Social determinants of health such as low income, costs, disease severity, and insurance status contribute to asthma and eczema disparities and may drive higher hospitalization rates in marginalized minority populations. Both asthma and eczema often require lifelong treatment to achieve and maintain disease control, but this can create emotional burden and increase costs for patients. “What healthcare providers (HCPs) see as a burden or barrier is not always the same as what patients perceive,” explains Tonya Winders, MBA.
Race/Ethnicity & Income May Drive Disparities in Care
For a study published in Advances in Therapy, Winders and colleagues surveyed self-reported perceptions of patients with asthma and/or eczema on their disease burden and barriers to care. In total, 841 adult patients were surveyed, 554 of whom had asthma, 398 had eczema, and 111 had both. Most respondents were White and self-reported as having an income of at least $15,000/year.
Participants from all racial/ethnic backgrounds and income levels stated that their asthma or eczema impacted their lifestyle and daily activities. “The cost of prescriptions not covered by insurance was the most common reason for treatment nonadherence, even though most respondents had health insurance,” says Winders. “Transportation to and from appointments was also difficult for people living in communities of color.”
Respondents with low incomes (less than $15,000/year) were more likely to report receiving ineffective health education and communication, to have fewer asthma management discussions with their HCP, and to have undermanaged eczema. Health literacy problems—such as issues with filling out official documents or understanding written materials—were more likely to be a barrier to care for Black and Hispanic patients and for those with self-reported low-income. “About 14% of Hispanics reported that their HCP rarely or never understood their needs,” Winder adds.
Key Findings in Asthma & Eczema Among Ethnic & Racial Groups
Black and Hispanic participants were more likely to have an ED visit or hospitalization for asthma within the last 12 months, according to the study. Those with low incomes were less likely to have an asthma action plan or to discuss asthma control with their HCP. Many participants reported their asthma kept them from getting much done at work, school, and/or home at least some of the time over the past 4 weeks.
“Although 80% of respondents stated their asthma was ‘under control,’ about one-third of racial/ethnic subgroups reported using rescue inhalers at least once a day in the last 4 weeks, which is a sign of asthma not being well controlled,” says Winders. “Furthermore, 15% of patients with asthma changed jobs because of their disease.” Participants commonly had to modify or stop doing activities because of asthma, especially exercise and sports (Table).
The analysis also showed that respondents with low incomes experienced eczema symptoms more frequently. Despite experiencing a high frequency of eczema symptoms and the negative impact the disease has on sleep, 35% of low-income participants reported they had not tried any eczema treatments.
Clinicians Should Address Health Literacy & Cost as Barriers to Care
Findings from the study suggest asthma and/or eczema and their treatment impacts patients differently. “To improve health literacy, HCPs should consider using an interpreter to overcome language barriers when managing Hispanic patients,” Winders says. “All written communication should be offered in Spanish and English on the same document. It’s also important to use terminology that patients use to ensure communication is clear, understandable, and culturally appropriate.”
Winders notes that shared decision making (SDM) and consideration of costs are critical to improving care for racial/ethnic populations. “SDM can give patients and caregivers the opportunity to learn at their pace, in their language, and at their literacy level,” she says. “It’s also important to be mindful of costs when prescribing therapy and ensure that treatments are covered by formulary or insurance.”
To minimize use of EDs and urgent care clinics, Winders recommends extending or modifying office hours to meet needs of the working community, setting up practices in communities of color, and developing relationships with trusted messengers and faith leaders. “In future research, we hope to learn more from communities of color about the specifics of living with these diseases, the cultural implications, and where they obtain health information,” says Winders.