What does this research mean for the field?

The COVID-19 pandemic has led to a lasting decline in asthma exacerbations among adults and a transient reduction among children, while widening socioeconomic disparities in exacerbation risk. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

This study aims to assess how the COVID-19 pandemic affected asthma exacerbations across various sociodemographic groups.

February 26, 2026Open Access

Effects of COVID-19 pandemic on incidence of asthma exacerbation in an urban population

Key Points

This study aims to assess how the COVID-19 pandemic affected asthma exacerbations across various sociodemographic groups.
Conducted a retrospective cohort study of 162,113 asthma patients within a health system.
Applied difference-in-differences logistic regression to compare pre-pandemic and late-pandemic exacerbation risks.
Used interrupted time series regression to identify level and trend changes in asthma exacerbation.
Performed sensitivity analyses to confirm the robustness of findings across demographic groups.
Exacerbation odds were higher among specific racial and ethnic groups, females, and low-income individuals prior to the pandemic.
Post-pandemic, raised risk was seen in children, males, Medicaid holders, and those with unmet social needs.
Adults experienced a sustained decline in exacerbations, while children showed a rebound to baseline levels.
The pandemic widened existing socioeconomic disparities related to asthma outcomes.

Abstract

The long-term effects of the COVID-19 pandemic on asthma exacerbations across sociodemographic groups is unknown. We conducted a retrospective cohort study of 162,113 asthma patients within the Montefiore Health System from March 2018 to February 2024 to evaluate pandemic-related changes in exacerbation risk across demographic, socioeconomic, and social determinant subgroups. Difference-in-differences logistic regression compared pre-pandemic (2018–2020) and late-pandemic (2022–2024) periods by age, sex, race and ethnicity, income, insurance, and unmet social needs. Interrupted time series regression assessed level and trend changes in March 2020, with sensitivity analyses confirming robustness. Before the pandemic, exacerbation odds were higher among Black, Hispanic, and Other race patients, females, Medicaid-insured individuals, and children. After pandemic onset, risk increased disproportionately for patients with unmet social needs, children, males, Medicaid, and low-income groups, while racial and ethnic disparities persisted. Interrupted time series showed immediate decreases among children and adults, with subsequent rebound to baseline in children but sustained suppression among adults. The pandemic was associated with widened socioeconomic disparities, a transient reduction in pediatric exacerbations, and a lasting decline among adults, underscoring the need for interventions addressing socioeconomic and social drivers of asthma outcomes.

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