TY - JOUR
T1 - Risk of COVID-19 hospital admission among children aged 5–17 years with asthma in Scotland
T2 - a national incident cohort study
AU - Shi, Ting
AU - Pan, Jiafeng
AU - Katikireddi, Srinivasa Vittal
AU - McCowan, Colin
AU - Kerr, Steven
AU - Agrawal, Utkarsh
AU - Shah, Syed Ahmar
AU - Simpson, Colin R
AU - Ritchie, Lewis Duthie
AU - Robertson, Chris
AU - Sheikh, Aziz
AU - Public Health Scotland and the EAVE II Collaborators
N1 - Authors thank the EAVE II Patient Advisory Group for their support. EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE—The Health Data Research Hub for Respiratory Health (MC_PC_19004)—which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. Additional support has been provided through Public Health Scotland and Scottish Government Director-General Health and Social Care and the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research and Innovation. SVK acknowledges funding from an NHS Research Scotland Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17).
PY - 2021/11/30
Y1 - 2021/11/30
N2 - BackgroundThere
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.MethodsThis 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.FindingsBetween
March 1, 2020, and July 27, 2021, 752 867 children were included in the
EAVE II dataset, 63 463 (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
689 404 children without asthma, 40 231 (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.InterpretationSchool-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 109 448 children across the UK.
AB - BackgroundThere
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.MethodsThis 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.FindingsBetween
March 1, 2020, and July 27, 2021, 752 867 children were included in the
EAVE II dataset, 63 463 (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
689 404 children without asthma, 40 231 (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.InterpretationSchool-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 109 448 children across the UK.
KW - COVID-19
U2 - 10.1016/S2213-2600
DO - 10.1016/S2213-2600
M3 - Article
SN - 2213-2600
VL - In press
JO - The Lancet Respiratory Medicine
JF - The Lancet Respiratory Medicine
ER -
