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. 2021 Sep 1;175(9):919-927.
doi: 10.1001/jamapediatrics.2021.0667.

US Childhood Asthma Incidence Rate Patterns From the ECHO Consortium to Identify High-risk Groups for Primary Prevention

Christine Cole Johnson  1 , Aruna Chandran  2 , Suzanne Havstad  1 , Xiuhong Li  2 , Cynthia T McEvoy  3 , Dennis R Ownby  1 , Augusto A Litonjua  4 , Margaret R Karagas  5 , Carlos A Camargo Jr  6 , James E Gern  7 , Frank Gilliland  8 , Alkis Togias  9 ; Environmental Influences on Child Health Outcomes (ECHO) collaborators
Collaborators, Affiliations

US Childhood Asthma Incidence Rate Patterns From the ECHO Consortium to Identify High-risk Groups for Primary Prevention

Christine Cole Johnson et al. JAMA Pediatr. .

Abstract

Importance: Asthma is the leading chronic illness in US children, but most descriptive epidemiological data are focused on prevalence.

Objective: To evaluate childhood asthma incidence rates across the nation by core demographic strata and parental history of asthma.

Design, setting, and participants: For this cohort study, a distributed meta-analysis was conducted within the Environmental Influences on Child Health Outcomes (ECHO) consortium for data collected from May 1, 1980, through March 31, 2018. Birth cohort data of children from 34 gestational weeks of age or older to 18 years of age from 31 cohorts in the ECHO consortium were included. Data were analyzed from June 14, 2018, to February 18, 2020.

Exposures: Caregiver report of physician-diagnosed asthma with age of diagnosis.

Main outcome and measures: Asthma incidence survival tables generated by each cohort were combined for each year of age using the Kaplan-Meier method. Age-specific incidence rates for each stratum and asthma incidence rate ratios by parental family history (FH), sex, and race/ethnicity were calculated.

Results: Of the 11 404 children (mean [SD] age, 10.0 [0.7] years; 5836 boys [51%]; 5909 White children [53%]) included in the primary analysis, 7326 children (64%) had no FH of asthma, 4078 (36%) had an FH of asthma, and 2494 (23%) were non-Hispanic Black children. Children with an FH had a nearly 2-fold higher incidence rate through the fourth year of life (incidence rate ratio [IRR], 1.94; 95% CI, 1.76-2.16) after which the rates converged with the non-FH group. Regardless of FH, asthma incidence rates among non-Hispanic Black children were markedly higher than those of non-Hispanic White children during the preschool years (IRR, 1.58; 95% CI, 1.31-1.86) with no FH at age 4 years and became lower than that of White children after age 9 to 10 years (IRR, 0.67; 95% CI, 0.50-0.89) with no FH. The rates for boys declined with age, whereas rates among girls were relatively steady across all ages, particularly among those without an FH of asthma.

Conclusions and relevance: Analysis of these diverse birth cohorts suggests that asthma FH, as well as race/ethnicity and sex, were all associated with childhood asthma incidence rates. Black children had much higher incidences rates but only during the preschool years, irrespective of FH. To prevent asthma among children with an FH of asthma or among Black infants, results suggest that interventions should be developed to target early life.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Johnson reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study. Ms Havstad reported receiving grants from NIH during the conduct of the study. Dr Li reported receiving grants from NIH during the conduct of the study. Dr McEvoy reported receiving grants from the NIH during the conduct of the study. Dr Ownby reported receiving grants from the NIH during the conduct of the study. Dr Litonjua reported receiving personal fees from UpToDate Inc outside the submitted work. Dr Camargo reported receiving grants from the NIH during the conduct of the study. Dr Gern reported receiving personal fees from AstraZeneca outside the submitted work and receiving grants from the NIH in addition to ECHO funding. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Locations of Enrollment Sites for Children Included in the Primary and Supplementary Analyses
Several Environmental Influences on Child Health Outcomes (ECHO) cohorts have multiple enrollment sites. Figure reprinted courtesy of ECHO, a program supported by the National Institutes of Health.
Figure 2.
Figure 2.. Estimated Age-Specific Asthma Incidence Rates in Children Aged 1-17 Years Stratified by Family History of Asthma
Numbers are shown for specific age groups only. Shaded area represents 95% CIs.
Figure 3.
Figure 3.. Incidence Rate Ratios (IRRs) of Asthma Diagnosis at Ages 4, 9, and 14 Years
Panels compare family history (A), sex (B), and race/ethnicity (C) stratified by family history.
Figure 4.
Figure 4.. Estimated Age-Specific Asthma Incidence Rates in Children Aged 1-17 Years
Panels compare child sex (A and B) or child race/ethnicity (C and D) stratified by family history. Shaded area represents 95% CIs.
See this image and copyright information in PMC

References

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