Joy Hsu

Objectives: Asthma has substantial morbidity and impact on quality of life. Symptoms can worsen when asthma coexists with allergy. We assessed the prevalence of asthma–allergy comorbidity in a nationally representative sample. Methods: We used 2021 National Health Interview Survey data for 7343 children and adolescents aged 2 to 17 years and 29 329 adults aged ≥18 years to estimate the prevalence of asthma, allergy symptoms, and lifetime allergy diagnosis. We assessed associations between asthma–allergy comorbidity and characteristics (sex, age group, race and ethnicity, family income, region, urbanicity) and between asthma attacks and allergy by using logistic regression. Results: Almost 8% of people aged ≥2 years had asthma, and 52.3% had allergy symptoms. Among children and adolescents, boys had a higher prevalence of asthma–allergy comorbidity than girls (6.2%; 95% CI, 5.3%-7.2% vs 5.0%; 95% CI, 4.2%-5.9%). Among adults, men had a lower prevalence of asthma–allergy comorbidity than women (4.9%; 95% CI, 4.5%-5.4% vs 8.3%; 95% CI, 7.7%-8.8%). The prevalence of asthma–allergy comorbidity was higher among people with low income (<100% vs ≥200% federal poverty level) and non-Hispanic Black (vs non-Hispanic White) people. Among people with asthma, 82.1% had allergy symptoms and 67.3% had a lifetime allergy diagnosis. The prevalence of allergy symptoms differed by sex among adults with asthma but not among children and adolescents with asthma. Among adults with asthma, asthma attacks were associated with allergy symptoms (adjusted prevalence ratio = 1.23; 95% CI, 1.04-1.46). Conclusion: Disparities in asthma–allergy comorbidity exist by sex, family income, and race and ethnicity. These findings support national asthma management guidelines on the importance of identifying and treating comorbid allergies among people with asthma.

Objectives: Asthma disproportionately affects Black people and people with low incomes, but Medicaid expansion (hereinafter, expansion) data on these populations are limited. We investigated health care use among adults with asthma, before and after expansion, and examined whether asthma-related health care use after expansion varied by demographic characteristics. Methods: We analyzed data from the 2011-2013 and 2015-2019 Behavioral Risk Factor Surveillance System Adult Asthma Call-Back Survey on participants aged 18-64 years with current asthma and low incomes in 23 US states. We assessed 5 asthma-related outcomes, including medical visits (routine and emergency) and medication use, for expansion and nonexpansion groups. We used t tests to compare weighted percentages and 95% CIs, then performed adjusted difference-in-differences analyses. Secondary analyses stratified data by race, ethnicity, and sex. Results: Primary analyses (N = 10 796) found no significant associations between expansion and any outcome. Analyses stratified by race and ethnicity found no significant changes (eg, asthma controller medication use among non-Hispanic Black participants in the expansion group was 24.1% [95% CI, 14.4%-37.5%] in 2011-2013 and 35.5% [95% CI, 27.0%-45.1%] in 2015-2019; P = .13). Use of asthma controller medication increased significantly among non-Hispanic Other participants in the nonexpansion group (2011-2013: 16.0% [95% CI, 9.5%-25.5%]; 2015-2019: 40.2% [95% CI, 25.5%-56.8%]; P = .01). Asthma-related hospitalizations decreased significantly among women in the expansion group: 2011-2013 (7.8%; 95% CI, 5.3%-11.3%) and 2015-2019 (3.5%; 95% CI, 2.5%-4.9%) ( P = .009). Conclusions: Investigating factors other than health insurance (eg, social determinants of health) that influence the use of asthma-related health care could advance knowledge of potential strategies to advance health equity for adults with asthma and lower incomes.

Purpose of Review This review discusses climate change-related impacts on asthma and allergic-immunologic disease, relevant US public health efforts, and healthcare professional resources. Recent Findings Climate change can impact people with asthma and allergic-immunologic disease through various pathways, including increased exposure to asthma triggers (e.g., aeroallergens, ground-level ozone). Climate change-related disasters (e.g., wildfires, floods) disrupting healthcare access can complicate management of any allergic-immunologic disease. Climate change disproportionately affects some communities, which can exacerbate disparities in climate-sensitive diseases like asthma. Public health efforts include implementing a national strategic framework to help communities track, prevent, and respond to climate change-related health threats. Healthcare professionals can use resources or tools to help patients with asthma and allergic-immunologic disease prevent climate change-related health impacts. Summary Climate change can affect people with asthma and allergic-immunologic disease and exacerbate health disparities. Resources and tools are available to help prevent climate change-related health impacts at the community and individual level.

Objective: To examine Medicaid expansion (ME) effects on health insurance coverage (HIC) and cost barriers to medical care among people with asthma. Method: We analyzed 2012–2013 and 2015–2016 data from low-income adults with current asthma aged 18–64 years in the Behavioral Risk Factor Surveillance System Asthma Call-Back Survey (state-level telephone survey). We calculated weighted percentages and 95% confidence intervals from ME and non-ME jurisdictions (according to 2014 ME status). Outcomes were HIC and cost barriers to buying asthma medication (MED), seeing a health care provider for asthma (HCP), or any asthma care (AAC). Using SUDAAN, we performed survey-weighted difference-in-differences analyses, adjusting for demographics. Subgroup analyses were stratified by demographics. Results: Our study population included 6445 participants from 25 states plus Puerto Rico. In 2015–2016 compared to 2012–2013, HIC was more common in ME jurisdictions (P < 0.001) but unchanged in non-ME jurisdictions. Adjusted difference-in-differences analyses showed ME was associated with a statistically significant 13.36 percentage-point increase in HIC (standard error =0.053). Cost barriers to MED, HCP, and AAC did not change significantly for either group in descriptive and difference-in-differences analyses. In subgroup analyses, we noted variation in outcomes by demographics and 2014 ME status. Conclusions: We found ME significantly affected HIC among low-income adults with asthma, but not cost barriers to asthma-related health care. Strategies to reduce cost barriers to asthma care could further improve health care access among low-income adults with asthma in ME jurisdictions.

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.