BackgroundPatients from ethnic minority groups (EMGs) frequently report poorer asthma outcomes, however a broad synthesises summarizing ethnic disparities is yet to be undertaken.ObjectiveWhat is the magnitude of ethnic disparities in asthma healthcare utilisation, exacerbations and mortality?MethodsMEDLINE, EMBASE and Web of Science databases were searched for studies reporting ethnic variation in asthma healthcare outcomes (primary care attendance, exacerbation, emergency department [ED] visit, hospitalisation, hospital readmission, ventilation/intubation, and mortality) between White and EMGs. Estimates were displayed using forest plots and random-effects models were used to calculate pooled estimates.‏ We conducted subgroup analyses to explore heterogeneity, including by specific ethnicity (Black, Hispanic, Asian, and Other).Results65 studies, comprising 699 882 patients, were included. Most studies (92.3%) were conducted in the U.S.A. Patients from EMGs had evidence suggestive of lower levels of primary care attendances (OR:0.72, 95%CI:0.48–1.09), but substantially higher ED visits (OR:1.74, 95%CI:1.53–1.98), hospitalisations (OR:1.63, 95%CI:1.48–1.79) and ventilation / intubation (OR:2.67, 95%CI:1.65–4.31) when compared to White patients. We also found evidence suggestive of increased hospital readmissions (OR:1.19, 95%CI:0.90–1.57) and exacerbation rates (OR:1.10, 95%CI:0.94–1.28) among EMGs. No eligible studies explored disparities in mortality. ED attendances were much higher among Black and Hispanic patients, while Asian and other ethnicities had similar rates to White patients.ConclusionsEMGs had higher secondary care utilisation and exacerbations. Despite the global importance of this issue, the majority of studies were performed in the U.S.A. Further research into the causes of these disparities, including whether these vary by specific ethnicity, is required to aid the design of effective interventions.Systematic review registration:The review was registered on PROSPERO (registration number: CRD42020200392).