Risk of COVID-19 hospital admission among children aged 5–17 years with asthma in Scotland: a national incident cohort study

Shi, T. et al. (2022) Risk of COVID-19 hospital admission among children aged 5–17 years with asthma in Scotland: a national incident cohort study. Lancet Respiratory Medicine, 10(2), pp. 191-198. (doi: 10.1016/S2213-2600(21)00491-4) (PMID:34861180) (PMCID:PMC8631918)

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Abstract

Background: There is an urgent need to inform policy deliberations about whether children with asthma should be vaccinated against SARS-CoV-2 and, if so, which subset of children with asthma should be prioritised. We were asked by the UK’s Joint Commission on Vaccination and Immunisation to undertake an urgent analysis to identify which children with asthma were at increased risk of serious COVID-19 outcomes. Methods: This national incident cohort study was done in all children in Scotland aged 5–17 years who were included in the linked dataset of Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II). We used data from EAVE II to investigate the risk of COVID-19 hospitalisation among children with markers of uncontrolled asthma defined by either previous asthma hospital admission or oral corticosteroid prescription in the previous 2 years. A Cox proportional hazard model was used to derive hazard ratios (HRs) and 95% CIs for the association between asthma and COVID-19 hospital admission, stratified by markers of asthma control (previous asthma hospital admission and number of previous prescriptions for oral corticosteroids within 2 years of the study start date). Analyses were adjusted for age, sex, socioeconomic status, comorbidity, and previous hospital admission. Findings: Between March 1, 2020, and July 27, 2021, 752867 children were included in the EAVE II dataset, 63463 (8·4%) of whom had clinician-diagnosed-and-recorded asthma. Of these, 4339 (6·8%) had RT-PCR confirmed SARS-CoV-2 infection. In those with confirmed infection, 67 (1·5%) were admitted to hospital with COVID-19. Among the 689404 children without asthma, 40231 (5·8%) had confirmed SARS-CoV-2 infections, of whom 382 (0·9%) were admitted to hospital with COVID-19. The rate of COVID-19 hospital admission was higher in children with poorly controlled asthma than in those with well controlled asthma or without asthma. When using previous hospital admission for asthma as the marker of uncontrolled asthma, the adjusted HR was 6·40 (95% CI 3·27–12·53) for those with poorly controlled asthma and 1·36 (1·02–1·80) for those with well controlled asthma, compared with those with no asthma. When using oral corticosteroid prescriptions as the marker of uncontrolled asthma, the adjusted HR was 3·38 (1·84–6·21) for those with three or more prescribed courses of corticosteroids, 3·53 (1·87–6·67) for those with two prescribed courses of corticosteroids, 1·52 (0·90–2·57) for those with one prescribed course of corticosteroids, and 1·34 (0·98–1·82) for those with no prescribed course, compared with those with no asthma. Interpretation: School-aged children with asthma with previous recent hospital admission or two or more courses of oral corticosteroids are at markedly increased risk of COVID-19 hospital admission and should be considered a priority for vaccinations. This would translate into 9124 children across Scotland and an estimated 109448 children across the UK.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Katikireddi, Professor Vittal and Mccowan, Professor Colin
Authors: Shi, T., Pan, J., Katikireddi, S. V., McCowan, C., Kerr, S., Agrawal, U., Shah, S. A., Simpson, C. R., Ritchie, S. L. D., Robertson, C., and Sheikh, A.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:Lancet Respiratory Medicine
Publisher:The Lancet Publishing Group
ISSN:2213-2600
ISSN (Online):2213-2619
Published Online:30 November 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Lancet Respiratory Medicine 10(2): 191-198
Publisher Policy:Reproduced under a Creative Commons licence

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
172690Understanding the impacts of welfare policy on health: A novel data linkage studySrinivasa KatikireddiOffice of the Chief Scientific Adviser (CSO)SCAF/15/02HW - Public Health
3048231Inequalities in healthAlastair LeylandMedical Research Council (MRC)MC_UU_00022/2HW - MRC/CSO Social and Public Health Sciences Unit
3048231Inequalities in healthAlastair LeylandChief Scientist Office (CSO)SPHSU17HW - MRC/CSO Social and Public Health Sciences Unit