Modelling and predicting low count child asthma hospital readmissions using General Additive Models

Abstract

Background: Daily paediatric asthma readmissions within 28 days are a good example of a low count time series and not easily amenable to common time series methods used in studies of asthma seasonality and time trends. We sought to model and predict daily trends of childhood asthma readmissions over time in Victoria, Australia. Methods: We used a database of 75,000 childhood asthma admissions from the Department of Health, Victoria, Australia in 1997-2009. Daily admissions over time were modeled using a semi parametric Generalized Additive Model (GAM) and by sex and age group. Predictions were also estimated by using these models. Results: N = 2401 asthma readmissions within 28 days occurred during study period. Of these, n = 1358 (57%) were boys. Overall, seasonal peaks occurred in winter (30.5%) followed by autumn (28.6%) and then spring (24.6%) (p < 0.0005). Day of the week and month were significantly associated with trends in readmission. Smooth function of time was significant (p < 0.0005) and indicated declining trends in readmissions in 2001-2002 and then increasing, returning to roughly initial levels. Predictions suggested readmissions would continue to increase by 5% per year with boys in the 2 to 5 years age group experiencing the largest increase. Conclusions: GAMs are reliable methods for low count time series such as repeat admissions. Our model implied: health services may need to be revised to accommodate for seasonal peaks in readmission especially for younger age groups.

Do human rhinovirus infections and food allergy modify grass pollen–induced asthma hospital admissions in children?

“…1 Although the role of outdoor aeroallergens as triggers for asthma exacerbations requiring hospitalization in children and adolescents is complex, there is evidence that increasing concentrations of grass pollen are associated with an increased risk of asthma exacerbations in children. 2 Human rhinovirus (HRV) infections are implicated in most of the serious asthma exacerbations in school-age children.…”

Risk factors associated with 30‐day all‐cause unplanned hospital readmissions at a tertiary children's hospital in Western Australia

“…In Western Australia (WA), the prevalence of 28‐day all‐cause readmissions to the same hospital across all metropolitan public health services has increased from 2.1% (2010–2011) to 3.9% (2014–2015) . Studies conducted in Australia examining risk factors associated with paediatric readmissions have focused on specific health conditions, such as asthma and mental health conditions . This study aimed to identify risk factors associated with 30‐day all‐cause unplanned hospital readmission based on an electronic administrative dataset at a tertiary children's hospital in Western Australia.…”

Differences in grass pollen allergen exposure across Australia

“…Overseas experience and limited experience in Melbourne strongly suggests that patients with allergic rhinitis and allergic asthma feel a sense of empowerment and control over their symptoms when they have access to actual and forecast pollen levels, which may result in greater compliance with preventative medication use and long-term prevention of pollen allergen-induced emergency department visits and hospital admissions for respiratory disease. 36 …”