OBJECTIVES: This study aimed at analyzing patterns of biologic utilizations for allergic diseases among patients in a large healthcare system in the U.S. and assessing potential disparity in access to biologics by geographic location, race and insurance status.

METHODS: Patient data from a large U.S. Midwest Healthcare System (2017-2021) were analyzed for individuals diagnosed with allergic rhinitis, asthma, atopic dermatitis, chronic sinusitis, chronic urticaria, and/or nasal polyps. Patients were categorized as rural or urban based on their postal ZIP code and rural-urban commuting area (RUCA) code. Biologic prescriptions were obtained from electronic order databases and validated through chart abstraction. T-test or Chi-square tests were used to compare continuous and categorical variables, respectively.

RESULTS: The study included 120,458 allergic patient diagnoses, with 100,527 in adults and 19,931 in children. Among these, only 478 patients were prescribed biologics. Biologic use varied across disease categories, ranging from 0.16% to 2.59% in adults and 0% to 0.4% in children. Adults with asthma had the highest number of biologic prescriptions. Urban location was significantly associated with biologics prescription for all the allergic conditions (p<=0.05) except asthma, which was not statistically significant. Focusing on the asthma cohort due to its larger number of biologics prescriptions (n=180), we found that non-White patients were more likely to receive biologics, although this difference was not statistically significant (p=0.065). Additionally, for asthma cohort, patients on biologics were less likely to have government insurance (p=0.006) and had fewer comorbidities (p<0.001) compared to those not receiving biologics.

CONCLUSIONS: Our findings indicate potential disparities in the use of biologics for allergic diseases, with higher biologic utilization rates in urban areas. Asthma patients receiving biologics were more likely to be non-White, have private insurance, and have fewer comorbidities. Further research needs to address access issues and insurance-related barriers to improve equitable access to biologic medications.