African-Americans and Hispanics of Puerto-Rican origin bear a disproportionate burden of asthma morbidity and mortality, despite decades of attention to asthma disparities. The advent of biologic therapies offers a promising route to narrow these disparities. However, despite the well documented disparities in asthma treatment and outcomes, little is known about the use of biologics in these minority groups. Furthermore, ethnic minorities have been grossly underrepresented in trials that form the evidence base of the efficacy of these drugs. The goal of this Postdoctoral Career Transition Award to Promote Diversity (K99/R00 MOSAIC) is to expedite the candidate's transition to an independent investigator who possesses unique expertise in the use of mixed methods in pharmacoepidemiology and disparities research. Through the application of rigorous qualitative methods and sophisticated non-experimental designs, the candidate will determine patients? attitudes and beliefs about biologics and providers motivators for prescribing, and evaluate how these influence real-world utilization patterns and effectiveness of biologics, with focus on treatment effect heterogeneity by race/ethnicity. In the K99 phase of this award, the candidate will obtain focused training needed to accomplish these goals. In the R00 phase, the candidate will conduct a prospective cohort of patients with severe asthma and assess how time-varying patient factors and provider factors influence biologic initiation, adherence, and discontinuation.
The aims are to 1) Describe biologic use and identify differences in use across racial/ethnic groups, 2) Compare the real-world effectiveness of these biologics on asthma-related outcomes; and determine effect modification by race/ethnicity, and 3) Identify patient- and provider factors that influence biologic use and adherence over time. Findings from this R00 study will form the basis for further research such as using mediation and decomposition analysis to partition any identified differences in biologic use or patient outcomes to the various sources of bias. This will be helpful as we identify interventions which are likely to be effective in eliminating disparities related to biologics use. These activities will also establish the candidate's portfolio for applying mixed methods to generate evidence on interventions to reduce disparities in minority patients with severe asthma.
(Public Health Relevance): We will determine patients? attitudes and beliefs about biologics, provider motivators for prescribing biologics, and establish the real-world comparative effectiveness of biologic therapies in minority patients with asthma. These could lead to interventions to improve asthma outcomes in minority patients.