Childhood obesity and in-hospital asthma resource utilization

Abstract

OBJECTIVE: To examine the relationship between pediatric obesity and inpatient length of stay (LOS), resource utilization, readmission rates, and total billed charges for inhospital status asthmaticus. DESIGN/METHODS:We conducted a cross-sectional study of patients 5 to 17 years old hospitalized with status asthmaticus to 1 free-standing children's hospital system over 12 months. Only hospitalized patients initially treated in the hospital's emergency department were included to ensure all therapies/charges were examined. Patients with complex chronic conditions, pneumonia, or lacking recorded body mass index (BMI) were excluded. The primary exposure was BMI percentile for age. The primary outcome was LOS (in hours). Secondary outcomes were 90-day readmission rate, billed charges, and resource utilization: number of albuterol treatments, chest radiographs, intravenous fluids, intravenous or intramuscular steroids, and intensive care unit admission. Bivariate, adjusted Poisson and logistic regression model analyses were performed. RESULTS:Five hundred eighteen patients met inclusion criteria. Most had a normal BMI (59.7%); 36.7% were overweight or obese. LOS, readmissions, and resource utilization outcomes were not associated with BMI category on bivariate analyses. After adjustment for demographic/ clinical characteristics, LOS decreased by 2% for each decile increase in BMI percentile for age. BMI percentile for age was not associated with billed charges, readmissions, or other measures of resource utilization.CONCLUSIONS: Although BMI decile for age is inversely associated with LOS for in-hospital pediatric status asthmaticus, the effect likely is not clinically meaningful. Pediatric hospitalizations for obesity-related conditions have doubled in the last decade, mirroring the trend of higher levels of childhood obesity in the United States. [1][2][3] Recent studies have demonstrated worsened pediatric in-hospital outcomes, including mortality and increased resource utilization, for children with obesity across a range of diagnoses. [4][5][6][7][8][9][10] Although the mechanisms driving the association between obesity and in-hospital outcomes are not fully known, for asthma it is believed that adipocytes expressing inflammatory markers create a low level of systemic inflammation, thereby increasing the severity of allergic-type illnesses and decreasing the response to anti-inflammatory medications, such as steroids. [11][12][13][14][15][16][17][18] The relationship of obesity and in-hospital asthma outcomes is of particular interest because status asthmaticus is the most common reason for admission in children aged 3 to 12 years, accounting for approximately 150,000 admissions (7.4% of all hospitalizations for children and adolescents) and $835 million in hospital costs annually. 19 Few prior studies have examined the association of obesity and asthma outcomes in the in-hospital setting. The studies examining this association have found patients with obesity to have a longer hospital length of stay (LOS) and i...

Impact of Obesity on Clinical Outcomes in Urban Children Hospitalized for Status Asthmaticus

“…Our results may be more reliable because we calculated BMI percentile rather than using administrative data, which has been shown to be inaccurate in identifying obese patients. 36,37 In our study, billing data captured only 4% of children as obese and none as overweight. It is also possible that associations between obesity and poor asthma hospitalization outcomes identified by previous studies were confounded by asthma severity, which was controlled for in our study.…”

“…12,13 Although a smaller study assessing health care costs for multiple diagnoses in obese children from urban communities found obesity was associated with increased costs for asthma admissions, another assessing for hospitalization outcomes found that obesity was not associated with measures of resource utilization. 14,15 We used chart review and direct calculation of BMI percentile rather than diagnostic obesity codes to more accurately assess a range of hospitalization outcomes (LOS, charges, ICU stay, repeat admissions, and subsequent ED visits). This method was chosen to avoid misclassification of obesity status that may occur with administrative data and because it allowed us to control for variables not captured by administrative data that can affect admission outcomes (such as asthma severity and comorbidities).…”

Lack of Recognition, Diagnosis, and Treatment of Overweight/Obesity in Children Hospitalized for Asthma

“…Although cost of care and rate of readmission or return to the hospital are important issues in health care, a recent study by Bettenhausen et al 17 did not show a relationship between BMI and resource utilization or cost of care; however, Aragona et al 36 did show that obese patients were more likely to have return visits.…”

“…[7][8][9][12][13][14] However, there is inconsistency in the literature, and some studies have not found that higher BMI percentile predicts admission or effects health care outcomes in children with asthma. [15][16][17] There remains a lack of data on the prevalence of overweight and obesity among children with asthma in the inpatient setting and, more importantly, a lack of information about the clinical practices related to this population.…”

Investigations into the relationship between respiratory disorders and excessive body weight in the adolescents presenting with bronchial asthma treated based at a specialized health resort facility

“…), многие из которых синтезируются и секретиру-ются клетками жировой (адипозной) ткани [4,5] и поэтому названы адипокинами, включая IL-6, IL-10, эотаксин, фактор некроза опухоли α, трансфор-мируемый фактор роста β1, C-реактивный протеин, лептин и адипонектин. Наконец, было идентифи-цировано, что идентичные локусы генома человека отвечают как за БА, так и за ожирение [6][7][8][9][10][11].…”