Suboptimal Care Escalation for Severe Asthma in Black and Hispanic Patients

Tara Carr, MD

Data featured at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2023 Annual Meeting in San Antonio, TX, illuminated the need to address racial and ethnic disparities in the management of severe asthma (SA).¹

In the past few years, research findings have shown that severe asthma disproportionately affects Black individuals, as well as certain Hispanic individuals. Standard of care recommends escalation of care for patients with uncontrolled disease.

A team of investigators led by Tara Carr, MD, Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, University of Arizona College of Medicine, evaluated gaps in care escalation by race/ethnicity among patients who experienced events indicating uncontrolled disease (EUD) by collecting information from Medicare Fee-for-Service claims spanning 2015-2020.

The results of the study suggested that these disparities exist in the management of uncontrolled severe asthma. Investigators stated that addressing these disparities is essential to improve the quality of care for patients with severe asthma, particularly those who are Black or Hispanic/Latino.

Comparing Instances of Care Escalation

The analysis included 97,164 patients with severe asthma, among which 48,582 had uncontrolled asthma, and 48,582 were controlled. Data showed 41% of the patients who identified as non-Hispanic Black, and had uncontrolled disease, had no specialist visit nor medication escalation following the EUD event, compared with 38% of patients who identified as Hispanic/Latino, and 33% of non-Hispanic White patients.

Even following an asthma hospitalization, 35% of non-Hispanic Black patients, 32% of Hispanic/Latino patients, and 28% of non-Hispanic White patients had no specialist visits nor medication escalation.

Investigators indexed cases of severe, persistent asthma hierarchically on asthma-related EUD: ≥ 1 hospitalization,≥ 2 emergency department (ED) visits with systemic corticosteroid treatment (SCS), 1 ED + ≥ 1 outpatient (OP) visit with SCS, or ≥ 2 OP visits with SCS. Patients with severe asthma without any events were matched as controls. All participating patients were at least 12 years of age, had 12 months enrollment pre- and post-index, and presented no other major respiratory disease or biologic treatment during the pre-period.

Unmet Needs of Patients with Severe Asthma

According to the study, these findings indicated that escalation for uncontrolled disease was suboptimal for all patients and worse among Black and Hispanic/Latino patients. Given the high burden of disease among patients with severe asthma, investigators stated that closing care gaps could reduce healthcare costs and improve outcomes.

The team proposed the implementation of interventions aimed at improving care escalation, not only for patients with uncontrolled asthma, but for this specific population, as a potential solution. It is a general recommendation that healthcare providers receive additional training on cultural competence and implicit bias to provide equitable care to all patients, which has been supported by various studies and organizations.²

Additionally, patient education and engagement may also serve as  a critical role in closing care gaps.³ Patients could be provided with educational resources on asthma management, including information on the importance of regular follow-up appointments with healthcare providers and the benefits of medication escalation. Those who are actively engaged in their care may be more likely to seek out the necessary resources to manage their asthma effectively.

Investigators called for further research to identify specific interventions that can effectively reduce disparities in care escalation and improve outcomes for patients with severe asthma, particularly those who are Black or Hispanic/Latino. By closing care gaps and providing equitable care to all patients, healthcare providers and policymakers can work towards reducing healthcare costs and improving outcomes for patients with severe asthma.

References:

1. Carr T, Chung Y, Ambrose C, et al. Racial and Ethnic Disparities in Treatment of Uncontrolled Disease Among Severe, Persistent Asthma Patients: An Analysis of Medicare Fee-for-Service Claims. Journal of Allergy and Clinical Immunology. 2023;151(2):AB46. https://doi.org/10.1016/j.jaci.2022.12.145
2. Sabin JA. Tackling Implicit Bias in Health Care. N Engl J Med. 2022;387(2):105-7. https://www.nejm.org/doi/full/10.1056/NEJMp2201180
3. National Heart, Lung, and Blood Institute. Asthma. Accessed February 24, 2023. https://www.nhlbi.nih.gov/health/asthma.