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Hussain T, van den Berg S, Ziesemer KA, Markhorst DG, Vijverberg SJH, Kapitein B. The influence of disparities on intensive care outcomes in children with respiratory diseases: A systematic review. Pediatr Pulmonol 2023. [PMID: 37560882 DOI: 10.1002/ppul.26629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023]
Abstract
CONTEXT The negative effects of socioeconomic, environmental and ethnic inequalities on childhood respiratory diseases are known in the development of persistent asthma and can result in adverse outcomes. However, little is known about the effects of these disparities on pediatric intensive care unit (PICU) outcomes in respiratory diseases. OBJECTIVE The purpose of this systematic review is to evaluate the literature on disparities in socioeconomic, environmental and ethnic determinants and PICU outcomes. We hypothesize that these disparities negatively influence the outcomes of children's respiratory diseases at the PICU. METHODS A literature search (in PubMed, Embase.com and Web of Science Core Collection) was performed up to September 30, 2022. Two authors extracted the data and independently evaluated the risk of bias with appropriate assessment methods. Articles were included if the patients were below 18 years of age (excluding neonatal intensive care unit admissions), they concerned respiratory diseases and incorporated socioeconomic, ethnic or environmental disparities. RESULTS Eight thousand seven hundred fourty-six references were reviewed, and 15 articles were included; seven articles on the effect of socioeconomic status, five articles on ethnicity, one on the effect of sex and lastly two on environmental factors. All articles but one showed an unfavorable outcome at the PICU. CONCLUSION Disparities in socioeconomic (such as a low-income household, public health insurance), ethnic and environmental factors (such as exposure to tobacco smoke and diet) have been assessed as risk factors for the severity of children's respiratory diseases and can negatively influence the outcomes of these children admitted and treated at the PICU.
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Affiliation(s)
- Tahira Hussain
- Pediatric intensive care unit, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sarah van den Berg
- Pediatric intensive care unit, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Kirsten A Ziesemer
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dick G Markhorst
- Pediatric intensive care unit, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Susanne J H Vijverberg
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Berber Kapitein
- Pediatric intensive care unit, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
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Boeschoten SA, Boehmer AL, Merkus PJ, van Rosmalen J, de Jongste JC, Fraaij PLA, Molenkamp R, Heisterkamp SG, van Woensel JB, Kapitein B, Haarman EG, Wösten-van Asperen RM, Kneyber MC, Lemson J, Hartman S, van Waardenburg DA, Bunker-Wiersma HE, Brouwer CN, van Ewijk BE, Landstra AM, Verwaal M, Vaessen-Verberne AA, Hammer S, Buysse CM, de Hoog M. Risk factors for intensive care admission in children with severe acute asthma in the Netherlands: a prospective multicentre study. ERJ Open Res 2020; 6:00126-2020. [PMID: 32832524 PMCID: PMC7430140 DOI: 10.1183/23120541.00126-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/06/2020] [Indexed: 01/08/2023] Open
Abstract
Rationale Severe acute asthma (SAA) can be fatal, but is often preventable. We previously observed in a retrospective cohort study, a three-fold increase in SAA paediatric intensive care (PICU) admissions between 2003 and 2013 in the Netherlands, with a significant increase during those years of numbers of children without treatment of inhaled corticosteroids (ICS). Objectives To determine whether steroid-naïve children are at higher risk of PICU admission among those hospitalised for SAA. Furthermore, we included the secondary risk factors tobacco smoke exposure, allergic sensitisation, previous admissions and viral infections. Methods A prospective, nationwide multicentre study of children with SAA (2–18 years) admitted to all Dutch PICUs and four general wards between 2016 and 2018. Potential risk factors for PICU admission were assessed using logistic regression analyses. Measurements and main results 110 PICU and 111 general ward patients were included. The proportion of steroid-naïve children did not differ significantly between PICU and ward patients. PICU children were significantly older and more exposed to tobacco smoke, with symptoms >1 week prior to admission. Viral susceptibility was not a significant risk factor for PICU admission. Conclusions Children with SAA admitted to a PICU were comparable to those admitted to a general ward with respect to ICS treatment prior to admission. Preventable risk factors for PICU admission were >7 days of symptoms without adjustment of therapy and exposure to tobacco smoke. Physicians who treat children with asthma must be aware of these risk factors. Preventable risk factors for PICU admission among those with severe acute asthma are >7 days of symptoms without adjustment of therapy and environmental exposure to tobacco smoke, underlining the importance of smoking cessation of caregivershttps://bit.ly/3ezPzxT
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Affiliation(s)
- Shelley A Boeschoten
- Intensive Care and Dept of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Annemie L Boehmer
- Dept of Paediatrics, Maasstad Hospital, Rotterdam, The Netherlands.,Dept of Paediatrics, Spaarne Hospital, Haarlem, The Netherlands
| | - Peter J Merkus
- Division of Respiratory Medicine, Dept of Paediatrics, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Joost van Rosmalen
- Dept of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Dept of Paediatric Pulmonology and Allergology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Pieter L A Fraaij
- Dept of Paediatrics, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands.,ViroScience, Erasmus Medical Centre, Rotterdam, Netherlands
| | | | - Sabien G Heisterkamp
- Paediatric Intensive Care Unit, Amsterdam University Medical Centers - Emma's Children's Hospital, Amsterdam, The Netherlands
| | - Job B van Woensel
- Paediatric Intensive Care Unit, Amsterdam University Medical Centers - Emma's Children's Hospital, Amsterdam, The Netherlands
| | - Berber Kapitein
- Paediatric Intensive Care Unit, Amsterdam University Medical Centers - Emma's Children's Hospital, Amsterdam, The Netherlands
| | - Eric G Haarman
- Dept of Paediatrics, Amsterdam University Medical Centers - Emma's Children's Hospital, Amsterdam, The Netherlands
| | - Roelie M Wösten-van Asperen
- Paediatric Intensive Care Unit, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin C Kneyber
- Paediatric Intensive Care Unit, Beatrix Children's Hospital/University Medical Center Groningen, Groningen, The Netherlands
| | - Joris Lemson
- Paediatric Intensive Care Unit, University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Stan Hartman
- Paediatric Intensive Care Unit, University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Dick A van Waardenburg
- Paediatric Intensive Care Unit, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Carole N Brouwer
- Paediatric Intensive Care Unit, Leiden University Medical Center, Leiden, The Netherlands
| | - Bart E van Ewijk
- Dept of Paediatrics, Tergooi Hospital, Blaricum, The Netherlands
| | | | - Mariel Verwaal
- Dept of Paediatrics, Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Sanne Hammer
- Dept of Paediatrics, Amphia Hospital, Breda, The Netherlands
| | - Corinne M Buysse
- Intensive Care and Dept of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Matthijs de Hoog
- Intensive Care and Dept of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
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Abstract
OBJECTIVES To compare the time to asthma-related readmissions between children with a previous ICU hospitalization for asthma and those with a non-ICU hospitalization and to explore predictors of time to readmission in children admitted to the ICU. DESIGN Retrospective cohort study using a pan-Canadian administrative inpatient database from April 1, 2008, to March 31, 2014. SETTING All adult and pediatric Canadian hospitals. SUBJECTS Children 2-17 years old with a hospitalization for asthma. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 26,168 children were hospitalized 33,304 times during the study period. The time to readmission was shorter in the ICU group compared with the non-ICU group (median time to readmission 27 mo in ICU vs 35 mo in non-ICU group). Preschool-aged children (hazard ratio, 1.48; 95% CI, 1.02-2.14) and increased length of stay (hazard ratio, 1.63; 95% CI, 1.17-2.27) were associated with a shorter time to readmission. CONCLUSIONS Children previously admitted to the ICU for asthma had a shorter time to asthma-related readmission, compared with children who did not require intensive care, underlining the importance of targeted long-term postdischarge follow-up of these children. Children of preschool age and who have a lengthier hospital stay are particularly at risk for future morbidity.
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Matsui EC. Environmental exposures and asthma morbidity in children living in urban neighborhoods. Allergy 2014; 69:553-8. [PMID: 24697316 DOI: 10.1111/all.12361] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2013] [Indexed: 12/15/2022]
Abstract
A substantial disparity in asthma prevalence and morbidity among urban children compared with their nonurban counterparts has been recognized for more than two decades. Because of the nature of urban neighborhoods, pest allergens, such as cockroach and mouse, are present in high concentrations in US urban housing and have both repeatedly been linked to asthma morbidity in sensitized children. In addition, there is a growing body of evidence demonstrating that concentrations of many pollutants are higher indoors than outdoors in both US and European urban communities and that exposures to indoor pollutants such as particulate matter (PM) and nitrogen dioxide (NO2 ) are independently associated with symptoms in children with asthma. Although environmental interventions are challenging to implement, when they reduce relevant indoor allergen and pollutant exposures, they are associated with clear improvements in asthma. Other modifiable risk factors in urban childhood asthma that have emerged include dietary and nutritional factors. Overweight and obese children, for example, may be more susceptible to the pulmonary effects of pollutant exposure. Insufficiency of vitamin D and folate has also emerged as modifiable risk factors for asthma morbidity in children. The identification of these modifiable risk factors for urban childhood asthma morbidity offers a ripe opportunity for intervention.
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Affiliation(s)
- E. C. Matsui
- Division of Pediatric Allergy and Immunology; Johns Hopkins University School of Medicine; Baltimore MD USA
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