COVID-19 Pandemic Did Not Exacerbate Racial Disparity in Incidence of Emergency Department Visits For Asthma Exacerbations

Hossain, R.; Ruff, J.; Kaelber, D.; Tarabichi, Y.

Study Objectives: Racial disparities between White and minority (non-White) asthmatics in the United States have long been documented before the COVID-19 pandemic. During the COVID-19 pandemic, minorities were also found to disproportionately bear the burden of COVID-19-related severe outcomes. The pandemic hastened the adoption of several health care system and societal changes, including expansion of telemedicine via video or phone visits, mask usage, social distancing, and remote work and schooling. These could be seen as protective to asthmatics via decreased exposure to respiratory pathogens, and increased provider access. However, it is unclear how the pandemic affected racial disparities for asthmatics. In this study, we employ the Epic Corporation’s Aggregate Data Program (ADP) to examine how the pandemic affected emergency department (ED) utilization between White and minority asthmatics. Methods: Epic’s ADP General Asthma Data Set collects national level data across all Epic customers and reports asthma prevalence, cumulative incidence of asthma exacerbation ED visits, and proportion of ED visits that comprise asthma exacerbations. This de-identified aggregate data is broken down by race, ethnicity, age groups, sex, and location (ie, state). We examined data from January 1, 2017 to February 1, 2021. We defined the start of the pandemic as March 11, 2020, when the World Health Organization officially declared a pandemic. We determined the monthly incidence of asthma ED visits for non-White and White asthmatics separately, and then calculated the risk ratio by dividing incidence for minority asthmatics by incidence for White asthmatics. This risk ratio served as our measure for racial disparity. We compared the pre-pandemic and pandemic risk ratio with an unpaired t-test. We then performed an interrupted time series (ITS) analysis to compare the trends of pre-pandemic and pandemic risk ratio. Results: Our data included 15.4e6 asthma ED visits, with 59.0% of visits comprised by minority asthmatics. The number of asthma ED visits per month on average were 3.1e5 +/- 1.2e5. Pandemic risk ratio was statistically significantly lower than pre-pandemic risk ratio (pre-pandemic mean 2.61, pandemic mean 2.54, 95% CI [0.024, 0.128], p < 0.01). ITS analysis demonstrated pre-pandemic risk ratio trend of 0.006/month, (95% CI 0.003, 0.009, p < 0.01). During the pandemic, the change in the risk ratio trend was -0.027/month, (95% CI -0.043, -0.012, p < 0.01). Pre-pandemic and pandemic trends in risk ratio are demonstrated in the figure. Conclusion: Our study demonstrates that during the pandemic, known racial disparities in asthmatic ED utilization (ie, risk ratio between minority and White asthmatics) did not worsen. In fact, the pandemic reversed a marginally positive trend pre-pandemic, although this trend appeared to begin normalizing. It is possible that any one of the changes during the pandemic caused this shift in trend, but the limitations of our dataset prevent further investigation. More research is needed to investigate the factors underlying this trend change to learn how we may address racial disparities going forward. [Formula presented]