A105-12 Demographic and Insurance Status Predict Guideline Directed Asthma Care After Exacerbation

Abstract Introduction Asthma is the most common respiratory disorder in the United States, with a population prevalence of 7.7%. Asthma exacerbations are associated with considerable cost, morbidity, and mortality. Specialty care with labs for phenotyping are an important part of evidence based management following an exacerbation requiring an ED visit or hospital admission. We sought to determine predictors for obtaining proper labs and attending a pulmonary or allergy appointment following an exacerbation. Methods This was a retrospective, observational analysis using a claims database for a health system that covers the District of Columbia, Baltimore, and other areas of Maryland. We abstracted demographic and insurance data, along with clinical encounters and laboratory values. Our outcome variables were allergy or pulmonary specialist appointments, absolute eosinophil (eos) counts, and Immunoglobulin E (IgE) levels. We modeled sex, age, insurance status, and race to see which variables predicted each outcome. Results There were a total of 314,162 asthma encounters available for analysis between 2015 and 2024. Of these, 63,440 (20.2%) were ED or inpatient visits. Mean age for these patients was 42.5±21.6, 64.1% were female, 20.2% identified as White, and 5.3% were uninsured. While the majority (43,599 (68.7%)) had eos drawn, only 580 (0.8%) had IgE levels ordered. Mean values for eos and IgE were 247±40 cells/uL and 579.6±195 IU/mL respectively. Only 282 (0.4%) were on record as having seen a Pulmonologist or Allergist. In logistic regression modeling, older age increased (OR 1.055 (95% CI: 1.053-1.056; p 0.01) for eos and OR 1.012 (95% CI: 1.008-1.016; p 0.01) for IgE) and decreased (OR 0.985 (95% CI: 0.979-0.990; p 0.01)) the odds of having labs drawn and specialty referral respectively. Those with insurance were more likely to have eos drawn (OR 1.51 (95% CI: 1.40-1.63; p 0.01) and specialty referral (OR 2.75 (95%: 1.13-6.70; p = 0.03)). Non-white patients were less likely to have labs drawn (OR 0.60 (95% CI: 0.57-0.64; p 0.01) for eos and OR (0.64 (95% CI: 0.54-0.78; p 0.01) for IgE). Females were more likely to have eos drawn (OR 1.167 (95% CI: 1.60-1.73; p 0.01)). Conclusions There are demographic factors associated with important lab orders and specialty referrals after asthma exacerbation. Having health insurance also predicts labs and referrals. Our data help identify those at risk for not receiving guideline directed asthma care. This abstract is funded by: None