Abstract
BackgroundAsthma remains a common cause of hospital admissions across the life course. We estimated the contribution of key risk factors to asthma-related hospital and intensive care unit (ICU) admissions in children, adolescents and adults.MethodsThis was a UK-based cohort study using linked primary care (Clinical Practice Research Datalink Aurum) and secondary care (Hospital Episode Statistics Admitted Patient Care) data. Patients were eligible if they were aged 5 years and older and had been diagnosed with asthma. This included 90 989 children aged 5–11 years, 114 927 adolescents aged 12–17 years and 1 179 410 adults aged 18 years or older. The primary outcome was asthma-related hospital admissions from 1 January 2017 to 31 December 2019. The secondary outcome was asthma-related ICU admissions. Incidence rate ratios adjusted for demographic and clinical risk factors were estimated using negative binomial models. Population attributable fraction (PAF) was estimated for modifiable risk factors.ResultsYounger age groups, females and those from ethnic minority and lower socioeconomic backgrounds had an increased risk of asthma-related hospital admissions. Increasing medication burden, including excessive use of short-acting bronchodilators, was also strongly associated with the primary outcome. Similar risk factors were observed for asthma-related ICU admissions. The key potentially modifiable or treatable risk factors were smoking in adolescents and adults (PAF 6.8%, 95% CI 0.9% to 12.3% and 4.3%, 95% CI 3.0% to 5.7%, respectively), and obesity (PAF 23.3%, 95% CI 20.5% to 26.1%), depression (11.1%, 95% CI 9.1% to 13.1%), gastro-oesophageal reflux disease (2.3%, 95% CI 1.2% to 3.4%), anxiety (2.0%, 95% CI 0.5% to 3.6%) and chronic rhinosinusitis (0.8%, 95% CI 0.3% to 1.3%) in adults.ConclusionsThere are significant sociodemographic inequalities in the rates of asthma-related hospital and ICU admissions. Treating age-specific modifiable risk factors should be considered an integral part of asthma management, which could potentially reduce the rate of avoidable hospital admissions.
Funder
National Institute for Health and Research Clinical Research Network West Midlands Improvement and Innovation Strategic Funding
Reference47 articles.
1. Global, regional, and national prevalence of asthma in 2019: a systematic analysis and modelling study;Song;J Glob Health,2022
2. National Institute of Health and Care Excellence . Available: https://cks.nice.org.uk/topics/asthma/background-information/prevalence/ [Accessed 7 Jul 2021].
3. The epidemiology, healthcare and societal burden and costs of asthma in the UK and its member nations: analyses of Standalone and linked national databases;Mukherjee;BMC Med,2016
4. NICE Guideline . Asthma: diagnosis, monitoring and chronic asthma management. Available: https://www.nice.org.uk/guidance/ng80 [Accessed 7 Jul 2021].
5. The National review of asthma deaths: what did we learn and what needs to change;Levy;Breathe (Sheff),2015