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

Tsai CL, Lee WY, Hanania NA, Camargo CA Jr.

Source

Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, TX 77030, USA. cltsai@post.harvard.edu

Abstract

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 admission="admission" adults="adults" all-cause="all-cause" and="and" asthma-related="asthma-related" charges="charges" events="events" hospital="hospital" in-hospital="in-hospital" length="length" measures="measures" mechanical="mechanical" mortality="mortality" near-fatal="near-fatal" noninvasive="noninvasive" of="of" older="older" or="or" outcome="outcome" rates="rates" stay.="stay." the="the" ventilation="ventilation" were="were" years="years" younger="younger">

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.
Copyright © 2012 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.