Harvard T.H. Chan School of Public Health, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass.
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass.
J Allergy Clin Immunol Pract. 2018 Nov-Dec;6(6):1936-1941.e4. doi: 10.1016/j.jaip.2018.02.001. Epub 2018 Feb 14.
Although studies have demonstrated relations between obesity and incident asthma, little is known about the association of obesity with acute severity in adults hospitalized for asthma exacerbation.
To investigate the association of obesity with acute severity of asthma exacerbation.
This is a retrospective cohort study using population-based data of 8 geographically diverse US states from 2010 through 2013. We included adults (age 18-54 years) hospitalized for asthma exacerbation. The outcome measures were markers of acute severity-use of mechanical ventilation (defined by noninvasive positive pressure ventilation and/or invasive mechanical ventilation) and hospital length of stay. To determine the association of obesity with each outcome, we fit multivariable models adjusting for patient-level confounders (eg, age, sex, race/ethnicity, primary insurance, quartiles for household income, residential status, and comorbidities) and potential patient clustering within hospitals.
Among the 72,086 patients hospitalized for asthma exacerbation, 24% were obese. Obesity was associated with a significantly higher risk of any mechanical ventilation use (8.3% vs 5.0%; adjusted odds ratio [OR], 1.77; 95% CI, 1.63-1.92; P < .001) driven by the higher risk of noninvasive positive pressure ventilation use (7.2% vs 3.4%; adjusted OR, 2.14; 95% CI, 1.96-2.35; P < .001). Likewise, obese patients were more likely to have a hospital length of stay of 3 or more days compared with nonobese patients (59.4% vs 46.5%; adjusted OR, 1.37; 95% CI, 1.32-1.43; P < .001). These findings were consistent with stratifications by age, sex, and race/ethnicity.
In this population-based study of adults hospitalized for asthma exacerbation, obesity was associated with higher acute severity.
尽管已有研究表明肥胖与哮喘发病之间存在关联，但对于肥胖与成人哮喘加重住院患者急性严重程度之间的关系知之甚少。
探讨肥胖与哮喘加重急性严重程度的关系。
这是一项使用 2010 年至 2013 年美国 8 个地理位置不同的州的基于人群的数据进行的回顾性队列研究。我们纳入了因哮喘加重而住院的成年人（年龄 18-54 岁）。主要结局指标是急性严重程度的标志物——使用机械通气（定义为无创正压通气和/或有创机械通气）和住院时间。为了确定肥胖与每种结局的关系，我们使用多变量模型进行拟合，该模型调整了患者水平的混杂因素（例如，年龄、性别、种族/民族、主要保险、家庭收入四分位数、居住状况和合并症）和医院内潜在的患者聚类。
在因哮喘加重而住院的 72086 名患者中，有 24%为肥胖患者。肥胖与任何机械通气使用的风险显著增加相关（8.3%比 5.0%；调整后的优势比[OR]，1.77；95%置信区间[CI]，1.63-1.92；P<0.001），这主要是由于无创正压通气使用的风险增加（7.2%比 3.4%；调整后的 OR，2.14；95% CI，1.96-2.35；P<0.001）。同样，肥胖患者的住院时间为 3 天或以上的可能性也高于非肥胖患者（59.4%比 46.5%；调整后的 OR，1.37；95% CI，1.32-1.43；P<0.001）。这些发现与年龄、性别和种族/民族的分层结果一致。
在这项针对因哮喘加重而住院的成年人的基于人群的研究中，肥胖与更高的急性严重程度相关。
