Using Socioeconomic, Insurance Status to Help Identify Risk Factors for Uncontrolled Asthma in a US Cohort

A recent study conducted in the United States aimed to uncover the risk factors associated with uncontrolled moderate-to-severe asthma, with a specific focus on demographics and comorbidities.

"Socioeconomic and insurance status, asthma severity, and prior health care utilization have been shown to predict the risk of hospitalization, in the US, explained authors. "Thus, identifying patients who are at the higher risk for uncontrolled asthma and proactively applying targeted interventions to high-risk asthma patients could lead to reduced asthma morbidity and mortality."

The objective was to enhance our understanding of the contributors to suboptimal asthma management.

To achieve this goal, the researchers utilized electronic health record (EHR)-derived data and followed a retrospective, real-world approach. The study enrolled adolescent and adult patients aged 12 and above who exhibited moderate-to-severe asthma, as indicated by their use of asthma medications within the year leading up to their asthma-related healthcare visit (referred to as the "index date"). The data were sourced from the Optum® Humedica EHR system, with a baseline period encompassing the 12 months preceding the index date. Uncontrolled asthma was defined as either two or more outpatient oral corticosteroid bursts for asthma or two or more visits to the emergency department, or one or more inpatient admissions for asthma. The research employed a Cox proportional hazard model for data analysis.

The study included a substantial cohort of 402,403 patients whose data met the defined inclusion criteria. The data spanned from January 1, 2012, to December 31, 2018. From this analysis, several significant findings emerged:

• Demographic Risk Factors: The study identified a range of demographic factors that were strongly associated with an increased risk of uncontrolled asthma. These included being of African American (AA) race (hazard ratio [HR]: 2.08), having Medicaid insurance (HR: 1.71), identifying as Hispanic (HR: 1.34), belonging to the age group between 12 and <18 years (HR: 1.20), having a body mass index (BMI) of ≥35 kg/m2 (HR: 1.20), and being female (HR: 1.19). All of these demographic factors demonstrated a statistically significant impact on asthma control, highlighting disparities in asthma management among different demographic groups (P < 0.001).
• Comorbidities: The study also examined comorbid conditions that often accompany asthma. Comorbidities characterized by type 2 inflammation, such as having a blood eosinophil count of ≥300 cells/μL (compared to eosinophil counts <150 cells/μL; HR: 1.40, P < 0.001) and having food allergies (HR: 1.31), were found to be associated with a significantly higher risk of uncontrolled asthma. In addition, pneumonia emerged as a comorbidity linked to an increased risk of uncontrolled asthma (HR: 1.35). Conversely, individuals with allergic rhinitis (HR: 0.84) appeared to have a lower risk of uncontrolled asthma.

In conclusion, this extensive study has illuminated several critical risk factors contributing to uncontrolled asthma in the United States. Notably, individuals who are African American or Hispanic, covered by Medicaid insurance, and belonging to certain age and BMI groups face a substantially higher risk of uncontrolled asthma when compared to their White, non-Hispanic counterparts with commercial insurance. Furthermore, specific comorbid conditions, such as elevated blood eosinophil counts and food allergies, were identified as significant contributors to uncontrolled asthma, while allergic rhinitis seemed to have a protective effect.

Understanding these risk factors is crucial for improving asthma management and patient outcomes. Armed with this knowledge, healthcare providers can tailor their interventions and support to address the specific needs of patients most vulnerable to uncontrolled asthma. By addressing healthcare disparities and targeting relevant comorbidities, healthcare professionals can work towards achieving better asthma control and ultimately enhancing the quality of life for asthma patients in the United States.

"These findings may assist healthcare providers in identifying patients who are at the highest risk for uncontrolled asthma, such as AA adolescent females with Medicaid insurance, and may need closer and more frequent follow up to ensure their asthma is adequately controlled," concluded the study authors.

"Additionally, these data may assist providers in identifying patients who may warrant additional on adequate management of their asthma."

Reference:

George M, Camargo CA Jr, 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. Published 2023 May 12. doi:10.2147/JAA.S383817