Abstract
The prevalence of asthma in US children with various developmental disabilities and delays is unclear, including how estimates vary by ethnic group. To report asthma prevalence estimates by various disability categories and developmental delays in a diverse sample of the US pediatric population. This population-based cross-sectional study encompassed a total of 71 811 families with children or adolescents aged 0 to 17 years (hereinafter referred to as children) who participated in the 2016 and 2017 National Survey of Children's Health. Data were collected from June 10, 2016, to February 10, 2017, for the 2016 survey and from August 10, 2017, to February 10, 2018, for the 2017 survey. Data were analyzed from September 20, 2019, to April 5, 2020. Developmental disability, including attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, seizure, intellectual and/or learning disability, and vision, hearing, and/or speech delay. Delay was defined as not meeting growth milestones with unknown cause. Weighted asthma prevalence estimates and 95% CIs were generated for children with and without disabilities. A total of 71 811 participants (mean [SE] age, 8.6 [0.1] years; 36 800 boys [51.1%; 95% CI, 50.2%-52.0%]; 50 219 non-Hispanic white [51.4%; 95% CI, 50.6%-52.3%]) were included in our final analytical sample, of whom 5687 (7.9%; 95% CI, 7.5%-8.4%) had asthma and 11 426 (15.3%; 95% CI, 14.7%-16.0%) had at least 1 disability. Overall asthma prevalence estimates were 10 percentage points higher in children with a disability (16.1%; 95% CI, 14.3%-17.8%) vs children without a disability (6.5%; 95% CI, 6.0%-6.9%). The odds of asthma were significantly higher in children with a disability (odds ratio [OR], 2.77; 95% CI, 2.39-3.21) or delay (OR, 2.22; 95% CI, 1.78-2.77) vs typically growing children. Adjusted models remained significant for all disability categories (overall adjusted OR, 2.21; 95% CI, 1.87-2.62). Subgroup analyses showed ethnic minorities had a higher prevalence of concurrent asthma and developmental disabilities vs non-Hispanic whites (19.8% [95% CI, 16.6%-23.0%] vs 12.6% [95% CI, 11.1%-14.0%]; P < .001). These results suggest that US children with various developmental disabilities or delay may have higher odds for developing asthma vs their typically developing peers. These findings support asthma screening in pediatric health care settings among patients with developmental disabilities and delays, particularly among those from ethnic minority backgrounds. In addition, very young children with asthma should be screened for disabilities and delays, because temporality cannot be determined by the current data source and analytical approach.
Highlights
Asthma is one of the most common chronic diseases in the world among children.[1]
The odds of asthma were significantly higher in children with a disability or delay (OR, 2.22; 95% CI, 1.78-2.77) vs typically growing children
Subgroup analyses showed ethnic minorities had a higher prevalence of concurrent asthma and developmental disabilities vs non-Hispanic whites (19.8% [95% CI, 16.6%23.0%] vs 12.6% [95% CI, 11.1%-14.0%]; P < .001)
Summary
Asthma is one of the most common chronic diseases in the world among children.[1]. At present, 6 million children (approximately 8%) living in the United States are diagnosed with asthma, incurring $81.9 billion in annual health care expenditures.[2,3] non-Hispanic black male youths in the United States are disproportionally diagnosed with childhood asthma vs their female and non-Hispanic white counterparts.[2]Concurrently, 53 million (approximately 9%) of the world’s children have a developmental disability.[4]. Developmental disabilities are typically categorized as follows: (1) behavioral disorders, including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASD); (2) motor disabilities, including cerebral palsy and seizure; (3) vision, hearing, and speech disabilities; and (4) cognitive disabilities, including intellectual disability (characterized by significant limitations in both intellectual functioning and adaptive behavior, including conceptual, social, and practical skills) and learning disability.[6,7] Developmental delay is defined as not meeting growth milestones with unknown cause of the delay.[6,7]
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