Impact of COVID-19 pandemic on sex disparities in asthma healthcare utilisation and outcomes: a population study

Background Sex disparities in healthcare access were exacerbated during the coronavirus disease 2019 (COVID-19) pandemic. For respiratory conditions such as asthma, where females have poorer disease outcomes, it is unclear whether the pandemic further worsened this sex disparity. Thus, the objective of this study was to compare the impact of the pandemic on healthcare utilisation, exacerbations and mortality rates in males and females with asthma. Methods A retrospective population-based provincial-level analysis was conducted using linked administrative datasets from Alberta, Canada. We measured hospitalisation, emergency department and outpatient visits, and asthma outpatient exacerbations in female and males with asthma 18 months before and after 12 March 2020. Mortality data were compared pre- versus post-pandemic, taking into account confirmed COVID-19 infection within 30 days. Subgroup analysis was undertaken to determine whether healthcare utilisation differed in those with severe asthma. Results Acute care and outpatient encounters for patients with asthma declined for both females and males. Those with severe asthma of either sex experienced a reduction in hospitalisations during the pandemic. Total number of outpatient asthma visits, including both virtual and in-person, increased during the pandemic for both sexes but significantly more in females. Mortality rate was unchanged after adjusting for COVID-19-associated deaths pre- versus post-pandemic. Conclusion All patients with asthma accessed acute care resources less but outpatient visits increased during the pandemic. There was no increase in non-COVID-related mortality, regardless of sex, suggesting that the previously established sex disparity in asthma outcomes was not seen during the pandemic.