Age-related differences in clinical outcomes for acute asthma in the United States, 2006-2008

• Published in: Journal of allergy and clinical immunology Vol. 129; no. 5; pp. 1252 - 1258.e1
• Main Authors: Tsai, Chu-Lin, MD, ScD, Lee, Wen-Ya, MS, MPH, Hanania, Nicola A., MD, MS, Camargo, Carlos A., MD, DrPH
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.05.2012; Elsevier
• Subjects: Acute asthma; Acute Disease; Adult; Age; Age Factors; Aged; Aging; Allergy and Immunology; Asthma; Asthma - economics; Asthma - epidemiology; Asthma - mortality; Asthma - physiopathology; Biological and medical sciences; Child; Child, Preschool; Children; Chronic obstructive pulmonary disease, asthma; Classification; emergency department; Emergency Medical Services - statistics & numerical data; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hospitals; Humans; Immunopathology; Length of Stay - statistics & numerical data; Male; Medical sciences; Middle Aged; Morbidity; Mortality; outcomes; Patient Admission - statistics & numerical data; Pneumology; Recurrence; Risk factors; Risk groups; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Survival Analysis; Treatment Outcome; United States; Ventilation; United States; North America; America; NEDS; OR; International Classification of Disease, ninth revision, Clinical Modification; Healthcare Cost and Utilization Project; IQR; emergency department; LOS; Agency for Healthcare Research and Quality; ICD-9-CM; outcomes; HCUP; Interquartile range; Acute asthma; AHRQ; Odds ratio; Chronic obstructive pulmonary disease; Nationwide Emergency Department Sample; age; COPD; ED; Length of stay; Lung disease; Immunopathology; Prognosis; Respiratory disease; Acute; Asthma; Immunology; Emergency department; Bronchus disease; Evolution; Obstructive pulmonary disease; Age
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2012.01.061

Background Little is known about the effect of age on acute asthma outcomes. Objective We sought to investigate age-related differences in the emergency department (ED) presentation and clinical outcomes for patients with acute asthma. Methods We analyzed the 2006-2008 Nationwide Emergency Department Sample, the largest, all-payer, US ED and inpatient database. ED visits for acute asthma were identified with a principal diagnosis of International Classification of Disease, ninth revision, Clinical Modification code 493.xx. Patients were divided into 3 age groups: children (<18 years), younger adults (18-54 years), and older adults (≥55 years). The outcome measures were in-hospital all-cause mortality, near-fatal asthma-related events (noninvasive or mechanical ventilation), hospital charges, admission rates, and hospital length of stay. Results There were an estimated 1,813,000 visits annually for acute asthma from approximately 4,700 EDs. The estimated overall annual number of in-hospital asthma-related deaths was 1,144 (0.06%); 101 died in the ED, and 1,043 died as inpatients. By age group, there were 37 asthma-related deaths per year in children, 204 in younger adults, and 903 in older adults. Compared with younger adults, older adults had higher mortality, had higher rates of near-fatal asthma-related events, had higher hospital charges, were more likely to be hospitalized, and had a longer hospital length of stay ( P  < .001 for all). After adjusting for comorbidities, older asthmatic patients had a 5-fold increased risk of overall mortality (adjusted odds ratio, 5.2; 95% CI, 4.0-6.9), compared with younger adults. Conclusions Older adults with acute asthma have a substantial burden of morbidity and mortality. With the US population aging, there is an urgent need for targeted interventions for this high-risk population.