Atmospheric environment and persistence of pediatricasthma: A population-based cohort study
Hwan Soo Kim,1,† Kyunghoon Kim,2,† Eun Hee Rhee,3,4 Woo Kyung Kim,5 Dae Jin Song,6 Ji Soo Park,2 Dong In Suh,2 Jisun Yoon,7 Eun Lee,8 Seung Won Lee,9 Jin Tack Kim,1 Dae Hyun Lim,10 Hey Sung Baek,11 Meeyong Shin,3 Ji Won Kwon,2 Gwang Cheon Jang,12 Ju Hee Seo,13 Sung Il Woo,14 Hyung Young Kim,15 Ju Suk Lee,16 Jinho Yu,17 Hyeon-Jong Yang,3,4,‡ Young Yoo6,‡
Affiliations:
1 Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
2 Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
3 Department of Pediatrics, Pediatric Allergy and Respiratory Center, Soonchunhyang University School of Medicine, Korea
4 SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
5 Department of Pediatrics, Inje University Seoul Paik Hospital, Seoul, Korea
6 Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
7 Department of Pediatrics, Chung-Ang University Gwang-Myeong Hospital, Chung-Ang University College of Medicine, Seoul, Korea
8 Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
9 Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
10 Department of Pediatrics, College of Medicine, Inha University, Incheon, Korea
11 Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
12 Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Ilsan, Korea
13 Department of Pediatrics, Dankook University Hospital, Cheonan, Korea
14 Department of Pediatrics, College of Medicine, Chungbuk National University, Cheongju, Korea
15 Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
16 Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
17 Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
†These authors contributed equally to this work as co-first authors
‡These authors contributed equally to this work as co-corresponding authors.
Abstract
Background: Asthma is a heterogeneous disease with different outcomes. For children with asthma at the age of 7 years, 67–75% are symptom-free as adults. Data on the important link between childhood and adult asthma are sparse.
Objective: We aimed to investigate factors associated with persistence of childhood asthma over three years of follow-up by linking data between Korea childhood Asthma Study (KAS) and their matched claims data from Health Insurance Review and Assessment Service (HIRA).
Methods: We analyzed data from 450 preadolescent children aged 7 to 10 years and classified them into remission or persistence groups. Baseline clinical characteristics and exposure to air pollution materials including PM2.5 and PM10 during three years of follow-up were compared. The main outcome was asthma persistence which was defined as the presence of asthma episodes with healthcare utilization and prescription of asthma medications within three years after KAS enrollment.
Results: At the third year of follow-up, after stepwise regression analysis, lower age at enrollment (adjusted odds ratio (aOR): 0.79; 95% confidence interval (CI): 0.64–0.96), male sex (aOR: 1.66; 95%CI: 1.05–2.63), proximity from an air-polluting facility (aOR: 2.4; 95%CI: 1.34–4.29), higher level outdoor PM2.5 (aOR: 1.1; 95%CI: 1.02–1.20), and higher rate of doctor-diagnosed food allergy (FA) (aOR: 2.33; 95%CI: 1.06–5.12) were significantly associated with persistence.
Conclusion: We discovered various independent risk factors for the persistence of childhood asthma. By linking HIRA claims data, we could clarify risk factors for persistence in a well-defined study population.
Key words: Asthma, Children, Persistence, Air pollution, National Claims Data