Social Determinants May Influence Health Care Utilization, Symptom Burden in Patients With Asthma and Eczema

Minority patients and those with low income may be at greater risk of experiencing adverse outcomes in the management of asthma and eczema, according to study findings published in Advances in Therapy.

Although disparities have been reported regarding asthma and eczema outcomes across various populations, researchers highlight that little is known on how patients with these conditions perceive their medical care and burden of disease.

Notably, negative physical, emotional, and social impacts have been reported in prior surveys among patients with asthma and eczema, also known as atopic dermatitis, in which participants who identified as Black or Hispanic and those with low income were at significant risk.

“Both asthma and eczema are chronic conditions which often require lifelong treatment to achieve and maintain control, creating additional costs and emotional burden,” they added. “Individuals from racially/ethnically marginalized populations and those who report lower income also have reported lower rates of health insurance enrollment than those from non-marginalized groups, which impacts overall access to quality health care.”

The study authors conducted a 94-question online survey to evaluate the perceptions among the general patient population with asthma and/or eczema regarding disease and treatment burden and barriers to adequate care.

After recruiting 841 US patients with asthma (n = 554), eczema (n = 398), or both conditions (n = 111), participants 18 years or older provided survey responses between March 24, 2020, and April 6, 2020, and were stratified by racial/ethnic status and income level.

Of the study cohort, 76% were women, 50% identified as White (n = 421), 30% identified as Black (n = 252), and 11% identified as Hispanic (n = 95). A total of 99 patients reported low-income status (less than $15,000/year) and 713 were classified as having high income (at least $15,000/year).

“Asthma was reported by a higher percentage of participants identifying as Black or Hispanic than White participants (85% and 87% vs 48%, respectively),” noted researchers. “Whereas eczema was reported by a lower percentage of participants identifying as Black or Hispanic than White participants (21% and 19% vs 71%, respectively).”

In their findings, participants of low-income status reported greater prevalence of adverse management outcomes vs high-income counterparts:

• Prevalence of an asthma action plan was lower among participants with low income vs higher income counterparts (42% vs 53%).
• Prevalence of discussing asthma control with one’s health care provider was lower among participants with low income vs higher-income counterparts (54% vs 69%).
• More frequent eczema symptom burden among participants with low vs high income
• Fewer patients with eczema who had low income reported that they had not tried any eczema treatments vs those with high income (35% vs 15%)
  

Furthermore, more Black and Hispanic participants than White participants, as well as more participants with low income than higher income, endorsed health literacy as a barrier (eg, filling out official documents, understanding written materials).

Black and Hispanic participants were also more likely than White participants to have an emergency department visit (52% and 49% vs 31%, respectively) or hospitalization (31% and 39% vs 16%) for asthma within the last 12 months. Participants in all racial/ethnic and income-level groups reported that their asthma or eczema affected their lifestyle and daily activities.

“More effective and culturally informed communication and education strategies to improve health information uptake and shared decision-making are needed to reduce the burdens of disease and treatment in highly impacted populations,” concluded researchers.

Reference

Bukstein DA, Friedman A, Reyes EG, Hart M, Jones BL, Winders T. Impact of social determinants on the burden of asthma and eczema: results from a US patient survey. Adv Ther. Published online January 24, 2022. doi:10.1007/s12325-021-02021-0