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Trends in asthma hospital admissions by seasonal period. Dias AS, Soares AS, Rodrigues D, Rosinha I, Vilela M, Pinto M, Dias M, Barbosa N, Rosinha P, Sá T, Cabreira V, Bessa V Turma 11, 1º ano do Mestrado Integrado em Medicina 2010/2011 - PowerPoint PPT Presentation
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Trends in asthma hospital admissions by seasonal period
Dias AS, Soares AS, Rodrigues D, Rosinha I, Vilela M, Pinto M, Dias M, Barbosa N, Rosinha P, Sá T, Cabreira V, Bessa V
Turma 11, 1º ano do Mestrado Integrado em Medicina2010/2011
SUMMARY
Introduction
Methods
Results
Discussion
Bibliography
The disease, its prevalenceTobacco SmokeSmoke-free LegislationResearch question
The disease, its prevalence The most common chronic
pulmonary disease1. Causing wheezing, breathlessness,
chest tightness and coughing2. Increase of airways reactivity
(hyperresponsive) because they become obstructed and airflow is limited1.
Its prevalence has increased considerably over the past 20 years, especially in children3.
1 Global Initiative for Asthma, Pocket guide for asthma management and prevention, 20092 Mallol J, Castro-Rodriguez JA, Cortez E. Int J Chron Obstruct Pulmon Dis 20073 Arruda LK, Sole D, Baena-Cagnani CE, Naspitz CK. Curr Opin Allergy Clin Immunol 2005
Magazine on European Research. The allergy enigma. 2004
Tobacco Smoke Gene-environmental interactions play a key role in the
develpment of asthma4. Tobacco smoke is a major component of indoor air pollution5. Secondhand smoke increases the risk of severity asthma6. Longitudinal and case-control studies have described tobacco
smoke, mainstream or secondhand, as a risk factor for developing asthma7-9.
4 Baena-Cagnani CE, Gómez RM, Baena-Cagnani R, Canonica GW. Curr Opin Allergy Clin Immunol, 20095 Atkinson, Anderson, Sunyer et al. American Journal of Respiratory and Critical Care Medicine, 2001.6 Rayens MK, Burkhart PV, Zhang M, Lee S, Moser DK, Mannino D, Hahn EJ. J Allergy Clin Immunol., 2008.7 Plaschke PP, Janson C, Norrman E, et al. Am J Respir Crit Care Med 2000.8 Genuneit J, Weinmayr G, Radon K, et al. Thorax 2006.9 Gilliland FD, Islam T, Berhane K, et al. Am J Respir Crit Care Med 2006.
Smoke-free Legislation Smoke-free legislation aims to protect non-smokers from
secondhand smoke, but it also may reduce the risk among smokers because of reduced smoking or increased smoking cessation.
FULL bans(all public places)
PARTIAL bans(smoking is allowed in some
places)
Public Smoking Bans
Smoke-free legislation has a positive effect as it decreases the hospital admissions for asthma and other diseases.
Research questions
Have trends in ASTHMA-RELATED
HOSPITAL ADMISSIONS by season
changed on the past decade in Portugal?
What is the impact of smoke-free legislation on the number of
ASTHMA-RELATED HOSPITAL ADMISSIONS in Portugal?
SUMMARY
Introduction
Methods
Results
Discussion
Bibliography
Data sourcesExclusion criteriaDefinitonsStatistical analysis
Data sources
National Database
Hospital Admissions (Portuguese Public Hospitals)
[Jan 1, 2000 ----(Jan 1, 2008)---- May 31, 2009]
Exclusion criteria
POPULATION: people attending public hospitals
CAUSE: Asthma Crisis as Discharge Diagnosis
(ICD9-Code 493,xx)
Definitions
ICD 9 codes: 493.0 [0-2] – Extrinsic asthma 493.1 [0-2] – Intrinsic asthma 493.2 [0-2] – Chronic obstructive asthma 493.8 – Other forms of asthma 493.9 [0-2] – Asthma, unspecified
Statistical analysis
Groups of participants:Group I children (1-17 years)Group II adults (18 or more years)
Variables analised: Discharge diagnosis (categorical: ICD9) Age group (categorical: children, adults)
Statistical analysis
Aproppriate summary statistics for the continuous variables Describe categorical variables Investigate time trends in hospital admissions
2008
Implementation of Smoke-free Legislation
20092000
Admissions for asthma
Total number of records in the database: 11944725
SELECTION CRITERIA:
Total number of records analysed: 28765
Discharge diagnosisAdmission date prior to June 2009 (due to changes in
the registry)Age >= 1 year
Asthma Hospital Admissions
CHILDREN – 13678 (48%)ADULTS – 15087 (52%)
MALE – 12733 (44 %) FEMALE – 16032 (56%)
ChildrenMean – 5Std. Deviation – 4
28765(2000 to 2009)
AdultsMean – 55Std. Deviation – 19
AGE
SUMMARY
Introduction
Methods
Results
Discussion
Bibliography
Admissions for asthmaAnalysis by subgroups
General analysis
Introduction of smoke-free legislation
Children 13678Adults 15087Total 28765
2000 2001 2002 2003 2004 2005 2006 2007 2008 20090
500
1000
1500
2000
2500
3000
3500Anual asthma hospital admissions
TotalChildrenAdults
Year
Num
ber
of a
dmis
sion
s
Number of Asthma related Admissions by Month
Children 13289Adults 14491Total 27780
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec0
500
1000
1500
2000
2500
3000
3500TotalChildrenAdults
Month
Num
ber
of a
dmis
sion
sAnalysis by subgroups
2009 excluded
Analysis by subgroupsChildren
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
R2=0,961
R2=0,882 R2=0,860
Analysis by subgroupsAdults
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
R2=0,813
R2=0,932 R2=0,910
2000 2001 2002 2003 2004 2005 2006 2007 2008 20090
0.10.20.30.40.50.60.70.80.9
1
Anual asthma hospital admissions
Children Adults Total
YearPerc
enta
ge o
f Ast
hma
Adm
issi
ons
in a
ll H
ospi
tal A
dmis
sion
s
Children 13678Adults 15087Total 28765
Analysis by subgroups
Analysis by subgroupsChildren
2000 2001 2002 2003 2004 2005 2006 2007 2008
2000 2001 2002 2003 2004 2005 2006 2007 2008 2000 2001 2002 2003 2004 2005 2006 2007 2008
R2=0,590
R2=0,213
R2=0,286
Analysis by subgroupsAdults
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
R2=0,228
R2=0,874 R2=0,357
SUMMARY
Introduction
Methods
Results
Discussion
Bibliography
LimitationsConclusion
Data inconsistence of database and low quality of registry;
Large amount of data (that caused a difficult selection and loading of information);
In 2008 there is no registry of the variable “Hospital” which give us information about the kind of admission’s hospital. Therefore, to analyze the influence of this variable in asthma trends was not possible.
Only the first five months of 2009 have the total cases of admissions in Portugal. All the other cases of this year were not considered.
Limitations
Relative to variable “Módulo_origem” that categorizes episodes as “ambulatory” or “admission”
o In the case of asthma we assumed that all strings represent admissions;
o In all other cases we cannot admit this idea, so we eliminated all strings as well as ambulatory cases.
This assumptions may introduce bias.
Limitations
In a general analysis, the number of asthma hospital admissions has decreased
There was a influence of the weather (and consequently the season) in the number of asthma episodes
Children are more affected than adults
For both groups, the period from January to May seems to be the most critical one (with a higher number of admissions for asthma)
Conclusions
The trends in asthma-related hospital admissions had not change on the past decade in Portugal
There is not evidence that there was a decrease in asthma related-hospital admissions after the introduction of the smoke-free legislation in Portugal
Conclusions
SUMMARY
Introduction
Methods
Results
Discussion
Bibliography
Pocket guide for asthma management and prevention. Global Initiative for Asthma 2009. Mallol J, Castro-Rodriguez JA, Cortez E. Effects of active tobacco smoking on the prevalence of
asthma-like symptoms in adolescents. Int J Chron Obstruct Pulmon Dis 2007;2:65-9. Arruda LK, Sole D, Baena-Cagnani CE, Naspitz CK. Risk factors for asthma and atopy. Curr Opin
Allergy Clin Immunol 2005;5:153-9. Baena-Cagnani CE, Gomez RM, Baena-Cagnani R, Canonica GW. Impact of environmental tobacco
smoke and active tobacco smoking on the development and outcomes of asthma and rhinitis. Curr Opin Allergy Clin Immunol 2009;9:136-40.
Atkinson, Anderson, Sunyer, et al. Acute effects of particulate air pollution on respiratory admissions: results from APHEA 2 project. Air Pollution and Health: a European Approach. Am J Respir Crit Care Med 2001;164:1860-6.
Rayens MK, Burkhart PV, Zhang M, Lee S, Moser DK, Mannino D, Hahn EJ. Reduction in asthma-related emergency department visits after implementation of a smoke-free law. J Allergy Clin Immunol. 2008;122:537-41.
Plaschke PP, Janson C, Norrman E, et al. Onset and remission of allergic rhinitis and asthma and the relationship with atopic sensitization and smoking. Am J Respir Crit Care Med 2000; 162:920–924.
Genuneit J, Weinmayr G, Radon K, et al. Smoking and the incidence of asthma during adolescence: results of a large cohort study in Germany. Thorax 2006; 61:572–578.
Gilliland FD, Islam T, Berhane K, et al. Regular smoking and asthma incidence in adolescents. Am J Respir Crit Care Med 2006; 174:1094–1100.
Bibliography
