC level and with increasing patient age&#44; but the only variable associated with a clinically important difference in quality of life &#40;difference &#62;0&#46;3 points in the IFABI-R&#41; was the history on demand&#47;urgent visits in 2021&#46; None of the multivariate models evinced an independent association of SEI with the outcome variables&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Findings</span><p id="par0140" class="elsevierStylePara elsevierViewall">In this study&#44; we did not find evidence that lower SES is associated with differences in asthma control in children in our population nor with a poorer quality of life in caregivers or poorer quality of the care received&#46; A higher parental educational attainment seems to be associated with better asthma control&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Limitations</span><p id="par0145" class="elsevierStylePara elsevierViewall">There are several limitations to this study that may have reduced the observed effect of SEI&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">1</span><p id="par0150" class="elsevierStylePara elsevierViewall">The identification of the income level based on the place of residence is considered an efficient method with a low risk of bias that generates results in the same direction as measures at the individual level&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a> However&#44; there is a risk of incorrect classification&#44; which could have diluted the actual impact of SEI&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">2</span><p id="par0155" class="elsevierStylePara elsevierViewall">The fact that census sections and the catchment areas of PCCs do not match may have resulted in contamination bias&#46; Although we excluded PCCs with catchment areas across census sections in different ARPR categories&#44; we cannot rule out the possibility of contamination&#44; which would also reduce the apparent effect of SES&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">3</span><p id="par0160" class="elsevierStylePara elsevierViewall">The census section income data correspond to 2018&#44; but we collected data on asthma control variables in 2022&#46; If there were changes in the income distribution&#44; they would have hindered the detection of an association between income and asthma control&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">4</span><p id="par0165" class="elsevierStylePara elsevierViewall">The COVID pandemic affected both the health care services provided to children with asthma as well as asthma control at the global level&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> which may have also affected the association between SEI and asthma control&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">5</span><p id="par0170" class="elsevierStylePara elsevierViewall">Spain is very diverse in certain socioeconomic and health care aspects&#44; so our results cannot be generalised without carrying out similar studies in other regions&#46; Our region is sparsely urbanised&#44; there are no large cities and no large economically depressed areas&#44; which are the main targets of studies conducted in countries such as the United States&#46; Thus&#44; the impact of urban poverty&#44; which may be substantial&#44; is not adequately represented in our sample&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">6</span><p id="par0175" class="elsevierStylePara elsevierViewall">We used instruments &#40;CAN&#44; IFABI-R&#41; validated in Spanish&#44; so we excluded families with language barriers&#46; As a result&#44; our study is not representative of the immigrant population with language barriers&#44; which may be particularly socioeconomically vulnerable&#46;</p></li></ul></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Interpretation</span><p id="par0180" class="elsevierStylePara elsevierViewall">The Beveridge health care system model &#40;National Health Service model&#44; such as the systems found in Spain&#44; United Kingdom&#44; Denmark&#44; Portugal&#44; Sweden and other European countries&#41; aims at providing universal coverage for health care services in order to decrease the impact of SEI on health&#46; It is important to confirm that this objective is achieved&#44; but in Spain the evidence on socioeconomic health determinants is scarce&#44; especially in relation child health&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> As for asthma&#44; most of the evidence comes from countries with other types of health care systems &#40;especially the United States&#41; and studies in adults&#46; A recent metanalysis &#40;61 studies&#44; most conducted in the USA&#44; only 2 including paediatric participants&#41;&#44; found that a lower SES was associated with adverse events during asthma follow-up &#40;emergency visits&#44; hospital admission&#44; readmission&#44; need of ventilation&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> However&#44; there is also recent evidence in Europe of an adverse impact of SEI on asthma control in children and adolescents&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> Our findings were not in agreement with those results&#44; which could be due to several reasons&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">1</span><p id="par0185" class="elsevierStylePara elsevierViewall">Some studies found an association between lower SES and less frequent use of asthma medication&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> which could contribute to poorer asthma control&#46; In our study&#44; however&#44; we found a higher frequency of polypharmacy in patients who resided in low-income areas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">2</span><p id="par0190" class="elsevierStylePara elsevierViewall">The impact of SEI on asthma-related outcomes is chiefly mediated by factors like social and family support&#44; caregiver stress and self-management education&#44; while factors such as access to the health care system&#44; individual behaviour and lifestyle habits are less important&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;34</span></a> This may explain why standardised management has been found not to eliminate the effect of SEI in asthma control in the United States&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> while interventions aimed at reducing social risks do achieve this goal&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> Social and family-related variables and stress may differ significantly in our population compared to the populations of these other studies&#46;</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">3</span><p id="par0195" class="elsevierStylePara elsevierViewall">Particularities of the Spanish health care system&#44; with a high number of paediatricians on staff in the PC network&#44; which is not the case of other European countries&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> Furthermore&#44; while other studies found that patients of lower SES were less frequently managed by specialists&#44;<span class="elsevierStyleSup">37</span> the opposite was observed in our sample&#58; exclusive follow-up in the PC system was less frequent with decreasing SES&#46; We found that management exclusively at the PC level was associated with lower adherence to certain care quality standards&#44; but at the same time was associated with better asthma control and caregiver quality of life&#44; which we attributed to the lower severity of asthma cases managed exclusively at the PC level&#46;</p></li></ul></p><p id="par0200" class="elsevierStylePara elsevierViewall">In conclusion&#44; we found that in the population of our region&#44; SEI was not associated with relevant outcomes of asthma in children&#44; nor with differences in health care quality&#46; We consider that this evinces the effectiveness of the National Health System in reducing the health care disparities that may result from SEI&#46; Nevertheless&#44; the quality of health care should improve&#44; especially at the PC level&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Funding</span><p id="par0205" class="elsevierStylePara elsevierViewall">The study was funded by a research grant of the <span class="elsevierStyleGrantSponsor" id="gs0005">Gerencia Regional de Salud de Castilla and Le&#243;n</span> &#40;<span class="elsevierStyleGrantNumber" refid="gs0005">GRS 2349&#47;A&#47;21</span>&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicts of interest</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Socioeconomic inequality &#40;SEI&#41; can adversely affect asthma control&#46; The aim of this study was to establish the association of SEI with asthma control in children and caregiver quality of life&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">We assessed socioeconomic status based on the area of residence&#44; according to the at risk of poverty rate &#40;ARPR&#41;&#46; After stratifying the paediatric population of Castilla y Le&#243;n &#40;Spain&#41; in ARPR tertiles&#44; we selected participants by stratified random sampling&#44; and identified children with asthma aged 6&#8211;14 years from the health records of primary care centres&#46; We collected data through questionnaires completed by parents&#46; The primary outcomes were asthma control and caregiver quality of life&#46; We assessed their association with SEI&#44; health care quality measures and individual factors &#40;such as parental educational attainment&#41; by means of multivariate regression models&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Result</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The ARPR tertile was not associated with asthma control&#44; quality of life or health care quality&#46; A medium or high maternal educational attainment was associated with a lower risk of making an unscheduled or urgent visit &#40;OR&#8239;&#61;&#8239;&#46;50&#59; 95&#37; CI&#44; &#46;27&#8211;&#46;95&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;034&#41; and paternal educational attainment was associated with a lower risk of uncontrolled asthma &#40;OR&#8239;&#61;&#8239;0&#46;51&#59; 95&#37; CI&#44; &#46;28&#8211;&#46;94&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;030&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">In the sample under study&#44; SEI assessed at the local level was not associated with asthma control in children&#46; Other factors&#44; such as parental educational attainment&#44; may have a protective effect&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">La desigualdad socioecon&#243;mica &#40;DSE&#41; puede afectar negativamente al control del asma&#46; El objetivo de este estudio fue identificar la relaci&#243;n de la DSE con el control del asma y la calidad de vida de los cuidadores&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">M&#233;todos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">El nivel socioecon&#243;mico se determin&#243; por &#225;rea de residencia&#44; seg&#250;n la tasa de riesgo de pobreza &#40;TRP&#41;&#46; La poblaci&#243;n pedi&#225;trica de la comunidad aut&#243;noma se estratific&#243; en terciles de TRP&#44; y se seleccion&#243; una muestra mediante muestreo aleatorio estratificado&#44; identificando a los ni&#241;os &#40;6&#8211;14 a&#241;os&#41; con asma activa en los registros cl&#237;nicos de centros de atenci&#243;n primaria&#46; La informaci&#243;n se obtuvo mediante cuestionarios cumplimentados por los padres&#46; Las variables primarias fueron el control del asma y la calidad de vida de los cuidadores&#46; Se analiz&#243; su relaci&#243;n con la DSE&#44; la calidad de la atenci&#243;n sanitaria y factores individuales &#40;como el nivel educativo de los padres&#41; mediante modelos multivariantes de regresi&#243;n&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">El tercil de TRP no se relacion&#243; con ninguna medida de control del asma&#44; calidad de vida ni calidad de la asistencia&#46; El nivel educativo de la madre &#40;educaci&#243;n media o superior&#41; se asociaba a menor riesgo de consulta no programada&#47;urgente &#40;OR&#8239;&#61;&#8239;0&#44;50&#44; IC 95&#37;&#58; 0&#44;27&#8722;0&#44;95&#44; p&#8239;&#61;&#8239;0&#44;034&#41; y el del padre a menor riesgo de asma mal controlada &#40;OR&#8239;&#61;&#8239;0&#44;51&#44; IC 95&#37;&#58; 0&#44;28&#8722;0&#44;94&#44; p&#8239;&#61;&#8239;0&#44;030&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusi&#243;n</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">En la poblaci&#243;n que hemos estudiado&#44; no se encuentra asociaci&#243;n entre DSE&#44; medida por &#225;rea de residencia&#44; y el control del asma en ni&#241;os&#46; Otros factores&#44; como la educaci&#243;n de los padres&#44; pueden ser factores protectores&#46;</p></span>"
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            "apendice" => "<p id="par0215" class="elsevierStylePara elsevierViewall">Ana Bel&#233;n Camina Guti&#233;rrez &#40;Centro de Salud &#91;CS&#93; Casa del Barco&#44; Valladolid&#41;&#59; Ana Rodr&#237;guez Gonz&#225;lez &#40;CS Lerma&#44; Burgos&#41;&#59; Ana Libr&#225;n Pe&#241;a &#40;CS Circunvalaci&#243;n&#44; Valladolid&#41;&#59; David Garc&#237;a Vaquero &#40;CS Villarcayo&#44; Burgos&#41;&#59; Elena Gonz&#225;lez Garc&#237;a &#40;CS Eras de Renueva&#44; Leon&#41;&#59; Francisco Fern&#225;ndez Pastor &#40;CS Santa Elena&#44; Zamora&#41;&#59; Ignacio Ledesma Ben&#237;tez &#40;CS Trobajo del Camino&#44; Leon&#41;&#59; Isabel Redondo D&#237;ez &#40;CS Pe&#241;afiel&#44; Valladolid&#41;&#59; Jos&#233; Francisco Colinas Herrero &#40;CS Jardinillos&#44; Palencia&#41;&#59; Jos&#233; Francisco Garc&#237;a de la Fuente &#40;CS Ponferrada I&#44; Leon&#41;&#59; Jos&#233; Jorge Mart&#237;n Mart&#237;n &#40;CS Alba de Tormes&#44; Salamanca&#41;&#59; Jos&#233; Luis Urquiza F&#237;sico &#40;CS Huelgas&#44; Burgos&#41;&#59; Juncal Reguera Bernardino &#40;CS Astorga I&#44; Leon&#41;&#59; Leyre L&#243;pez Villanueva &#40;CS Miranda Este&#44; Burgos&#41;&#59; Mar&#237;a Isabel G&#243;mez Martin &#40;CS Tudela de Duero&#44; Valladolid&#41;&#59; Mar&#237;a Jes&#250;s Alonso Ballesteros &#40;CS Medina del Campo&#44; Valladolid&#41;&#59; Mar&#237;a Jes&#250;s Vaquerizo Pollino &#40;CS Circular&#44; Valladolid&#41;&#59; Mar&#237;a Jos&#233; D&#237;ez Huerga &#40;CS Salda&#241;a&#44; Palencia&#41;&#59; Mar&#237;a Jos&#233; Mart&#237;n Sierra &#40;CS Tudela de Duero&#44; Valladolid&#41;&#59; Mar&#237;a Montserrat Rodr&#237;guez Fern&#225;ndez &#40;CS Jos&#233; Aguado I&#44; Leon&#41;&#59; Mar&#237;a Romero Calvo D&#237;az &#40;CS Miranda Este&#44; Burgos&#41;&#59; Mar&#237;a Dom&#237;nguez Villoria &#40;CS Casto Prieto&#44; Salamanca&#41;&#59; Mar&#237;a Polo de Dios &#40;CS Zamora Sur&#44; Zamora&#41;&#59; Mar&#237;a Rodr&#237;guez Rodr&#237;guez &#40;CS Aguilar de Campo&#243;&#44; Palencia&#41;&#59; Mar&#237;a Teresa S&#225;nchez V&#233;lez &#40;CS B&#233;jar&#44; Salamanca&#41;&#59; Marta Esther V&#225;zquez Fern&#225;ndez &#40;CS Circunvalaci&#243;n&#44; Valladolid&#41;&#59; Marta Pascual S&#225;nchez &#40;CS Estaci&#243;n&#44; Avila&#41;&#59; Miriam Mata Jorge &#40;CS Magdalena&#44; Valladolid&#41;&#59; Montserrat Piriz Veloso &#40;CS Pe&#241;afiel&#44; Valladolid&#41;&#59; Nieves San Jos&#233; Calleja &#40;CS Huelgas&#44; Burgos&#41;&#59; Olga Garc&#237;a Bodega &#40;CS Soria Rural&#44; Soria&#41;&#59; Patricia Gonz&#225;lez Ildefonso &#40;CS Estaci&#243;n&#44; Avila&#41;&#59; Pedro Florencio Mart&#237;nez &#40;CS Miranda Oeste&#44; Burgos&#41;&#59; Pilar &#193;lvarez Mingorance &#40;CS Medina del Campo&#44; Valladolid&#41;&#59; Pilar G&#243;mez Sorrigueta &#40;CS Eras de Renueva&#44; Le&#243;n&#41;&#59; Rafael Pe&#241;alver Penedo &#40;CS Almaz&#225;n&#44; Soria&#41;&#59; Raquel Roll&#243;n Casillas &#40;CS Estaci&#243;n&#44; &#193;vila&#41;&#59; Sara Anibarro P&#233;rez &#40;CS Tordesillas&#44; Valladolid&#41;&#59; Soledad L&#243;pez Palacios &#40;CS Alba de Tormes&#44; Salamanca&#41;&#59; Susana Alberola L&#243;pez &#40;CS Jardinillos&#44; Palencia&#41; y Teresa Centeno Robles &#40;CS Rondilla I&#44; Valladolid&#41;&#46;</p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Members of the CANDAS group"
            "identificador" => "sec0075"
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">SD&#44; standard deviation&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age in years &#40;mean&#8239;&#177;&#8239;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;0&#8239;&#177;&#8239;2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male sex &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">At risk of poverty rate &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Low risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Medium risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>High risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rural setting &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Person completing questionnaire &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mother&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Father&#47;both&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mother cohabitant &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Father cohabitant &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mother completed secondary&#47;higher ed &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Father completed secondary&#47;higher ed &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smoker in household &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Managed only by primary care paediatrician &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Daily maintenance treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number of daily drugs in combination &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Allergy testing &#40;ever&#41; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spirometry &#40;ever&#41; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spirometry in 2021 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Written asthma action plan &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Know what to do in exacerbation &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inhaler technique assessed &#40;ever&#41; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inhaler technique assessed in 2021 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Counselled to avoid exposure to tobacco smoke &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hospitalization due to asthma &#40;ever&#41; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Attended scheduled follow-up in 2021 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">On demand&#47;urgent visit in 2021 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hospitalization due to asthma in 2021 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral corticosteroids in 2021 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IFABI-R score &#40;mean&#8239;&#177;&#8239;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;61&#8239;&#177;&#8239;0&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poor control &#40;CAN&#8239;&#8805;&#8239;8&#41; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">At risk of poverty rate&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ARPR as &#37; &#40;range&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;1&#8722;22&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;6&#8722;29&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;6&#8722;38&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age in years &#40;mean&#8239;&#177;&#8239;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;1&#8239;&#177;&#8239;2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;9&#8239;&#177;&#8239;2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;0&#8239;&#177;&#8239;2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;836&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Male sex &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;882&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">45&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">63&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Person completing questionnaire &#40;&#37;&#41;</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;094&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mother&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Father&#47;both&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Number of other household members&#44; &#40;mean&#8239;&#177;&#8239;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;7&#8239;&#177;&#8239;0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;7&#8239;&#177;&#8239;0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;9&#8239;&#177;&#8239;0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;101&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Smoker in household &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Allergy testing &#40;ever&#41; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Spirometry &#40;ever&#41; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Spirometry in 2021 &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">On demand&#47;urgent visits &#40;2021&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Hospitalization due to asthma &#40;2021&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Oral corticosteroids &#40;2021&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Poor control &#40;2022&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">IFABI-R &#40;2022&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Regression coefficient&#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">At risk of poverty rate</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Low risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Medium risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;86 &#40;0&#46;46&#8722;1&#46;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;07 &#40;0&#46;56&#8722;2&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;37 &#40;0&#46;66&#8722;2&#46;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00 &#40;&#8722;0&#46;18&#8722;0&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;645&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;839&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;396&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;990&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>High risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;09 &#40;0&#46;59&#8722;2&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;45 &#40;0&#46;12&#8722;1&#46;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;66 &#40;0&#46;36&#8722;1&#46;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;11 &#40;0&#46;56&#8722;2&#46;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;02 &#40;&#8722;0&#46;20&#8722;0&#46;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;784&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;236&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;177&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;757&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;778&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Rural setting</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;09 &#40;0&#46;65&#8722;1&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;00 &#40;0&#46;72&#8722;12&#46;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;13 &#40;0&#46;68&#8722;1&#46;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;99 &#40;0&#46;57&#8722;1&#46;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;06 &#40;&#8722;0&#46;20&#8722;0&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;753&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;131&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;625&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;976&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;450&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age in years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;92 &#40;0&#46;83&#8722;1&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;84 &#40;0&#46;65&#8722;1&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;92 &#40;0&#46;84&#8722;1&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;96 &#40;0&#46;86&#8722;1&#46;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;04 &#40;&#8722;0&#46;06&#8722;0&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;097&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#46;14 &#40;&#8722;0&#46;30&#8722;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
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ISSN: 23412879
Original language: English
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Anales de Pediatría (English Edition)