Temporal trends of hospitalizations, comorbidity burden and in-hospital outcomes in patients admitted with asthma in the United States: Population-based study

Abstract

Background Asthma is a prevalent chronic respiratory condition and remains a common cause for hospitalization. However, contemporary data on asthma hospitalization rates, comorbidity burden, and in-hospital outcomes are lacking. Methods Survey-weighted analysis of hospitalization records with a primary diagnosis of asthma using data from the US National (Nationwide) Inpatient Sample between 2004 and 2017. Outcomes were number of hospitalizations per 100,000 population and in-hospital outcomes including receipt of ventilation, length of stay, and hospital costs. Patient and admission characteristics and comorbidity burden were examined over time. Multivariable logistic and linear regression models were fitted for over-time risks of the outcomes. Results Among 3,098,863 asthma admissions between 2004 and 2017, mean (±SD) age was 29 (±25), 57% females, 36% White, 40% had Medicaid as primary payer. During 2004-2017, asthma hospitalizations declined from 89 to 56 per 100,000 population; length of stay remained overall stable; median (interquartile range IQR) inflation-adjusted hospital costs doubled from $8,446 (9,227) in 2004 to $17,756 (19,434) in 2017. Common comorbidities in patients admitted with asthma were hypertension and diabetes in adults, but gastroesophageal reflux disease, obstructive sleep apnoea, anemia, and obesity in children. Over time, the prevalence of mental illness increased by >50%. Severe asthma (IRR, 2.48; 95%CI: 2.27-2.72) and psychoses (IRR, 1.10; 1.05-1.14) were predictors of prolonged hospitalization. Asian/Pacific Islanders were more likely to receive ventilation (OR: 2.35; 1.73-3.20) than White patients. Hospital costs were significantly higher in females and adults with hypertension (coefficient, 1405.2; 283.1-2527.4) or psychoses (coefficient, 1978.4; 674.9- 3282.0). Conclusions US asthma hospitalization rates fluctuated in earlier years but declined over time, which may reflect improvements in community care and declining asthma prevalence. Comorbidity burden, including mental illness, increased over time and is associated with in-hospital outcomes. This highlights the changing landscape of asthma admissions which may inform redesigning services to support pre-hospitalization asthma care and help further reduce admissions, particularly among patients with multimorbidity.