A36-03 Disparities in HealthRelated Social Needs Prevalence Among Patients With Asthma: A Retrospective Cohort Study

Rationale Health-related social needs (HRSN) are modifiable social and economic factors that affect health and represent potential intervenable mechanisms for health inequities, including asthma severity, morbidity, and mortality. However, evidence on the prevalence and cumulative burden of HRSN in asthma is limited. Using national HRSN screening data, we aimed to quantify disparities in (1) any HRSN and (2) the total number of positive HRSN domains by race, ethnicity, sex, rurality, and insurance type. Methods We performed a retrospective cohort study of asthma patients who completed HRSN screening within Trinity Health from January 2020-November 2024. HRSN screening assessed six domains: food insecurity, financial risk, housing instability, transportation barriers, social isolation, and health literacy. An accompanying abstract demonstrates minimal selection effects in screening within this cohort. Exposures were race, ethnicity, sex, rurality, and insurance type. For each exposure, we fit generalized linear models with a log link for (1) any positive HRSN domain, and (2) the number of positive domains. We adjusted models for age, race, ethnicity, sex, insurance type, preferred language, Elixhauser comorbidity index, region, care setting, year, and patient portal access. When evaluating race and ethnicity, we omitted known confounders of race/ethnicity-outcome relationships. Results The cohort included 114,534 patients; 49,538 (31.8%) reported ≥1 HRSN. 15,572 (13.6%) identified as Black, 4,658 (4.0%) as Hispanic/Latinx, 81,441 (71.1%) as female, and 7,361 (6.4%) as a rural resident. 35,475 (31.0%) had Medicare, and 20,264 (17.7%) had Medicaid insurance. In adjusted models, Black patients had higher relative risk of any positive HRSN (1.42, 95% CI 1.33-1.51), and higher rate ratio for total number of positive domains (1.69, 95% CI 1.52-1.88) compared to White patients; Asian patients had similar risk for any positive HRSN (0.94, 95% CI 0.86-1.03) and lower numbers of positive domains (0.85, 95% CI 0.74-0.97). Compared to commercial insurance, Medicaid and Medicare recipients had higher risk of any positive HRSN (1.74, 95% CI 1.66-1.82; 1.58 95% CI 1.50-1.67) and higher rates of numbers of HRSN domains (2.44, 95% CI 2.31-2.59; 2.01, 95% CI 1.93-2.11). Hispanic/Latinx and female patients had modestly higher ratios for both outcomes; there were no differences by rurality (Table). Conclusion Among HRSN-screened asthma patients in a national health system, marginalized racial and ethnic groups, female sex, and publicly insured patients had higher risks of any positive HRSN and greater HRSN domain burdens. Results may inform future HRSN screening and mitigation strategies to advance equity in asthma care and outcomes.