Effects of COVID-19 pandemic on incidence of asthma exacerbation in an urban population

The long-term effects of the COVID-19 pandemic on asthma exacerbations across sociodemographic groups is unknown. We conducted a retrospective cohort study of 162,113 asthma patients within the Montefiore Health System from March 2018 to February 2024 to evaluate pandemic-related changes in exacerbation risk across demographic, socioeconomic, and social determinant subgroups. Difference-in-differences logistic regression compared pre-pandemic (2018-2020) and late-pandemic (2022-2024) periods by age, sex, race and ethnicity, income, insurance, and unmet social needs. Interrupted time series regression assessed level and trend changes in March 2020, with sensitivity analyses confirming robustness. Before the pandemic, exacerbation odds were higher among Black, Hispanic, and Other race patients, females, Medicaid-insured individuals, and children. After pandemic onset, risk increased disproportionately for patients with unmet social needs, children, males, Medicaid, and low-income groups, while racial and ethnic disparities persisted. Interrupted time series showed immediate decreases among children and adults, with subsequent rebound to baseline in children but sustained suppression among adults. The pandemic was associated with widened socioeconomic disparities, a transient reduction in pediatric exacerbations, and a lasting decline among adults, underscoring the need for interventions addressing socioeconomic and social drivers of asthma outcomes.