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Reduced pediatric urgent asthma utilization and exacerbations during the COVID-19 pandemic
Jillian H Hurst1,2, Congwen Zhao2,3, Nicholas S Fitzpatrick4
1Department of Pediatrics, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.
Insights
The COVID-19 pandemic saw reduced healthcare visits for children with asthma, but also fewer asthma attacks. Telehealth use surged, and social distancing may have decreased exposure to asthma triggers.
Area of Science:
- Pediatric Healthcare
- Respiratory Medicine
- Epidemiology
Background:
- The COVID-19 pandemic significantly altered healthcare access and utilization.
- Children with chronic conditions like asthma may face unique challenges and outcomes during public health crises.
Purpose of the Study:
- To evaluate changes in healthcare utilization and asthma-related outcomes in children during the COVID-19 pandemic.
- To compare healthcare encounters and asthma exacerbations in the year before and the first year of the pandemic.
Main Methods:
- Utilized electronic health records for 3959 children (5-17 years) with asthma.
- Compared healthcare utilization (well-child visits, ED visits, inpatient admissions, telehealth) and asthma exacerbations (requiring systemic steroids) between March 2019-February 2020 and March 2020-February 2021.
Main Results:
- All-cause healthcare encounters decreased significantly during the pandemic, including well-child visits, emergency department visits, and inpatient admissions.
- Telehealth encounters increased over 100-fold.
- Asthma exacerbations requiring systemic steroids also decreased significantly during the pandemic.
- No association found between race/ethnicity and changes in healthcare utilization or asthma outcomes.
Conclusions:
- The COVID-19 pandemic period was associated with substantial shifts in pediatric healthcare utilization, marked by increased telehealth adoption.
- Children with asthma experienced improved outcomes, with fewer exacerbations during the pandemic.
- Public health measures like social distancing may have contributed to reduced exposure to asthma triggers, alongside changes in healthcare-seeking behaviors.
Abstract:
The COVID-19 pandemic has had a profound impact on healthcare access and utilization, which could have important implications for children with chronic diseases, including asthma. We sought to evaluate changes in healthcare utilization and outcomes in children with asthma during the COVID-19 pandemic. We used electronic health records data to evaluate healthcare use and asthma outcomes in 3959 children and adolescents, 5-17 years of age, with a prior diagnosis of asthma who had a history of well-child visits and encounters within the healthcare system. We assessed all-cause healthcare encounters and asthma exacerbations in the 12-months preceding the start of the COVID-19 pandemic (March 1, 2019-February 29, 2020) and the first 12 months of the pandemic (March 1, 2020-February 28, 2021). All-cause healthcare encounters decreased significantly during the pandemic compared to the preceding year, including well-child visits (48.1% during the pandemic vs. 66.6% in the prior year; p < .01), emergency department visits (9.7% vs. 21.0%; p < .01), and inpatient admissions (1.6% vs. 2.5%; p < .01), though there was over a 100-fold increase in telehealth encounters. Asthma exacerbations that required treatment with systemic steroids also decreased (127 vs. 504 exacerbations; p < .01). Race/ethnicity was not associated with changes in healthcare utilization or asthma outcomes. The COVID-19 pandemic corresponded to dramatic shifts in healthcare utilization, including increased telehealth use and improved outcomes among children with asthma. Social distancing measures may have also reduced asthma trigger exposure.
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