Black, Hispanic patients with Medicaid at high risk for uncontrolled asthma
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Black and Hispanic individuals and those on Medicaid insurance have the highest risk for uncontrolled asthma, researchers reported at the CHEST Annual Meeting.
Maureen George, PhD, RN, AE-C, FAAN, from the Office of Research and Scholarship at Columbia University School of Nursing at Columbia University Irving Medical Center, and colleagues conducted a retrospective, real-world study to evaluate risk factors for uncontrolled asthma and to characterize risk in Medicaid vs. commercially insured patients.
The researchers used the Optum Humedica electronic health record database to identify U.S. patients with Medicaid or commercial insurance from 2012 to 2018. All patients had moderate to severe asthma, were aged at least 12 years, and were prescribed medium- to high-dose inhaled corticosteroid (ICS) plus one additional inhaler medication, oral corticosteroids for at least 90 days or at least three oral corticosteroids (OCS) for asthma in the past year.
Uncontrolled asthma was defined as at least one ED or inpatient visit for asthma or at least three outpatient OCS bursts for asthma.
Black race (HR = 2.1; 95% CI, 2.04-2.16; P < .00001), Hispanic ethnicity (HR = 1.25; 95% CI, 1.17-1.33; P < .00001) and Medicaid insurance (HR = 1.76; 95% CI, 1.71-1.81; P = .05) were identified as factors highly associated with risk for uncontrolled asthma. In addition, prior asthma exacerbations in the form of an OCS (HR = 1.29; 95% CI, 1.25-1.32; P < .00001) and inpatient visits (HR = 1.87; 95% CI, 1.79-1.95; P < .00001) or ED visits (HR = 1.4; 95% CI, 1.39-1.42; P < .0001) were also highly associated with uncontrolled asthma risk, according to the results.
ICS use (HR = 0.91; 95% CI, 0.89-0.92) and having had the flu vaccine (HR = 0.88; 95% CI, 0.86-0.91) were associated with significantly lower risk for uncontrolled asthma (P < .00001 for both).
Upper airway comorbidities including chronic rhinosinusitis (HR = 1.11; 95% CI, 1.07-1.16; P < .00001) and nasal polyps (HR = 1.15; 95% CI, 1-1.32; P = .04) were highly associated with an increased risk for uncontrolled asthma. Conversely, other upper airway comorbidities such as allergic rhinitis (HR = 0.86; 95% CI, 0.83-0.89; P < .00001) and allergic conjunctivitis (HR = 0.87; 95% CI, 0.8-0.95; P = .001) were associated with significantly lower risk, according to the results.
Researchers also noted increased risk for uncontrolled asthma among those with elevated eosinophil counts of 300 µg/cells or more (HR = 1.37; 95% CI, 1.32-1.42; P < .00001), which further highlights uncontrolled type 2 inflammation effects in patients with asthma, the researchers said.
According to George, these results may aid health care providers in identifying patients at highest risk for uncontrolled asthma.
“Future studies assessing risk factors for uncontrolled asthma may incorporate EHR data to more fully capture patient characteristics [that] may otherwise be excluded,” George said during a virtual presentation of the findings.