Study of Risk Factors Associated with Fatal Asthma

Autor: Meng-Shui Lu, 盧孟穗
Rok vydání: 2016
Druh dokumentu: 學位論文 ; thesis
Popis: 104
Background: Asthma is a chronic inflammatory respiratory disease characterized by reversible airflow limitation resulting in symptoms of wheeze, short of breath, chest tightness and cough. More than 300 million people suffer from asthma worldwide. According to the National Center for Health Statistics (NCHS) survey, acute asthma attack accounts for about a quarter of emergency visits, and it is also ranked as the third cause of hospitalization among children. Asthma is linked to 3,300 death and the related medical costs are up to 18 billion per year in the United States. While asthma is extremely common, fatal asthma is rare but often preventable if risk factors could be early recognized and addressed. The prevention of asthma mortality could not only reduce economic burden but also improve quality of life. Therefore, assessing patients at risk for future asthma exacerbation is important. Since the long-term observational evidence in Asia regarding assessment of risk factors for fatal asthma is relatively limited, the aim of this study is to identify factors which are related to fatal asthma so that patients with high risks can be identified and be given appropriate intervention. Method: This retrospective nested case-control study utilized claim data of Taiwan National Health Insurance Research Database (NHIRD) from January 1, 2001, through December 31, 2011. The asthma cohort was consisted of patients who have been diagnosed as asthma (ICD-9-CM 493.xx) at least twice at outpatient clinic or once during hospitalization within one year and were prescribed asthma controllers after the date of first diagnosis between January 1, 2001 and December 31, 2010. In asthma cohort, individuals who had fatal exacerbation within study period were identified as case group. These cases were matched with randomly selected controls on a 1:4 ratio by sex, age (±2) and entry year. Patient characteristics, health service use, comorbidities, asthma medications, short-acting beta2-agonist (SABA) and oral corticosteroid (OCS) dosage were included in the multivariable model to estimate adjusted odds ratio (OR) and 95% confidence intervals (CI) of each variable on asthma mortality. Results: A total of 18,503 patients were enrolled in the asthma cohort within study periods. Two hundred and sixty seven eligible cases and 1,035 matched controls were analyzed in this study. Female was more than male in the case group (51.3% vs. 48.7%). The median (SD) age was 77 (12.22) in case group and 77 (11.83) in control group (p=0.9830). The distribution of patient characteristics, health service use, comorbidities, asthmatic prescriptions and adherence to controller among case and control group was significantly different. Compared to matched controls, the risk of fatal asthma was 4.83-fold increased (OR 4.83, 95%CI: 3.00-7.77, p
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