African American, Hispanic Individuals With Medicaid at Higher Risk of Uncontrolled Asthma

There are multiple risk factors for uncontrolled asthma, and African American and Hispanic individuals with Medicaid insurance are at a significantly higher risk of uncontrolled asthma compared with their White, non-Hispanic counterparts with commercial insurance, according to a study published in the Journal of Asthma and Allergy.

Identifying risk factors associated with uncontrolled moderate-to-severe asthma is vital for advancing asthma outcomes through the use of applying targeted interventions to high-risk patients with asthma, the authors noted

“Asthma is one of the most common chronic diseases, affecting > 300 million people worldwide. Among the 26 million Americans with asthma, approximately 5% to 10% of patients have severe asthma. In about half of these patients, severe asthma remains uncontrolled,” explained the researchers.

This burden cost the United States an estimated $81.9 billion (2008-2013).

The authors used electronic health record (EHR)-derived data to identify risk factors for uncontrolled asthma in a United States cohort. Uncontrolled asthma was defined as more than or equal to 2 outpatient oral corticosteroid bursts for asthma or more than or equal to 2 emergency department visits or more than or equal to 1 inpatient visit for asthma.

A total of 402,403 patients in the Optum Humedica EHR US database between January 1, 2012 and December 31, 2018, were evaluated. The majority were female (68%), non-Hispanic (90%), and White (79%). Forty-one percent were nonsmokers. Inhaled corticosteroids (ICS) were the most common asthma medications (93%), followed by long-acting bronchodilator inhaler (80%), and short-acting beta agonists (SABA; 70%).

African American race (hazard ratio [HR]: 2.08), Medicaid insurance (HR: 1.71), Hispanic ethnicity (HR: 1.34), age of 12 to less than 18 years (HR 1.20), body mass index of more than or equal to 35 kg/m² (HR: 1.20), and female sex (HR 1.19) were identified as risk factors associated with uncontrolled asthma (P < .001).

The researchers also found:

• Asthma-related health care resource utilization had an significantly increased risk of uncontrolled asthma, with outpatient visits having a relative risk of 1.03, emergency department visits having a 1.41 increase risk, and inpatient visits having a 2.01 increased risk
• Blood eosinophil count of greater than or equal to 300 cells/μL or 150 to < 300 cells/μL (as compared with eosinophil less than 150 cells/μL; HR: 1.40, P < .001)
• Penumonia was associated with a 1.35 times increased risk, food allergy with a 1.31 times increased risk, and anxiety/depression with a 1.10 times increased risk
  • In contrast, allergic rhinitis (HR: 0.84) was associated with a significantly lower risk of uncontrolled asthma

Medications at baseline were also associated with a significant increased risk of uncontrolled asthma. SABA increased the risk of uncontrolled asthma by 1.04 times and oral corticosteroids increased the risk by 1.45 times. Conversely, ICS and receiving the flu vaccine significantly lowered the risk of uncontrolled asthma.

Some limitations of this study consisted of the definition of uncontrolled asthma, the intrinsic variability of uncontrolled asthma, and the use of an EHR.

“These findings may assist healthcare providers in identifying patients who are at the highest risk for uncontrolled asthma, such as [African American] adolescent females with Medicaid insurance, and may need closer and more frequent follow up to ensure their asthma is adequately controlled,” wrote the researchers. "Additionally, these data may assist providers in identifying patients who may warrant additional on adequate management of their asthma."

Reference

George M, Camargo Jr CA, Burnette A, et al. Racial and ethnic minorities at the highest risk of uncontrolled moderate-to-severe asthma: a united states electronic health record analysis. J Asthma Allergy. 2023;16:567-577. doi: 10.2147/JAA.S383817