Presentation (CTI)

OBJECTIVES: Maintenance therapy is important for preventing exacerbation of asthma. This study aimed to describe the utilization of maintenance therapy, asthma exacerbation and disparities associated with insurance status in the United States among patients with mild asthma.
METHODS: This retrospective observational study used Premier Healthcare Database (PHD)-linked administrative claims (10/01/2021-09/30/2022) for US patients aged ≥ 18 years with mild intermittent or persistent asthma, a short-acting beta₂-agonist (SABA) fill, a history of asthma exacerbation within 12-month pre-index date (the earliest SABA fill date), and Medicaid, Medicare, or commercial insurance. Maintenance medication included inhaled corticosteroid (ICS), long-acting beta₂-agonist (LABA), long-acting muscarinic antagonist (LAMA), leukotriene receptor antagonists (LTRA), and xanthines.
RESULTS: Among 5,617 patients, average age was 36 years, 72% were women, 32% were Black, 21% were Hispanic, and 53% were White. Medicaid patients were younger (mean age 35 vs. 39 years) and more likely to be Black (34% vs. 22%) than commercial patients (both p<0.01). A significantly lower proportion of Medicaid patients (27%) filled maintenance medications during 12-month post-index period compared to commercial (37%) and Medicare (33%, p<0.01) patients. Compared to commercial patients, Medicaid patients were significantly less likely to fill ICS+LABA (7% vs. 10%), ICS+LABA+LAMA (0.7% vs. 2.5%), and LTRA (17% vs. 24%)(all p<0.01). Although the mean number of exacerbations was similar between commercial and Medicaid patients (0.31 vs. 0.35, p=0.07), Medicaid patients were more likely to be hospitalized (3.3% vs. 1.6%), visit an emergency department (15% vs. 8%), and fill an oral corticosteroid prescription (23% vs. 18%) for exacerbations than commercial patients during the 12-month post-index period (all p<0.01).
CONCLUSIONS: Mild asthma patients with Medicaid were less likely to fill maintenance medications and more likely to have inpatient or ED outpatient visits than patients with commercial insurance. Further studies are needed to understand the causes and reduce disparities in access to care.