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Asthma and Risk of Appendicitis in Children: A Population-Based Case-Control Study
M Earth Hasassri1, Eric R Jackson1, Husam Ghawi2
1Mayo Medical School, Mayo Clinic, Rochester, Minn.
Insights
Active asthma significantly increases children's risk of appendicitis, while inactive asthma does not. This suggests active asthma may be an overlooked risk factor requiring further study.
Area of Science:
- Pediatrics
- Epidemiology
- Respiratory Medicine
Background:
- Asthma is a common chronic respiratory condition in children.
- The relationship between asthma and other pediatric conditions, such as appendicitis, is not well understood.
- Appendicitis remains a common surgical emergency in children.
Purpose of the Study:
- To investigate the association between active and inactive asthma and the risk of developing appendicitis in children.
- To determine if asthma status is an independent risk factor for pediatric appendicitis.
Main Methods:
- Population-based case-control study design.
- Inclusion of children under 18 years residing in Olmsted County, Minnesota, from 2006-2012.
- Matching of appendicitis cases (n=309) with controls (1:1) based on birthday, gender, registration, and index dates.
- Asthma status ascertained using predefined criteria: active (symptoms or events within 1 year) vs. inactive.
- Conditional logistic regression analysis to assess risk, controlling for confounders.
Main Results:
- Active asthma was associated with a significantly increased risk of appendicitis compared to inactive asthma (OR=2.48) and no asthma (OR=1.88).
- After adjusting for confounders, active asthma remained associated with a higher odds of appendicitis (aOR=1.75), while inactive asthma did not.
- Tobacco smoke exposure within 3 months also increased appendicitis risk (aOR=1.66).
- Leukotriene receptor antagonists, a type of asthma medication, were associated with a reduced risk of appendicitis (OR=0.18).
Conclusions:
- Active asthma may be an unrecognized risk factor for appendicitis in children.
- Inactive asthma history does not appear to confer an increased risk for appendicitis.
- Further research is warranted to explore the underlying biological mechanisms linking active asthma and appendicitis.
Objective:
To assess whether asthma is associated with risk of appendicitis in children.
Methods:
We used a population-based case-control study design using a comprehensive medical record review and predetermined criteria for appendicitis and asthma. All children (age younger than 18 years of age) who resided in Olmsted County, Minnesota, and developed appendicitis between 2006 and 2012 were matched to controls (1:1) with regard to birthday, gender, registration date, and index date. Asthma status was ascertained using predetermined criteria. Active (current) asthma was defined as the presence of asthma symptoms or asthma-related events (eg, medication use, clinic visits, emergency department, or hospitalization) within 1 year before the index date. Inactive asthma was defined as subjects without these events. A conditional logistic regression model was used.
Results:
Among the 309 appendicitis cases identified, when stratified according to asthma status, active asthma was associated with significantly increased risk of appendicitis compared with inactive asthma (odds ratio [OR] = 2.48; 95% confidence interval [CI], 1.22-5.03) and to no asthma (OR = 1.88; 95% CI, 1.07-3.27; overall P = .035). When controlling for potential confounders such as gender, age, and smoking status, active asthma was associated with a higher odds of developing appendicitis compared with nonasthmatic patients (adjusted OR = 1.75; 95% CI, 0.99-3.11) whereas inactive asthma was not (overall P = .049). Tobacco smoke exposure within 3 months was associated with an increased risk of appendicitis (adjusted OR = 1.66; 95% CI, 1.02-2.69). Among asthma medications, leukotriene receptor antagonists reduced the risk of appendicitis (OR = 0.18; 95% CI, 0.04-0.74).
Conclusions:
Active asthma might be an unrecognized risk factor for appendicitis in children whereas a history of inactive asthma does not pose such risk. Further investigation exploring the underlying mechanisms is warranted.
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