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Racial, Ethnic,
And Socioeconomic
Disparities in Chronic
Spontaneous Urticaria:
A United States Claims
Database Study
Marc A. Riedl,1 Dhaval Patil,2 Jonathan Rodrigues,2 Merin
Kuruvilla,2 Jason Doran,3 Irina Pivneva,4 Frédéric Kinkead,4
Panagiotis Orfanos,5 Tara Raftery,6 Gil Yosipovitch7
1Department of Medicine, Division of Allergy & Immunology, University of California,
San Diego, La Jolla, CA, USA; 2Novartis Pharmaceuticals Corporation, East Hanover,
NJ, USA; 3Analysis Group, Inc., Washington, DC, USA; 4Analysis Group, Inc.,
Montréal, QC, Canada; 5Novartis Pharma AG, Basel, Switzerland; 6Novartis Ireland
Ltd., Dublin, Ireland; 7Dr. Phillip Frost Department of Dermatology and Cutaneous
Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
This study was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
Poster presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting,
November 6–10, 2025, Orlando, FL, USA.
• This analysis characterized racial, ethnic, and socioeconomic disparities
in the management of CSU
• Across groups, the highest proportions of corticosteroid use and ED visits
were among Black patients with Medicaid, suggesting more uncontrolled
disease in this population. Despite this, only 10% of Black patients with
Medicaid received biologic (advanced) treatment
• Patients with Medicaid were observed to rely on emergency care rather
than specialist treatment relative to those with commercial insurance
• Ensuring access to guidelines-based treatment may improve outcomes in
patients with CSU1
INTRODUCTION
• CSU is characterized by the occurrence of itch, wheals, and/or angioedema lasting >6 weeks without an
identifiable trigger,1 and is prevalent in 0.23% to 0.78% of the US population2,3
• The recommended 1st-line treatment for CSU is second-generation H1-AHs1
– Subsequent lines of treatment include up-dosed H1-AHs and biologics1
– Short-term oral corticosteroids are reserved for acute exacerbations1
• A large proportion of patients with CSU have uncontrolled disease despite H1-AH treatment4,5
• Patients with CSU often experience a prolonged disease journey, although health inequities in the
management of CSU are not fully understood6,7
• A UK-based study reported racial, ethnic, and socioeconomic disparities in the management of CSU,
with White patients more likely to receive a referral for specialist treatment relative to ethnic minority groups8
• Here, we investigate disparities in the management of CSU by race and ethnicity and by type of insurance
coverage in a large US cohort
METHODS
• This retrospective cohort study used data from the US HealthVerity health insurance claims database between
January 2016 and October 2023 (Figure 1)
• HealthVerity data are HIPAA compliant; therefore, no IRB approval was necessary
• Patients ≥18 years of age, with a confirmed diagnosis of CSU, and at least 1 year of continuous enrollment prior
to the index date (allowing gaps in continuous enrollment of less than 30 days), were included
• Treatment patterns (excluding OTC medication), specialist physician visits, and HCRU were assessed according
to race and ethnicity and by commercial or Medicaid insurance coverage
– Patients with multiple conflicting records of race or ethnicity were categorized as unknown and not included in
this analysis
– When multiple payer types were reported, commercial insurance was prioritized, followed by Medicaid,
and then Medicare Advantage (patients with Medicaid Advantage were excluded from this analysis)
• Results from all available follow-up including the index date are presented here and summarized using
descriptive statistics
• HealthVerity race and ethnicity data were supplemented by partially modeled data from Acxiom, a global data
analytics company
Racial, Ethnic,
And Socioeconomic
Disparities in Chronic
Spontaneous Urticaria:
A United States Claims
Database Study
Marc A. Riedl,1 Dhaval Patil,2 Jonathan Rodrigues,2 Merin
Kuruvilla,2 Jason Doran,3 Irina Pivneva,4 Frédéric Kinkead,4
Panagiotis Orfanos,5 Tara Raftery,6 Gil Yosipovitch7
1Department of Medicine, Division of Allergy & Immunology, University of California,
San Diego, La Jolla, CA, USA; 2Novartis Pharmaceuticals Corporation, East Hanover,
NJ, USA; 3Analysis Group, Inc., Washington, DC, USA; 4Analysis Group, Inc.,
Montréal, QC, Canada; 5Novartis Pharma AG, Basel, Switzerland; 6Novartis Ireland
Ltd., Dublin, Ireland; 7Dr. Phillip Frost Department of Dermatology and Cutaneous
Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
This study was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
Poster presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting,
November 6–10, 2025, Orlando, FL, USA.
• This analysis characterized racial, ethnic, and socioeconomic disparities
in the management of CSU
• Across groups, the highest proportions of corticosteroid use and ED visits
were among Black patients with Medicaid, suggesting more uncontrolled
disease in this population. Despite this, only 10% of Black patients with
Medicaid received biologic (advanced) treatment
• Patients with Medicaid were observed to rely on emergency care rather
than specialist treatment relative to those with commercial insurance
• Ensuring access to guidelines-based treatment may improve outcomes in
patients with CSU1
KEY FINDINGS & CONCLUSIONS
RESULTS
Patient Selection and Baseline Characteristics
• Of 224,958 patients meeting the inclusion criteria, 92,171 had available race, ethnicity, and insurance coverage
data (Figure 2)
• The mean age was 42.0 and the majority of patients were female (Table 1)
Limitations
• Race and ethnicity proportions may not be representative, as the claims dataset contained a substantial portion of
patients categorized as “unknown” ethnicity who were not included in this analysis
• For some patients whose self-reported race and ethnicity information was not available in claims, this information
was supplemented using modeled data; therefore, certain patients could have been misclassified
• The US HealthVerity health insurance claims database may present missing or incomplete follow-up data for the
study population. Moreover, health care claims data are subject to residual confounding
• No statistical comparative analyses were performed, and differences reported are numerical only
Treatment Patterns and Specialist Visits
• The proportion of patients who received systemic corticosteroids was highest among Black patients with
Medicaid (74.5%) and lowest among Asian patients with Medicaid (52.7%) (Table 2)
• The proportion of patients who received biologics was highest among White patients with commercial
insurance (13.7%) and lowest among Asian patients with Medicaid (5.7%)
• The proportion of patients who received antihistamines was higher among patients with Medicaid
(79.9% to 88.4%) than those with commercial insurance (49.5% to 57.9%)
• Relative to those with Medicaid, a higher proportion of patients with commercial insurance had allergist/
immunologist, or dermatologist specialist visits
– Across groups, the lowest proportion of allergist/immunologist visits was among Asian patients with
Medicaid (14.0%), and the lowest proportion of dermatologist visits was among Black patients with
Medicaid (5.5%)
CSU-Related HCRU
• Relative to those with commercial insurance, a higher proportion of patients with Medicaid had CSU-related ED
visits (Figure 3)
• Across groups, the highest proportion of CSU-related ED visits was among Black patients with Medicaid (36.2%)
• Overall, the lowest proportion of urgent care visits was among Asian patients (6.4% with commercial insurance;
5.7% with Medicaid)
Acknowledgments
Writing support was provided by Holly Oates, PhD
(BOLDSCIENCE Ltd., UK), and was funded by Novartis
Pharmaceuticals Corporation. This poster was developed
in accordance with Good Publication Practice (GPP)
guidelines. The authors had full control of the content and
made the final decision on all aspects of this publication.
Abbreviations
CCI, Charlson Comorbidity Index; CSU, chronic spontaneous urticaria;
ED, emergency department; H1-AH, H1-antihistamine; HCRU, health care resource
utilization; HIPAA, Health Insurance Portability and Accountability Act; IRB, institutional
review board; JAK-STAT, Janus kinase/signal transducer and activator of transcription;
OTC, over-the-counter; PPPY, per patient per year; SD, standard deviation;
UK, United Kingdom; US, United States.
Disclosures
MAR has received research and/or consulting support from Astria Therapeutics, BioCryst, BioMarin, Celldex, CSL Behring, Cycle Pharmaceuticals, Grifols, Intellia Therapeutics,
Ionis Pharmaceuticals, KalVista Pharmaceuticals, Novartis, Pfizer, Pharming, Pharvaris, Sanofi-Regeneron, and Takeda Pharmaceuticals. DP, JR, MK, PO, and TR are full-time
employees of Novartis and may own stock or stock options. JD, IP, and FK are full-time employees of Analysis Group, Inc., a consulting company that has provided paid consulting
services to Novartis Pharma AG. GY has received honoraria as a consultant and/or advisory board member for AbbVie, Amgen, Arcutis Biotherapeutics, Celldex, CSL Vifor, Eli Lilly,
Escient Pharmaceuticals, Galderma, GSK, Kamari Pharma, Kiniksa Pharmaceuticals, LEO Pharma, Maruho, Novartis, Pfizer, Pierre Fabre, Regeneron Pharmaceuticals, Inc., Sanofi,
and Trevi Therapeutics; has received research funding from Celldex, Eli Lilly, Escient Health, Kiniksa Pharmaceuticals, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., and Sanofi.
Marc A. Riedl | mriedl@health.ucsd.edu
Poster R396
Figure 1. Study Design
References
1. Zuberbier T, et al. Allergy. 2022;77(3):734–766.
2. Soong W, et al. World Allergy Organ J. 2025;18(8):101081.
3. Wertenteil S, et al. J Am Acad Dermatol. 2019;81(1):152–156.
4. Riedl MA, et al. Ann Allergy Asthma Immunol. 2025;134(3):324–332.e4.
5. Soong W, et al. World Allergy Organ J. 2023;16(12):100843.
6. Weller K, et al. Dermatol Ther (Heidelb). 2025;15(3):747–761.
7. Mosnaim GS, et al. J Allergy Clin Immunol. 2022;150(6):1260–1264.e7.
8. Erlewyn-Lajeunesse M, et al. Clin Exp Allergy. 2025;55(6):458–468.
Table 1. Patient Characteristics
Race/ethnicity White Black Asian Hispanic
Insurance coverage Commercial
(n = 32,489)
Medicaid
(n = 24,371)
Commercial
(n = 6169)
Medicaid
(n = 11,513)
Commercial
(n = 6498)
Medicaid
(n = 5748)
Commercial
(n = 3220)
Medicaid
(n = 2163)
Age at index date,a
years, mean (SD)
43.3
(14.0)
40.0
(14.4)
43.2
(13.5)
39.0
(13.4)
43.4
(13.3)
46.5
(17.7)
43.0
(13.7)
38.6
(14.7)
Female sex, n (%) 24,809
(76.4)
19,846
(81.4)
5,123
(83.0)
9,924
(86.2)
4,550
(70.0)
4,107
(71.5)
2,422
(75.2)
1,871
(86.5)
CCI, mean (SD) 0.5
(1.0)
0.7
(1.3)
0.5
(1.1)
0.8
(1.4)
0.4
(1.0)
0.7
(1.3)
0.5
(1.1)
0.8
(1.3)
Duration of follow-up
period, years, mean (SD)
2.5
(1.7)
2.3
(1.6)
2.4
(1.6)
2.4
(1.6)
2.4
(1.6)
2.4
(1.6)
2.6
(1.6)
2.8
(1.7)
aThe index date was specified as the earliest of the two diagnosis dates used to confirm CSU.
CCI, Charlson Comorbidity Index; CSU, chronic spontaneous urticaria; SD, standard deviation.
Table 2. Treatments and Specialist Physician Visits During Follow-Up
Race/ethnicity White Black Asian Hispanic
Insurance coverage Commercial
(n = 32,489)
Medicaid
(n = 24,371)
Commercial
(n = 6169)
Medicaid
(n = 11,513)
Commercial
(n = 6498)
Medicaid
(n = 5748)
Commercial
(n = 3220)
Medicaid
(n = 2163)
Treatment patterns,a,b
n (%)
Systemic corticosteroids 22,872
(70.4)
17,954
(73.7)
4491
(72.8)
8582
(74.5)
3708
(57.1)
3031
(52.7)
2279
(70.8)
1499
(69.3)
Antihistamines 16,233
(50.0)
19,466
(79.9)
3570
(57.9)
9844
(85.5)
3218
(49.5)
4854
(84.4)
1703
(52.9)
1913
(88.4)
Leukotriene receptor
antagonists
9217
(28.4)
7168
(29.4)
1770
(28.7)
3421
(29.7)
1497
(23.0)
1191
(20.7)
960
(29.8)
660
(30.5)
Biologics 4453
(13.7)
2614
(10.7)
731
(11.8)
1149
(10.0)
514
(7.9)
328
(5.7)
355
(11.0)
174
(8.0)
Immunosuppressive
agentsc
2148
(6.6)
1278
(5.2)
389
(6.3)
613
(5.3)
406
(6.2)
375
(6.5)
203
(6.3)
173
(8.0)
Immunomodulator agentsd 1746
(5.4)
982
(4.0)
321
(5.2)
466
(4.0)
207
(3.2)
129
(2.2)
193
(6.0)
95
(4.4)
JAK-STAT inhibitors 194
(0.60)
105
(0.43)
24
(0.39)
48
(0.42)
26
(0.40)
36
(0.63)
19
(0.59)
14
(0.65)
Specialist physician visits,a,b
n (%)
Allergist/immunologist 13,923
(42.9)
3888
(16.0)
2427
(39.3)
1849
(16.1)
2062
(31.7)
803
(14.0)
1344
(41.7)
455
(21.0)
Dermatologist 9834
(30.3)
1685
(6.9)
1312
(21.3)
636
(5.5)
1442
(22.2)
426
(7.4)
901
(28.0)
183
(8.5)
Patients with Medicare Advantage were excluded from this analysis. Highest n (%) values among groups are shown in bold.
aAll-cause and not specific to CSU. bEvaluated during the follow-up period, including the index date. cImmunosuppressive agents included azathioprine, mycophenolate,
methotrexate, tacrolimus and cyclosporine. dImmunomodulator agents included dapsone, hydroxychloroquine and sulfasalazine.
CSU, chronic spontaneous urticaria; JAK-STAT, Janus kinase/signal transducer and activator of transcription.
CSU, chronic spontaneous urticaria.
Index date
Date of first CSU diagnosis
Baseline period
1 year pre-index
Follow-up period
Time after the index date
Data end
End of medical
insurance
coverage/death
Data start
Beginning of
medical insurance
coverage
January 2016 October 2023
aA confirmed diagnosis for CSU was defined as ≥2 diagnoses of either idiopathic, other, or unspecified urticaria or ≥1 diagnosis of idiopathic, other, or unspecified urticaria
and ≥1 diagnosis of angioedema separated by ≥6 weeks but ≤1 year apart, in either order. bThe index date was specified as the earliest of the two diagnosis dates used to
confirm CSU. cContinuous enrollment (both medical and drug coverage) was assessed, allowing for gaps in continuous enrollment of <30 days.
CSU, chronic spontaneous urticaria.
Patients with available race, ethnicity, and insurance data
n = 92,171 (41.0%)
Figure 2. Patient Selection
N = 4,037,835
Patients with ≥1 diagnosis code of urticaria
Patients with a confirmed diagnosis of CSUa
n = 553,691 (13.7%)
Patients with ≥1 year of continuous enrollment prior to the index datec
n = 224,958 (59.8%)
Patients ≥18 years of age at the index dateb
n = 376,178 (67.9%)
The proportion of patients with outpatient visits across all groups was >90%. Patients with Medicare Advantage were excluded from this analysis.
Evaluated during the follow-up period, including the index date.
CSU, chronic spontaneous urticaria; ED, emergency department; HCRU, health care resource utilization; PPPY, per patient per year.
Figure 3. CSU-Related HCRU PPPY During Follow-Up
White Black Asian Hispanic
≥1 inpatient visit
White Black Asian Hispanic
≥1 ED visit
White Black Asian Hispanic
≥1 urgent care visit
0
10
20
30
40
50
60
Proportion of patients (%)
21.3