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Unexpected decline in pediatric asthma morbidity during the coronavirus pandemic
Lisa Ulrich1,2, Charlie Macias3, Ashish George1
1Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
Insights
The COVID-19 pandemic led to a significant decrease in asthma-related emergency visits and hospitalizations for children in Ohio. Reduced air pollution and increased telehealth may have contributed to fewer asthma exacerbations.
Area of Science:
- Pediatric Health
- Epidemiology
- Public Health
Background:
- The COVID-19 pandemic significantly altered healthcare access and utilization patterns.
- Asthma is a common chronic respiratory condition in children, requiring regular medical attention.
Purpose of the Study:
- To evaluate the impact of the COVID-19 pandemic on asthma-related emergency department (ED) and inpatient healthcare utilization among pediatric Medicaid enrollees.
- To compare healthcare utilization during the pandemic with a pre-pandemic 3-year average (2017-2019).
Main Methods:
- Retrospective analysis of asthma-related ED visits and inpatient admissions for children aged 2-18 covered by Medicaid.
- Comparison of utilization rates during the pandemic period (January-June) with the 2017-2019 average.
- Evaluation of all-cause ED utilization and asthma medication fill rates.
Main Results:
- Asthma-related ED visits decreased by 45.8% and inpatient admissions by 50.5% compared to the 2017-2019 average (p<0.05).
- The decline in asthma ED visits exceeded the reduction in overall ED utilization, suggesting asthma-specific factors.
- Fill rates for asthma controller medications decreased (p<0.05), while quick-relief medication fills remained unchanged.
Conclusions:
- The COVID-19 pandemic was associated with a substantial reduction in pediatric asthma-related acute care utilization.
- Factors such as decreased air pollution, reduced viral exposure, and increased telehealth may have contributed to this decline.
- Understanding the drivers of reduced utilization can inform interventions to improve asthma management and reduce healthcare burdens.
Abstract:
The Coronavirus disease 2019 (COVID-19) pandemic profoundly impacted health care utilization. We evaluated asthma-related emergency department (ED) and inpatient health care utilization by a county-specific Medicaid population, ages 2-18, during the COVID-19 pandemic and compared it to utilization from a 3-year average including 2017-2019. All-cause ED utilization and asthma medication fill rates were evaluated during the same timeframes. Relative to the 2017-2019 3-year average, cumulative asthma-related ED visits from January through June decreased by 45.8% (p = .03) and inpatient admission rates decreased by 50.5% (p = .03). The decline in asthma-related ED utilization was greater than the reduction of overall ED use during the same time period, suggesting that the decline involved factors specific to asthma and was not due solely to avoidance of health care facilities. Fill rates for asthma controller medications decreased during this time (p = .03) and quick relief medication fill rates had no significant change (p = .31). Multiple factors may have contributed to the decrease in acute asthma health care visits. Locally, decreased air pollution and viral exposures coincided with the "Stay-at-home" order in Ohio, and increased utilization of telehealth for assessment during exacerbations may have impacted outcomes. Identification of the cause of the decline in visit rates could spur new interventions to limit the need for ED and inpatient visits for asthma patients, leading to both economic and health-associated benefits.
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