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High-Resolution Geographic Mapping of Severe Uncontrolled Asthma Data Regionally Across the United States
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A4860 - High-Resolution Geographic Mapping of Severe Uncontrolled Asthma Data Regionally Across the United States
Author Block: E. Bleecker1, H. Gandhi2, I. Gilbert2, G. Chupp3; 1University of Arizona Health Sciences, Tucson, AZ, United States, 2AstraZeneca, Wilmington, DE, United States, 3Yale University, New Haven, CT, United States.
Rationale: Emerging data demonstrating substantial heterogeneity among severe asthma phenotypes has led to precise therapies that improve outcomes and a debate about the definition and scope of severe uncontrolled asthma (SUA). We compared public-domain US morbidity/mortality statistics with county/city prescription claims data to understand SUA magnitude and geographic distribution.
Methods: The following variables were mapped: CDC Behavioral Risk Factor Surveillance System age-adjusted asthma mortality (2015) and self-reported prevalence (2014); Asthma and Allergy Foundation of America (AAFA) Asthma Capitals (2015)–reflecting a composite of prevalence, risk, medical factors determining cities with greatest disease burden; and QuintilesIMS anonymous patient-level prescriptions (4/2014-5/2017) and physician-affiliations data. Prescription-based morbidity (PBM) was defined as ICS/LABA prescriptions and ≥2 OCS prescriptions/year. States were ranked by percentage ICS/LABA asthmatics with PBM. Cities/counties with >25 asthmatics prescribed ICS/LABA (7918) were included (county score weighted equally by number of ICS/LABA asthmatics and percentage PBM).
Results: US mortality/prevalence rates were 10.3/million and 7.6%, respectively. WV-12.5(mortality)/11%(prevalence), NY-13.1/10.7%, OH-12.3/10.7% were top-10 states for both mortality and prevalence. OH (7 Asthma Capitals), NY (5) were also top-10 for Asthma Capitals. However, CA (10), FL (9), TX (7) had as many, if not more, AAFA high-disease burden cities. 25% of 2,216,252 asthmatics with ICS/LABA prescriptions had ≥2 OCS bursts/year (17% of those on low-dosage ICS/LABA, 25% medium, 31% high). Although not top-10 mortality/prevalence states, FL, TN (4 Asthma Capitals), SC (3 Asthma Capitals) were top-10 for Asthma Capitals and PBM. Four FL counties (6 cities), 3 TN counties (4 cities), 3 SC counties (3 cities) met PBM criteria; 6 of these 13 cities being Asthma Capitals (FL-1, TN-2, SC-3). City/county variation in PBM was greater than state variation (SD 8% vs 4%). Five southern (GA, FL, SC, AL, TN), 2 midwestern (OH, PA) states had ≥3 PBM counties, despite 38 states having greater prevalence. Although not top-10 in mortality, prevalence, or Asthma Capitals, GA had the most PBM counties (9)/cities (12). Only WV was top-10 for prevalence (11%), mortality (12.5), and PBM (2 counties/2 cities).
Conclusions: Findings indicate significant asthma morbidity heterogeneity across the US not reflected in individual state statistics. Disproportionate OCS use despite appropriate maintenance therapy occurs in counties/cities with and without state statistics reflecting SUA. State morbidity indices do not directly reflect locales with OCS overuse. Improved SUA awareness in areas with disproportionate OCS use and deploying regionally-directed education/clinical practice interventions could improve morbidity through appropriate use of therapies including targeted biologics.
Author Block: E. Bleecker1, H. Gandhi2, I. Gilbert2, G. Chupp3; 1University of Arizona Health Sciences, Tucson, AZ, United States, 2AstraZeneca, Wilmington, DE, United States, 3Yale University, New Haven, CT, United States.
Rationale: Emerging data demonstrating substantial heterogeneity among severe asthma phenotypes has led to precise therapies that improve outcomes and a debate about the definition and scope of severe uncontrolled asthma (SUA). We compared public-domain US morbidity/mortality statistics with county/city prescription claims data to understand SUA magnitude and geographic distribution.
Methods: The following variables were mapped: CDC Behavioral Risk Factor Surveillance System age-adjusted asthma mortality (2015) and self-reported prevalence (2014); Asthma and Allergy Foundation of America (AAFA) Asthma Capitals (2015)–reflecting a composite of prevalence, risk, medical factors determining cities with greatest disease burden; and QuintilesIMS anonymous patient-level prescriptions (4/2014-5/2017) and physician-affiliations data. Prescription-based morbidity (PBM) was defined as ICS/LABA prescriptions and ≥2 OCS prescriptions/year. States were ranked by percentage ICS/LABA asthmatics with PBM. Cities/counties with >25 asthmatics prescribed ICS/LABA (7918) were included (county score weighted equally by number of ICS/LABA asthmatics and percentage PBM).
Results: US mortality/prevalence rates were 10.3/million and 7.6%, respectively. WV-12.5(mortality)/11%(prevalence), NY-13.1/10.7%, OH-12.3/10.7% were top-10 states for both mortality and prevalence. OH (7 Asthma Capitals), NY (5) were also top-10 for Asthma Capitals. However, CA (10), FL (9), TX (7) had as many, if not more, AAFA high-disease burden cities. 25% of 2,216,252 asthmatics with ICS/LABA prescriptions had ≥2 OCS bursts/year (17% of those on low-dosage ICS/LABA, 25% medium, 31% high). Although not top-10 mortality/prevalence states, FL, TN (4 Asthma Capitals), SC (3 Asthma Capitals) were top-10 for Asthma Capitals and PBM. Four FL counties (6 cities), 3 TN counties (4 cities), 3 SC counties (3 cities) met PBM criteria; 6 of these 13 cities being Asthma Capitals (FL-1, TN-2, SC-3). City/county variation in PBM was greater than state variation (SD 8% vs 4%). Five southern (GA, FL, SC, AL, TN), 2 midwestern (OH, PA) states had ≥3 PBM counties, despite 38 states having greater prevalence. Although not top-10 in mortality, prevalence, or Asthma Capitals, GA had the most PBM counties (9)/cities (12). Only WV was top-10 for prevalence (11%), mortality (12.5), and PBM (2 counties/2 cities).
Conclusions: Findings indicate significant asthma morbidity heterogeneity across the US not reflected in individual state statistics. Disproportionate OCS use despite appropriate maintenance therapy occurs in counties/cities with and without state statistics reflecting SUA. State morbidity indices do not directly reflect locales with OCS overuse. Improved SUA awareness in areas with disproportionate OCS use and deploying regionally-directed education/clinical practice interventions could improve morbidity through appropriate use of therapies including targeted biologics.
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