405 - Rising Burden Of Morbid Obesity And Its Adverse Impact On Hospital Outcomes In Children With Asthma.

Poster Number: 405
Publication Number: 405.146

Jasmine Khatana, Metro Health Medical Center, Cleveland, OH, United States; Aravind Thavamani, UH Rainbow babies and Children's Hospital, Cleveland, OH, United States; Krishna Kishore Umapathi, West Virginia University, Charleston, WV, United States; Aparna Roy, The Metrohealth System, Cleveland, OH, United States; Senthilkumar Sankararaman, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States

Background: Obesity, being a proinflammatory state is closely associated with metabolic and inflammatory dysregulation in asthmatic patients. Use of steroids and activity limitation in poorly controlled asthma with sedentary lifestyle predisposes to the development of obesity, further highlights the bidirectional relationship.

Objective: To evaluate the impact of morbid obesity on hospital outcomes in pediatric asthma hospitalizations.

Design/Methods:

We analyzed Healthcare cost and utilization project (HCUP) – National Inpatient Sample and Kids Inpatient Database to include all pediatric hospitalization of children between 6 and 20 years of age, with a primary diagnosis of asthma. We analyzed over a 14 year period from 2003 to 2016. Using International Classification of diseases (ICD) codes the cohort was divided into two groups with and without a concomitant diagnosis of morbid obesity. Primary outcome variables were inhospital mortality and need for mechanical ventilation. Secondary outcome variables were length of hospital stay and total hospitalization charges to compare health care resource utilizations between the groups.

Results:

We analyzed a total of 761,762 pediatric hospitalizations during the 14-year study period. The overall prevalence rate of morbid obesity was 1.2% (8,926).  The overall prevalence of morbid obesity among asthma hospitalizations more than doubled from 0.9% in 2003 to 2% in 2016. Asthmatic patients with morbid obesity were significantly older (14.5 vs 10.5 years), more often females, P< 0.001.  Compared to the control group, morbid obesity group have increased proportion of African-American ethnicity and majority had public insurance.  Morbid obesity group also had increased comorbidities including type 2 diabetes, metabolic syndrome and dyslipidemia  Although the overall mortality rate was only 0.05%, multivariate regression analysis showed that morbid obesity was associated with 2.5 times increased odds of in-hospital mortality (95% CI: 1.5 to 4.04, P=0.001). Further morbid obesity was associated with 1.6 times increased need for mechanical ventilation (95% CI: 1.45 to 1.74, P< 0.001). Linear regression analyses demonstrated that morbid obesity independently contributed to additional 0.37 days of hospital stay (95% CI: 0.33 to 0.42, P< 0.001) and 12,138 USD (95% CI: 11,986 to 12,291, P< 0.001) in hospitalization charges.

Conclusion(s):

Prevalence of morbid obesity is increasing among pediatric asthma hospitalization and was associated with poor hospital outcomes, contributing to increased mortality risk, need for mechanical ventilation and higher health care utilization.