Demographic disparities in patient-reported use of inhaled corticosteroids among patients with persistent asthma

Varun Vaidya, Monica Holiday-Goodman, Sharrel Pinto
Pharmacy Health Care Administration, Department of Pharmacy Practice, University of Toledo, Ohio, USA
Background: Despite the presence of existing guidelines, underuse of inhaled corticosteroids (ICSs) still exists among patients with persistent asthma in the United States. Inappropriate utilization of asthma medications has been attributed as one of the reasons for the significant economic burden due to asthma.
Objectives: To determine the demographic factors predicting patient-reported use of ICSs among patients with asthma.
Methods: The study utilized data from the 4-state sample of the National Asthma Survey (NAS), sponsored by the National Center for Environmental Health (NCEH), Centers for Disease Control and Prevention (CDC). The study population consisted of patients with persistent asthma as defined by National Heart, Lung, and Blood Institute (NHLBI) guidelines. Frequency distributions were made to characterize the study population. Logistic regression analysis was carried out to determine the odds of reported use of ICSs across various demographic variables (age, gender, race, income level, insurance coverage, and disease severity). Data were analyzed using SAS v9.0 software.
Results: Underutilization of ICSs was found to exist in the patients with asthma, as more than half of the study population (52.8%, n = 304) did not report the use of ICSs. African American patients were found to have much lower odds for use of ICSs (odds ratio [OR] = 0.495; ­confidence interval [CI], 0.248–0.987) when compared with whites. Insured patients had significantly higher odds for the use of ICSs (OR = 2.378; CI, 1.106–5.110) compared with uninsured patients. The findings held true even after adjusting for other demographic factors.
Conclusion: Underuse of ICSs continues to be a problem in patients with asthma. Vulnerable populations identified in this study are targeted for the use of ICSs. The importance of adherence to treatment and use of ICSs is an issue that needs to be addressed.
Keywords: inhaled corticosteroids, asthma, demographics