Immunology

Racial/ethnic differences in eligibility for asthma biologics among pediatric populations



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Background

Asthma is a heterogeneous disease. Clinical blood parameters differ by race/ethnicity and are used to distinguish asthma subtypes and inform therapies. Differences in subtypes may explain population-specific trends in asthma outcomes. However, these differences in racial/ethnic minority pediatric populations are unclear.

Objective

We investigated the association of blood parameters and asthma subtypes with asthma outcomes and examined population-specific eligibility for biologic therapies in minority pediatric populations.

Methods

Using data from 2 asthma case-control studies of pediatric minority populations, we performed case-control (N = 3738) and case-only (N = 2743) logistic regressions to quantify the association of blood parameters and asthma subtypes with asthma outcomes. Heterogeneity of these associations was tested using an interaction term between race/ethnicity and each exposure. Differences in therapeutic eligibility were investigated using chi-square tests.

Results

Race/ethnicity modified the association between total IgE and asthma exacerbations. Elevated IgE level was associated with worse asthma outcomes in Puerto Ricans. Allergic asthma was associated with worse outcomes in Mexican Americans, whereas eosinophilic asthma was associated with worse outcomes in Puerto Ricans. A lower proportion of Puerto Ricans met dosing criteria for allergic asthma–directed biologic therapy than other groups. A higher proportion of Puerto Ricans qualified for eosinophilic asthma–directed biologic therapy than African Americans.

Conclusions

We found population-specific associations between blood parameters and asthma subtypes with asthma outcomes. Our findings suggest that eligibility for asthma biologic therapies differs across pediatric racial/ethnic populations. These findings call for more studies in diverse populations for equitable treatment of minority patients with asthma.

Key words

Abbreviations used:

AEC (Absolute eosinophil count), GALA II (Genes-environments & Admixture in Latino Americans study), ICS (Inhaled corticosteroid), OR (Odds ratio), SAGE (Study of African Americans, Asthma, Genes, & Environments), SES (Socioeconomic status), WBC (White blood cell)

Asthma is a chronic inflammatory obstructive lung disease associated with significant morbidity and mortality for racial/ethnic minority groups.

Institute of Medicine (US) Committee on the Assessment of Asthma and Indoor Air. 3, Patterns of asthma morbidity and mortality.