Comorbidities in childhood-onset and adult-onset asthma

Abstract

Background: Age of asthma onset has emerged as an important determinant of asthma phenotypes; however, the comorbidities that predominate in either childhood- or adult-onset asthma are not known.

Objective: To identify comorbidities associated with adult-onset asthma vs childhood-onset asthma and with age of asthma diagnosis.

Methods: We analyzed data on 27,437 adult participants in the National Health and Nutrition Examination Surveys conducted from 2001 to 2018. Logistic regression adjusted for covariates was used to identify comorbidities associated with the asthma phenotypes and age of asthma diagnosis.

Results: Approximately 12.6% of participants were ever diagnosed with asthma; the prevalence of childhood-onset (before 18 years old) and adult-onset (≥ 18 years old) current asthma was 2.7% and 5.5%, respectively. After adjustment for covariates including age, adult-onset asthma was associated with higher odds of obesity (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.09-1.96), hypercholesterolemia (OR, 1.67; 95% CI, 1.08-2.56), borderline high serum triglycerides (OR, 1.78; 95% CI, 1.17-2.71), and osteoarthritis (OR, 1.52; 95% CI, 1.04-2.20) than was childhood-onset asthma. Older age of asthma diagnosis (per 5-year increase) was also associated with higher odds of diabetes (OR, 1.04; 95% CI, 1.00-1.07) and hypertension (OR, 1.05; 95% CI, 1.02-1.07), whereas younger age of asthma diagnosis was associated with higher odds of chronic obstructive pulmonary disease (OR, 1.12; 95% CI, 1.04-1.19).

Conclusion: Age- and covariates-adjusted prevalence of obesity, dyslipidemia, arthritis, diabetes, and hypertension is higher in adult-onset asthma than in childhood-onset asthma, and with older age of asthma diagnosis. Conversely, the prevalence of chronic obstructive pulmonary disease increases with younger age of asthma diagnosis.

Figure 1.

Comorbidities associated with adult vs childhood asthma onset among adults with current asthma. Models adjusted for age, sex, race and ethnicity, poverty income ratio, pack-years of cigarette smoking, health insurance, and NHANES survey cycle. CI: confidence interval, CKD: chronic kidney disease, COPD: chronic obstructive pulmonary disease, CVD: cardiovascular disease, LDL: low density lipoprotein, NHANES: National Health and Nutrition Examination Survey. * P < 0.05, ** P < 0.01.

Figure 2.

Association between age of asthma diagnosis and comorbidities among adults with current asthma. Odds ratios reported for each 5 years increase in age of asthma diagnosis and adjusted for age, sex, race and ethnicity, poverty income ratio, pack-years of cigarette smoking, health insurance, and NHANES survey cycle. CI, confidence interval; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; CVD, cardiovascular disease; LDL, low density lipoprotein; NHANES, National Health and Nutrition Examination Survey. * P < 0.05, ** P < 0.01, *** P < 0.001.