Impact of Age and Sex on Outcomes and Hospital Cost of Acute Asthma in the United States, 2011-2012

• Type of Material: Article
• Authors: Joe G. Zein, Cleveland Clinic; Belinda L. Udeh, Cleveland Clinic; W. Gerald Teague, University of Virginia; Siran M. Koroukian, Case Western Reserve University; Nicholas K. Schlitz, Case Western Reserve University; Eugene R. Bleecker, Wake Forest University; William B. Busse, University of Wisconsin; William J. Calhoun, University of Texas Medical Branch; Mario Castro, Washington University in St. Louis; Suzy A. Comhair, Cleveland Clinic; Anne Fitzpatrick, Emory University; Elliot Israel, Harvard University; Sally E. Wenzel, University of Pittsburgh; Fernando Holguin, University of Pittsburgh; Benjamin M. Gaston, Case Western Reserve University; Serpil C. Erzurum, Cleveland Clinic; The Severe Asthma Research Program
• Language: English
• Date: 2016-06-13
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2016 Zein et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0157301
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 11
• Issue: 6
• Start Page: e0157301
• End Page: e0157301
• Grant/Funding Information: SCE received funding from the National Institute of Health-National Heart, Lung, and Blood Institute: HL109250, HL081064, HL69170, HL103453, U10 HL109250, and UL1TR000439.
• Keywords: Respiratory failure; Health care; Multidisciplinary Sciences; SECONDARY DATABASES; Chronic obstructive pulmonary disease; Death rates; CHILDHOOD; PREVALENCE; EXACERBATIONS; Asthma; NATIONAL HEART; Science & Technology; SIMULATED PATIENTS; Age distribution; Hospitals; Health economics; SYMPTOMS
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management; Health Sciences, Epidemiology

Abstract

Background: Worldwide, asthma is a leading cause of morbidity, mortality and economic burden, with significant gender and racial disparities. However, little attention has been given to the independent role of age on lifetime asthma severity and hospitalization. We aimed to assess the effect of age, gender, race and ethnicity on indicators of asthma severity including asthma related hospitalization, mortality, hospital cost, and the rate of respiratory failure. Methods: We analyzed the 2011 and 2012 Healthcare Cost and Utilization Project- National Inpatient Sample (NIS). We validated and extended those results using the National Heart, Lung, and Blood Institute-Severe Asthma Research Program (SARP; 2002-2011) database. Severe asthma was prospectively defined using the stringent American Thoracic Society (ATS) definition. Results: Hospitalization for asthma was reported in 372,685 encounters in 2012 and 368,528 in 2011. The yearly aggregate cost exceeded $2 billion. There were distinct bimodal distributions for hospitalization age, with an initial peak at 5 years and a second at 50 years. Likewise, this bimodal age distribution of patients with severe asthma was identified using SARP. Males comprised the majority of individuals in the first peak, but women in the second. Aggregate hospital cost mirrored the bimodal peak distribution. The probability of respiratory failure increased with age until the age of 60, after which it continued to increase in men, but not in women. Conclusions: Severe asthma is primarily a disease of young boys and middle age women. Greater understanding of the biology of lung aging and influence of sex hormones will allow us to plan for targeted interventions during these times in order to reduce the personal and societal burdens of asthma.