Identifying Disparities in Treatment and Quality of Care Team Relationships for Patients With Asthma

While patients of color with asthma perceive they have lower quality interactions with their care teams, resulting in lower satisfaction of therapy, patients with moderate-to-severe persistent asthma are receiving the optimal add-on biologic care regardless of race and ethnicity, according to 2 abstracts presented at the 2022 American Academy of Allergy, Asthma & Immunology Annual Meeting.

In the first abstract, researchers explored the association of racial/ethnic or socioeconomic factors on perceived quality of care team interactions. In addition to Black, Hispanic, and Indigenous Americans being disproportionately burdened by asthma, “minority patients have been shown to experience poorer communication quality, information-giving, patient participation, and participatory decision-making than White patients,” the authors explained.

Between August and October 2021, they sent survey questions to 550 people through the Allergy & Asthma Network. A total of 212 individuals between the ages of 6 and 74 years completed the surveys. The survey questions assess patient perceptions of asthma care teams on measures of trust, equality, empathy and communication.

The majority of respondents (66%) self-identified as Black; 15% were White, 8% were Hispanic, 8% were American Indiana/Alaska Native (AI/AN) and 3% were other. Half of respondents were female. The majority of patients (68%) had private insurance with White patients having the highest rate (68%) followed by AI/AN patients (71%), Black patients (68%) and Hispanic patients (59%). Less than a third (30%) of all patients were on public insurance.

While White patients had the lowest proportion reporting well/very well controlled asthma (63%), they had the highest proportion of respondents reporting being satisfied/very satisfied with their current treatments (82%). Only 65% of AI/AN patients said their asthma as well controlled and they had the lowest satisfaction (47%). Patients on private insurance were more likely to say their asthma was well controlled (71% vs 64% on public insurance) and more likely to be satisfied with treatments (79% vs 73% on public insurance).

Black patients were least likely to agree their asthma care team gave them fair medical advice in their best interest, while White patients were overwhelmingly likely to agree (57% vs 91%). The difference was large between insurance coverage with 72% of patients on private insurance agreeing the medical advice they received was in their best interest compared with only 4% on public insurance.

The authors also noted that respondents who felt they received equal treatment and respect from their care team were more likely to report well-controlled asthma symptoms and satisfaction with treatments compared with respondents who did not perceive they received equal treatment/respect.

“Persons of color and publicly insured individuals generally perceive lower quality interactions with their care teams,” the authors concluded. “Suboptimal patient/care team relationships appear to be associated with poor perceptions of asthma control and lower satisfaction with therapy.”

In the second abstract, researchers evaluated prescriptions of biologic medications to patients with moderate-severe persistent asthma to determine whether racial/ethnic disparities exist.

The authors noted that patients with asthma from minority backgrounds have a “disproportionately higher baseline morbidity compared to White patients,” and that “patients of minority backgrounds are often the subject of disparate management and inequitable prescription practices.”

They used the claims-based database TriNetX Diamond Network to identify 29,027 White patients and 29,027 Black patients with asthma and 19,418 Hispanic patients and 19,418 White patients with asthma.

The researchers compared the three-year incidence of biologic prescriptions among cohorts after performing 1:1 propensity score matching for baseline demographics, comorbid conditions, and systemic corticosteroid use.

There were no significant differences in the prescription of biologic medications between Black and White patients and between Hispanic and White patients. However, the authors noted that fewer Hispanic patients (0.14%) were prescribed anti-interleukin (IL) 5 agents compared with White patients (0.26%). It was not clear why Hispanic patients were less likely to be prescribed anti-IL-5 agents.

Overall, the data showed patients with moderate-to-severe persistent asthma are “receiving optimal add-on biologic care irrespective of race/ethnicity.”

“It is important to remain vigilant of opportunities to identify and rectify disparities in the management of chronic health conditions,” the authors concluded.