Asthma disparities during the COVID-19 pandemic: a survey of patients and physicians

Abstract Background The COVID-19 pandemic has demonstrated significantly worse outcomes for Minority (Black and Hispanic) individuals. Understanding the reasons for COVID-19-related disparities among asthma patients 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 (SES), 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 (e.g., became unemployed, lived in a community with high COVID-19 cases). They had worse asthma control (increased emergency visits for asthma, lower ACT 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, were more likely to have lost health insurance due to COVID-19, and that 25% of physicians found it more challenging to care for Black individuals with asthma during COVID-19. Conclusion Differences in SES and the effects of institutional racism, but not health behaviors, sources of information, or attitudes, are playing a role in disparities seen for asthma patients during COVID-19.