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Published on: August 7, 2017
Asthma and allergy trajectories in children based on combined parental report and register data
Daniil Lisik1, Göran Wennergren2, Hannu Kankaanranta1,3,4
1Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
This study identified nine distinct childhood trajectories for asthma, allergic rhinitis, and eczema using combined parental reports and medication data. These trajectories show varied disease development and prescription patterns, indicating different health burdens.
Area of Science:
- Pediatric Allergy and Immunology
- Longitudinal Cohort Studies
- Data Integration in Health Research
Background:
- Childhood asthma and allergy trajectories are complex and often assessed via parental reports or clinical records.
- This study aimed to enhance trajectory characterization by integrating parental-reported data with objective medication dispensing records.
Purpose of the Study:
- To characterize longitudinal trajectories of co-existing asthma, allergic rhinitis, and eczema in children.
- To explore the utility of combining parental reports with dispensed medication data for trajectory analysis.
Main Methods:
- Utilized a Swedish population-based birth cohort (N=5654) with longitudinal survey data (ages 1-12 years).
- Linked survey data with dispensed medication register data (ages 2-13 years).
- Employed latent class analysis to identify distinct disease trajectories, guided by statistical and clinical interpretability.
Main Results:
- Identified nine distinct trajectories, including asthma-dominated (remitting, late-onset, persistent), eczema-dominated (persistent, remitting), allergic rhinitis-dominated (late-onset), multimorbidity, and low-disease burden groups.
- Observed significant differences across trajectories in parental disease reporting and medication use (type and quantity).
- The majority (72.2%) had a low-disease burden trajectory, while specific multimorbidity trajectories involved persistent eczema and late-onset allergic rhinitis.
Conclusions:
- Combining parental reports with dispensed medication data provides a richer characterization of childhood asthma and allergy trajectories.
- The identified trajectories exhibit distinct patterns of disease development and prescription, suggesting differential clinical morbidity burdens.
- This integrated approach merges subjective patient experience with objective healthcare utilization for improved understanding of allergic disease progression.
Background:
Trajectories of asthma and allergy in children are heterogeneous and commonly derived from parental report of disease or clinical records. This study combined parental-reported and register-based dispensed medication data to characterize childhood trajectories of co-existing asthma, allergic rhinitis, and eczema.
Methods:
From a Swedish population-based birth cohort (N = 5654), survey responses collected at the age of 1, 4.5, 8, and 12 years were linked to dispensed medication register data for the period of 2-13 years. Trajectories were identified with latent class analysis. Statistical metrics and clinical interpretability guided the model selection.
Results:
Nine distinct trajectories were identified: three asthma-dominated (early-onset remitting [n = 189, 3.3%], late-onset [n = 117, 2.1%], and persistent [n = 149, 2.6%]), two eczema-dominated (persistent [n = 190, 3.4%] and remitting [n = 432, 7.6%]), one allergic rhinitis-dominated (late-onset [n = 259, 4.6%]), two multimorbidity (mid-childhood asthma and late-onset allergic rhinitis [n = 144, 2.5%], and persistent eczema and late-onset allergic rhinitis [n = 90, 1.6%]), and one low-disease burden trajectory (n = 4084, 72.2%). Differences were seen across the trajectories in the proportion of parental report of disease and dispensed medication as well as by class and quantity of medication dispensed.
Conclusion:
Combined parental-reported and dispensed medication data enriches characterization of longitudinal trajectories of asthma and allergy in children by merging subjective experience of disease with healthcare utilization. The identified trajectories were characterized by distinct disease development and prescription patterns suggesting clinically differential morbidity burden.
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