COVID-19 Increased Asthma-Related Hospitalizations Among African American Children

By Alexa Josaphouitch, /alert Contributor

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During COVID-19, there was a reduced rate of hospitalization and emergency department visits for pediatric asthma patients, except for African American children. The results are associated with a significant increase in telehealth visits and reductions in influenza, according to a new study published in Annals of Allergy, Asthma, & Immunology.

“It was anticipated that asthmatic patients would experience increased asthma-associated morbidity due to the respiratory virus SARS-CoV-2 infection, based on experience with other respiratory viral infections,” Olga L Guijon, M.D., Children’s Hospital Orange County, and her colleagues wrote. “Unexpectedly, children with asthma have not contracted SARS-CoV-2 at higher rates than non-asthmatic children, nor have asthmatic children experienced more asthma exacerbations during the current pandemic, even in those who have been presumptively infected with SARS-CoV- 2.”

The retrospective study focused on pediatric asthma patients treated in the Children’s Hospital of Orange County, California network from 2017-2020. Monthly asthma-related encounters and medication summaries were extracted from electronic health records. Changes in outcomes from January-March to April-June were compared to historical data using GEE analyses for patient outcomes and GLM for pollution exceedance, influenza positive, and telehealth visit rates.

A total of 18,912 pediatric asthma patients were treated in the hospital from 2017-2020. Approximately 49.7% were Hispanic and the average age was 9.6 years. The majority were male and 66.3% were on public health insurance. Over two-thirds of patients were diagnosed with asthma prior to 2017.

During the COVID-19 shutdown (April-June of 2020), there was a 78% decrease in the hospitalization rate, a 90% decrease in emergency department visit rate, and a 68% decrease in OCS use rate per 1,000 patients per month. This is compared to January-March of the same year. There were significant reductions in albuterol and ICS usage as well.

The reduced emergency department visit rates were observed across all demographic characteristics with exception of African Americans.

The rates of asthma-associated morbidity were lower in April-June compared to January-March in prior years, but not to the same extent observed in 2020. Comparing April-June to January-March across years 2017-19 prior to COVID-19, the hospitalization rate decreased from 56% to 22%, emergency department visit rate 42% to 26%, and OCS use 36% to 25%.

Telehealth visits were initiated in March 2020, increased dramatically in April, and remained well above the initial rate in May and June. There were greater rates of telehealth visits in the publicly insured group compared to commercially insured. 

The rate of influenza per 1,000 pediatric and adult patients decreased 77% from January-March to April-June in 2020. This reduction was significantly greater than the 49% reduction comparing rates in the concurrent monthly periods during years prior to COVID-19.


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