Geographic variation in disease burden among patients with severe persistent asthma in the United States

Background: In the United States, a few studies have evaluated geographic variation of severe asthma at the subnational level. Objective: To assess state -level geographic variation in the prevalence and characteristics of severe persistent asthma in the United States. Methods: Patients aged above or equal to 12 years with severe persistent asthma were identified using nationally representative data from IQVIA open -source Medical/Pharmacy Claims and PharMetrics Plus databases (January 2019 -December 2020). The index date was defined as the patient's earliest qualifying date for a severe asthma diagnosis. Baseline characteristics were measured during the 12 -month pre -index period. Outcomes including exacerbation occurrence, asthma control, and medication use were measured during the 12 -month post -index period and compared across states using census -level projections. Results: A total of 2,092,799 patients with asthma were identified; 496,750 (23.7%) met criteria for severe persistent asthma and all inclusion criteria. Mean age was 50.5 years; 68.4% were females. The prevalence of severe persistent asthma varied across states, ranging from 19.6% (New Mexico) to 31.9% (Alaska). Among patients with severe persistent asthma, 40.9% had more than or equal to 1 exacerbation, ranging from 34.2% (Vermont) to 45.6% (Louisiana); 21.1% had uncontrolled disease, ranging from 16.5% (Vermont) to 24.0% (Arizona). Among patients with exacerbations, 13.7% had exacerbation -related emergency department visits or hospitalizations, ranging from 7.0% (North Carolina) to 17.7% (Nevada). Among patients with severe uncontrolled asthma, 15.6% used biologics post -index, ranging from 2.2% (Hawaii) to 27.9% (Mississippi). Conclusion: There is significant variability in severe persistent asthma prevalence and disease burden across US states. Reasons for geographic variation may include differences in socioeconomic/environmental factors or asthma management. (c) 2024 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)