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

Alan P Baptist; Desmond Lowe; Nadeen Sarsour; Hannah Jaffee; Sanaz Eftekhari; Laurie M Carpenter; Priya Bansal

doi:10.1016/j.jaip.2020.09.015

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

J Allergy Clin Immunol Pract. 2020 Nov-Dec;8(10):3371-3377.e1. doi: 10.1016/j.jaip.2020.09.015. Epub 2020 Sep 24.

Authors

Alan P Baptist¹, Desmond Lowe², Nadeen Sarsour², Hannah Jaffee³, Sanaz Eftekhari³, Laurie M Carpenter⁴, Priya Bansal⁵

Affiliations

¹ Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich. Electronic address: abaptist@med.umich.edu.
² University of Michigan Medical School, Ann Arbor, Mich.
³ Asthma and Allergy Foundation of America, Arlington, Va.
⁴ Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich.
⁵ Asthma and Allergy Wellness Center, St Charles, Ill.

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.

Keywords: Asthma; Attitudes; COVID-19; Health disparities; Implicit bias; Institutional racism; Structural racism; Survey.

MeSH terms

Adult
Anti-Asthmatic Agents / therapeutic use*
Asthma / drug therapy*
Asthma / physiopathology
Betacoronavirus
Black or African American / statistics & numerical data
COVID-19
Coronavirus Infections / epidemiology*
Coronavirus Infections / ethnology
Female
Health Knowledge, Attitudes, Practice / ethnology
Health Status Disparities*
Healthcare Disparities / ethnology*
Hispanic or Latino / statistics & numerical data
Humans
Male
Medically Uninsured / ethnology
Pandemics
Physicians, Primary Care
Pneumonia, Viral / epidemiology*
Pneumonia, Viral / ethnology
Pulmonologists
Racism*
SARS-CoV-2
Severity of Illness Index
Social Class
Surveys and Questionnaires
Unemployment / statistics & numerical data*
United States / epidemiology
White People / statistics & numerical data

Substances

Anti-Asthmatic Agents