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The association between COVID-19 vaccine/infection and new-onset asthma in children - based on the global TriNetX
Chiao-Yu Yang1,2, Yu-Hsiang Shih2,3, Chia-Chi Lung4,5,6
1Department of Occupational Health Nursing Center, Institute of Public Health, Chung Shan Medical University Hospital, Taichung City, Taiwan.
Insights
COVID-19 infection significantly increases the risk of new-onset asthma in children, even in vaccinated individuals. This finding highlights the need for continued monitoring and tailored strategies to address long-term respiratory health impacts.
Area of Science:
- Pediatric Respiratory Health
- Infectious Disease Epidemiology
- Public Health
Background:
- The COVID-19 pandemic has raised concerns about its potential long-term health consequences, particularly new-onset asthma in children.
- Asthma in children leads to significant health issues and school absenteeism.
- Emerging data suggests a link between COVID-19 and new-onset asthma in adults, prompting investigation into pediatric populations.
Purpose of the Study:
- To investigate the association between COVID-19 infection and the risk of new-onset asthma in children.
- To compare asthma incidence in infected versus uninfected children, considering vaccination status.
- To identify specific demographic groups at higher risk for post-COVID-19 asthma.
Main Methods:
- A retrospective cohort study utilized electronic medical records from the TriNetX database (January 2021-December 2022).
- Two cohorts of children (ages 5-18) with SARS-CoV-2 RT-PCR testing were analyzed: unvaccinated and vaccinated groups, with and without COVID-19 infection.
- Propensity score matching was applied to control for bias, and hazard ratios (HR) with 95% confidence intervals (CI) were calculated.
Main Results:
- COVID-19 infected children exhibited a significantly higher incidence of new-onset asthma compared to uninfected children, irrespective of vaccination status.
- In unvaccinated children, new-onset asthma occurred in 4.7% of infected versus 2.0% of uninfected children (HR=2.26).
- In vaccinated children, new-onset asthma occurred in 8.3% of infected versus 3.1% of uninfected children (HR=2.745). Higher risks were observed in males, younger children (5-12 years), and Black or African American children.
Conclusions:
- COVID-19 infection is strongly associated with an increased risk of new-onset asthma in children, with a more pronounced effect in vaccinated children.
- These findings underscore the necessity for continuous monitoring of respiratory health in children post-COVID-19.
- Tailored healthcare strategies are crucial to mitigate long-term respiratory complications and manage asthma development in pediatric populations affected by the pandemic.
Introduction:
The COVID-19 pandemic has underscored the importance of its potential long-term health effects, including its link to new-onset asthma in children. Asthma significantly impacts children's health, causing adverse outcomes and increased absenteeism. Emerging evidence suggests a potential association between COVID-19 infection and higher rates of new-onset asthma in adults, raising concerns about its impact on children's respiratory health.
Methods:
A retrospective cohort study design was employed, using electronic medical records from the TriNetX database, covering January 1, 2021, to December 31, 2022. Two cohorts of children aged 5 to 18 who underwent SARS-CoV-2 RT-PCR testing were analyzed: unvaccinated children with and without COVID-19 infection, and vaccinated children with and without infection. Propensity score matching was used to mitigate selection bias, and hazard ratio (HR) and 95% CI were calculated to assess the risk of new-onset asthma.
Results:
Our study found a significantly higher incidence of new-onset asthma in COVID-19 infected children compared to uninfected children, regardless of vaccination status. In Cohort 1, 4.7% of COVID-19 infected children without vaccination developed new-onset asthma, versus 2.0% in their non-COVID-19 counterparts within a year (HR = 2.26; 95% CI = 2.158-2.367). For Cohort 2, COVID-19 infected children with vaccination showed an 8.3% incidence of new-onset asthma, higher than the 3.1% in those not infected (HR = 2.745; 95% CI = 2.521-2.99). Subgroup analyses further identified higher risks in males, children aged 5-12 years, and Black or African American children. Sensitivity analyses confirmed the reliability of these findings.
Conclusion:
The study highlights a strong link between COVID-19 infection and an increased risk of new-onset asthma in children, which is even more marked in those vaccinated. This emphasizes the critical need for ongoing monitoring and customized healthcare strategies to mitigate the long-term respiratory impacts of COVID-19 in children, advocating for thorough strategies to manage and prevent asthma amidst the pandemic.
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