Hospital Admissions For Childhood Asthma 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.

Increased Risk of Hospital Admission for Asthma in Children From Short-Term Exposure to Air Pollution: Case-Crossover Evidence From Northern China

Background: Previous studies suggested that exposure to air pollution could increase risk of asthma attacks in children. The aim of this study is to investigate the short-term effects of exposure to ambient air pollution on asthma hospital admissions in children in Beijing, a city with serious air pollution and high-quality medical care at the same time.Methods: We collected hospital admission data of asthma patients aged ≤ 18 years old from 56 hospitals from 2013 to 2016 in Beijing, China. Time-stratified case-crossover design and conditional Poisson regression were applied to explore the association between risk of asthma admission in children and the daily concentration of six air pollutants [particulate matter ≤ 2.5 μm (PM2.5), particulate matter ≤ 10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3)], adjusting for meteorological factors and other pollutants. Additionally, stratified analyses were performed by age, gender, and season.Results: In the single-pollutant models, higher levels of PM2.5, SO2, and NO2 were significantly associated with increased risk of hospital admission for asthma in children. The strongest effect was observed in NO2 at lag06 (RR = 1.25, 95%CI: 1.06-1.48), followed by SO2 at lag05 (RR = 1.17, 95%CI: 1.05–1.31). The robustness of effects of SO2 and NO2 were shown in two-pollutant models. Stratified analyses further indicated that pre-school children (aged ≤ 6 years) were more susceptible to SO2. The effects of SO2 were stronger in the cold season, while the effects of NO2 were stronger in the warm season. No significant sex-specific differences were observed.Conclusions: These results suggested that high levels of air pollution had an adverse effect on childhood asthma, even in a region with high-quality healthcare. Therefore, it will be significant to decrease hospital admissions for asthma in children by controlling air pollution emission and avoiding exposure to air pollution.

Associations between smoke-free vehicle legislation and childhood admissions to hospital for asthma in Scotland: an interrupted time-series analysis of whole-population data

In Scotland, childhood admissions to hospital for asthma fell from March, 2006, after legislation was introduced to prohibit smoking in public places. In December, 2016, new Scottish legislation banned smoking in vehicles containing a child. We aimed to determine whether the introduction of this new legislation produced additional benefits. We obtained data on all asthma emergency admissions to hospitals in Scotland between 2000 and 2018 for individuals younger than 16 years. We used interrupted time-series analyses to study changes in monthly incidence of asthma emergency admissions to hospital per 100 000 children after the introduction of smoke-free vehicle legislation, taking into account previous smoke-free interventions. We did subgroup analyses according to age and area deprivation, using the Scottish Index of Multiple Deprivation, and repeated the analyses for a control condition, gastroenteritis, and other respiratory conditions. Of the 32 342 emergency admissions to hospital for asthma among children younger than 16 years over the 19-year study period (Jan 1, 2000, to Dec 31, 2018), 13 954 (43%) were among children younger than 5 years and 18 388 (57%) were among children aged 5-15 years. After the introduction of smoke-free vehicle legislation, there was a non-significant decline in the slope for monthly emergency admissions to hospital for asthma among children younger than 16 years (-1·21%, 95% CI -2·64 to 0·23) relative to the underlying trend in hospital admissions for childhood asthma. However, children younger than 5 years had a significant decline in the slope for monthly asthma admissions (-1·49%, -2·69 to -0·27) over and above the underlying trend among children in this age group (equivalent to six fewer hospitalisations per year), but no such decline was seen in children aged 5-15 years. Monthly admissions to hospital for asthma fell significantly among children living in the most affluent areas (-2·27%, -4·41 to -0·07) but not among those living in the most deprived areas. We found no change in admissions to hospital for gastroenteritis or other respiratory conditions after the introduction of the smoke-free vehicle legislation. Although legislation banning smoking in vehicles did not affect hospital admissions for severe asthma among children overall or in the older age group, this legislation was associated with a reduction in severe asthma exacerbations requiring hospital admission among preschool children, over and above the underlying trend and previous interventions designed to reduce exposure to second-hand smoke. Similar legislation prohibiting smoking in vehicles that contain children should be adopted in other countries. None.

Potential health benefits of sustained air quality improvements in New York City: A simulation based on air pollution levels during the COVID-19 shutdown

New York City (NYC) experienced a sharp decline in air pollution during the COVID-19 shutdown period (March 15, 2020 to May 15, 2020)—albeit at high social and economic costs. It provided a unique opportunity to simulate a scenario in which the city-wide air quality improvement during the shutdown were sustained over the five-year period, 2021 through 2025, allowing us to estimate the potential public health benefits to children and adults and their associated economic benefits.We focused on fine particulate matter (PM2.5) and modeled potential future health benefits to children and adults. The analysis considered outcomes in children that have not generally been accounted for in clean air benefits assessments, including preterm birth, term low birthweight, infant mortality, child asthma incidence, child asthma hospital admissions and emergency department visits, autism spectrum disorder, as well as adult mortality.We estimated a city-wide 23% improvement in PM2.5 levels during the COVID-19 shutdown months compared to the average level for those months in 2015–2018 (the business as usual period). Based on the data for 2020, we extrapolated the ambient levels of PM2.5 for the following five-year period. The estimated cumulative benefits for 2021–2025 included thousands of avoided cases of illness and death, with associated economic benefits from $31.8 billion to $77 billion.This “natural experiment,” tragic though the cause, has provided a hypothetical clean air scenario that can be considered aspirational—one that could be achieved through transportation, climate, and environmental policies that support robust economic recovery with similarly reduced emissions.

Associations between a smoke-free homes intervention and childhood admissions to hospital in Scotland: an interrupted time-series analysis of whole-population data

Many children are exposed to second-hand smoke in the home and are at increased risk of asthma and other respiratory conditions. In Scotland, a public health mass-media campaign was launched on March 24, 2014, called Take it Right Outside (TiRO), with a focus on reducing the exposure of children to domestic second-hand smoke. In this study, our aim was to establish whether the TiRO campaign was followed by a decrease in hospital admissions for childhood asthma and other respiratory conditions related to second-hand smoke exposure across Scotland. For an interrupted time-series analysis, data were obtained on all hospital admissions in Scotland between 2000 and 2018 for children aged younger than 16 years. We studied changes in the monthly incidence of admissions for conditions potentially related to second-hand smoke exposure (asthma, lower respiratory tract infection, bronchiolitis, croup, and acute otitis media) per 1000 children following the 2014 TiRO campaign, while considering national legislation banning smoking in public spaces from 2006. We considered asthma to be the primary condition related to second-hand smoke exposure, with monthly asthma admissions as the primary outcome. Gastroenteritis was included as a control condition. The analysis of asthma admissions considered subgroups stratified by age and area quintile of the Scottish Index of Multiple Deprivations (SIMD). 740 055 hospital admissions were recorded for children. 138 931 (18·8%) admissions were for respiratory conditions potentially related to second-hand smoke exposure, of which 32 342 (23·3%) were for asthma. After TiRO in 2014, we identified a decrease relative to the underlying trend in the slope of admissions for asthma (-0·48% [-0·85 to -0·12], p=0·0096) in younger children (age <5 years), but not in older children (age 5-15 years). Asthma admissions did not change after TiRO among children 0-15 years of age when data were analysed according to area deprivation quintile. Following the 2006 legislation, independent of TiRO, asthma admissions decreased in both younger children (-0·36% [-0·67 to -0·05], p=0·021) and older children (-0·68% [-1·00 to -0·36], p<0·0001), and in children from the most deprived (SIMD 1; -0·49% [-0·87 to -0·11], p=0·011) and intermediate deprived (SIMD 3; -0·70% [-1·17 to -0·23], p=0·0043) area quintiles, but not in those from the least deprived (SIMD 5) area quintile. Our findings suggest that smoke-free home interventions could be an important tool to reduce asthma admissions in young children, and that smoke-free public space legislation might improve child health for many years, especially in the most deprived communities. University of Aberdeen Research Excellence Framework 2021 Impact Support Award Scheme.

Diurnal temperature range and childhood asthma in Hefei, China: Does temperature modify the association?

BackgroundThe present study aimed to understand the effect of diurnal temperature range (DTR) on childhood asthma in Hefei, China, and to explore the effect of temperature on the DTR-asthma association. Materials and methodsDaily data on hospital admissions for childhood asthma, air pollutants, and weather variables in Hefei, China, from 1st January 2014 to 31st December 2015, were collected. A generalized additive model combined with a distributed lag non-linear model was used to quantify the effects of DTR on the total, age- and gender-specific hospital admissions for childhood asthma. A non-parametric bivariate response surface model, and a generalized additive model combined with a stratified parametric model were used to explore the interaction between DTR and temperature. ResultsWe observed that high DTR was associated with an increase in hospital admissions for childhood asthma. When DTR increased from 6.7 °C to 16.8 °C (99% percentile), hospital admissions for childhood asthma increased by 13% (relative risk: 1.13, 95% confidence interval: 1.07, 1.12). The analysis stratified, by mean temperature level, suggested that when DTR increased by 1 °C at low temperatures, asthma hospitalizations in total children, girls, boys and school-age children increased by 5.0% (95% CI: 2.6%, 7.5%), 3.7% (95% CI: 0.4%, 5.7%), 2.9% (95% CI: 0.8%, 4.4%) and 5.0% (95% CI: 2.6%, 7.5%), respectively. ConclusionsThis study suggests that the impact of high DTR should be considered among public health advice for children with existing asthma. Those days with high DTR and low mean temperature need extra attention.

Health Benefits of Sustained Air Quality Improvements in New York City: A Simulation Based on Air Pollution Levels During the COVID-19 Shutdown

New York City (NYC) experienced a sharp decline in air pollution during the COVID-19 shutdown period (March 15, 2020 to May 15, 2020) — albeit at high social and economic costs. It provided a unique opportunity to simulate a scenario in which the city-wide air quality improvement during the shutdown was sustained over the five-year period, 2021 through 2025, allowing us to estimate the potential public health benefits to children and adults and their associated economic benefits. We focused on fine particulate matter (PM2.5) and modelled potential future health benefits to children and adults. The analysis considered outcomes in children that have not generally been accounted for in clean air benefits assessments, including preterm birth, term low birthweight, infant mortality, child asthma incidence, child asthma hospital admissions and emergency department visits, autism spectrum disorder, as well as adult mortality. We estimated a city-wide 23% improvement in PM2.5 levels during the COVID-19 shutdown months compared to the average level for those months in 2015-2018 (the business as usual period). Based on the data for 2020, we extrapolated the ambient levels of PM2.5 for the following five-year period. The estimated cumulative benefits for 2021-2025 included thousands of avoided cases of illness and death, with associated economic benefits from $31.8 billion to $77 billion.This “natural experiment,” tragic though the cause, resulted in a clean air scenario that can be considered aspirational — one that could be achieved through transportation, climate, and environmental policies that support robust economic recovery with similarly reduced emissions.Funding Statement: This study was supported by the Environmental Protection Agency (EPA) RD83615401 and National Institute of Environmental Health Sciences (NIEHS) P50ES09600, The John Merck Fund (JMF), and New York Community Trust (NYCT).Declaration of Interests: The authors declare no competing interests.

Impact of respiratory infections, outdoor pollen, and socioeconomic status on associations between air pollutants and pediatric asthma hospital admissions.

BackgroundEpidemiology studies have shown that ambient concentrations of ozone and fine particulate matter (PM2.5) are associated with increased emergency department (ED) visits and hospital admissions (HAs) for asthma.ObjectiveEvaluate the impact of outdoor pollen, respiratory infections, and socioeconomic status (SES) on the associations between ambient ozone and PM2.5 and asthma HAs in New York City.MethodsDaily ozone, PM2.5, meteorological factors, pollen, and hospitalization records during 1999 to 2009 were obtained for New York City residents. Daily counts of HAs for asthma and respiratory infections were calculated for all-age and specific age groups, and for high- and low-SES communities. Generalized additive models were used to examine ambient concentrations of ozone and PM2.5 and asthma HAs, potential confounding effects of outdoor pollen and HAs for respiratory infections, and potential effect modification by neighborhood SES.ResultsBoth ozone and PM2.5 were statistically significantly associated with increased asthma HAs in children aged 6–18 years (per 10 ppb increase in ozone: RR = 1.0203, 95% CI: 1.0028–1.0382; per 10 μg/m3 increase in PM2.5: RR = 1.0218, 95% CI: 1.0007–1.0434), but not with total asthma HAs, or asthma HAs in other age groups. These associations were stronger for children living in the high-SES areas. Adjustment for respiratory infection HAs at various lags did not result in changes greater than 10% in the risk estimates for either ozone or PM2.5. In contrast, adjustment for outdoor pollen generally attenuated the estimated RRs for both ozone and PM2.5.ConclusionsAmbient ozone and PM2.5 are associated with asthma HAs in school-age children, and these associations are not modified by SES. HAs for respiratory infections do not appear to be a confounder for observed ozone- and PM2.5-asthma HAs associations, but pollen may be a weak confounder.

The role of outdoor fungi on asthma hospital admissions in children and adolescents: A 5-year time stratified case-crossover analysis

BackgroundSome fungal spores can trigger asthma exacerbation but knowledge of which outdoor fungal spores contribute to asthma hospitalisation is limited. ObjectivesTo examine the role of outdoor fungal spores in child and adolescent asthma hospitalisations. MethodsWe conducted a bi-directional time-stratified case-crossover study of child and adolescent asthma hospitalisations over 5 years. Conditional logistic regression assessed the role of 20 fungi taxa (Same day [L0] and lagged [L1-3]) adjusted for maximum temperature, humidity and grass pollen. Strata specific effects were explored if there was evidence of effect modification by age, sex, air pollutants or grass pollen. Non-linear effects examined with Generalized Additive Models. ResultsOf 2098 children hospitalised for asthma, 60% were boys; mean age was 5.5±3.7 years. Fungal spore counts peaked during warm months. Regression models found weak associations with Coprinus [L0,L1: OR=1.03, 1.01–1.06], Periconia [L0: OR=1.03, 1.001–1.07] and Chaetomium [L2: OR=1.08, 1.0–1.2]. Sex appeared to act as an effect modifier with girls having stronger associations with Cladosporium, Coprinus and total fungi. Older adolescent (14–18 years) hospitalisation was significantly associated with Coprinus and Ustilago/smuts. Air pollutants and grass pollen did not appear to act as effect modifiers. Non-linearity was not detected. ConclusionThere may be associations between some outdoor fungal spores and asthma hospitalisations. Further research needed to explore whether these findings can be replicated; and examine whether fungal sensitisation and/or human rhinovirus infections are associated with stronger effects. If findings are replicated, then the need to develop predictive models for fungal spore distribution and levels may become more important.

Do human rhinovirus infections and food allergy modify grass pollen–induced asthma hospital admissions in children?

Asthma prevalence in children has remained relatively constant in many Western countries, but hospital admissions for younger age groups have increased over time.1 Although the role of outdoor aeroallergens as triggers for asthma exacerbations requiring hospitalization in children and adolescents is complex, there is evidence that increasing concentrations of grass pollen are associated with an increased risk of asthma exacerbations in children.2 Human rhinovirus (HRV) infections are implicated in most of the serious asthma exacerbations in school-age children.3 In previous research, HRV infections and aeroallergen exposure have usually been studied independently. To our knowledge, only 1 study has examined interactions between these 2 factors,4 but lack of power prevented any meaningful interpretation...

Decline in admissions for childhood asthma, a 26‐year period population‐based study

The prevalence of childhood asthma has increased, although the rate of hospitalization for asthma seems to decrease. In Norway, the rate of hospital admission for childhood asthma from 1984 to 2000 increased. The aim of this study was to assess further trends in hospital admissions for childhood asthma up to 2010. A population-based study including children 1-13yrs of age hospitalized for asthma during six periods from 1984/1985 to 2009/2010 in Rogaland, Norway, was performed. Medical records from 1536 admissions (1050 children) were studied; and gender, age, number of admissions, length of hospital stay, medications and symptoms were recorded. For all age groups, the rate of admissions per 10.000 increased from 20.1 in 1984/85 to 33.7 in 1989/90, but declined to 14.4 in 2009/2010. Rates were highest in boys (OR 1.87; 95% CI: 1.69, 2.09), younger age groups (OR 2.51; 2.38, 2.64) and decreased from 1984 to 2010 (OR 0.92; 0.88, 0.94). The rates of readmissions were higher than for primary admissions (OR 1.33; 1.19, 1.47). From 1984 to 2010, there was an increased use of inhaled corticosteroids prior to admission (6 to 51%) and started at discharge (7 to 37%), and systemic steroids given during admission (19 to 83%). There has been a substantial decline in the rate of hospital admissions for childhood asthma after 1989/1990, with major differences between age groups and genders. The decline could be due to improved care of children with asthma or a real reduction in asthma exacerbations.

Bedroom air quality and vacuuming frequency are associated with repeat child asthma hospital admissions

Objective: Indoor environment factors have been associated with risk of asthma exacerbations in children but little is known about their role on asthma hospital readmissions. As children in Western societies continually spend more time indoors, understanding the influence of these factors on asthma exacerbation is important. We examined the role of indoor environmental and lifestyle characteristics on child asthma readmissions. Methods: A hospital-based case–control study recruited 22 children readmitted for asthma and 22 controls not readmitted for asthma. Logistic regression models were used to examine the association between aeroallergens and fungi in the bedroom and indoor lifestyle characteristics factors for asthma readmissions. To determine the best possible set of predictors among a large set of risk factors, we used random forests (RF) techniques. Results: Higher levels of airborne Cladosporium and yeast in the child’s bedroom increased risk of readmission (OR = 1.68, 95% CI 1.04–2.72 and OR = 1.52, 95% CI 0.99–2.34, respectively). Carpeted floors in the bedroom and synthetic doonas were also associated with increase in asthma readmissions (OR = 4.07, 95% CI 1.03–16.06 and OR = 14.6, 95% CI 1.26–169.4, respectively). In the home, frequent vacuuming using bagged cleaners increased risk of asthma readmission OR = 15.7 (95% CI 2.82–87.2). Conclusions: Factors in the child’s bedroom play an important role in increasing the risk of asthma hospital readmissions. These findings have major clinical implications as the identified potential risk factors may be modifiable. Further epidemiological studies with larger samples are necessary to evaluate these associations further.

Meta-analysis of the relationship between particulate matter (PM(10) and PM(2.5)) and asthma hospital admissions in children

To systematically review and assess the relationship between particulate matter (PM(10) and PM(2.5)) and children's hospital admissions for asthma, using both time-series and case-crossover analyses. The PubMed, Ebsco, Ovid and four Chinese periodical databases were screened for studies related to short-term effects of particulate matter on pediatric asthma hospital admissions published from 1 January 1990 to 31 December 2013.Sixteen studies on PM(10) and 10 studies on PM(2.5) were selected finally for meta-analysis. Relative risk (RR) or odds ratio (OR) and 95% confidence intervals (CI) of asthma hospital admissions per 10 µg/m³ increase of daily particulate matter were obtained from each study. RevMan 5.2.11 was used to test the heterogeneity of the results among the different studies and amalgamat the effect size by fixed or random effect model. As the concentration of PM(10) increased per 10 µg/m³, the children's hospital admissions for asthma increased by 1.75%; for PM(2.5), a 3.45% increase for asthma hospital admissions as the concentration increased per 10 µg/m³. By subgroup analysis based on study design, the effect size on both PM(10) and PM(2.5) of case-crossover study's results were higher than time-series analysis. The short-term increase of the concentration of PM(10) and PM(2.5) may led to the increase of Children's hospital admissions for asthma, and PM(2.5) will present a higher risk contribution.

Aerosol optical depth as a measure of particulate exposure using imputed censored data, and relationship with childhood asthma hospital admissions for 2004 in athens, Greece.

An understanding of human health implications from atmosphere exposure is a priority in both the geographic and the public health domains. The unique properties of geographic tools for remote sensing of the atmosphere offer a distinct ability to characterize and model aerosols in the urban atmosphere for evaluation of impacts on health. Asthma, as a manifestation of upper respiratory disease prevalence, is a good example of the potential interface of geographic and public health interests. The current study focused on Athens, Greece during the year of 2004 and (1) demonstrates a systemized process for aligning data obtained from satellite aerosol optical depth (AOD) with geographic location and time, (2) evaluates the ability to apply imputation methods to censored data, and (3) explores whether AOD data can be used satisfactorily to investigate the association between AOD and health impacts using an example of hospital admission for childhood asthma. This work demonstrates the ability to apply remote sensing data in the evaluation of health outcomes, that the alignment process for remote sensing data is readily feasible, and that missing data can be imputed with a sufficient degree of reliability to develop complete datasets. Individual variables demonstrated small but significant effect levels on hospital admission of children for AOD, nitrogen oxides (NOx), relative humidity (rH), temperature, smoke, and inversely for ozone. However, when applying a multivari-able model, an association with asthma hospital admissions and air quality could not be demonstrated. This work is promising and will be expanded to include additional years.

Hospital admissions for childhood asthma after smoke‐free legislation in England

Hospital admissions for childhood asthma after smoke‐free legislation in England

Hospital Admissions for Childhood Asthma After Smoke-Free Legislation in England

To assess whether the implementation of English smoke-free legislation in July 2007 was associated with a reduction in hospital admissions for childhood asthma. Interrupted time series study using Hospital Episodes Statistics data from April 2002 to November 2010. Sample consisted of all children (aged ≤14 years) having an emergency hospital admission with a principle diagnosis of asthma. Before the implementation of the legislation, the admission rate for childhood asthma was increasing by 2.2% per year (adjusted rate ratio 1.02; 95% confidence interval [CI]: 1.02-1.03). After implementation of the legislation, there was a significant immediate change in the admission rate of -8.9% (adjusted rate ratio 0.91; 95% CI: 0.89-0.93) and change in time trend of -3.4% per year (adjusted rate ratio 0.97; 95% CI: 0.96-0.98). This change was equivalent to 6802 fewer hospital admissions in the first 3 years after implementation. There were similar reductions in asthma admission rates among children from different age, gender, and socioeconomic status groups and among those residing in urban and rural locations. These findings confirm those from a small number of previous studies suggesting that the well-documented population health benefits of comprehensive smoke-free legislation appear to extend to reducing hospital admissions for childhood asthma.

Good public health practice

British Journal of School NursingVol. 8, No. 1 EditorialGood public health practiceEmma CroghanEmma CroghanSearch for more papers by this authorEmma CroghanPublished Online:16 Aug 2013https://doi.org/10.12968/bjsn.2013.8.1.5AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References British Medical Association (2013) BMA seeks HPV vaccination for gay men. http://bma.org.uk/news-views-analysis/news/2013/january/bma-seeks-hpv-vaccination-for-gay-men (accessed 1 February 2013) Google ScholarEllwood P, Asher MI, García-Marcos L et al. (2013) Do fast foods cause asthma, rhinoconjunctivitis and eczema? Global findings from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three. Thorax [Epub ahead of print] Crossref, Google ScholarMillett C, Lee JT, Laverty AA, Glantz SA, Majeed A (2013) Hospital admissions for childhood asthma after smoke-free legislation in England. Pediatrics [Epub ahead of print] Crossref, Google Scholar FiguresReferencesRelatedDetails 1 February 2013Volume 8Issue 1ISSN (print): 1752-2803ISSN (online): 2052-2827 Metrics History Published online 16 August 2013 Published in print 1 February 2013 Information© MA Healthcare LimitedPDF download

Hospital Admissions for Childhood Asthma After Smoke-Free Legislation in England

Hospital Admissions for Childhood Asthma After Smoke-Free Legislation in England

Socioeconomic and Environmental Determinants of Hospitalizations for Childhood and Adult Asthma in Hawaii

PP-30-168 Background/Aims: Asthma has been estimated to affect 17 million people or over 5% of the total population, with 1.9 million emergency room visits, and 466,000 hospital admissions annually in the United States. Approximately 9.7% of children and 6.9% of adults have been diagnosed with asthma in Hawaii. Understanding the disproportionate increase and remarkable disparities in asthma among low socioeconomic status indigenous and ethnic minority population groups may provide insight into the roots of the asthma epidemics and more effective disease management. Methods: The data on annual asthma hospitalizations for children and adults (ICD-9-CM 493.0–493.9), at sub-county school administrative district level (n = 22), in 2000–2005, was collected from Hawaii Health Information Corporation, and covered the counties of Honolulu, Hawaii, and Maui. The information on socioeconomic status, included socio-behavioral, economic, housing, and environmental characteristics was obtained from Hawaii Behavioral Risk factors Surveillance System and Healthy Hawaii Survey Programs, conducted in 2005. Principal component analysis techniques were employed to reduce the total number of significant area socioeconomic status indicators (n = 18), and to develop the composite area socioeconomic deprivation index for each administrative district as a single predictor of asthma hospital admissions in children and adults. Poisson log-linear regression models were used to estimate the influence of each selected socio-behavioral, economic, housing, and environmental factors on children and adult asthma hospitalization rates. The GIS ArcView 9.2 program was utilized for geospatial data analysis and result representation. Results: The study results revealed that the number of inactive, adult smokers, overweight and obese people, as well as fast food and other unhealthy food entities in the area were significant predictors of asthma hospitalization rates for both children and adults. Developed composite area socioeconomic deprivation index was a significant predictor of children and adult hospitalization rates for asthma. Conclusion: The study results support previous empirical findings that severe exacerbations and hospital admissions for asthma are distributed unequally within specific geographical areas and among specific ethnic minority population groups. The socioeconomic deprivation index could be used to explain social, economic, cultural, and environmental disparities in health as a powerful tool to describe social inequalities and also to identify high risk geographical areas and population groups in order to develop more effective disease prevention and health promotion strategies for asthma.

Relationship between ambient ozone concentrations and daily hospital admissions for childhood asthma/atopic dermatitis in two cities of Korea during 2004–2005

The objective of this study was to estimate the association between ambient ozone levels and hospitalization for asthma/atopic dermatitis among children younger than 15 years old living in Seoul and Ulsan, Korea, in the years 2004–2005. Estimated relative risks of hospital admissions associated with an interquartile range (IQR) increase in ozone concentration were calculated using a generalized additive Poisson model. For childhood asthma, the effect of an ozone increase on the relative risks in Ulsan [1.21 (95% CI, 1.10–1.34)] was higher than that in Seoul [1.05 (95% CI, 0.99–1.11)]. The relative risks for childhood atopic dermatitis were also found to be higher in Ulsan [1.38 (95% CI, 0.80–2.36)] than in Seoul [1.28 (95% CI, 1.04–1.58)]. These results support previously reported findings and also indicate that ozone concentrations at levels below the standards in the Republic of Korea can be correlated with asthma hospital admissions in children.