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Asthma disparities during COVID-19 – what are the causes?

Published online: September 24, 2020

The coronavirus disease 2019 (COVID-19) pandemic has demonstrated significantly worse outcomes for minority (Black and Hispanic) individuals. Initial reports suggested that a number of individuals are considered “high risk” for increased severe illness and/or death from COVID-19, including those with respiratory diseases such as moderate to severe asthma. Understanding the reasons for COVID-19-related disparities among patients with asthma has important public health implications. This study was geared towards determining factors that are contributing to health disparities in patients with asthma during the COVID-19 Pandemic.

In The Journal of Allergy and Clinical Immunology: In Practice, Baptist et al administered an anonymous survey to individuals with asthma as well as a short survey to physicians who provided care for patients with asthma. The survey was delivered throughout the country through email listservs as well as social media patient support group pages. The patient survey obtained basic demographic information (e.g., age, sex, race/ethnicity, employment status, insurance status), asthma specific information (e.g., severity of asthma, medication use), effects of COVID-19 (e.g., loss of employment) and information regarding attitudes/health behaviors during the COVID-19 pandemic. The physician survey was designed with specific questions related to the care of minority patients and explored perceived obstacles encountered while managing minority patients’ asthma during the COVID-19 pandemic.

A total of 1,171 patients (10.1% minority individuals) and 225 physicians completed the survey. The study found that minorities were more likely to have been affected by COVID-19 (became unemployed, live 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. Institutional racism was demonstrated by findings which showed that minority individuals were less likely to have a primary care physician, had more difficulty affording asthma medications, and were more likely to have lost health insurance because of COVID-19. However, there was no difference between minority and non-minority individuals regarding social distancing behaviors nor where individuals turn to for sources of information related to COVID-19. A concerning result from the study found that 24% of physicians found it more challenging to care for black patients with asthma during COVID-19, and 28% of physicians encountered more obstacles when managing asthma for a black patient. Ultimately the findings of this study show that differences in socioeconomic status along with 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.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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