Emergency department utilization for infantile acute bronchiolitis and subsequent risk of childhood asthma 公开

Marsh, Caitlin Andrea (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/6h440s59n?locale=zh
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Abstract

Background: Asthma etiology is poorly understood; early diagnosis and treatment are recommended for optimum symptom control. Studies using existing datasets, such as emergency department (ED) information, allow investigation of associations between early risk factors and subsequent asthma. Infantile acute bronchiolitis (AB) is considered a possible risk factor.

Methods: Linked datasets of ED utilization and birth records were used to assemble a cohort of children born in the state of Georgia between 2002 and 2004; children included had at least one ED visit before, and survived to, age one. Outcome (asthma ED visit after age five vs. none) and exposure (AB before age one) status were assigned on the basis of ED record ICD-9 codes. The effects of loss to follow-up in this dataset were evaluated through a sensitivity analysis of three additional study designs using variations of the sample population reflecting different patterns of loss to follow-up.

Results: Logistic regression resulted in an adjusted odds ratio (95% CI) of 1.83 (1.70, 1.96). . Sensitivity analysis of cumulative case-control designs produced ORs of 2.01 (1.86, 2.15) for the total population (including those potentially lost to follow-up), and 1.99 (1.85, 2.14) for a population subset excluding those without ED visits after age five (less loss to follow-up). An incidence density sampled case-control study resulted in an OR of 1.92 (1.78-2.07).

Conclusion: A positive association was observed between ED utilization for infantile AB and subsequent asthma ED visits after age five; loss to follow-up appeared to have little effect on the estimate.

Table of Contents

Table of Contents

Chapter I-Background...................................... 1 Chapter II-Manuscript ......................................7

Introduction...................................................8

Methods........................................................9

Results........................................................11

Comments...................................................12

References...................................................15

Tables.........................................................17

Table 1 ........................................................17

Table 2 ........................................................18

Chapter III-Background ...................................19 Appendix-IRB Approval ....................................21

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