Dataset Information

Association Between Obesity and Acute Severity Among Patients Hospitalized for Asthma Exacerbation.

ABSTRACT: Background: Although studies have demonstrated relations between obesity and incident asthma, little is known about the association of obesity with acute severity in adults hospitalized for asthma exacerbation.

Objectives: To investigate the association of obesity with acute severity of asthma exacerbation.

Methods: This is a retrospective cohort study using population-based data of 8 geographically diverse US states from 2010 through 2013. We included adults (age 18-54 years) hospitalized for asthma exacerbation. The outcome measures were markers of acute severity-use of mechanical ventilation (defined by noninvasive positive pressure ventilation and/or invasive mechanical ventilation) and hospital length of stay. To determine the association of obesity with each outcome, we fit multivariable models adjusting for patient-level confounders (eg, age, sex, race/ethnicity, primary insurance, quartiles for household income, residential status, and comorbidities) and potential patient clustering within hospitals.

Results: Among the 72,086 patients hospitalized for asthma exacerbation, 24% were obese. Obesity was associated with a significantly higher risk of any mechanical ventilation use (8.3% vs 5.0%; adjusted odds ratio [OR], 1.77; 95% CI, 1.63-1.92; P < .001) driven by the higher risk of noninvasive positive pressure ventilation use (7.2% vs 3.4%; adjusted OR, 2.14; 95% CI, 1.96-2.35; P < .001). Likewise, obese patients were more likely to have a hospital length of stay of 3 or more days compared with nonobese patients (59.4% vs 46.5%; adjusted OR, 1.37; 95% CI, 1.32-1.43; P < .001). These findings were consistent with stratifications by age, sex, and race/ethnicity.

Conclusions: In this population-based study of adults hospitalized for asthma exacerbation, obesity was associated with higher acute severity.

SUBMITTER: Luthe SK

PROVIDER: S-EPMC7723818 | biostudies-literature | 2018 Nov - Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Association Between Obesity and Acute Severity Among Patients Hospitalized for Asthma Exacerbation.

Luthe Sarah Kyuragi SK Hirayama Atsushi A Goto Tadahiro T Faridi Mohammad Kamal MK Camargo Carlos A CA Hasegawa Kohei K

The journal of allergy and clinical immunology. In practice 20180214 6

<h4>Background</h4>Although studies have demonstrated relations between obesity and incident asthma, little is known about the association of obesity with acute severity in adults hospitalized for asthma exacerbation.<h4>Objectives</h4>To investigate the association of obesity with acute severity of asthma exacerbation.<h4>Methods</h4>This is a retrospective cohort study using population-based data of 8 geographically diverse US states from 2010 through 2013. We included adults (age 18-54 years) ...[more]

PMID: 29452277

Similar Datasets

Project description:IntroductionPrevious studies have demonstrated an association of low socioeconomic status with frequent asthma exacerbations. However, there have been no recent multicenter efforts to examine the relationship of insurance status - a proxy for socioeconomic status - with asthma severity and management in adults. The objective is to investigate chronic and acute asthma management disparities by insurance status among adults requiring emergency department (ED) treatment in the United States.MethodsWe conducted a multicenter chart review study (48 EDs in 23 U.S. states) on ED patients, aged 18-54 years, with acute asthma between 2011 and 2012. Each site underwent training (lecture, practice charts, certification) before reviewing randomly selected charts. We categorized patients into three groups based on their primary health insurance: private, public, and no insurance. Outcome measures were chronic asthma severity (as measured by ?2 ED visits in one-year period) and management prior to the index ED visit, acute asthma management in the ED, and prescription at ED discharge.ResultsThe analytic cohort comprised 1,928 ED patients with acute asthma. Among these, 33% had private insurance, 40% had public insurance, and 27% had no insurance. Compared to patients with private insurance, those with public insurance or no insurance were more likely to have ?2 ED visits during the preceding year (35%, 49%, and 45%, respectively; p<0.001). Despite the higher chronic severity, those with no insurance were less likely to have guideline-recommended chronic asthma care - i.e., lower use of inhaled corticosteroids (ICS [41%, 41%, and 29%; p<0.001]) and asthma specialist care (9%, 10%, and 4%; p<0.001). By contrast, there were no significant differences in acute asthma management in the ED - e.g., use of systemic corticosteroids (75%, 79%, and 78%; p=0.08) or initiation of ICS at ED discharge (12%, 12%, and 14%; p=0.57) - by insurance status.ConclusionIn this multicenter observational study of ED patients with acute asthma, we found significant discrepancies in chronic asthma severity and management by insurance status. By contrast, there were no differences in acute asthma management among the insurance groups.

Project description:ImportanceAlthough professional society guidelines discourage use of empirical antibiotics in the treatment of asthma exacerbation, high antibiotic prescribing rates have been recorded in the United States and elsewhere.ObjectiveTo determine the association of antibiotic treatment with outcomes among patients hospitalized for asthma and treated with corticosteroids.Design, setting, and participantsRetrospective cohort study of data of 19 811 adults hospitalized for asthma exacerbation and treated with systemic corticosteroids in 542 US acute care hospitals from January 1, 2015, through December 31, 2016.ExposuresEarly antibiotic treatment, defined as an treatment with an antibiotic initiated during the first 2 days of hospitalization and prescribed for a minimum of 2 days.Main outcomes and measuresThe primary outcome measure was hospital length of stay. Other measures were treatment failure (initiation of mechanical ventilation, transfer to the intensive care unit after hospital day 2, in-hospital mortality, or readmission for asthma) within 30 days of discharge, hospital costs, and antibiotic-related diarrhea. Multivariable adjustment, propensity score matching, propensity weighting, and instrumental variable analysis were used to assess the association of antibiotic treatment with outcomes.ResultsOf the 19 811 patients, the median (interquartile range [IQR]) age was 46 (34-59) years, 14 389 (72.6%) were women, 8771 (44.3%) were white, and Medicare was the primary form of health insurance for 5120 (25.8%). Antibiotics were prescribed for 8788 patients (44.4%). Compared with patients not treated with antibiotics, treated patients were older (median [IQR] age, 48 [36-61] vs 45 [32-57] years), more likely to be white (48.6% vs 40.9%) and smokers (6.6% vs 5.3%), and had a higher number of comorbidities (eg, congestive heart failure, 6.2% vs 5.8%). Those treated with antibiotics had a significantly longer hospital stay (median [IQR], 4 [3-5] vs 3 [2-4] days) and a similar rate of treatment failure (5.4% vs 5.8%). In propensity score-matched analysis, receipt of antibiotics was associated with a 29% longer hospital stay (length of stay ratio, 1.29; 95% CI, 1.27-1.31) and higher cost of hospitalization (median [IQR] cost, $4776 [$3219-$7373] vs $3641 [$2346-$5942]) but with no difference in the risk of treatment failure (propensity score-matched OR, 0.95; 95% CI, 0.82-1.11). Multivariable adjustment, propensity score weighting, and instrumental variable analysis as well as several sensitivity analyses yielded similar results.Conclusions and relevanceAntibiotic therapy may be associated with a longer hospital length of stay, higher hospital cost, and similar risk of treatment failure. These results highlight the need to reduce inappropriate antibiotic prescribing among patients hospitalized for asthma.

Dataset Information

Association Between Obesity and Acute Severity Among Patients Hospitalized for Asthma Exacerbation.

Publications

Association Between Obesity and Acute Severity Among Patients Hospitalized for Asthma Exacerbation.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets