Racial and Ethnic Minorities at the Highest Risk of Uncontrolled Moderate-to-Severe Asthma: A United States Electronic Health Record Analysis

Figures & data

Table 1 Patient Characteristics During 12-Month Baseline Period

	All Patients (N= 402,304)	Uncontrolled (N= 40,424)	Controlled (N= 361,880)
Demographics, n (%)
Age (years)
12 to <18	32,117 (7.9)	3261 (8.1)	28,856 (8.0)
18 to <45	153,107 (38.1)	16,961 (42.0)	136,146 (37.6)
45 to <65	156,040 (38.8)	14,587 (36.1)	141,453 (39.1)
≥65	61,040 (15.2)	5615 (13.9)	55,425 (15.3)
Sex
Female	273,721 (68.0)	29,528 (73.1)	244,193 (67.5)
Male	128,392 (31.9)	10,876 (26.9)	117,516 (32.5)
Unknown	191 (0.1)	20 (0.05)	171 (0.05)
Race
African-American	54,300 (13.5)	8841 (21.9)	45,459 (12.6)
Asian	6,204 (1.5)	449 (1.1)	5,755 (1.6)
White	317,433 (78.9)	28,519 (70.5)	288,914 (79.8)
Other/Unknown	24,367 (6.1)	2615 (6.5)	21,752 (6.0)
Ethnicity
Hispanic	22,052 (5.5)	3036 (7.5)	19,016 (5.3)
Non-Hispanic	360,899 (89.7)	35,850 (88.7)	325,049 (89.8)
Unknown	19,353 (4.8)	1538 (3.8)	17,815 (4.9)
Region
Midwest	213,852 (53.2)	17,843 (44.1)	196,009 (54.2)
Northeast	48,267 (12.0)	5643 (14)	42,624 (11.8)
South	96,124 (23.9)	13,356 (33)	82,768 (22.9)
West	29,441 (7.3)	1962 (4.9)	27,479 (7.6)
Other/Unknown	14,620 (3.6)	1620 (4)	13,000 (3.6)
Insurance type, n (%)
Commercial	227,209 (56.5)	-	-
Medicaid	56,857 (14.1)	-	-
Medicare	60,530 (15)	-	-
Comorbidities, n (%)
Anxiety	58,130 (14.5)	6896 (17.1)	51,234 (14.2)
Chronic rhinitis	35,749 (8.9)	4421 (10.9)	31,328 (8.7)
Acute sinusitis	47,035 (11.7)	5527 (13.7)	41,508 (11.5)
Pneumonia	16,602 (4.1)	2515 (6.2)	14,087 (3.9)
Hives	5,611 (1.4)	631 (1.6)	4980 (1.4)
Obesity	58,370 (14.5)	7065 (17.5)	51,305 (14.2)
Food allergy	3322 (0.8)	482 (1.2)	2840 (0.8)
Atopic dermatitis	3209 (0.8)	382 (0.9)	2827 (0.8)
Nasal polyps	3055 (0.8)	418 (1.0)	2637 (0.7)
Eosinophilic esophagitis	1557 (0.4)	137 (0.3)	1420 (0.4)
Allergic rhinitis	79,140 (19.7)	8125 (20.1)	71,015 (19.6)
Allergic conjunctivitis	9392 (2.3)	867 (2.1)	8525 (2.4)
Depression	59,785 (14.9)	6983 (17.3)	52,802 (14.6)
CCI
0	326,963 (81.3)	32152 (79.5)	294,811 (81.5)
1	14,883 (3.7)	1603 (4.0)	13,280 (3.7)
2	37,323 (9.3)	4158 (10.3)	33,165 (9.2)
≥3	23,135 (5.8)	2511 (6.2)	20,624 (5.7)
Medication, n (%)
ICS	374,269 (93.0)	34,269 (84.8)	340,000 (94.0)
LABA	319,904 (79.5)	29,501 (73.0)	290,403 (80.2)
SABA	29,305 (72.9)	32,490 (80.4)	260,915 (72.1)
Leukotriene	127,192 (31.6)	13,397 (33.1)	113,795 (31.4)
Any OCS use	115,459 (28.7)	21,440 (53)	94,019 (26)
Influenza vaccination	86,305 (21.5)	9022 (22.3)	77,283 (21.4)
OCS dependency	34,883 (8.7)	8410 (20.8)	26,473 (7.3)
Tiotropium	5447 (1.4)	779 (1.9)	4668 (1.3)
Biologics	2482 (0.6)	411 (1.0)	2071 (0.6)
Theophylline	1734 (0.4)	277 (0.7)	1457 (0.4)
Prescription fills, mean (±SD)
ICS fills*	6.84 (±56.5)	5.01 (±49.1)	7.05 (±57.2)
ICS days** supply	43.97 (±1888.1)	42.99 (±2094.7)	44.08 (±1863.6)
SABA fills	8.66 (±110.1)	8.15 (±129.5)	8.72 (±107.7)
SABA days supply	32.32 (±2065.1)	38.88 (±2426.6)	31.59 (±2020.7)
Laboratory observations, n (%)
Absolute eosinophil count (cells/µL)
<150	64,249 (16.0)	7565 (18.7)	56,684 (15.7)
150 to <300	42,397 (10.5)	4460 (11.0)	37,937 (10.5)
≥300	44,563 (11.1)	5920 (14.6)	38,643 (10.7)
Not recorded	251,095 (62.4)	22,479 (55.6)	228,616 (63.2)
Other, n (%)
Smoking status
Current	61,620 (15.3)	7224 (17.9)	54,396 (15.0)
Never	164,957 (41.0)	16,435 (40.7)	148,522 (41.0)
Previous	67,240 (16.7)	6241 (15.4)	60,999 (16.9)
Not currently	49,545 (12.3)	6407 (15.8)	43,138 (11.9)
Other /Unknown	58,942 (14.7)	4117 (10.2)	54,825 (15.2)
BMI (kg/m^2)
<25	85,977 (21.4)	7525 (18.6)	78,452 (21.7)
25 to <30	98,145 (24.4)	8891 (22.0)	89,254 (24.7)
30 to <35	82,147 (20.4)	8178 (20.2)	73,969 (20.4)
≥35	109,458 (27.2)	12,941 (32.0)	96,517 (26.7)
Not recorded	26,577 (6.6)	2889 (7.1)	23,688 (6.5)

Notes: *Fills defined as “any prescription fill in claims data for a given medication.” **Days supply defined as “number of days for which prescription was filled”.

Abbreviations: BMI, body mass index; CCI, Charlson comorbidity index; ICS, inhalational corticosteroids; LABA, long-acting beta agonists; OCS, oral corticosteroids; SABA, short-acting beta agonists; SD, standard deviation.

Table 2 Summary of Sociodemographic Related Risk Factors

Variable	HR	95% CI
Age (12 to <18 years)	1.20*	1.13–1.28
Sex, female	1.18*	1.14–1.23
Race^†
Asian	0.93	0.79–1.10
African American	2.08*	2.00–2.16
Ethnicity, Hispanic	1.34*	1.24–1.45
BMI^††, kg/m^2
25–30	1.04	0.99–1.09
30–35	1.06	1.00–1.12
≥35	1.20*	1.14–1.26
Smoking status^†††
Current smoker	1.14*	1.09–1.19
Previous smoker	1.14*	1.10–1.19
Insurance type, Medicaid	1.71*	1.65–1.78

Notes: HR >1 indicates an increased risk; HR <1 indicates a decreased risk. *Statistically significant (p < 0.001). ^†Caucasian/White was used as the reference point. ^††BMI < 25 was used as the reference point. ^†††Never smoker was used as the reference point.

Abbreviations: BMI, body mass index; CI, confidence interval; HR, hazard ratio.

Table 3 Summary of Risk Factors Related to Healthcare Resource Utilization

Variable	HR	95% CI
Outpatient visit	1.03	1.01–1.05
Inpatient visit	2.01*	1.92–2.11
Emergency visit	1.41*	1.40–1.43

Notes: HR >1 indicates an increased risk; HR <1 indicates a decreased risk. *Statistically significant (P < 0.001).

Abbreviations: CI, confidence interval; ED, emergency department; Hosp, hospitalization; HR, hazard ratio; OCS, oral corticosteroids.

Table 4 Summary of Risk Factors Related to Eosinophil Count

Variable	HR	95% CI
EOS^†
150 to <300	1.11*	1.06–1.17
≥300	1.40*	1.34–1.47

Notes: HR >1 indicates an increased risk; HR <1 indicates a decreased risk. ^†EOS <150/μL is reference point. *Statistically significant (P < 0.001).

Abbreviations: BMI, body mass index; CI, confidence interval; HR, hazard ratio.

Table 5 Summary of Risk Factors Related to Comorbidities

Variable	HR	95% CI
Chronic rhinosinusitis	1.07	1.02–1.13
Eosinophilic esophagitis	0.96	0.74–1.24
Allergic conjunctivitis	0.87	0.78–0.96
Hives/Urticaria	0.96	0.85–1.09
Food allergy	1.31*	1.16–1.49
Atopic dermatitis	1.07	0.92–1.25
Nasal polyps	1.23	1.04–1.46
Allergic rhinitis	0.84*	0.81–0.88
Pneumonia	1.35*	1.27–1.44
Acute sinusitis	1.00	0.95–1.05
CCI
1	1.03	0.95–1.12
2	0.93	0.88–0.98
≥3	0.92	0.85–0.99
Anxiety/Depression	1.10*	1.06–1.14

Notes: HR >1 indicates an increased risk; HR <1 indicates a decreased risk. *Statistically significant (P < 0.001).

Abbreviations: CCI, Charlson comorbidity index; CI, confidence interval; HR, hazard ratio.

Table 6 Summary of Risk Factors Related to Baseline Medication

	HR	95% CI
Prescription counts at baseline
SABA	1.04*	1.04–1.04
ICS	0.91*	0.89–0.93
OCS bursts	1.45*	1.41–1.50
Flu vaccine	0.90*	0.86–0.93

Notes: HR >1 indicates an increased risk; HR <1 indicates a decreased risk. *Statistically significant (P < 0.001).

Abbreviations: CI, confidence interval; HR, hazard ratio; ICS, inhalational corticosteroids; OCS, oral corticosteroids; SABA, short-acting beta agonists.