The following is a summary of “Race & ethnicity, not just insurance, is associated with biologics initiation in asthma and related conditions,” published in the August 2024 issue of Allergy and Immunology by Akenroye et al.

Existing disparities in asthma care are well-documented, particularly in the context of biologic therapy initiation.

This study aimed to investigate whether race modifies the effect of insurance type on the initiation of biological therapies, specifically omalizumab and mepolizumab, among patients with asthma and related conditions.

Researchers conducted an inverse probability weighted (IPW) analysis using electronic health record data collected from a large healthcare system in Boston, MA, spanning from 2011 to 2020. The study focused on assessing the odds of patients not initiating prescribed biologic therapy within one year of prescription, despite having an approved indication for treatment.

A total of 1,132 patients met the study criteria. Among these, 27% were publicly insured, and 12% were identified as belonging to historically marginalized groups (HMG). Notably, one-quarter of the patients did not initiate the prescribed biologic therapy. Within the asthma cohort, HMG individuals exhibited higher exacerbation rates prior to biologic initiation compared to non-HMG individuals, regardless of their insurance status. Among HMG patients with asthma, those with private insurance were less likely to forgo initiating biologic therapy compared to their publicly insured counterparts (Odds Ratio [OR]: 0.67; 95% Confidence Interval [CI]: 0.56–0.79). Conversely, non-HMG patients with asthma showed no significant difference in biologic initiation rates between privately and publicly insured individuals (OR: 1.02; 95% CI: 0.95–1.09). Furthermore, publicly insured patients with HMG with asthma had significantly higher odds of not initiating therapy compared to non-HMG patients (OR: 1.16; 95% CI: 1.03–1.31), while privately insured HMG and non-HMG patients did not exhibit a significant difference in biologic initiation rates (OR: 0.99; 95% CI: 0.91–1.07).

Publicly insured individuals from historically marginalized groups are less likely to initiate prescribed biologic therapies despite experiencing more severe asthma, whereas insurance status does not seem to affect biologic initiation rates among individuals from other demographic groups. These findings highlight the persistent inequities in asthma care and underscore the need for targeted interventions to address these disparities.

Source: sciencedirect.com/science/article/abs/pii/S0091674924007802