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Adverse asthma outcomes among children hospitalized with asthma in California
D Calmes1, B D Leake, D M Carlisle
1Department of Pediatrics, King-Drew Medical Center/Charles R. Drew University of Medicine and Science, Los Angeles, California 90059, USA.
Insights
Adverse asthma outcomes in hospitalized children are increasing, particularly in older age groups and among Asian Pacific-American children. Pneumonia as a secondary diagnosis also elevates risk. These trends highlight the need for targeted interventions.
Area of Science:
- Pediatric Health
- Respiratory Medicine
- Health Services Research
Background:
- Asthma is a significant pediatric health concern, with hospitalizations indicating severe exacerbations.
- Understanding risk factors for adverse outcomes in pediatric asthma hospitalizations is crucial for improving patient care and outcomes.
Purpose of the Study:
- To investigate the relationship between clinical and nonclinical patient characteristics and adverse asthma outcomes in hospitalized children.
- To identify demographic and clinical factors associated with severe asthma events in pediatric patients.
Main Methods:
- A cross-sectional study utilizing administrative data from California pediatric asthma-related hospital discharges between 1986 and 1993.
- Analysis included 113,974 eligible patients, examining outcomes such as intubation, cardiopulmonary arrest, and death.
Main Results:
- Adverse asthma outcomes occurred in 0.48% of pediatric hospitalizations and showed an increasing trend in the 1990s.
- Older children (5-11 and 12-17 years) and Asian Pacific-American children had higher odds of adverse outcomes compared to younger children and white children, respectively.
- Pneumonia as a secondary diagnosis was associated with increased odds of adverse asthma outcomes; gender and insurance type were not significant factors.
Conclusions:
- Adverse asthma outcomes among hospitalized children are rising and linked to specific patient characteristics.
- Age, race, and comorbid conditions like pneumonia are significant predictors of severe asthma events in pediatric hospitalizations.
- Findings underscore the importance of considering patient-specific factors in managing pediatric asthma to prevent severe outcomes.
Objective:
To use administrative data to determine whether adverse asthma outcomes for pediatric asthma hospitalizations are related to specific clinical and nonclinical patient characteristics.
Design:
Cross-sectional study.
Setting:
All pediatric (0 to 17 years of age) asthma-related hospital discharges, 1986 to 1993, in California.
Patients:
A total of 113 974 eligible patients with asthma-related discharges.
Main Outcome Measure:
Adverse asthma outcomes (intubation, cardiopulmonary arrest, and death).
Results:
Adverse asthma outcomes occurred in 0.48% of subjects. The frequency of adverse asthma outcomes increased during the 1990s compared with 1986. After controlling for differences in gender, age, specific comorbid conditions, year, race, and insurance type, adverse asthma outcomes were more likely to occur in the 5- to 11-year-old group (odds ratio [OR]: 1.39; 95% confidence interval [CI]: 1.13-1.69) and in the 12- to 17-year-old group (OR: 4.48; CI: 3.20-6.21) compared with those children in the 0 to 4-year-old age group. Asian Pacific-American children were more likely (OR: 1.59; CI: 1.24-2.59) than were white children to experience an adverse asthma outcome. Children who had a secondary diagnoses of pneumonia (OR: 1.54; CI: 1. 19-2.00) also were more likely to experience an adverse asthma outcome. The odds of an adverse outcome increased progressively after 1986, becoming significant after 1989. Gender and insurance type were not associated with increased odds of experiencing an adverse asthma outcome.
Conclusions:
Adverse asthma outcomes among hospitalized children are increasing in the 1990s and are associated with specific clinical and nonclinical patient characteristics.