Asthma Attacks Decreased Among Black Patients During the Pandemic

Despite Black patients having the highest prevalence of asthma prior to the COVID-19 pandemic, decreasing trends in asthma attacks were observed for this population during the pandemic relative to white patients, according to findings from a national survey study.

Asthma attack rates decreased from 29.3% in 2019 to 22.1% in 2022 among Black adults, with relative adjusted differences between Black and white adults going from +2.3 percentage points to -5.8 percentage points over this time period, reported Adam Gaffney, MD, MPH, of Harvard Medical School in Boston, and co-authors.

Despite the decrease in asthma attacks, emergency department (ED) visits were consistently higher among Black versus white adults, although the adjusted difference narrowed over time, from a 5.2 percentage point difference in 2019 to a 2.6 percentage point difference in 2022, they noted in their Annals of Internal Medicine research letter.

The study included 120,698 adults and 30,708 children included in the National Health Interview Survey from 2019 to 2022. Overall, asthma prevalence among adults increased from 8% in 2019 to 8.7% in 2022, which the researchers said is likely driven by increases among white patients.

"For children, asthma prevalence was stable, but consistently highest among Black children, despite a transient dip in 2020," the authors wrote. Asthma attacks decreased through 2021, but then increased in 2022, especially among white kids compared with Hispanic and Black kids, with an adjusted difference of -13.1 percentage points and -12.4 percentage points, respectively. Rates of ED visits decreased from 17.3% in 2019 to 12.1% in 2022, driven by decreases among Black and Hispanic children, Gaffney and team reported.

"The gradual decrease in ED visits and rebound of asthma attacks in 2022 [in kids] after a small drop may be attributed to a decrease in the circulation of common respiratory viruses," they wrote. "Differential exposure to tobacco, allergens, pollution, COVID-19, or controller inhaler usage during the pandemic could also have affected asthma trends and deserve further study."

"Healthcare avoidance, which likely played a role in 2020, is less likely to explain reductions in subsequent years as care use rebounded," they added.

Michael Wechsler, MD, MMSc, of National Jewish Health in Denver, Colorado, agreed that protection measures taken during the pandemic, such as social distancing, played a role in the decreases observed.

"During the pandemic, because of increasing isolation, asthma exacerbation rates went down globally because people weren't exposed to the same degree of viruses," he told MedPage Today. "And people were taking greater precautions. So, during the pandemic, rates went down, the incidence of exacerbations went down significantly."

Gaffney and colleagues noted that understanding the existing disparities and providing care based on that understanding could help address disparities even outside the framework of the COVID-19 pandemic.

"The narrowing asthma morbidity disparities through the pandemic suggest opportunities for mitigation, for example, improving environmental conditions or developing and equitably delivering vaccines against respiratory pathogens," they wrote. "However, other policies are needed to address the multitude of factors that drive both asthma pathogenesis and exacerbations."

Wechsler said the major takeaways from the study include the need to "continue to invest in education and the development of novel therapies and novel strategies. And I think we also need to work with communities and [have] better engagement with minority communities to appreciate the nuances of diseases like asthma -- which have significant interactions between the environment, education -- and there are clearly ways to prevent disease worsening if we can get to people."

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