Addressing Health Disparities in Asthma Care

The COVID-19 pandemic has exposed the impact of health disparities that have long plagued our healthcare system. As with COVID and a host of other illnesses, the burden of asthma also falls disproportionately on Black, Hispanic, and Indigenous populations in the United States. Not only are these groups more likely to have asthma, but they are also likely to suffer worse outcomes from the condition.

The racial and ethnic disparities in asthma’s impact reflect a variety of complex factors, including structural determinants, such as systemic racism that impacts access to care; social determinants such as socioeconomic status, education, and employment; biological determinants such as genes and ancestry; and behavioral determinants, such as tobacco use and adherence to treatment regimens. 

As a call-to-action, the Asthma and Allergy Foundation of America (AAFA) recently published its Asthma Disparities in America report, which outlines contributing causes of health disparities in the treatment of asthma, as well as strategies to improve care in underserved populations. In addition, Komodo Health recently worked with AAFA to complete an analysis of real-world health data to identify variations in asthma care across different communities, adding to the mounting body of evidence around asthma disparities. 

As part of Asthma Awareness Month this May, Komodo Health Chief Marketing Officer Bill Evans interviewed Kenneth Mendez, President and CEO of AAFA, for our For the Health of It series to discuss the foundation's work to uncover and address disparities in asthma and allergy care.

Check out the video of the conversation between Bill and Kenneth. A transcript of their discussion follows: 

Bill Evans: Welcome to For The Health Of It, our series where we bring together some of the world's top scientists, analysts, and health experts to discuss some of the biggest challenges in healthcare today. On today's episode, we're excited to be joined by Kenneth Mendez, President and CEO of the Asthma and Allergy Foundation of America, to talk about the foundation's work to better understand and address disparities in asthma and allergy care. We've recently completed an analysis of these disparities in partnership with their foundation, and we're looking forward to talking about the role data can play in helping to tackle these chronic and widespread conditions. 

Welcome, Kenny.

Kenneth Mendez: Great. Thanks for having me. Nice to see you, Bill.

Bill: Based on the research you've done over the past few years, what are the biggest hurdles that need to be overcome to improve asthma and allergy care nationwide, and how have those challenges changed over the past decade? 

Kenneth:  Access to care and access to medications continue to be major impediments to enhancing asthma and allergy care. Though we've had new therapies introduced over the last few years, access can be challenging due to cost and the complexities of gaining insurance approval for those treatments. 

Other big picture issues include air quality and climate change since polluted air can trigger asthma. 

The final major hurdle is education. Patients need to have an asthma action plan, they need to know how to take their medications, and they need to know how to use their inhalers correctly. 

Bill: Both allergies and asthma are widespread chronic conditions, with asthma alone impacting more than 25 million people in the U.S. Our research found that in both 2019 and 2020, predominantly Black and heavily Black cities saw a higher rate of ER visits per total asthma patients than in predominantly white cities. 

This echoes AAFA's work, which has found that the burden of asthma falls disproportionately on Black, Hispanic, and Indigenous American populations. How do these insights inform public health efforts that can close the gaps in care?

Kenneth: That's critical data to share and builds on AAFA's work. In 2020, we released our Asthma Disparities Report, a 15-year update to our 2005 report on health, inequity, and asthma. 

The report shows that Black Americans are still three times more likely to die from asthma than white Americans and are five times more likely to be treated in emergency rooms. In addition, Black women still have the highest prevalence of death from asthma compared to any other group. Those figures have not changed since 2005, when we last released our Asthma Disparities in America Report. 

Even while the treatments have improved, and the overall incidence of asthma may have fallen over time, the disparities we identified 15 years ago remain.

Bill: Widespread media coverage of the development of the COVID-19 vaccine has fueled a public conversation about how racial and ethnic minorities are often underrepresented in clinical studies. What can be done as an industry to get more representation in trials, and how does technology fit into this challenge?

Kenneth: There's not a lot of diversity in clinical trials and racial and ethnic minorities are significantly underrepresented. 

That's hugely important. When the FDA looks at the safety and efficacy of new medications, it examines data from the patient cohorts included in a clinical study. If racial and ethnic minorities aren't represented, then that could have a major impact on the safety profile of those treatments among those populations. 

I know the healthcare industry is working on ways to address this problem. One approach is to meet people where they are and include more diversity in the doctors and practitioners who are conducting the clinical trials. Try to make the people conducting the trials look like the people they are trying to recruit. 

Bill: Thanks, Kenny. It's been great to have you join us on For the Health of It. I want to thank you so much for sharing your insights today. To learn more about asthma and allergies and what AAFA is doing to support the community, please visit aafa.org. And to learn more about Komodo and how we are working to reduce the burden of disease, please check out komodohealth.com and be sure to follow us on social media including LinkedIn and Twitter for news and updates about future episodes. See you next time.