Children's Health & Discovery Initiative, Departments of Pediatrics and
Duke Clinical Research Institute, Duke University, Durham, North Carolina; and.
Pediatrics. 2020 Dec;146(6). doi: 10.1542/peds.2020-1023.
Asthma remains a leading cause of hospitalization in US children. Well-child care (WCC) visits are routinely recommended, but how WCC adherence relates to asthma outcomes is poorly described.
We conducted a retrospective longitudinal cohort study using electronic health records among 5 to 17 year old children residing in Durham County with confirmed asthma and receiving primary care within a single health system, to compare the association between asthma exacerbations and previous WCC exposure. Exacerbations included any , or , coded asthma exacerbation encounter with an accompanying systemic glucocorticoid prescription. Exacerbations were grouped by severity: ambulatory encounter only, urgent care, emergency department, hospital encounters <24 hours, and hospital admissions ≥24 hours. In the primary analysis, we assessed time to asthma exacerbation based on the presence or absence of a WCC visit in the preceding year using a time-varying covariate Cox model.
A total of 5656 children met eligibility criteria and were included in the primary analysis. Patients with the highest WCC visit attendance tended to be younger, had a higher prevalence of private insurance, had greater asthma medication usage, and were less likely to be obese. The presence of a WCC visit in the previous 12 months was associated with a reduced risk of all-cause exacerbations (hazard ratio: 0.90; 95% confidence interval: 0.83-0.98) and severe exacerbations requiring hospital admission (hazard ratio: 0.53; 95% confidence interval: 0.39-0.71).
WCC visits were associated with a lower risk of subsequent severe exacerbations, including asthma-related emergency department visits and hospitalizations. Poor WCC visit adherence predicts pediatric asthma morbidity, especially exacerbations requiring hospitalization.
哮喘仍然是美国儿童住院的主要原因。常规推荐进行儿童保健（WCC）就诊，但 WCC 依从性与哮喘结局的关系描述得很差。
我们使用电子健康记录，对居住在达勒姆县、确诊哮喘且在单一医疗系统内接受初级保健的 5 至 17 岁儿童进行了回顾性纵向队列研究，以比较哮喘加重与之前 WCC 暴露之间的关联。加重包括任何或，编码的哮喘加重就诊，伴有伴随的全身糖皮质激素处方。加重按严重程度分组：仅门诊就诊、紧急护理、急诊、住院时间<24 小时和住院时间≥24 小时。在主要分析中，我们根据前一年是否进行 WCC 就诊，使用时间变化协变量 Cox 模型评估哮喘加重的时间。
共有 5656 名儿童符合入选标准，并纳入主要分析。就诊次数最多的患者往往年龄较小，私人保险比例较高，哮喘药物使用率较高，肥胖的可能性较低。过去 12 个月内进行 WCC 就诊与全因加重的风险降低相关（风险比：0.90；95%置信区间：0.83-0.98）和需要住院治疗的严重加重（风险比：0.53；95%置信区间：0.39-0.71）。
WCC 就诊与随后发生严重加重的风险降低相关，包括与哮喘相关的急诊就诊和住院治疗。较差的 WCC 就诊依从性预示着儿科哮喘发病率增加，特别是需要住院治疗的加重。
