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. 2016 Jun 13;11(6):e0157301.
doi: 10.1371/journal.pone.0157301. eCollection 2016.

Impact of Age and Sex on Outcomes and Hospital Cost of Acute Asthma in the United States, 2011-2012

Joe G Zein  1 , Belinda L Udeh  2 , W Gerald Teague  3 , Siran M Koroukian  4 , Nicholas K Schlitz  4 , Eugene R Bleecker  5 , William B Busse  6 , William J Calhoun  7 , Mario Castro  8 , Suzy A Comhair  1 , Anne M Fitzpatrick  9 , Elliot Israel  10 , Sally E Wenzel  11 , Fernando Holguin  11 , Benjamin M Gaston  12 , Serpil C Erzurum  1 ; Severe Asthma Research Program
Affiliations

Impact of Age and Sex on Outcomes and Hospital Cost of Acute Asthma in the United States, 2011-2012

Joe G Zein et al. PLoS One. .

Abstract

Background: Worldwide, asthma is a leading cause of morbidity, mortality and economic burden, with significant gender and racial disparities. However, little attention has been given to the independent role of age on lifetime asthma severity and hospitalization. We aimed to assess the effect of age, gender, race and ethnicity on indicators of asthma severity including asthma related hospitalization, mortality, hospital cost, and the rate of respiratory failure.

Methods: We analyzed the 2011 and 2012 Healthcare Cost and Utilization Project- National Inpatient Sample (NIS). We validated and extended those results using the National Heart, Lung, and Blood Institute-Severe Asthma Research Program (SARP; 2002-2011) database. Severe asthma was prospectively defined using the stringent American Thoracic Society (ATS) definition.

Results: Hospitalization for asthma was reported in 372,685 encounters in 2012 and 368,528 in 2011. The yearly aggregate cost exceeded $2 billion. There were distinct bimodal distributions for hospitalization age, with an initial peak at 5 years and a second at 50 years. Likewise, this bimodal age distribution of patients with severe asthma was identified using SARP. Males comprised the majority of individuals in the first peak, but women in the second. Aggregate hospital cost mirrored the bimodal peak distribution. The probability of respiratory failure increased with age until the age of 60, after which it continued to increase in men, but not in women.

Conclusions: Severe asthma is primarily a disease of young boys and middle age women. Greater understanding of the biology of lung aging and influence of sex hormones will allow us to plan for targeted interventions during these times in order to reduce the personal and societal burdens of asthma.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
Histogram with smoothed density estimate of age distribution of asthma related hospitalizations in the United States in 2011 (Panel A) and 2012 (Panel B). Panel C and Panel D reflect the age distribution of severe asthma and asthma hospitalization in the Severe Asthma Research Program (SARP) database. All 3 databases show a bimodal age distribution of severe asthma.
Fig 2
Fig 2. Density plots of the distribution of asthma hospitalizations stratified by gender and race.
Panel A shows that asthma hospitalization is more frequent among young boys and middle age women. Panel B shows a bi-modal distribution of asthma severity across different races. Panel A and B are abstracted from NIS 2012.
Fig 3
Fig 3
Risk-adjusted probabilities of asthma related hospital mortality (Panel A) and respiratory failure (Panel B) as a function of age using the NIS 2012 database. The probabilities were calculated by fitting a logistic regression using a restricted cubic spline function for age. The 95% CIs are indicated by the gray area around the fitted line.
See this image and copyright information in PMC

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