The association of prenatal risk factors with childhood asthma

Objective: The purpose of the study was to examine the relationship of maternal complications during pregnancy and prenatal exposures with childhood asthma among low-income families in Karachi, Pakistan. Methods: Parents/guardians of children with and without asthma visiting a charity hospital were enrolled. Information about prenatal and perinatal exposures was collected. Univariable and multiple stepwise logistic regression analysis were conducted to explore the relationship of socio-demographic, maternal complications during pregnancy, access to prenatal care, and exposure to animals and pests while pregnant with childhood asthma. Results: Maternal symptoms of nocturnal cough (adjusted OR [aOR?=?2.87, 95% CI?=?1.60–5.14) and wheezing (aOR?=?5.57, 95% CI?=?2.32–13.37) during pregnancy significantly increased the odds of childhood asthma. The family history of asthma or hay fever, also elevated the odds of childhood asthma (adjusted OR [aOR]?=?5.86 (3.03–11.34). The odds of asthma among children whose mothers received prenatal care by Dai, an unskilled health worker, were significantly elevated. Lastly, prenatal exposure to rats/mice and contact with goats while pregnant was significantly associated with childhood asthma. Whereas, prenatal exposure to cows/cattle reduces the odds of childhood asthma. Conclusions: This study identified important maternal and prenatal risk factors for childhood asthma, the majority of which are avoidable. Appropriate steps are needed to create awareness about the prenatal risk factors in this population.     

The Association Between Symptomatic Asthma and Neurobehavioral Comorbidities Among Children

Background. Asthma affects millions of children in the United States. The extent to which asthma and other medical conditions coexist, however, is largely unknown. Objective. This study aimed to determine associations between symptomatic asthma and neurobehavioral comorbidities among children in rural United States. Methods. This cross-sectional study used data from 406 parents/caregivers of children aged 16 or younger, who completed survey questionnaires assessing their child's health status. Symptomatic asthma was defined as parents’/caregivers’ report of physician diagnosed asthma and presence of night-time asthma symptoms in their children. The dependent variables were parents’/caregivers’ reported comorbidities in children. Results. Symptomatic asthma was present in 9% of the sample. Approximately 26% parents/caregivers reported their child had one or more mental health problems and 13% reported one or more neurological problems. In multivariable logistic regression analyses, a statistically nonsignificant 50% elevated odds of one or more mental health problems were observed for children with symptomatic asthma (adjusted odds ratio [OR] = 1.5, 95% confidence interval [CI] = 0.6–3.5). Of the individual comorbidities included in the mental health construct, more than 2-fold elevated odds of anxiety problems (adjusted OR = 2.6, 95% CI = 0.8–8.6) and attentional problems (adjusted OR = 2.4, 95% CI = 1.0–5.8) were observed for symptomatic asthma. The odds of reporting one or more neurological problems were 4-fold elevated (adjusted OR = 4.0, 95% CI = 1.6–10.0) for symptomatic asthma. Of the individual comorbidities included in the neurological construct a significantly elevated odds of hearing impairment or deafness was observed among children with symptomatic asthma (adjusted OR = 8.2, 95% CI = 1.5–45.3) as compared to the no asthma/no symptoms reference group. Conclusion. These data suggest significant associations between symptomatic asthma and neurological comorbidities.     

Determinants of asthma control among children in Saudi Arabia

Objective: Asthma is the most common chronic disease among children. Uncontrolled asthma may considerably decrease the quality of life for patients and their families. Our objective was to identify possible risk factors for poor asthma control in children. Methods: A cross-sectional study was conducted among children with asthma aged 4–11?years who attended a pediatric clinic for follow-up visits at one of the major teaching hospitals in Riyadh, Saudi Arabia. Asthma control status was measured by the childhood asthma control test. Multiple logistic regression analysis was performed to explore the relationships between the outcome and exposure variables. Results: Uncontrolled asthma was present in 89 out of 158 children (59.3%). Asthma control improved with the number of siblings. Control improved by 69% with two or three siblings (OR?=?0.31, 95% CI?=?0.10–0.96) and by 87% with four or more siblings (OR?=?0.13, 95% CI?=?0.04–0.48). Similarly, asthma control improved with an increased asthma knowledge of the caregiver (OR?=?0.87, 95% CI?=?0.81–0.93). Household incomes less than SAR 15?000 and sharing a bedroom increased the odds of having uncontrolled asthma by 2.30 (95% CI?=?1.02–5.21) and 3.33 (95% CI?=?1.33–8.35), respectively. Conclusions: In addition to knowledge, socioeconomic factors, such as family income, household crowding, and the number of siblings are associated with asthma control among children in Saudi Arabia. Further research is needed to investigate the role of these factors.     

Complementary and alternative medicine use among people with asthma and health-related quality of life

Objective: This study investigated the relationship between complementary and alternative medicine (CAM) use and self-reported health-related quality of life among people with asthma. Method: Data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) survey and the 2010 Asthma Callback Survey (ACBS) were used. Survey respondents were men and women with asthma who were 18–99 years of age who responded to both surveys. Results: CAM use was associated with an increase in the number of days of poor mental health (OR?=?1.02, 95% CI 1.02, 1.03) and poor physical health (OR?=?1.02, 95% CI 1.01, 1.02). The odds ratios are adjusted for covariates such as asthma severity, age, sex, race/ethnicity, income, and educational attainment. CAM users report more days of poor mental health (7.2 versus 4.6) and poor physical health (9.6 versus 6.5) compared with those not using CAM therapies. Conclusions: Contrary to the hypotheses, CAM use is associated with poorer health-related quality of life. Implications for research and practice are discussed in detail.     

Maternal Mental Health and Childhood Asthma among Puerto Rican Youth: The Role of Prenatal Smoking

Rationale. Childhood asthma is a major public health problem, with mainland and island Puerto Rican children having the highest asthma rates of any ethnic group in the United States. Objectives. To examine the relationship between maternal mental health problems, prenatal smoking, and risk of asthma among children in Puerto Rico and the Bronx, New York. Methods. A cross-sectional community-based study was conducted in the South Bronx in New York City and the San Juan Standard Metropolitan Area in Puerto Rico. Participants were Puerto Rican children 5 to 13 years of age and their adult caretakers with probability samples of children 5 to 13 years of age and their caregivers drawn at two sites: the South Bronx in New York City (n = 1,135) and San Juan and Caguas, Puerto Rico (n = 1,351). Measurements. Self-reported maternal mental health, prenatal smoking, and rates of childhood asthma. Results. Maternal mental health problems were associated with significantly higher levels of prenatal smoking, compared with that among women without mental health problems (p < 0.0001). Both maternal mental health problems and prenatal smoking appear to make a contribution to increased odds of asthma among youth. After adjusting for prenatal smoking, the relationship between maternal mental health problems and childhood asthma was no longer statistically significant. Conclusions. Previous research suggests children of Puerto Rican descent are especially vulnerable to asthma. Our results suggest that maternal mental health problems and prenatal smoking are both associated with increased odds of asthma among Puerto Rican youth and that prenatal smoking may partly explain the observed relationship between maternal psychopathology and childhood asthma. Future longitudinal and geographically diverse epidemiological studies may help to identify the role of both maternal mental health problems and prenatal smoking in the health disparities in childhood asthma.     

Asthma and asthma-related symptoms in 16 789 Chinese children in relation to pet keeping and parental atopy.

BACKGROUND: The relationship between exposure to animals and allergic respiratory diseases in childhood is controversial, and there is little information about how exposure to pets affects the respiratory health of Chinese children, who have lower rates of asthma. OBJECTIVE: To study the association between exposure to pets and doctor-diagnosed asthma and asthma-related symptoms in Chinese children. We also investigated whether genetic propensity as a result of parental atopy modifies these relations. METHODS: A cross-sectional study of 16 789 children was conducted at 24 randomly selected kindergartens and 12 elementary schools in Liaoning province, China. Information on respiratory health and exposure to indoor allergens was obtained by a standard questionnaire from the American Thoracic Society. RESULTS: In children, exposure to animals was associated with a diagnosis of asthma (adjusted odds ratio [OR], 1.49; 95% confidence interval [CI], 1.30-1.70), wheezing (adjusted OR, 1.37; 95% CI, 1.18-1.60), persistent cough (adjusted OR, 1.71; 95% CI, 1.52-1.91), and persistent phlegm (adjusted OR, 2.26; 95% CI, 1.94-2.64). Parental atopy increased the risk of a diagnosis of asthma (adjusted OR, 3.12; 95% CI, 2.61-3.73) and asthma-related symptoms. There was an interaction between parental atopy and pet exposure in persistent cough and persistent phlegm, but not in doctor-diagnosed asthma. CONCLUSIONS: Pet keeping and parental atopy increased the risk of asthma and allergic respiratory diseases in children. Parental atopy modified the effect of pet exposure in persistent cough and persistent phlegm but not in doctor-diagnosed asthma.     

Trends in prevalence and risk factors of childhood asthma in Fuzhou,a city in Southeastern China

Abstract

Objective: The prevalence of asthma in children age 0–14 years in Fuzhou, a city in Southeast China, was 1.57% in 1990 and 3.28% in 2000. The aim of this study was to investigate the asthma prevalence and risk factors in children in the same city in 2010. Methods: This was a cross-sectional study with a two-stage, clustered, stratified random sample design. Parents of 12?235 children 0–14 years of age in Fuzhou were surveyed using a questionnaire. Children with history and/or symptoms of asthma were then interviewed by pediatricians in a nearby clinic to confirm the diagnosis of asthma, and a second questionnaire listing reported risk factors of asthma was completed by the parents in the clinic. Results: About 11?738 questionnaires were completed with a response rate of 95.9%. Among the responders, 648 children had history and/or symptoms of asthma but only 485 (4.13%) were confirmed with asthma. The prevalence was 1.83%, 7.64% and 6.27% in the age groups of 0–1 years, 3–4 years and 13–14 years, respectively. The most significant (binary logistic regression test) factors associated with asthma were presence of atopic or allergic diseases (OR?=?21.5, 95% CI: 12–38.5), family history of allergy or asthma (OR?=?29.4, 95% CI: 12.6–68.6), use of at least one course of antibiotics in the first year of life (OR?=?7.61, 95% CI: 3.4–17.06), supplementary protein feedings before 6 months (OR?=?1.90, 95% CI: 1.23–2.95). Natural ventilation at home (versus frequent use of air-conditioning) appeared to be a protective factor (OR?=?0.5, 95% CI: 0.3–0.8). Conclusion: The prevalence of asthma in childhood has increased significantly during the past 20 years in Fuzhou.     

Is elective cesarean section associated with a higher risk of asthma? A meta-analysis

Abstract

Background: Recent meta-analyses indicate that children delivered by cesarean section have increased risk for asthma. However, the studies included in these previous meta-analyses showed significant heterogeneity. Furthermore, no previous meta-analysis has distinguished the association of elective and emergency CS, spontaneous and instrumental vaginal deliveries (VD) with the odds of asthma. Objective: To examine the association between specific mode of delivery and the prevalence of asthma. Methods: PUBMED, Google Scholar, EMBASE, and MEDLINE were searched to identify relevant studies. Odds ratio (OR) and 95% confidence interval (CI) were calculated from the prevalence of asthma in children born by elective CS, emergent CS, instrumental VD and spontaneous VD. Meta-analysis was then used to derive a combined OR. Heterogeneity between studies was also tested in the findings. Results: A total of 26 studies were identified. The overall meta-analysis revealed an increase in the risk of asthma in children delivered by CS (OR?=?1.16, 95% CI 1.14, 1.29), and no evidence of heterogeneity was found (I²?=?24.6%). Elective and emergency CS moderately increased the risk of asthma (OR?=?1.21, 95% CI 1.17, 1.25; I²?=?39.9%; OR?=?1.23, 95% CI 1.19–1.26). The risk of asthma was also higher in the children born by instrumental VD (OR?=?1.07, 95% CI, 1.04–1.11) but with evidence of heterogeneity (I²?=?54.9%). Conclusion: About 20% increase in the subsequent risk of asthma was both found in children delivered by elective and emergency CS. The increasing rates of CS worldwide might partly explain the concomitant rise in asthma during the same time period.     

Prevalence and severity of asthma among Indian school children aged between 6 and 14 years: associations with parental smoking and traffic pollution

Objective: Phase three of the International Study of Asthma and Allergy in Children (ISAAC) was carried out at various sites in India. The prevalence of asthma symptoms in school children and the effect of environmental tobacco smoke and traffic pollution on the occurrence of asthma were analysed. Methods: Two groups of school children, aged 6–7?yr and 13–14?yr, participated according to the ISAAC protocol. Schools were randomly selected and responses to the ISAAC questionnaire were recorded. Results: The prevalence of asthma was 5.35% in the 6–7?yr age group and 6.05% in the 13–14?yr age group. The odds ratios (ORs) for the risk of asthma in children with exposure to mild, moderate and heavy traffic pollution compared with minimal traffic pollution were 1.63 (95% CI: 1.43, 1.85), 1.71 (95% CI: 1.49, 1.96) and 1.53 (95% CI: 1.31, 1.78), respectively, in the younger group. Similarly, in the older group, they were 1.19 (95% CI: 1.04, 1.36), 1.51 (95% CI: 1.31, 1.75) and 1.51 (95% CI: 1.29, 1.76). Asthma was associated with maternal smoking [6–7?yr group: OR?=?2.72 (2.05, 3.6); 13–14?yr group: OR?=?2.14 (1.72, 2.66)] and paternal smoking [6–7?yr group: OR?=?1.9 (1.70, 2.11); 13–14?yr group: OR?=?1.21 (1.09, 1.34)]. Conclusions: The prevalence of asthma was lower in the 6–7 than the 13–14?yr age group. Environmental tobacco smoke and traffic pollution were the factors most strongly associated with asthma in Indian children.     

Body mass index,adipokines and insulin resistance in asthmatic children and adolescents

Objective: This study aimed to describe the body mass index, insulin resistance, levels of adipokines and inflammatory markers in Brazilian asthmatic children and adolescents and to investigate their possible association with the severity and control of asthma. Methods: Cross-sectional study (n?=?92; age: 3–18 years). Assessed data: Body weight and height, used to calculate the body mass index (BMIZ) and height-for-age (HAZ). Laboratory measurements: Lipid profile; glycemia and insulin for homeostasis model assessment (HOMA); adipokines; tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP) and monocyte chemoattractant protein-1 (MCP-1); total immunoglobulin E (IgE) and specific IgE against aeroallergens. Results: The median age was 9.6 years (3.0–16.6); most participants were male (n?=?52, 56.5%), pre-pubertal (n?=?54, 58.6%) and had atopic asthma (n?=?85, 92.4%). Overweight/obesity (38%) showed an inverse correlation with age (adjusted odds ratio [OR]?=?0.781; 95% confidence interval [CI] 0.66–0.92) and a direct correlation with the leptin concentration (adjusted OR?=?1.13; 95% CI 1.04–1.22). Insulin concentration was independently associated with moderated persistent asthma (adjusted OR?=?1.31; 95% CI 1.09–1.52). HOMA showed a direct correlation with the leptin (β?=?0.475; 95% CI 0.117–0.268) and total IgE (β?=?0.197; 95% CI 0.002–0.096) levels and an inverse correlation with the TNF-α levels (β?=??0.255; 95% CI;?0.366–0.055). Conclusions: Asthma was associated with insulin resistance and a systemic inflammatory response possibly mediated by adipokines, with leptin levels standing out among the participants with excess weight.     

Racial and ethnic differences in asthma and mental health among US adults: results from the national survey on drug use and health

Objective: Evaluate the racial and ethnic differences in asthma and mental health comorbidity. Methods: A secondary analysis of 2008–2013 National Survey on Drug Use and Health was conducted, resulting in a total of 206?993 civilian adult respondents to evaluate the association between asthma and mental health (past year serious psychological distress [SPD] and doctor diagnosis of depression). Both survey weighted bivariate (chi-square) and multivariable (binary logistic) regression analyses, after accounting for control variables, were conducted to evaluate the asthma/mental health nexus. A p value of less than 0.05 was used to denote significance. Results: Current asthma was significantly associated with past year SPD for non-Hispanic Whites (adjusted odds ratio [aOR] = 1.45), Hispanics (aOR?=?1.68), and Black/African Americans (aOR?=?1.47). A similar association was noted for current asthma and past year doctor diagnosis of depression (non-Hispanic White aOR?=?1.74; Hispanics aOR?=?1.77; Black/African American aOR?=?1.62). Among those with lifetime asthma, higher odds of SPD were reported for non-Hispanic Whites (aOR?=?1.42), Hispanics (aOR?=?1.64), and Black/African Americans (aOR?=?1.50). Lifetime asthma also significantly associated with past year doctor diagnosis of depression for non-Hispanic Whites (aOR?=?1.42), Hispanics (aOR?=?1.41), and Black/African Americans (aOR?=?1.46). Conclusion: Our results demonstrate the significant burden of asthma and mental health comorbidity among diverse racial and ethnic groups. Improved public health efforts through promotion of integrated care for early screening and preventive measures are needed to alleviate the burden for at-risk groups.     

Antibiotic use in infancy and the risk of asthma in Mexican American children

Objective: This study examined the associations of antibiotic use in infancy with lifetime doctor-diagnosed asthma and current wheeze among Mexican American children. Methods: In a population-based, cross-sectional investigation, parents of 2023 children 4–18 years of age completed a questionnaire/interview addressing respiratory conditions, antibiotic use, and covariates. Results: In adjusted analyses, among children without history of ear infections in infancy, children who used antibiotics ≥3 times and 1–2 times were more likely to report doctor-diagnosed asthma compared with their peers who did not use antibiotics in infancy [adjusted odds ratio (aOR)?=?5.14, 95% confidence interval (CI): 2.88–9.17, and aOR?=?2.15, 95% CI: 1.26–3.69, respectively, p trend < 0.0001]. The respective aORs for current wheeze were 3.67 (95% CI: 1.95–6.89) and 1.63 (95% CI: 0.91–2.95). Antibiotic use in infancy was not associated with asthma or current wheeze in children who had ear infections in infancy. In additional analyses, antibiotic use in infancy was associated with asthma in children without parental history of asthma or allergies (aOR?=?2.73, 95% CI: 1.70–4.39) but not in those with parental history of asthma or allergies. Among Mexico-born participants born in rural areas, antibiotic use in infancy was associated with a seven-fold increase in risk of asthma (aOR?=?7.21, 95% CI: 1.46–35.65), while the association was non-significant in Mexico-born children born in urban areas in Mexico. Conclusions: Antibiotic use in infancy may increase the risk of asthma and wheezing, but these associations were limited to subgroups of children.     

Trends in asthma readmissions among children and adolescents over time by age,gender and season

Objectives: Little is known about asthma readmissions within 28 days over time by age or gender. We explored trends in childhood asthma hospital readmission rates over time by age, gender and season. Methods: Using a large database of 53?156 childhood admissions with a primary diagnosis of asthma from the Department of Health Victoria Australia for 1997–2009, we explored asthma hospital readmissions rates by seasonality, gender and age (2–18 years) using chi square tests, logistic regression models and graphical techniques. Results: Approximately 9459 (28%) of the children had two or more admissions over the whole study period, contributing to 55% (29?056/53?156) of all admissions. Approximately 5% of admissions were repeat admission within 28 days. Over time, despite a decline in asthma incidence, the rate of readmission within 28 days increased, particularly in the 2–12 year age groups. Girls were at greater risk of readmission within 28 days (odds ratio [OR]?=?1.15; 95% CI: 1.004–1.32; p?=?0.04) and 12 months (OR?=?1.11; 95% CI: 1.05–1.19; p?=?0.001). Grass pollen season was associated with readmissions within 28 days, but only in boys (p?=?0.01). Conclusion: Over time, despite a fall in asthma incidence, readmission rates for childhood asthma significantly increased in younger age groups with girls at a higher risk of being readmitted than boys. Increased risk of repeat admission for boys was observed during the grass pollen season. These findings highlight high-risk groups, which has implications for both clinical services and patient care. More detailed monitoring of readmission rates amongst various risk groups over time is required.     

Reduced asthma morbidity in endemic areas for helminth infections: a longitudinal ecological study in Brazil

Objective: The aim of this study was to evaluate whether endemic areas for helminth infections in Brazil have lower rates of hospital admission due to asthma and whether reduction in helminth endemicity impacts on asthma morbidity. Methods: This was a country-wide ecological study in Brazil. Government databases were the source of information. A cross-sectional analysis accessed the risk of a municipality having high rates of hospital admissions due to asthma according to its records of hospital admissions due to Schistossoma mansoni or intestinal helminth infections. A longitudinal analysis accessed the effect of prevention of helminth infection on asthma morbidity. Data were adjusted for the rates of hospital admissions due to influenza, pneumonia, diarrhea, per capita income, Gini index, number of physicians, proportion of literate inhabitants, urbanization and hospital beds. Results: Hospitalization rates due to asthma in the age range of 5–24 years were lower in municipalities endemic for S. mansoni [adjusted OR: 0.992, CI: 0.989–0.994] or for intestinal helminth infections [adjusted OR: 0.994, CI: 0.990–0.997]. Similar results were observed for the age range of 25–64 years. In the longitudinal analysis, municipalities that reduced hospitalizations due to S. mansoni had smaller odds to decrease hospital admissions due to asthma among young populations [adjusted OR: 0.43, CI: 0.22–0.82]. Conclusion: We conclude that populations exposed to helminths have lower asthma morbidity. Reduction of helminth infection prevalence in low-income populations was associated with a smaller decline in asthma morbidity.     

Burden of asthma among children in a developing megacity: childhood asthma study,Pakistan

Objectives: Global burden of childhood asthma has increased in the past few decades, particularly in low-income countries. In Pakistan, there is a lack of community-based epidemiological studies estimating the burden of asthma among children. This study determined the prevalence and predictors of asthma among children 3–17 years of age in Karachi, Pakistan. Methods: A two-stage community-based representative cross-sectional survey was conducted in Karachi from March 2012 to April 2013 comprising 1046 children aged 3–17 years. Of 7500 clusters, 80 were randomly selected, and of these, 15 children per cluster were enrolled randomly. A translated and pre-tested version of International Study of Asthma and Allergies in Children questionnaire was administered. Results: The overall prevalence of asthma among study participants was 10.2% (95% CI: 8.4–12.0). Asthma was more likely to occur among boys (adj. OR: 2.5, 95% CI: 1.6–4.0), children in the younger age group (3–7 years) (adj. OR: 2.9, 95% CI: 1.7–4.8), those living in households with ill-ventilated kitchens (adj. OR: 1.8, 95% CI: 1.1–3.1), having family history of asthma (adj. OR: 2.3, 95% CI: 1.3–3.9) and those of the Sindhi ethnicity (adj. OR: 2.2, 95% CI: 1.1–4.4). Conclusion: This study is the first robust evidence regarding asthma among children in Pakistan, reporting a high burden in this group. Family history, male gender, Sindhi ethnicity and ill-ventilated kitchen were identified as important predictors of asthma. Targeted preventive measures and intervention studies are required to better understand and reduce the burden of asthma among children in Pakistan.     

Bedroom air quality and vacuuming frequency are associated with repeat child asthma hospital admissions

Objective: Indoor environment factors have been associated with risk of asthma exacerbations in children but little is known about their role on asthma hospital readmissions. As children in Western societies continually spend more time indoors, understanding the influence of these factors on asthma exacerbation is important. We examined the role of indoor environmental and lifestyle characteristics on child asthma readmissions. Methods: A hospital-based case–control study recruited 22 children readmitted for asthma and 22 controls not readmitted for asthma. Logistic regression models were used to examine the association between aeroallergens and fungi in the bedroom and indoor lifestyle characteristics factors for asthma readmissions. To determine the best possible set of predictors among a large set of risk factors, we used random forests (RF) techniques. Results: Higher levels of airborne Cladosporium and yeast in the child’s bedroom increased risk of readmission (OR?=?1.68, 95% CI 1.04–2.72 and OR?=?1.52, 95% CI 0.99–2.34, respectively). Carpeted floors in the bedroom and synthetic doonas were also associated with increase in asthma readmissions (OR?=?4.07, 95% CI 1.03–16.06 and OR?=?14.6, 95% CI 1.26–169.4, respectively). In the home, frequent vacuuming using bagged cleaners increased risk of asthma readmission OR?=?15.7 (95% CI 2.82–87.2). Conclusions: Factors in the child’s bedroom play an important role in increasing the risk of asthma hospital readmissions. These findings have major clinical implications as the identified potential risk factors may be modifiable. Further epidemiological studies with larger samples are necessary to evaluate these associations further.     

Spatiotemporal patterns of childhood asthma hospitalization and utilization in Memphis Metropolitan Area from 2005 to 2015

Objective: To identify the key risk factors and explain the spatiotemporal patterns of childhood asthma in the Memphis metropolitan area (MMA) over an 11-year period (2005–2015). We hypothesize that in the MMA region this burden is more prevalent among urban children living south, downtown, and north of Memphis than in other areas. Methods: We used a large-scale longitudinal electronic health record database from an integrated healthcare system, Geographic information systems (GIS), and statistical and space-time models to study the spatiotemporal distributions of childhood asthma at census tract level. Results: We found statistically significant spatiotemporal clusters of childhood asthma in the south, west, and north of Memphis city after adjusting for key covariates. The results further show a significant increase in temporal gradient in frequency of emergency department (ED) visits and inpatient hospitalizations from 2009 to 2013, and an upward trajectory from 4 per 1,000 children in 2005 to 16 per 1,000 children in 2015. The multivariate logistic regression identified age, race, insurance, admit source, encounter type, and frequency of visits as significant risk factors for childhood asthma (p < 0.05). We observed a greater asthma burden and healthcare utilization for African American (AA) patients living in a high-risk area than those living in a low-risk area in comparison to the white patients: AA vs. white [odds ratio (OR) = 3.03, 95% confidence interval (CI): 2.75–3.34]; and Hispanic vs. white (OR = 1.62, 95% CI: 1.21–2.17). Conclusions: These findings provide a strong basis for developing geographically tailored population health strategies at the neighborhood level for young children with chronic respiratory conditions.     

Gaps in health insurance coverage and emergency department use among children with asthma

Background: Gaps in health insurance coverage may complicate asthma management and increase emergency department (ED) use. Using two nationally-representative surveys, we characterize the prevalence of coverage gaps among children with asthma, and describe their association with ED visits in this population. Methods: De-identified data were obtained from the 2016 National Survey of Children’s Health (NSCH) and National Health Interview Survey (NHIS). Among children with asthma, we classified coverage over the past year as: (1) continuous private, (2) continuous public, (3) gap in coverage, and (4) continuously uninsured. The primary outcome was all-cause ED visits in the past year (both surveys). Secondary outcomes included unmet health care needs (NSCH), asthma-related ED visits or hospitalizations (NHIS) and asthma exacerbations (NHIS). Results: The analysis included 3739 (NSCH) and 854 (NHIS) children with asthma, representing a population of 5.5 million children in the US. Estimated prevalence of coverage gaps was 5% in the NSCH and 3% in the NHIS. On multivariable ordinal logistic regression using NSCH data, coverage gaps were associated with increased all-cause ED use (OR?=?2.5; 95% CI: 1.3, 4.7, p?=?0.005), compared to continuous private coverage. Further analysis confirmed higher odds of unmet health care needs, asthma exacerbations, and asthma-related ED visits among children with coverage gaps. Conclusions: Children with asthma who experience insurance coverage gaps have increased ED use, possibly related to poorer access to appropriate health care. Protecting insurance coverage continuity may reduce ED use and improve clinical outcomes in this population.     

Associations between central obesity and asthma in children and adolescents: a case–control study

Introduction: Evidence supports a significant yet weak association between high-body weight and asthma in children. However, most studies investigating the obesity–asthma link use Body Mass Index (BMI) to evaluate body fatness. The relationship between body fat distribution and asthma remains largely unknown, especially in children. This pediatric case–control investigation examined associations between central obesity/high-body weight and asthma diagnosis. Methods: Five-hundred and fourteen children (217 physician diagnosed asthma cases and 297 healthy controls) of 5–11 years were recruited. Height, weight and waist circumference were measured. Asthma symptoms, past medical history, personal lifestyle, socioeconomic status, diet and physical activity history were also collected. Results: A higher proportion of children with asthma were centrally obese [(≥90th waist percentile) 15.2 vs. 9.4%, p<0.0001; (≥90th waist-to-height ratio percentile) 39.6 vs. 24.2%, p<0.0001)]. Regression analyses revealed that centrally obese children were more likely to have asthma (high-waist circumference (OR?=?1.99, 95% CI: 1.07-3.68) and high-waist circumference to height ratio (OR?=?2.24, 95% CI: 1.47-3.40), following adjustment for various confounders. Overweight/obese participants (BMI defined) were more likely to be asthmatic [odds ratio (OR)?=?1.52, 95% confidence interval (CI): 1.03-2.70)] when compared to controls. Conclusions: Presence of central obesity and high-body weight (at least overweight) as assessed by waist circumference, waist-to-height ratio, and BMI are associated with asthma diagnosis. More studies are needed, especially in children and adolescents, to confirm these findings and better understand how body fat distribution impacts the obesity–asthma relationship.