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. 2025 May 9;51(1):135.
doi: 10.1186/s13052-025-01974-0.

Impact of ASD and ADHD on pediatric asthma exacerbations: a retrospective analysis of the Nationwide Inpatient Sample 2005-2020

Dai-Xuan Lin  1   2 , Ya-Ting Chang  3 , Yu-Chun Lo  4 , Shih-Ming Weng  5   6
Affiliations

Impact of ASD and ADHD on pediatric asthma exacerbations: a retrospective analysis of the Nationwide Inpatient Sample 2005-2020

Dai-Xuan Lin et al. Ital J Pediatr. .

Abstract

Background: To explore the impact of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) on in-hospital outcomes in children hospitalized for asthma exacerbations.

Methods: This retrospective study utilized data from the Nationwide Inpatient Sample (NIS) database between 2005 and 2020. We included children aged 5 to 19 years admitted for asthma exacerbations. Children were categorized into four groups: those with ASD only, ADHD only, both ASD and ADHD, and neither condition. Propensity score matching was used to balance baseline characteristics.

Results: A total of 155,893 children hospitalized for asthma were identified, with 2,443 patients remaining after propensity score matching. Children with both ASD and ADHD had the highest total hospital costs, followed by those with ASD alone. Children with both ASD and ADHD had significantly increased risks of overall complications (aOR = 1.69, 95% CI: 1.27-2.26), including epilepsy (aOR = 3.56, 95% CI: 1.61-7.87), pneumonia (aOR = 2.00, 95% CI: 1.33-3.03), and constipation (aOR = 4.22, 95% CI: 1.58-11.26), compared to those without either condition. Children with ASD alone also had elevated risks for epilepsy (aOR = 3.79, 95% CI: 1.79-8.03) and constipation (aOR = 4.33, 95% CI: 1.78-10.54).

Conclusion: In the US children hospitalized for asthma exacerbations, those with both ASD and ADHD, or ASD alone, face significantly greater costs and higher risks of specific complications, particularly epilepsy, pneumonia, and constipation. The findings suggest a compounded impact of these neurodevelopmental conditions on asthma children, emphasizing the need for specialized care to manage these patients effectively and reduce the risks.

Keywords: Asthma; Attention deficit hyperactivity disorder (ADHD); Autism spectrum disorder (ASD); Children; Complication; In-hospital mortality.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All data were obtained through a request to the Online Healthcare Cost and Utilization Project (HCUP) Central Distributor (available at: https://www.distributor.hcup-us.ahrq.gov/ ), which administers the database (certificate # HCUP-863FXU18I). This study conforms to the NIS data-use agreement with HCUP. Because this study analyzed secondary data from the NIS database, patients and the public were not involved directly. The study protocol was submitted to the Institutional Review Board (IRB) of Chang-Gung Memorial Hospital, which exempted the study from IRB approval. Since all data in the NIS database are de-identified, the requirement for informed consent was also waived. Consent for publication: Not applicable. Competing interests: The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Flow diagram of the study population selection
See this image and copyright information in PMC

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