. 2023 Jul;152(1):84-93.

doi: 10.1016/j.jaci.2023.03.016. Epub 2023 Mar 25.

Incidence rates of childhood asthma with recurrent exacerbations in the US Environmental influences on Child Health Outcomes (ECHO) program

Rachel L Miller¹, Holly Schuh², Aruna Chandran², Izzuddin M Aris³, Casper Bendixsen⁴, Jeffrey Blossom⁵, Carrie Breton⁶, Carlos A Camargo Jr⁷, Glorisa Canino⁸, Kecia N Carroll⁹, Sarah Commodore¹⁰, José F Cordero¹¹, Dana M Dabelea¹², Assiamira Ferrara¹³, Rebecca C Fry¹⁴, Jody M Ganiban¹⁵, James E Gern¹⁶, Frank D Gilliland⁶, Diane R Gold¹⁷, Rima Habre⁶, Marion E Hare¹⁸, Robyn N Harte¹⁹, Tina Hartert²⁰, Kohei Hasegawa²¹, Gurjit K Khurana Hershey²², Daniel J Jackson¹⁶, Christine Joseph²³, Jean M Kerver²⁴, Haejin Kim²³, Augusto A Litonjua²⁵, Carmen J Marsit²⁶, Cindy McEvoy²⁷, Eneida A Mendonça²², Paul E Moore²⁰, Flory L Nkoy²⁸, Thomas G O'Connor²⁹, Emily Oken³, Dennis Ownby²³, Matthew Perzanowski³⁰, Katherine Rivera-Spoljaric³¹, Patrick H Ryan²², Anne Marie Singh¹⁶, Joseph B Stanford²⁸, Rosalind J Wright⁹, Robert O Wright⁹, Antonella Zanobetti³², Edward Zoratti²³, Christine C Johnson²³; of program collaborators for Environmental influences on Child Health Outcomes

Collaborators, Affiliations

Collaborators

of program collaborators for Environmental influences on Child Health Outcomes:
P B Smith, K L Newby, L P Jacobson, D J Catellier, R Gershon, D Cella, A Alshawabkeh, J Aschner, S Merhar, C Ren, A Reynolds, R Keller, G Pryhuber, A Duncan, A Lampland, R Wadhawan, C Wagner, M Hudak, D Mayock, L Walshburn, S L Teitelbaum, A Stroustrup, L Trasande, C Blair, L Gatzke-Kopp, M Swingler, J Mansbach, J Spergel, H Puls, M Stevenson, C Bauer, S Deoni, C Duarte, A Dunlop, A Elliott, L Croen, L Bacharier, G O'Connor, L Bacharier, M Kattan, R Wood, G Hershey, D Ownby, I Hertz-Picciotto, A Hipwell, M Karagas, C Karr, A Mason, S Sathyanarayana, B Lester, B Carter, C Neal, L Smith, J Helderman, L Leve, J Ganiban, J Neiderhiser, S Weiss, R Zeiger, R Tepper, K Lyall, R Landa, S Ozonoff, R Schmidt, S Dager, R Schultz, J Piven, H Volk, R Vaidya, R Obeid, C Rollins, K Bear, S Pastyrnak, M Lenski, M Msall, J Frazier, L Washburn, A Montgomery, C Barone, P McKane, N Paneth, M Elliott, J Herbstman, S Schantz, C Porucznik, R Silver, E Conradt, M Bosquet-Enlow, K Huddleston, N Bush, R Nguyen, T O'Connor, M Samuels-Kalow

Affiliations

¹ Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: Rachel.miller2@mssm.edu.
² Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md.
³ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Inc, Boston, Mass.
⁴ Marshfield Clinic Research Institute, Marshfield, Wis.
⁵ Harvard University Center for Geographic Analysis, Cambridge, Mass.
⁶ Keck School of Medicine of University of Southern California, Los Angeles, Calif.
⁷ Department of Epidemiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
⁸ University of Puerto Rico Behavioral Sciences Research Institute, San Juan, Puerto Rico.
⁹ Icahn School of Medicine at Mount Sinai, New York, NY.
¹⁰ Medical University of South Carolina, Charleston, SC.
¹¹ University of Georgia College of Public Health, Athens, Ga.
¹² University of Colorado Anschutz Medical Campus, Aurora, Colo.
¹³ Division of Research, Kaiser Permanente Northern California, Oakland, Calif.
¹⁴ Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
¹⁵ George Washington University, Washington, DC.
¹⁶ University of Wisconsin School of Medicine and Public Heath, Madison, Wis.
¹⁷ Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass.
¹⁸ University of Tennessee Health Science Center, Memphis, Tenn.
¹⁹ Colorado School of Public Health, Aurora, Colo.
²⁰ Vanderbilt University School of Medicine, Nashville, Tenn.
²¹ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
²² University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
²³ Henry Ford Health, Detroit, Mich.
²⁴ Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Mich.
²⁵ Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY.
²⁶ Rollins School of Public Health, Emory University, Atlanta, Ga.
²⁷ Oregon Health and Science University, Portland, Ore.
²⁸ University of Utah Health, Salt Lake City, Utah.
²⁹ School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY.
³⁰ Columbia University Mailman School of Public Health, New York, NY.
³¹ St Louis Children's Hospital, Washington University, St Louis, Mo.
³² Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass.

PMID: 36972767
PMCID: PMC10330473
DOI: 10.1016/j.jaci.2023.03.016

Incidence rates of childhood asthma with recurrent exacerbations in the US Environmental influences on Child Health Outcomes (ECHO) program

Rachel L Miller et al. J Allergy Clin Immunol. 2023 Jul.

. 2023 Jul;152(1):84-93.

doi: 10.1016/j.jaci.2023.03.016. Epub 2023 Mar 25.

Authors

Collaborators

of program collaborators for Environmental influences on Child Health Outcomes:
P B Smith, K L Newby, L P Jacobson, D J Catellier, R Gershon, D Cella, A Alshawabkeh, J Aschner, S Merhar, C Ren, A Reynolds, R Keller, G Pryhuber, A Duncan, A Lampland, R Wadhawan, C Wagner, M Hudak, D Mayock, L Walshburn, S L Teitelbaum, A Stroustrup, L Trasande, C Blair, L Gatzke-Kopp, M Swingler, J Mansbach, J Spergel, H Puls, M Stevenson, C Bauer, S Deoni, C Duarte, A Dunlop, A Elliott, L Croen, L Bacharier, G O'Connor, L Bacharier, M Kattan, R Wood, G Hershey, D Ownby, I Hertz-Picciotto, A Hipwell, M Karagas, C Karr, A Mason, S Sathyanarayana, B Lester, B Carter, C Neal, L Smith, J Helderman, L Leve, J Ganiban, J Neiderhiser, S Weiss, R Zeiger, R Tepper, K Lyall, R Landa, S Ozonoff, R Schmidt, S Dager, R Schultz, J Piven, H Volk, R Vaidya, R Obeid, C Rollins, K Bear, S Pastyrnak, M Lenski, M Msall, J Frazier, L Washburn, A Montgomery, C Barone, P McKane, N Paneth, M Elliott, J Herbstman, S Schantz, C Porucznik, R Silver, E Conradt, M Bosquet-Enlow, K Huddleston, N Bush, R Nguyen, T O'Connor, M Samuels-Kalow

Affiliations

¹ Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: Rachel.miller2@mssm.edu.
² Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md.
³ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Inc, Boston, Mass.
⁴ Marshfield Clinic Research Institute, Marshfield, Wis.
⁵ Harvard University Center for Geographic Analysis, Cambridge, Mass.
⁶ Keck School of Medicine of University of Southern California, Los Angeles, Calif.
⁷ Department of Epidemiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
⁸ University of Puerto Rico Behavioral Sciences Research Institute, San Juan, Puerto Rico.
⁹ Icahn School of Medicine at Mount Sinai, New York, NY.
¹⁰ Medical University of South Carolina, Charleston, SC.
¹¹ University of Georgia College of Public Health, Athens, Ga.
¹² University of Colorado Anschutz Medical Campus, Aurora, Colo.
¹³ Division of Research, Kaiser Permanente Northern California, Oakland, Calif.
¹⁴ Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
¹⁵ George Washington University, Washington, DC.
¹⁶ University of Wisconsin School of Medicine and Public Heath, Madison, Wis.
¹⁷ Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass.
¹⁸ University of Tennessee Health Science Center, Memphis, Tenn.
¹⁹ Colorado School of Public Health, Aurora, Colo.
²⁰ Vanderbilt University School of Medicine, Nashville, Tenn.
²¹ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
²² University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
²³ Henry Ford Health, Detroit, Mich.
²⁴ Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Mich.
²⁵ Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY.
²⁶ Rollins School of Public Health, Emory University, Atlanta, Ga.
²⁷ Oregon Health and Science University, Portland, Ore.
²⁸ University of Utah Health, Salt Lake City, Utah.
²⁹ School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY.
³⁰ Columbia University Mailman School of Public Health, New York, NY.
³¹ St Louis Children's Hospital, Washington University, St Louis, Mo.
³² Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass.

PMID: 36972767
PMCID: PMC10330473
DOI: 10.1016/j.jaci.2023.03.016

Abstract

Background: Descriptive epidemiological data on incidence rates (IRs) of asthma with recurrent exacerbations (ARE) are sparse.

Objectives: This study hypothesized that IRs for ARE would vary by time, geography, age, and race and ethnicity, irrespective of parental asthma history.

Methods: The investigators leveraged data from 17,246 children born after 1990 enrolled in 59 US with 1 Puerto Rican cohort in the Environmental Influences on Child Health Outcomes (ECHO) consortium to estimate IRs for ARE.

Results: The overall crude IR for ARE was 6.07 per 1000 person-years (95% CI: 5.63-6.51) and was highest for children aged 2-4 years, for Hispanic Black and non-Hispanic Black children, and for those with a parental history of asthma. ARE IRs were higher for 2- to 4-year-olds in each race and ethnicity category and for both sexes. Multivariable analysis confirmed higher adjusted ARE IRs (aIRRs) for children born 2000-2009 compared with those born 1990-1999 and 2010-2017, 2-4 versus 10-19 years old (aIRR = 15.36; 95% CI: 12.09-19.52), and for males versus females (aIRR = 1.34; 95% CI 1.16-1.55). Black children (non-Hispanic and Hispanic) had higher rates than non-Hispanic White children (aIRR = 2.51; 95% CI 2.10-2.99; and aIRR = 2.04; 95% CI: 1.22-3.39, respectively). Children born in the Midwest, Northeast and South had higher rates than those born in the West (P < .01 for each comparison). Children with a parental history of asthma had rates nearly 3 times higher than those without such history (aIRR = 2.90; 95% CI: 2.43-3.46).

Conclusions: Factors associated with time, geography, age, race and ethnicity, sex, and parental history appear to influence the inception of ARE among children and adolescents.

Keywords: Asthma; environmental and social determinants of asthma; incidence rates; recurrent exacerbations.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest:

Carlos A. Camargo, Jr. reports AstraZeneca (Scientific Advisory Board in 2020); Sanofi Genzyme (Scientific Advisory Board in 2021). José F. Cordero is a consultant to Sanofi Pasteur specifically about dengue vaccine development. James E. Gern has received consulting fees from AstraZeneca and Meissa Vaccines, Inc, and has stock options in Meissa Vaccines, Inc. Tina Hartert serves on vaccine DSMB and advisory panels for Pfizer and Sanofi (without funding). Daniel J. Jackson has funding from GlaxoSmithKline and Regeneron, personal fees for DSMB from Pfizer, and personal fees for consulting from AstraZeneca, Avillion, GlaxoSmithKline, Sanofi, Regeneron. All other authors (Rachel L. Miller, Holly Schuh, Aruna Chandran, Izzuddin M. Aris, Casper Bendixsen, Jeffrey Blossom, Carrie Breton, Glorisa Canino, Kecia N. Carroll, Sarah Commodore, Dana M. Dabelea, Assiamira Ferrara, Rebecca C. Fry, Jody M. Ganiban, Frank D. Gilliland, Diane R. Gold, Rima Habre, Marion E. Hare, Robyn N. Harte, Tina Hartert, Kohei Hasegawa, Gurjit K. Khurana Hershey, Daniel J. Jackson, Christine Joseph, Jean M. Kerver, Haejin Kim, Augusto A. Litonjua, Carmen J. Marsit, Cindy McEvoy, Eneida A. Mendonça, Paul E. Moore, Flory L. Nkoy, Thomas G. O’Connor, Emily Oken, Dennis Ownby, Matthew Perzanowski, Katherine Rivera-Spoljaric, Patrick H. Ryan, Anne Marie Singh, Joseph B. Stanford, Rosalind J. Wright, Robert O. Wright, Antonella Zanobetti, Edward Zoratti and Christine C. Johnson) have nothing to disclose.

Figures

**Figure 1:**
Consort diagram. N=4,114 children from the general ECHO population of n=17,246 who were determined to report healthcare provider diagnosis of ever asthma, and among these children, n=2,061 had at least one use of corticosteroids. N=278 children received corticosteroid prescriptions without determination of an asthma diagnosis prior to age 5 years.

**Figure 2:**
Participating ECHO cohort recruitment sites. 59 cohort recruitment sites across the United States and one from Puerto Rico, with coloring to indicate the 4 census regions, are displayed.

See this image and copyright information in PMC

References

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1. Denlinger LC, Heymann P, Lutter R, Gern JE. Exacerbation-prone asthma. J Allergy Clin Immunol Pract 2020; 8:474–82. - PMC - PubMed
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Incidence rates of childhood asthma with recurrent exacerbations in the US Environmental influences on Child Health Outcomes (ECHO) program

Collaborators

Affiliations

Incidence rates of childhood asthma with recurrent exacerbations in the US Environmental influences on Child Health Outcomes (ECHO) program

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical