Asthma Admission Rates Research Articles

The UK Soft Drinks Industry Levy and childhood hospital admissions for asthma in England

Sugar sweetened beverage consumption has been suggested as a risk factor for childhood asthma symptoms. We examined whether the UK Soft Drinks Industry Levy (SDIL), announced in March 2016 and implemented in April 2018, was associated with changes in National Health Service hospital admission rates for asthma in children, 22 months post-implementation of SDIL. We conducted interrupted time series analyses (2012-2020) to measure changes in monthly incidence rates of hospital admissions. Sub-analysis was by age-group (5-9,10-14,15-18 years) and neighbourhood deprivation quintiles. Changes were relative to counterfactual scenarios where the SDIL wasn’t announced, or implemented. Overall, incidence rates reduced by 20.9% (95%CI: 29.6-12.2). Reductions were similar across age-groups and deprivation quintiles. These findings give support to the idea that implementation of a UK tax intended to reduce childhood obesity may have contributed to a significant unexpected and additional public health benefit in the form of reduced hospital admissions for childhood asthma.

The increasing burden of asthma acute care in Singapore: an update on 15-year population-level evidence

BackgroundIn Singapore, there is currently scarce population-based research informing the recent trends of asthma-related healthcare burdens. In this study, we investigated the past 25-year trends of asthma-related hospitalisations, emergency department (ED) visits and deaths in Singapore and projected the future burdens from 2023 to 2040.MethodsWe acquired annually-measured data from the Singapore Ministry of Health Clinical and National Disease Registry, containing 25-year asthma-related hospitalisation and death rates as well as 15-year ED visit rates. We conducted change-point analysis and generalised linear modelling to identify time intervals with stable trends and estimate asthma-related healthcare utilisation and mortality rates. To project future asthma-related burdens, we developed a probabilistic model which combined projections of future population size with the estimated rate outcomes from the last stable period.ResultsOur results show that the asthma hospitalisation rate in Singapore had remained at approximately 80 episodes per 100,000 from 2003 to 2019 and are likely to grow by 1.7% each year (95% CI: 0.7, 5.0%), leading to a total of 163,633 episodes from 2023 to 2040 which corresponds to an estimated $103,075,820 based on 2022 USD. Besides, Singapore’s asthma-related ED visit rate was 390 per 100,000 in 2019 and is expected to decline by 3.4% each year (95% CI: − 5.8, 0.0%), leading to a total of 208,145 episodes from 2023 to 2040 which corresponds to USD$15,053,795. In contrast, the 2019 asthma-related mortality rate in Singapore was approximately 0.57 per 100,000 and is likely to stay stably low (change per year: -1.3, 95% CI: − 11.0, 4.3%). Between 2023 and 2040, Singapore’s estimated total number of asthma-related deaths is 638 episodes.ConclusionsCurrently, the burden of asthma acute care in Singapore is high; Singapore’s asthma-related hospitalisation and ED visit rates are relatively higher than those of other developed economies, and its asthma admission rate is expected to increase significantly over time, possibly indicating excess resource use for asthma. The established national asthma programme in Singapore, together with recent efforts in reinforcing primary care at the national level, provides opportunities to reduce avoidable asthma admissions.

A forecasting tool for predicting asthma related emergency department visits and hospitalizations using heterogeneous data sources

New Zealand (NZ) is one of the countries with the highest prevalence and mortality rate due to asthma. Organisation for Economic Co-operation and Development (OECD) statistics [3] indicate NZ has one of the highest hospital admission rates for asthma of OECD countries. According to recent records [1], on average 77 New Zealanders each year lost their battle to asthma. Furthermore, the cost burden of asthma to the NZ economy has not improved over the years [2]. Not much work has been accomplished in the direction of population health forecasting for asthma in NZ. The aim of this study is to develop a prediction model for anticipating asthma-related hospitalisations in Auckland, NZ while exploiting diverse heterogeneous data sources. These sources accounts for triggers that exacerbate asthma conditions like meteorological and air quality factors plus the social media resource accessed through Google search trends. The research work is divided into two parts; in the first phase I analysed the relationship between trigger parameters and asthma using the Pearson Correlation Coefficient. Subsequently, in part two a comparative examination has been conducted based upon the prediction models developed using different machine learning techniques on the continuous data of 1097 days. The experimental evaluation shows that the best forecasting tool could predict asthma-related hospitalisation with an accuracy of 78.87% while the precision and recall for the model were 79.80% and 78.87%. The outcome achieved from implementing such a model would be beneficial for public health surveillance, thereby helping in more efficient and timely healthcare resource deployment.

Dexamethasone for Pediatric Critical Asthma: A Multicenter Descriptive Study.

Systemic corticosteroids are vital to critical asthma management. While intravenous methylprednisolone is routinely used in the pediatric intensive care unit (PICU) setting, recent data supports dexamethasone as an alternative. Using the Pediatric Health Information System (PHIS) registry, we assessed trends and variation in corticosteroid prescribing among children hospitalized for critical asthma. We performed a multicenter retrospective cohort study using PHIS data among children 3-17 years of age admitted for critical asthma from 2011 through 2019. Primary outcomes were corticosteroid prescribing rates by year and participating sites. Exploratory outcomes were corticosteroid-related adverse effects, rates of adjunctive pharmaceutical and respiratory interventions, mortality and length of stay. Of the 49 children's hospitals assessed, 26 907 encounters were included for study. Mean dexamethasone exposure rates were 18.1 ± 2.4% where 2.4 ± 1.2% represented dexamethasone-alone prescribing. Dexamethasone alone prescribing exhibited a linear trend (annual increase of 0.5 ± 0.1% annually R2 = 0.845) without correlation to cumulative site critical asthma admission rates. Compared to encounters prescribed solely methylprednisolone or a combination of dexamethasone and methylprednisolone, subjects provided dexamethasone alone had reduced asthma severity indices, length of stay, and exposure rates to adjunctive asthma interventions. Adverse events were rare and the dexamethasone-alone group less frequently experienced gastritis and hyperglycemia. In this multicenter retrospective study from 49 children's hospitals, dexamethasone prescribing rates appear increasing for pediatric critical asthma. Observed variability in corticosteroid prescribing implies a continued need for controlled prospective comparative analyses to define ideal corticosteroid regimens for pediatric critical asthma.

Challenges of using asthma admission rates as a measure of primary care quality in children: An international comparison.

ObjectivesTo demonstrate the challenges of interpreting cross-country comparisons of paediatric asthma hospital admission rates as an indicator of primary care quality.MethodsWe used hospital administrative data from >10 million children aged 6–15 years, resident in Austria, England, Finland, Iceland, Ontario (Canada), Sweden or Victoria (Australia) between 2008 and 2015. Asthma hospital admission and emergency department (ED) attendance rates were compared between countries using Poisson regression models, adjusted for age and sex.ResultsHospital admission rates for asthma per 1000 child-years varied eight-fold across jurisdictions. Admission rates were 3.5 times higher when admissions with asthma recorded as any diagnosis were considered, compared with admissions with asthma as the primary diagnosis. Iceland had the lowest asthma admission rates; however, when ED attendance rates were considered, Sweden had the lowest rate of asthma hospital contacts.ConclusionsThe large variations in childhood hospital admission rates for asthma based on the whole child population reflect differing definitions, admission thresholds and underlying disease prevalence rather than primary care quality. Asthma hospital admissions among children diagnosed with asthma is a more meaningful indicator for inter-country comparisons of primary care quality.

Trends in hospital admissions and mortality rates for asthma in Ecuador: a joinpoint regression analysis of data from 2000 to 2018

BackgroundAlthough asthma has emerged as an important public health problem over recent decades in Latin America, there are limited published data on national hospital admission and mortality rates for asthma...

Regional differences in pediatric asthma hospital admissions: National data from Israel 1996-2017.

Asthma is a common chronic childhood illness and frequent cause of hospitalization. A decline in hospital admission rates was noted up to the 1990s, however, trends are not as clear since the turn of the century. This study aimed to assess the rates and regional differences of asthma admissions over more than two decades using the national Ministry of Health database, which registers data from all the hospitals. A retrospective cohort study, analysis of all pediatric asthma admissions, for Patients 1-14 years old, between 1996 and 2017 as recorded by the National Hospital Discharge Registry, was performed. Asthma admission rates were calculated per 1000 age adjusted residents, using the number of admission cases as the numerator, and age specific population size as the denominator. The annual asthma hospitalization rate decreased in the entire pediatric population from 2.14 in 1996-0.89 in 2017. Children in the 1-4 year age group comprised most of the hospital admissions, and most of the decline was attributable to this age group. Significant differences in hospitalizations were found between different regions as well as differences in the rate of decline in asthma hospitalizations with the lowest admission rate in the Jerusalem district, highest in Haifa, northern and southern Israeli regions and the greatest rate of decline in the Tel-Aviv district. This nationwide study, over more than two decades, shows clear regional differences in the rates of asthma admissions as well as regional differences in the rates of decline.

COVID-19 Severity in Hospitalized Pediatric Patients with Atopic Disease

Data from the Coronavirus-19 disease (COVID-19) pandemic suggests asthma is not a risk factor for severe disease in adults; it is unclear if this applies to pediatric patients. This study was undertaken to determine if pediatric patients with asthma or atopic disease had altered risk for severe disease when hospitalized with COVID-19. A retrospective chart review was performed of SARS-CoV-2 positive patients admitted to Nationwide Children’s Hospital from March 1 to July 31. Charts were evaluated for history of asthma or atopic disease (including asthma) and surrogate markers of COVID-19 severity, including ICU admission, supplemental oxygen requirement, and intubation. 49 patients were identified as positive for SARS-CoV-2, 22 of whom were admitted for COVID-19 related symptoms. Of the admitted patients, six patients (12%) had asthma and 18 (37%) atopic disease (including those with asthma). ICU admission rate for asthma versus non-asthma was 17% versus 12% (p=0.78) and for atopic versus non-atopic was 17% versus 6.4% (p=0.32), while supplemental oxygen rates were 17% versus 16% asthma versus non-asthma (p=0.98) and 22% versus 13% atopic versus non-atopic (p=0.43). Only two patients required intubation and both had atopic dermatitis. Two patients had Multisystem Inflammatory Syndrome in Children -- one with allergic rhinitis and atopic dermatitis, the other without any atopic disease. Markers of COVID-19 disease severity do not differ based on asthma or atopic status in pediatric patients. In children, like adults, the presence of asthma or atopy does not appear to alter the risk of severe COVID-19.

Spatiotemporal variations of asthma admission rates and their relationship with environmental factors in Guangxi, China

ObjectiveThe study aimed to determine if and how environmental factors correlated with asthma admission rates in geographically different parts of Guangxi province in China.SettingGuangxi, China.ParticipantsThis study was done among 7804...

Cost-benefit impact of free asthma medication provision for the pediatric population.

Asthma is a common chronic disease in childhood, resulting in high costs for health care systems and society. As of June 2011, the Brazilian Unified Health System (SUS) provides free asthma medications for the population. This study evaluated the impact of this program on asthma admissions in the population aged 1-19 years. In addition, a cost-benefit analysis compared data before and after the introduction of the program. This descriptive study was based on information from SUS Information Technology Department (DATASUS). Admission rates and costs of patients aged 1-19 years with diagnosed asthma were compared before (2008-2010) and after (2012-2017) the provision of free inhaled corticosteroid. The asthma admission rate reduced by 28.4% when comparing the two periods (OR 0.71; 95% CI 0.64-0.79). Children aged 1-4 years had a 27.3% reduction in asthma admissions (OR 0.72; 95% CI 0.63-0.82), while those aged 15-19 years had a 39.65% decrease (OR 0.59; 95% CI 0.37-0.95). Asthma admission costs decreased when comparing the two periods (OR 0.68; 95% CI 0.62-0.74). After the introduction of the program, mean cost savings reached US $27,865,905.08 in children aged 1-4 years and US $21,350,660.63 in those aged 5-19 years. The economic burden of pediatric asthma on Brazil's public health care system is significant. From 2012 to 2015, free provision of inhaled corticosteroid was cost-effective in all age groups. In 2017, no cost-benefit effect was observed in this population, but asthma admission rate decreased.

Land use regression for spatial distribution of urban particulate matter (PM10) and sulfur dioxide (SO2) in a heavily polluted city in Northeast China.

Particulate material 10 μm (PM10) and sulfur dioxide (SO2) are representative air pollutants in Northeast China and may contribute more to the morbidity of respiratory and cardiovascular disease than may other pollutants. Up to now, there have been few studies on the relation between health effect and air pollution by PM10 and SO2 in Northeast China, which may be due to the lack of a model for determination of air pollution exposure. For the first time, we used daily concentration data and influencing factors (different type of land use, road length and population density, and weather conditions as well) to develop land use regression models for spatial distribution of PM10 and SO2 in a central city in Northeast China in both heating and non-heating months. The final models of SO2 and PM10 estimation showed good performance (heating months: R2 = 0.88 for SO2, R2 = 0.88 for PM10; non-heating months: R2 = 0.79 for SO2; R2 = 0.87 for PM10). Estimated concentrations of air pollutants were more affected by population density in heating seasons and land use area in non-heating seasons. We used the land use regression (LUR) models developed to predict pollutant levels in nine districts in Shenyang and conducted a correlation analysis between air pollutant levels and hospital admission rates for childhood asthma. There were high associations between asthma hospital admission rates and air pollution levels of SO2 and PM10, which indicated the usability of the LUR models and the need for more concern about the health effects of SO2 and PM10 in Northeast China. This study may contribute to epidemiological research on the relation between air pollutant exposure and typical chronic disease in Northeast China as well as providing the government with more scientific recommendations for air pollution prevention.

Asthma admission rates and patterns of salbutamol and inhaled corticosteroid prescribing in England from 2013 to 2017

Asthma admission rates and patterns of salbutamol and inhaled corticosteroid prescribing in England from 2013 to 2017

Factors affecting readmission for asthma exacerbation in children attending Alexandria university children-hospital

Background: The admission rate for bronchial asthma has increased dramatically all over the world. This increase in admission influences the children’s quality of life in addition to health care cost. Objective of the study was to identify the risk factors for readmission because of acute asthmatic attacks.Methods: Case control study applied on asthmatic children admitted because of acute asthma attacks attending emergency room, paediatric intensive care unit and inpatient wards of Alexandria university children's hospital, Alexandria, Egypt in the period from September 2016 to July 2017. The study group was subdivided into 2 groups; group (A) readmitted within one year from first admission and group (B) firstly admitted.Results: The mean age in group (A) and (B) was 9.09±3.98 and 8.65±4.01 respectively. Males were more than females in both groups, and no sex differentiation effects on readmission. The duration of the disease in readmitted group ranged from 1-8 years, it was a risk factor for acute asthma readmission. Viral infection, exercise and dust were risk factors for acute asthma exacerbation readmission. Disease severity was found to have a higher percentage of hospitalization; cases with severe and moderate bronchial asthma compared to mild cases. Readmitted patients had more sleep disturbance and lack of school attendance. Readmitted patients were less adherent to treatment.Conclusions: Duration of the disease, viral infections, common cold, dust and exercise are risk factors for acute asthma readmission. Severity of the disease and adherence to medications affect acute asthma readmission.

The Role of Place as a Modifier of Asthma Associations among Children in Seattle

Asthma is the most common chronic illness of childhood and its prevalence is increasing, causing much concern for identification of risk factors. Previous work in Seattle has identified strong associations between air pollution and pediatric asthma emergency department (ED) visits. According to the CDC, Washington State’s asthma prevalence is among the highest in the nation and steadily increasing. Higher rates of asthma are found in African American children, and while many factors including socio-economic status and birth weight have been shown to be related to asthma prevalence, it has been difficult to account for the difference between various races. Here we examine whether this racial difference can be explained by neighborhood characteristics, such as racial composition, socioeconomic status, and land use. We use the Comprehensive Hospital Abstract Reporting System (CHARS) data from 2009-2016 in Seattle, WA and air pollution data from the Community Multiscale Air Quality Modeling System (CMAQ) along with neighborhood socioeconomic data (median income, percent below poverty, percent unemployed and percent white) from the American Community Survey (ACS) and land use data to explore the relationship between hospital admission rates for asthma and air pollution, race, and neighborhood characteristics. We use panel data statistical methods to explore these associations. Preliminary results demonstrate that in Seattle there are 8,315 ER visits for a primary or secondary diagnosis of asthma in children between the ages of 0-18. African Americans represent 7.0% of the population in Seattle yet of the pediatric visits, 1,225 (14.7%) were for African American children. The zipcodes with the highest counts of asthma also have higher ethnic diversity (> 20% black and < 30% white), high population density (> 5300/ mile2 compared to the average in Seattle of 4721/ mile2) and are lower income neighborhoods (median household income < $67,000 compared to $75,000 in Seattle).

Does specialist physician supply affect pediatric asthma health outcomes?

BackgroundPediatrician and pediatric subspecialist density varies substantially among the various Canadian provinces, as well as among various states in the US. It is unknown whether this variability impacts health outcomes. To study this knowledge gap, we evaluated pediatric asthma admission rates within the 2 Canadian provinces of Manitoba and Saskatchewan, which have similarly sized pediatric populations and substantially different physician densities.MethodsThis was a retrospective cross-sectional cohort study. Health regions defined by the provincial governments, have, in turn, been classified into “peer groups” by Statistics Canada, on the basis of common socio-economic characteristics and socio-demographic determinants of health. To study the relationship between the distribution of the pediatric workforce and health outcomes in Canadian children, asthma admission rates within comparable peer group regions in both provinces were examined by combining multiple national and provincial health databases. We generated physician density maps for general practitioners, and general pediatricians practicing in Manitoba and Saskatchewan in 2011.ResultsAt the provincial level, Manitoba had 48.6 pediatricians/100,000 child population, compared to 23.5/100,000 in Saskatchewan. There were 3.1 pediatric asthma specialists/100,000 child population in Manitoba and 1.4/100,000 in Saskatchewan. Among peer-group A, the differences were even more striking. A significantly higher number of patients were admitted in Saskatchewan (590.3/100,000 children) compared to Manitoba (309.3/100,000, p < 0.0001).ConclusionsSaskatchewan, which has a lower pediatrician and pediatric asthma specialist supply, had a higher asthma admission rate than Manitoba. Our data suggest that there is an inverse relationship between asthma admissions and pediatrician and asthma specialist supply.

Literature Review: Prediction Modeling of Emergency Department Disposition Decisions for Children with Acute Asthma Exacerbations

Emergency department (ED) visits and hospitalization are common, costly and the greatest disease burden to children with asthma. Admission rates for asthma vary substantially by site and ED provider. Disease heterogeneity and ED provider uncertainty surrounding likelihood of successful discharge contribute to potentially avoidable hospitalizations. New approaches to improve ED disposition decision-making could improve patient care and reduce waste associated with unnecessary hospitalizations. Several asthma severity scores and asthma prediction models have been evaluated for their ability to predict ED disposition for childhood asthma. Our objective is to review prior studies that modeled predictors of disposition outcomes for children treated in ED settings for acute asthma exacerbations.

Variation in hospital admission rates between a tertiary care and two freestanding emergency departments

BackgroundRecently, freestanding emergency departments (FSEDs) have grown significantly in number. Critics have expressed concern that FSEDs may increase healthcare costs. ObjectiveWe determined whether admission rates for identical diagnoses varied among the same group of physicians according to clinical setting. MethodsThis was a retrospective comparison of adult admission rates (n=3230) for chest pain, chronic obstructive pulmonary disease (COPD), asthma, and congestive heart failure (CHF) between a hospital-based ED (HBED) and two FSEDs throughout 2015. Frequency distribution and proportions were reported for categorical variables stratified by facility type. For categories with cell frequency less or equal to 5, Fisher's Exact test was used to calculate a P value. Chi square tests were used to assess difference in proportions of potential predictor variables between the HBED and FSEDs. For continuous variables, the mean was reported and Student's t-test assessed the difference in means between HBED and FSED patients. Multivariate logistic regression analyses were performed to estimate the unadjusted and adjusted prevalence odds ratio with 95% confidence interval (CI) for patient disposition outcomes associated with type of ED facility visited. ResultsOf 3230 patients, 53% used the HBED and 47% used the FSED. Patients visiting the HBED and FSED varied significantly in gender, acuity levels, diagnosis, and number of visits. Age was not significantly different between facilities. Multivariable adjusted estimated prevalence odds ratio for patients admitted were 1.2 [95%CI: 1.0–1.4] in the HBED facility compared to patients using FSEDs. ConclusionIn our healthcare system, FSEDs showed a trend towards a 20% lower admission rate for chest pain, COPD, asthma and CHF.

Location, Location, Location: Teaching About Neighborhoods in Pediatrics

Location, Location, Location: Teaching About Neighborhoods in Pediatrics

Spatial variation in nitrogen dioxide concentrations and cardiopulmonary hospital admissions

BackgroundAir pollution episodes are associated with increased cardiopulmonary hospital admissions. Cohort studies showed associations of spatial variation in traffic-related air pollution with respiratory and cardiovascular mortality. Much less is known in particular about associations with cardiovascular morbidity. We explored the relation between spatial variation in nitrogen dioxide (NO2) concentrations and cardiopulmonary hospital admissions. MethodsThis ecological study was based on hospital admissions data (2001–2004) from the National Medical Registration and general population data for the West of the Netherlands (population 4.04 million). At the 4-digit postcode area level (n=683) associations between modeled annual average outdoor NO2 concentrations and hospital admissions for respiratory and cardiovascular causes were evaluated by linear regression with the log of the postcode-specific percentage of subjects that have been admitted at least once during the study period as the dependent variable. All analyses were adjusted for differences in composition of the population of the postcode areas (age, sex, income). ResultsAt the postcode level, positive associations were found between outdoor NO2 concentrations and hospital admission rates for asthma, chronic obstructive pulmonary disease (COPD), all cardiovascular causes, ischemic heart disease and stroke (e.g. adjusted relative risk (95% confidence interval) for the second to fourth quartile relative to the first quartile of exposure were 1.87 (1.46–2.40), 2.34 (1.83–3.01) and 2.81 (2.16–3.65) for asthma; 1.44 (1.19–1.74), 1.50 (1.24–1.82) and 1.60 (1.31–1.96) for COPD). Associations remained after additional (indirect) adjustment for smoking (COPD admission rate) and degree of urbanization. ConclusionsOur study suggests an increased risk of hospitalization for respiratory and cardiovascular causes in areas with higher levels of NO2. Our findings add to the currently limited evidence of a long-term effect of air pollution on hospitalization. The ecological design of our study is a limitation and more studies with individual data are needed to confirm our findings.

Contextual, Ecological and Organizational Variations in Risk-Adjusted COPD and Asthma Hospitalization Rates of Rural Medicare Beneficiaries.

The purpose of this study is to examine what factors contributing to the variability in chronic obstructive pulmonary disorder (COPD) and asthma hospitalization rates when the influence of patient characteristics is being simultaneously considered by applying a risk adjustment method. A longitudinal analysis of COPD and asthma hospitalization of rural Medicare beneficiaries in 427 rural health clinics (RHCs) was conducted utilizing administrative data and inpatient and outpatient claims from Region 4. The repeated measures of risk-adjusted COPD and asthma admission rate were analyzed by growth curve modeling. A generalized estimating equation (GEE) method was used to identify the relevance of selected predictors in accounting for the variability in risk-adjusted admission rates for COPD and asthma. Both adjusted and unadjusted rates of COPD admission showed a slight decline from 2010 to 2013. The growth curve modeling showed the annual rates of change were gradually accentuated through time. GEE revealed that a moderate amount of variance (marginal R2 = 0.66) in the risk-adjusted hospital admission rates for COPD and asthma was accounted for by contextual, ecological, and organizational variables. The contextual, ecological, and organizational factors are those associated with RHCs, not hospitals. We cannot infer how the variability in hospital practices in RHC service areas may have contributed to the disparities in admissions. Identification of RHCs with substantially higher rates than an average rate can portray the need for further enhancement of needed ambulatory or primary care services for the specific groups of RHCs. Because the risk-adjusted rates of hospitalization do not very by classification of rural area, future research should address the variation in a specific COPD and asthma condition of RHC patients. Risk-adjusted admission rates for COPD and asthma are influenced by the synergism of multiple contextual, ecological, and organizational factors instead of a single factor.