Cotinine in Children Admitted for Asthma and Readmission

Howrylak, Judie A.; Spanier, Adam J.; Huang, Bin; Peake, Roy W A; Kellogg, Mark D.; Sauers, Hadley; Kahn, Robert S.

doi:10.1542/peds.2013-2422

Cited by 73 publications

(66 citation statements)

References 34 publications

(17 reference statements)

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“…Reported income was collected as a categorical variable, ranging from less than $15,000 to $90,000 or more per year. Cotinine levels were collected via salivary sampling during the admission and defined as above or below the level of detection (34). ECAT was estimated with a land-use regression model using the home address at the time of admission (32,33).…”

Section: Outcome and Predictorsmentioning

confidence: 99%

Allergen Sensitization Profiles in a Population-Based Cohort of Children Hospitalized for Asthma

Beck¹,

Huang

Kercsmar

et al. 2015

Annals ATS

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Rationale: Allergen sensitization is associated with asthma morbidity. A better understanding of allergen sensitization patterns among children hospitalized for asthma could help clinicians tailor care more effectively. To our knowledge, however, sensitization profiles among children hospitalized for asthma are unknown.Objectives: We sought to describe allergen sensitization profiles and the distribution of self-reported in-home exposures among children hospitalized for asthma. We also sought to assess how sensitization profiles varied by sociodemographic and clinical factors.Methods: This population-based cohort study includes data for 478 children, aged 4-16 years, hospitalized for an asthma exacerbation. Predictors included child age, race, sex, insurance status, reported income, salivary cotinine, exposure to traffic-related air pollution, asthma and atopic history, and season of admission. Outcomes included serum IgE specific to Alternaria alternata/A. tenuis, Aspergillus fumigatus, American cockroach, mouse epithelium, dust mite (Dermatophagoides pteronyssinus and farinae), cat dander, and dog dander (deemed sensitive if IgE > 0.35). Self-reported adverse exposures included mold/mildew, water leaks, cockroaches, rodents, and cracks or holes in the walls or ceiling. Presence of carpeting and furry pets was also assessed.Measurements and Main Results: More than 50% of included patients were sensitized to each of Alternaria, Aspergillus, dust mite, cat dander, and dog dander; 28% were sensitized to cockroach and 18% to mouse. Roughly 68% were sensitized to three or more allergens with evidence of clustering. African American children, compared with white children, were more likely to be sensitized to Alternaria, Aspergillus, cockroach, and dust mite (all P , 0.01). White children were more likely to be sensitized to mouse, cat, and dog (all P , 0.01). Lower income was associated with cockroach sensitization whereas higher income was associated with dog and cat sensitization (all P , 0.01). Atopic history was associated with sensitization to three or more allergens (P , 0.01). Although 42% reported exposure to at least one adverse in-home exposure (and 72% to carpet, 51% to furry pets), only weak relationships were seen between reported exposures and sensitizations.Conclusions: Most children admitted to the hospital for asthma exacerbations are sensitized to multiple indoor allergens. Atopy on the inpatient unit serves as a potential target for improvement in chronic asthma management.

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Section: Outcome and Predictorsmentioning

confidence: 99%

Allergen Sensitization Profiles in a Population-Based Cohort of Children Hospitalized for Asthma

Beck¹,

Huang

Kercsmar

et al. 2015

Annals ATS

Self Cite

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“…Details related to GCARS inclusion and exclusion criteria have been previously described. 9,16 Briefly, patients were identified by use of the evidence-based clinical pathway for acute asthma or bronchodilatorresponsive wheezing. Children were excluded if they had significant respiratory or cardiovascular comorbidity, if they lived outside the CCHMC 8-county primary service area, or if they had a non-Englishspeaking caregiver (∼2% of those otherwise eligible for inclusion).…”

Section: Study Design and Populationmentioning

confidence: 99%

“…Investigators at Boston Children's Hospital used validated techniques to measure serum cotinine by using liquid chromatography tandem mass spectrometry. 16 The serum cotinine assays had a limit of detection (LOD) of 0.1 ng/mL. 16 We evaluated this measurement as a dichotomous variable split at the LOD so that children were noted as having detectable or nondetectable exposure.…”

Section: Outcome: Serum Cotininementioning

confidence: 99%

“…[10][11][12] Smoking and passive smoke exposure are both more common among socioeconomically disadvantaged populations 13 and associated with asthma morbidity. [14][15][16] Therefore, they may provide insight into how poverty "gets under the skin" of children with asthma. Evidence suggests that tobacco smoke exposure affects airflow and airway responsiveness in children, leading to poor asthma control and subsequent asthma morbidity.…”

mentioning

confidence: 99%

“…Evidence suggests that tobacco smoke exposure affects airflow and airway responsiveness in children, leading to poor asthma control and subsequent asthma morbidity. [15][16][17][18] Investigators have previously evaluated socioeconomic determinants of child tobacco smoke exposure, but common measures of SES such as income and education are challenging targets for intervention and probably only part of the explanation for the environment that children in poverty experience. 19 Socioeconomic hardships, day-to-day challenges faced by families living in poverty such as difficulties paying bills or finding work, have been proposed as potentially explanatory and alternative models or pathways through which poverty affects health.…”

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confidence: 99%

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Family Hardships and Serum Cotinine in Children With Asthma

et al. 2015

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BACKGROUND AND OBJECTIVE: A better understanding of how poverty-related hardships affect child health could highlight remediable intervention targets. Tobacco smoke exposure may be 1 such consequence of family hardship. Our objective was to explore the relationship between family hardships and tobacco exposure, as measured by serum cotinine, a tobacco metabolite, among children hospitalized for asthma. METHODS:We prospectively enrolled a cohort of 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing. The primary outcome was detectable serum cotinine. We assessed family hardships, including 11 financial and social variables, through a survey of the child's caregiver. We used logistic regression to evaluate associations between family hardship and detectable cotinine. RESULTS:We had complete study data for 675 children; 57% were African American, and 74% were enrolled in Medicaid. In total, 56% of children had detectable cotinine. More than 80% of families reported $1 hardship, and 41% reported $4 hardships. Greater numbers of hardships were associated with greater odds of having detectable cotinine. Compared with children in families with no hardships, those in families with $4 hardships had 3.7-fold (95% confidence interval, 2.0-7.0) greater odds of having detectable serum cotinine in adjusted analyses. Lower parental income and educational attainment were also independently associated with detectable serum cotinine.

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Explaining Racial Disparities in Child Asthma Readmission Using a Causal Inference Approach

et al. 2016

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IMPORTANCE Childhood asthma is characterized by disparities in the experience of morbidity, including the risk for readmission to the hospital after an initial hospitalization. African American children have been shown to have more than 2 times the hazard of readmission when compared with their white counterparts.OBJECTIVE To explain why African American children are at greater risk for asthma-related readmissions than white children. DESIGN, SETTING, AND PARTICIPANTSThis study was completed as part of the Greater Cincinnati Asthma Risks Study, a population-based, prospective, observational cohort. From August 2010 to October 2011, it enrolled 695 children, aged 1 to 16 years, admitted for asthma or wheezing who identified as African American (n = 441) or white (n = 254) in an inpatient setting of an urban, tertiary care children's hospital. MAIN OUTCOMES AND MEASURESThe main outcome was time to asthma-related readmission and race was the predictor. Biologic, environmental, disease management, access, and socioeconomic hardship variables were measured; their roles in understanding racial readmission disparities were conceptualized using a directed acyclic graphic. Inverse probability of treatment weighting balanced African American and white children with respect to key measured variables. Racial differences in readmission hazard were assessed using weighted Cox proportional hazards regression and Kaplan-Meier curves. RESULTSThe sample was 65% male (n = 450), and the median age was 5.4 years. African American children were 2.26 times more likely to be readmitted than white children (95% CI, 1.56-3.26). African American children significantly differed with respect to nearly every measured biologic, environmental, disease management, access, and socioeconomic hardship variable. Socioeconomic hardship variables explained 53% of the observed disparity (hazard ratio, 1.47; 95% CI, 1.05-2.05). The addition of biologic, environmental, disease management, and access variables resulted in 80% of the readmission disparity being explained. The difference between African American and white children with respect to readmission hazard no longer reached the level of significance (hazard ratio, 1.18; 95% CI, 0.87-1.60; Cox P = .30 and log-rank P = .39). CONCLUSIONS AND RELEVANCEA total of 80% of the observed readmission disparity between African American and white children could be explained after statistically balancing available biologic, environmental, disease management, access to care, and socioeconomic and hardship variables across racial groups. Such a comprehensive, well-framed approach to exposures that are associated with morbidity is critical as we attempt to better understand and lessen persistent child asthma disparities.

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Cotinine in Children Admitted for Asthma and Readmission

Cited by 73 publications

References 34 publications

Allergen Sensitization Profiles in a Population-Based Cohort of Children Hospitalized for Asthma

Allergen Sensitization Profiles in a Population-Based Cohort of Children Hospitalized for Asthma

Family Hardships and Serum Cotinine in Children With Asthma

Explaining Racial Disparities in Child Asthma Readmission Using a Causal Inference Approach

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