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A Population-Based Asthma Birth Cohort Study

Teresa To, PhD; Andrea Gershon, MD, MSc; Chengning Wang, MD, MSc; Sharon Dell, MD; Lisa Cicutto, PhD

Arch Pediatr Adolesc Med. 2007;161(12):1197-1204.

Objectives  To examine and predict the persistence of childhood asthma.

Design  Longitudinal population-based cohort study.

Setting  Ontario, Canada.

Participants  Children born in 1994 and diagnosed with asthma before age 6 years were followed up until age 11 years. Diagnosis of asthma was defined as 1 asthma hospitalization or 2 asthma physician claims within 3 years prior to age 6 years.

Main Exposure  Intensity of health services use within 1 year postdiagnosis.

Main Outcome Measures  Those who continued to have asthma events (hospitalization and/or physician visit) between ages 6 and 11 years were considered to have "persistent asthma," while others were in "remission." Cumulative rates of health services use for asthma during follow-up were calculated. Logistic regression analysis was used to estimate risks of persistent asthma.

Results  The study included 34 216 children diagnosed with asthma before age 6 years. More than half (54.4%) experienced a second asthma health care encounter within 1 year after diagnosis. By age 12 years, nearly half (48.6%) were in remission. Children with asthma hospitalization during the first year postdiagnosis had a 3-fold risk of persistent asthma by age 12 years (95% confidence interval, 2.69-3.39; P < .001). Those with at least 4 physician visits also had a 2.6-fold risk of persistent asthma during follow-up (95% confidence interval, 2.34-2.81; P < .001).

Conclusion  The concentration of health services use within 1 year following the initial diagnosis of childhood asthma points to the need for attentive follow-up and ongoing management and education strategies in the early years.

Author Affiliations: Child Health Evaluative Sciences, Research Institute (Drs To, Gershon, Wang, and Dell), Respiratory Medicine (Drs To and Dell), The Hospital for Sick Children, The Institute for Clinical Evaluative Sciences (Drs To and Gershon), and Faculty of Nursing (Dr Cicutto) and Department of Public Health Sciences (Dr To), University of Toronto, Toronto, Ontario, Canada.

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