Asthma outcomes in a safety net hospital system: A comparative study to a national cohort

Asthma disproportionately affects vulnerable populations. Safety net hospitals (SNHs) manage a significant proportion of these patients. Despite the assumption that patients in SNHs have more severe asthma, little is known about how their outcomes compare to the general population.

Asthma patients from Harris Health System (HHS), a large SNH system in Texas, were compared to a representative national cohort of patients from Epic Cosmos (EC), a US-wide aggregated electronic health record database. Asthma was defined by ≥ 2 outpatient diagnoses and prescription for asthma medications from 2021 to 2022. Demographics, comorbidities, and asthma outcomes were analyzed. Comparisons between groups were made using standardized mean differences (SMD). Logistic regression was used to standardize exacerbation rates.

We identified 2644 HHS and 602,460 EC patients. HHS patients were more likely to identify as Hispanic (55.7 % vs. 7.6 %) and non-White (79.4 % vs. 30.2 %) and had higher rates of obesity and metabolic comorbidities. Despite more intensive asthma medication use and a higher proportion with elevated blood eosinophils and serum IgE, patients with asthma treated within HHS had a similar prevalence of severe asthma exacerbations as compared to EC (28.0 % vs. 27.5 %), which was not statistically different (SMD = 0.01). Direct standardization to EC showed a numerically but not statistically lower rate of exacerbations among patients seen at HHS (24.3 % vs 27.5 %).

Patients treated at a large SNH had comparable asthma outcomes to the general asthma population. These findings emphasize the critical role of resourcing SNHs to improve asthma management and reduce health disparities.