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Asthma disproportionately affect African American/Black (AA/B) and Hispanic/Latinx (H/L) individuals; but the extent to which socioeconomic status (SES) affects asthma morbidity within these racial/ethnic groups is limited. Our purpose was to determine whether SES associates with asthma morbidity measures among AA/B and H/L. METHODS:The PCORI-funded PeRson EmPowered Asthma RElief (PREPARE) study is a randomized, open-label, pragmatic clinical trial of AA/B and H/L adults with moderate to severe asthma. This ancillary study analyzed data collected at trial enrollment (n¼1201) to assess associations between SES and morbidity measures (self-reported steroid bursts, emergency room (ER) visits, hospitalization, and asthma control scores). Structural equation models were fit to test direct and indirect effects of SES on six different asthma morbidity measures. Indirect relationships between asthma and morbidity were tested via health literacy, stress, and discrimination scores. All models were adjusted by age, gender, body mass index, race/ethnicity, and medical comorbidity count.RESULTS: SES was found to have a direct positive association with asthma hospitalizations and worse asthma control scores. Stress was a mediator between SES and several outcomes (ER visits, and asthma control scores), with lower SES (lower income, unemployment, and less education) correlating with higher stress and worse asthma morbidity measures. Health literacy and discrimination did not mediate any associations between SES and asthma morbidity measures; however, a direct effect of discrimination on steroid bursts and APGAR scores was observed.CONCLUSIONS: Lower SES is directly associated with more asthma hospitalizations and worse asthma control in AA/B and H/L patients. Stress partially mediates the association between SES and morbidity measures, with more significant stress leading to more ER visits and worse asthma symptoms scores.CLINICAL IMPLICATIONS: Lower SES is directly associated with more severe asthma morbidity outcomes, an effect partially mediated by stress.