Abstract
Rationale Asthma is a common illness with significant morbidity and mortality. The Asthma and Allergy Foundation of America annually ranks US cities with the worst outcomes for asthma based on prevalence, emergency department visits, and asthma-related deaths. Omaha, Nebraska was recently ranked the 18th worst city for overall asthma outcomes and 8th in asthma-related deaths per capita. There is known disparity in asthma outcomes based on demographic factors including age, ethnicity, sex, and socioeconomic status. Disparity may also exist in provider prescription habits and specialty referral rates. These disparities may contribute to poor asthma outcomes in Omaha. This study assessed differences in asthma outcomes across CHI-affiliated clinics throughout the Omaha metropolitan area. Methods Study data included all adult patients with an outpatient encounter for asthma-related diagnoses at any of 19 CHI Health facilities in the Omaha metropolitan area between January 2020 and January 2023. Demographic information and clinical factors including referrals to pulmonary specialists and inhaled corticosteroid prescriptions were collected. The primary outcome was emergency department visits for asthma. Due to the low observed rate of this outcome, clinics were grouped into seven geographic districts for comparison. Generalized mixed effect models were estimated with fixed effects estimated for district. Covariates included age, patient-zip code associated median household income, sex, and ethnicity. All procedures were reviewed and approved by the Creighton University Institutional Review Board (InfoEd reference #2004689) Results A total of 4,492 patients were included. Patient characteristics are provided in Table 1. Among covariates, the sole significant predictor of emergency department visits for asthma was ethnicity, with Black patients demonstrating higher adjusted rates than white patients (5.4% versus 3.1%, risk ratio 1.75, 95% CI 1.13 – 2.67, p = 0.01). Across referral rates to pulmonary specialists, ICS prescription rate, and ICS compliance, none of the covariates were statistically significant predictors. Conclusion Our data suggests that our patient population’s risk of asthma-related emergency department visits does not differ based on age, sex, median income of their zip code, or geographic district in which they receive asthma care. Black patients were more likely to have asthma-related emergency department visits than other patients, which is consistent with known racial disparities seen in larger studies. The low observed rate of asthma-related emergency department visits may have limited our study’s power. Further studies utilizing higher-quality data are needed to determine what factors contribute to the poor asthma outcomes seen in Omaha. This abstract is funded by: None