Asthma Disparities During the COVID-19 Pandemic: A Survey of Patients and Physicians

Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic has demonstrated significantly worse outcomes for minority (black and Hispanic) individuals. Understanding the reasons for COVID-19–related disparities among patients with asthma has important public health implications. Objective To determine factors contributing to health disparities in those with asthma during the COVID-19 pandemic. Methods An anonymous survey was sent through social media to adult patients with asthma, and a separate survey was sent to physicians who provide asthma care. The patient survey addressed demographic information including socioeconomic status, asthma control, and attitudes/health behaviors during COVID-19. Results A total of 1171 patients (10.1% minority individuals) and 225 physicians completed the survey. Minority patients were more likely to have been affected by COVID-19 (eg, became unemployed, lived in a community with high COVID-19 cases). They had worse asthma control (increased emergency visits for asthma, lower Asthma Control Test score), were more likely to live in urban areas, and had a lower household income. Initial differences in attitudes and health behaviors disappeared after controlling for baseline demographic features. Institutional racism was demonstrated by findings that minority individuals were less likely to have a primary care physician, had more trouble affording asthma medications due to COVID-19, and were more likely to have lost health insurance because of COVID-19, and that 25% of physicians found it more challenging to care for black individuals with asthma during COVID-19. Conclusions Differences in socioeconomic status and the effects of institutional racism, but not health behaviors, sources of information, or attitudes, are playing a role in disparities seen for patients with asthma during COVID-19.

Asthma care during COVID-19: differences in attitudes and expectations between physicians and patients

“…The surveys have been previously published and are available for review. 9 The physician survey was distributed through social media (primarily Facebook) and through physician email lists.…”

Health disparities in allergic and immunologic conditions in racial and ethnic underserved populations: A Work Group Report of the AAAAI Committee on the Underserved

“…131 Despite improvement in health of the US population over time, disparities persist. 130 Addressing this problem involves equipping all underserved populations to facilitate their individual ability to achieve the highest level of health. This report illustrates the impact of racial and ethnic disparities in AR, asthma, AD, FA, drug allergy, and PIDD and serves as a call to action to address these disparities.…”

“…Minority patients are more likely to have lost health insurance due to unemployment and live in communities with a high prevalence of coronavirus disease 2019 cases, resulting in decreased access to care and increased challenges in care. 130 Vaccine administration has been hindered by lack of access. There is a need to educate patients regarding vaccine safety and address myths to mitigate inequities.…”

Asthma and COPD medicines prescription-claims: A time-series analysis of England’s national prescriptions during the COVID-19 pandemic (Jan 2019 to Oct 2020)

“…National [10] and international [11][12][13] guidelines for both these conditions recommend clinical management plans to keep acute attacks under control and prevent hospitalization by the routine and continued use of medications that patients have been stabilized on. During the pandemic, there have been disruptions to how patients have sought care, avoidance of care-settings [14], with socioeconomic disparities deepening health disparities for patients with asthma during the COVID-19 pandemic [15]. Patients with asthma and COPD are advised to closely adhere to their prescribed inhaler medication therapy [16].…”