Racial and Ethnic Minorities at the Highest Risk of Uncontrolled Moderate-to-Severe Asthma: A United States Electronic Health Record Analysis
Maureen George,1 Carlos A Camargo Jr,2 Autumn Burnette,3 Yuning Chen,4 Ajinkya Pawar,4 Cliona Molony,4 Melissa Auclair,4 Michael A Wells,4 Thomas J Ferro4 1Office of Research and Scholarship, Columbia University School of Nursing, New York, NY, USA; 2Department of Emergency Medicine, Massachusetts G...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2023-05-01
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| Series: | Journal of Asthma and Allergy |
| Subjects: | |
| Online Access: | https://www.dovepress.com/racial-and-ethnic-minorities-at-the-highest-risk-of-uncontrolled-moder-peer-reviewed-fulltext-article-JAA |
| _version_ | 1797827242112319488 |
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| author | George M Camargo Jr CA Burnette A Chen Y Pawar A Molony C Auclair M Wells MA Ferro TJ |
| author_facet | George M Camargo Jr CA Burnette A Chen Y Pawar A Molony C Auclair M Wells MA Ferro TJ |
| author_sort | George M |
| collection | DOAJ |
| description | Maureen George,1 Carlos A Camargo Jr,2 Autumn Burnette,3 Yuning Chen,4 Ajinkya Pawar,4 Cliona Molony,4 Melissa Auclair,4 Michael A Wells,4 Thomas J Ferro4 1Office of Research and Scholarship, Columbia University School of Nursing, New York, NY, USA; 2Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 3Division of Allergy and Immunology, Howard University Hospital, Howard University College of Medicine, Washington, DC, USA; 4Sanofi, Cambridge, MA, USACorrespondence: Maureen George, Office of Research and Scholarship, Columbia University School of Nursing, New York, NY, 10032, USA, Tel +1 212-305-1175, Email mg3656@cumc.columbia.eduPurpose: The identification of risk factors associated with uncontrolled moderate-to-severe asthma is important to improve asthma outcomes. Aim of this study was to identify risk factors for uncontrolled asthma in United States cohort using electronic health record (EHR)-derived data.Patients and Methods: In this retrospective real-world study, de-identified data of adolescent and adult patients (≥ 12 years old) with moderate-to-severe asthma, based on asthma medications within 12 months prior to asthma-related visit (index date), were extracted from the Optum® Humedica EHR. The baseline period was 12 months prior to the index date. Uncontrolled asthma was defined as ≥ 2 outpatient oral corticosteroid bursts for asthma or ≥ 2 emergency department visits or ≥ 1 inpatient visit for asthma. A Cox proportional hazard model was applied.Results: There were 402,403 patients in the EHR between January 1, 2012, and December 31, 2018, who met the inclusion criteria and were analyzed. African American (AA) race (hazard ratio [HR]: 2.08), Medicaid insurance (HR: 1.71), Hispanic ethnicity (HR: 1.34), age of 12 to < 18 years (HR 1.20), body mass index of ≥ 35 kg/m2 (HR: 1.20), and female sex (HR 1.19) were identified as risk factors associated with uncontrolled asthma (P < 0.001). Comorbidities characterized by type 2 inflammation, including a blood eosinophil count of ≥ 300 cells/μL (as compared with eosinophil < 150 cells/μL; HR: 1.40, P < 0.001) and food allergy (HR: 1.31), were associated with a significantly higher risk of uncontrolled asthma; pneumonia was also a comorbidity associated with an increased risk (HR: 1.35) of uncontrolled asthma. Conversely, allergic rhinitis (HR: 0.84) was associated with a significantly lower risk of uncontrolled asthma.Conclusion: This large study demonstrates multiple risk factors for uncontrolled asthma. Of note, AA and Hispanic individuals with Medicaid insurance are at a significantly higher risk of uncontrolled asthma versus their White, non-Hispanic counterparts with commercial insurance.Keywords: asthma, underserved, uncontrolled, Medicaid |
| first_indexed | 2024-04-09T12:45:07Z |
| format | Article |
| id | doaj.art-6a9414b2f9244773a84a77466e7d1fab |
| institution | Directory Open Access Journal |
| issn | 1178-6965 |
| language | English |
| last_indexed | 2024-04-09T12:45:07Z |
| publishDate | 2023-05-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Asthma and Allergy |
| spelling | doaj.art-6a9414b2f9244773a84a77466e7d1fab2023-05-14T16:00:11ZengDove Medical PressJournal of Asthma and Allergy1178-69652023-05-01Volume 1656757783691Racial and Ethnic Minorities at the Highest Risk of Uncontrolled Moderate-to-Severe Asthma: A United States Electronic Health Record AnalysisGeorge MCamargo Jr CABurnette AChen YPawar AMolony CAuclair MWells MAFerro TJMaureen George,1 Carlos A Camargo Jr,2 Autumn Burnette,3 Yuning Chen,4 Ajinkya Pawar,4 Cliona Molony,4 Melissa Auclair,4 Michael A Wells,4 Thomas J Ferro4 1Office of Research and Scholarship, Columbia University School of Nursing, New York, NY, USA; 2Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 3Division of Allergy and Immunology, Howard University Hospital, Howard University College of Medicine, Washington, DC, USA; 4Sanofi, Cambridge, MA, USACorrespondence: Maureen George, Office of Research and Scholarship, Columbia University School of Nursing, New York, NY, 10032, USA, Tel +1 212-305-1175, Email mg3656@cumc.columbia.eduPurpose: The identification of risk factors associated with uncontrolled moderate-to-severe asthma is important to improve asthma outcomes. Aim of this study was to identify risk factors for uncontrolled asthma in United States cohort using electronic health record (EHR)-derived data.Patients and Methods: In this retrospective real-world study, de-identified data of adolescent and adult patients (≥ 12 years old) with moderate-to-severe asthma, based on asthma medications within 12 months prior to asthma-related visit (index date), were extracted from the Optum® Humedica EHR. The baseline period was 12 months prior to the index date. Uncontrolled asthma was defined as ≥ 2 outpatient oral corticosteroid bursts for asthma or ≥ 2 emergency department visits or ≥ 1 inpatient visit for asthma. A Cox proportional hazard model was applied.Results: There were 402,403 patients in the EHR between January 1, 2012, and December 31, 2018, who met the inclusion criteria and were analyzed. African American (AA) race (hazard ratio [HR]: 2.08), Medicaid insurance (HR: 1.71), Hispanic ethnicity (HR: 1.34), age of 12 to < 18 years (HR 1.20), body mass index of ≥ 35 kg/m2 (HR: 1.20), and female sex (HR 1.19) were identified as risk factors associated with uncontrolled asthma (P < 0.001). Comorbidities characterized by type 2 inflammation, including a blood eosinophil count of ≥ 300 cells/μL (as compared with eosinophil < 150 cells/μL; HR: 1.40, P < 0.001) and food allergy (HR: 1.31), were associated with a significantly higher risk of uncontrolled asthma; pneumonia was also a comorbidity associated with an increased risk (HR: 1.35) of uncontrolled asthma. Conversely, allergic rhinitis (HR: 0.84) was associated with a significantly lower risk of uncontrolled asthma.Conclusion: This large study demonstrates multiple risk factors for uncontrolled asthma. Of note, AA and Hispanic individuals with Medicaid insurance are at a significantly higher risk of uncontrolled asthma versus their White, non-Hispanic counterparts with commercial insurance.Keywords: asthma, underserved, uncontrolled, Medicaidhttps://www.dovepress.com/racial-and-ethnic-minorities-at-the-highest-risk-of-uncontrolled-moder-peer-reviewed-fulltext-article-JAAasthmaunderserveduncontrolledmedicaid |
| spellingShingle | George M Camargo Jr CA Burnette A Chen Y Pawar A Molony C Auclair M Wells MA Ferro TJ 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 asthma underserved uncontrolled medicaid |
| title | Racial and Ethnic Minorities at the Highest Risk of Uncontrolled Moderate-to-Severe Asthma: A United States Electronic Health Record Analysis |
| title_full | Racial and Ethnic Minorities at the Highest Risk of Uncontrolled Moderate-to-Severe Asthma: A United States Electronic Health Record Analysis |
| title_fullStr | Racial and Ethnic Minorities at the Highest Risk of Uncontrolled Moderate-to-Severe Asthma: A United States Electronic Health Record Analysis |
| title_full_unstemmed | Racial and Ethnic Minorities at the Highest Risk of Uncontrolled Moderate-to-Severe Asthma: A United States Electronic Health Record Analysis |
| title_short | Racial and Ethnic Minorities at the Highest Risk of Uncontrolled Moderate-to-Severe Asthma: A United States Electronic Health Record Analysis |
| title_sort | racial and ethnic minorities at the highest risk of uncontrolled moderate to severe asthma a united states electronic health record analysis |
| topic | asthma underserved uncontrolled medicaid |
| url | https://www.dovepress.com/racial-and-ethnic-minorities-at-the-highest-risk-of-uncontrolled-moder-peer-reviewed-fulltext-article-JAA |
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