Factors associated with exacerbations among adults with asthma according to electronic health record data

Abstract

BackgroundAsthma is a chronic inflammatory lung disease that affects 18.7 million U.S. adults. Electronic health records (EHRs) are a unique source of information that can be leveraged to understand factors associated with asthma in real-life populations. In this study, we identify demographic factors and comorbidities associated with asthma exacerbations among adults according to EHR-derived data and compare these findings to those of epidemiological studies.MethodsWe obtained University of Pennsylvania Hospital System EHR-derived data for asthma encounters occurring between 2011 and 2014. Regression analyses were performed to model asthma exacerbation frequency as explained by age, sex, race/ethnicity, health insurance type, smoking status, body mass index (BMI) and various comorbidities. We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2012 to compare findings with those from the EHR-derived data.ResultsBased on data from 9068 adult patients with asthma, 33.37% had at least one exacerbation over the four-year study period. In a proportional odds logistic regression predicting number of exacerbations during the study period (levels: 0, 1–2, 3–4, 5+ exacerbations), after controlling for age, race/ethnicity, sex, health insurance type, and smoking status, the highest odds ratios (ORs) of significantly associated factors were: chronic bronchitis (2.70), sinusitis (1.50), emphysema (1.39), fluid and electrolyte disorders (1.35), class 3 obesity (1.32), and diabetes (1.28). An analysis of NHANES data showed associations for class 3 obesity, anemia and chronic bronchitis with exacerbation frequency in an adjusted model controlling for age, race/ethnicity, sex, financial class and smoking status.ConclusionsEHR-derived data is helpful to understand exacerbations in real-life asthma patients, facilitating design of detailed studies and interventions tailored for specific populations.Electronic supplementary materialThe online version of this article (10.1186/s40733-019-0048-y) contains supplementary material, which is available to authorized users.

Early readmission and its predictors among patients treated for acute exacerbations of chronic obstructive respiratory disease in Ethiopia: A prospective cohort study

“…In this study, one hundred sixteen (89.23%) patients were adherent (efficient) to inhalation technique. This adherence rate is relatively better than the study conducted by Kebede et al, 87 (62.14%) [28]. In a study conducted in Turkey, nearly 23% of the patients had suboptimal adherence to inhalation technique [43].…”

“…The data collection tool was developed based on previous similar studies [11,14,16,[26][27][28][29][30] and active patient follow-up chart. Data were collected both from active patient follow-up chart and patient interview.…”

“…The overall median time to 30-day readmission was 20 days (IQR, [16][17][18][19][20][21][22][23][24][25][26][27][28][29]. The median time to 30-day readmission for AECOPD was 20 days (IQR, 15-29), while 21.5days (IQR.…”

“…It was 59.9 per 100,000 person-year, 95% CI, [35.9-158.3), and 189.9 per100, 000 person-year, 95% CI [112.5-320.8] for AE of COPD and Asthma, respectively. The overall median survival time to 30-day readmission was 20 days (IQR, [16][17][18][19][20][21][22][23][24][25][26][27][28][29]. The median survival time to 30-day readmission for AECOPD was 20 days (IQR, [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29], and that of AE of asthma was 21.5 days (IQR.…”

“…The overall median survival time to 30-day readmission was 20 days (IQR, [16][17][18][19][20][21][22][23][24][25][26][27][28][29]. The median survival time to 30-day readmission for AECOPD was 20 days (IQR, [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29], and that of AE of asthma was 21.5 days (IQR. [16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”