Race and ethnicity, not just insurance, is associated with biologics initiation in asthma and related conditions - 05/09/24

Doi : 10.1016/j.jaci.2024.08.001

Ayobami Akenroye, MBChB, MPH, PhD ^a,^b,^c,^⁎ , Christopher Hvisdas, PharmD ^d, Jessica Stern, MD, MS ^e, John W. Jackson, ScD ^f,^{^{∗
These authors are co-senior authors.}}, Margee Louisias, MD, MPH ^a,^c,^{^{∗
These authors are co-senior authors.}}
^a Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
^b Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
^c Harvard Medical School, Boston, Mass
^d Department of Pharmacy, University of Pennsylvania, Philadelphia, Pa
^e Division of Allergy, Immunology and Rheumatology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
^f Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md

^∗Corresponding author: Ayobami T. Akenroye, MBChB, MPH, PhD, Assistant Professor of Medicine, Harvard Medical School, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.Harvard Medical SchoolDivision of Allergy and Clinical ImmunologyBrigham and Women's Hospital75 Francis StBostonMA02115

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 05 September 2024

Abstract

Background

There are pre-existing inequities in asthma care.

Objectives

We sought to evaluate effect modification by race of the effect of insurance on biologic therapy use in patients with asthma and related diseases.

Methods

We conducted inverse probability weighted analyses using electronic health records data from 2011 to 2020 from a large health care system in Boston, Mass. We evaluated the odds of not initiating omalizumab or mepolizumab therapy within 1 year of prescription for an approved indication.

Results

We identified 1132 individuals who met study criteria. Twenty-seven percent of these patients had public insurance and 12% belonged to a historically marginalized group (HMG). One-quarter of patients did not initiate the prescribed biologic. Among patients with asthma, individuals belonging to HMG had higher exacerbation rates in the period before initiation compared to non-HMG individuals, regardless of insurance type. Among HMG patients with asthma, those with private insurance were less likely to not initiate therapy compared to those with public insurance (odds ratio [OR]: 0.67, and 95% CI: 0.56-0.79). Among non-HMG with asthma, privately insured and publicly insured individuals had similar rates of not initiating the prescribed biologic (OR: 1.02; 95% CI: 0.95-1.09). Among those publicly insured with asthma, HMGs had higher odds of not initiating therapy compared to non-HMGs (OR: 1.16; 95% CI: 1.03-1.31), but privately insured HMG and non-HMG did not differ significantly (OR: 0.99; 95% CI: 0.91-1.07).

Conclusions

Publicly insured individuals belonging to HMG are less likely to initiate biologics when prescribed despite having more severe asthma, while there are no inequities by insurance in individuals belonging to other groups.

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Key words : mAb, biologics, prescription abandonment, health disparities, pharmacoequity, insurance, asthma, omalizumab, mepolizumab, race, ethnicity, historically marginalized groups

Abbreviations used : BMI, CCI, FDA, HMGs, IPCWs, IPTWs, OR