Impact of adolescence and gender on asthma hospitalization: A population‐based birth cohort study

Abstract

Our objective was to determine the impact of gender and age on asthma hospitalization rates among children. We used a population-based retrospective birth cohort study to determine yearly age- and gender-specific asthma hospitalization rates between ages 2-18 years in a cohort of all children born in Washington State between 1980-1985. In addition, we assessed factors associated with the hospitalization of a given child for asthma both before and during adolescence, and factors associated with an initial asthma hospitalization during adolescence. Outcome measures included age- and gender-specific rates of hospitalization for asthma, diabetes, seizures/epilepsy, and nonasthma respiratory diagnoses. Asthma hospitalization rates for boys were significantly higher than for girls between ages 2-12 years, the gender gap in asthma hospitalizations reversed between ages 13-14 years, and rates for girls were significantly higher than boys between 16-18 years of age. The male peak asthma hospitalization rate per 100,000 cohort members occurred at age 4 years (12.7; 95% confidence interval (CI), 11.1-14.3), and the male trough rate occurred at age 18 years (4.1; 95% CI, 2.8-5.4), whereas the female peak asthma hospitalization rate occurred at age 17 years (9.4; 95% CI, 7.8-11) and the female trough rate at age 2 years (5.2; 95% CI, 4.2-6.2). Age-specific hospitalization rates for diabetes mellitus and epilepsy were similar for boys and girls throughout childhood. Female gender was strongly associated with asthma hospitalization occurring in an individual child both prior to and during adolescence (rate ratio (RR), 2.0; 95% CI, 1.4-2.9), and was modestly associated with initial hospitalization in adolescence (RR, 1.15; 95% CI, 1.0-1.3). In conclusion, asthma hospitalization rates for boys and girls exhibit strikingly different patterns during adolescence. Potential explanations for these gender differences include hormonal changes during puberty, or gender-specific differences in environmental exposures such as diet, obesity, allergen exposure, or cigarette smoking.

Demographic and clinical characteristics of children and adolescents with severe or difficult-to-treat asthma

“…18,[35][36][37] Reasons for the gender discrepancy in asthma by age are not entirely clear but have been attributed to hormonal changes during puberty or to gender-specific differences in environmental exposures such as diet, obesity, allergen exposure, or cigarette smoking. 38 Several limitations of the current analysis should be mentioned. Data are cross-sectional and, therefore, provide a description of this cohort at a single point in time.…”

Endocrine disrupters – potential modulators of the immune system and allergic response

“…There is also an evidence that the prevalence of asthma in humans among children is higher in boys than in girls, but after puberty women are at higher risk to develop asthma as compared to men (52,53). Some studies suggest that asthma incidence is significantly higher in postmenopausal women being on hormone replacement therapy (HRT), than in those who never used it (54).…”

Natural Progression of Childhood Asthma Symptoms and Strong Influence of Sex and Puberty

“…Asthma is known to affect males more in childhood and females more in adulthood (1)(2)(3). Studies supporting this observation have focused on four epidemiologic aspects of the disease: (1) cross-sectional prevalence (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17), (2) onset (18)(19)(20), (3) remission and relapse (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31), and (4) healthcare use (32)(33)(34)(35)(36)(37)(38)(39)(40).…”