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Black, Hispanic Individuals at Highest Risk of Uncontrolled Moderate to Severe Asthma in the US


Multiple risk factors for uncontrolled asthma include racial and ethnic barriers, as well as health insurance status, according to one study.

Black and Hispanic individuals living in the United States with Medicaid insurance are at the highest risk of uncontrolled moderate-to-severe asthma compared with White individuals with commercial insurance, a study finds.

The full retrospective real-world study is published in the Journal of Asthma and Allergy.

About 26 million people in the United States are affected by asthma, one of the most common chronic diseases worldwide.

"Socioeconomic and insurance status, asthma severity, and prior healthcare utilization have been shown to predict the risk of hospitalization, in the US," the authors explained. "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 authors explained."

Black male patient sitting in a hospital bed

African American race and Medicaid insurance showed the greatest association for uncontrolled asthma risk.

The study population was comprised of electronic health record (EHR) data from the Optum Humedica EHR database of adult and adolescent patients, ages 12 years and older with moderate-to-severe asthma from January 1, 2012, to December 31, 2018, and was based on medication history within 12 months prior to the asthma-related visit.

Data collected at baseline included: asthma medication use; days’ supply, prescription counts, and fills for short-acting beta agonists (SABA) and inhaled corticosteroid (ICS); socioeconomic information; medical history; and clinical characteristics, such as asthma exacerbation-related data and comorbidities.

A total of 402,402 patients were identified with asthma and included in the study’s analyses. Most patients were female (68%), non-Hispanic (90%), White (79%), and non-smokers (41%). Additionally, the most common asthma medications were ICS (93%), long-acting bronchodilator inhaler (LABA; 80%), and SABA (73%).

After analyses, the researchers found a significant increase in the risk of uncontrolled asthma among the following sociodemographic factors: African American (AA) race, smoking, Medicaid insurance, adolescent age, Hispanic ethnicity, female sex, and obesity. Furthermore, Black individuals (2.08; 95% CI, 2.00-2.16) and Medicaid insurance (1.71; 95% CI, 1.65-1.78) showed the greatest association for uncontrolled asthma risk.

Certain comorbidities were also associated with a significantly increased risk of uncontrolled asthma: pneumonia (HR 1.35; 95% CI, 1.27–1.44), food allergy (HR 1.31; 95% CI, 1.16–1.49), and anxiety/depression (HR 1.10; 95% CI, 1.06–1.14). Meanwhile, there was a significantly lower risk of uncontrolled asthma with allergic rhinitis (HR 0.84; 95% CI, 1.06–1.14). However, the authors noted that this finding for allergic rhinitis is not consistent with previous studies.

"The contradictory findings could possibly be due to greater exposure of patients, included in our study, to the healthcare system and, thus, more regular touchpoints with the health system for disease management including asthma," they conjectured.

The researchers acknowledge some limitations to the study, such as the definition of uncontrolled asthma and its inherent variability, as well as the use of an EHR. Because of these limitations, the researchers suggest that their calculations may have been underestimated, and do not capture the full spectrum of uncontrolled disease among this patient population.

However, the researchers believe that despite these limitations, the study suggests how race/ethnicity and insurance status influence an individual’s perceptibility and risk of asthma 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,” wrote the researchers. “Additionally, these data may assist providers in identifying patients who may warrant additional on adequate management of their asthma.”


George M, Camargo 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. Journal of Asthma and Allergy. 2023;Volume 16:567-577. doi:10.2147/jaa.s383817

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