P3B210: Association Between High Weight for Age Percentile and Pediatric Asthma Morbidity in an Urban, Under-resourced Population

Background: The associations between weight and pediatric asthma (prevalence and severity) remain unclear. Both have been suggested as risk factors for the other, and weight may serve as a surrogate for other variables including obesity-related co-morbidities, exercise intolerance, social determinants of health, and unique immunologic pathophysiology. The purpose of this study was to examine the association between weight and unscheduled asthma-related healthcare utilization [emergency department (ED) visits, hospitalizations, and pediatric intensive care unit (PICU) admissions] in a large population of urban, under-resourced children with asthma.

Methods: We conducted a retrospective, cross-sectional, population-based study of patients drawn from the District of Columbia’s Pediatric Asthma Registry for the period 3/1/2018 to 3/1/2020. Children were included if they were 5-17 years old and resided in one of three contiguous under-resourced zip codes (20019, 20020, 20032) in southeast DC. We used binary logistic regression to examine the associations between weight for age percentile (WAP) and asthma-related morbidity. Covariates included age (5-11 years of age vs. 12-17 years of age) and insurance type (public/none vs. private).

Results: Of 8224 patients within the Registry who met inclusion criteria, 7018 (85.3%) patients had an available WAP. Their mean age was 10.1 years (SD=3.3), and 57.4% were male (Table 1). Large majorities were Black and used public insurance. A total of 25.2% had a 95th WAP while 17.9% were in the 85th-95th percentile. Compared to patients in the 5th-85th percentile, patients in the 85th-95th and ≥95th weight for age percentiles did not have different adjusted odds of ≥1 ED visits or hospitalizations (Table 2), but they had significantly lower adjusted odds of PICU admissions [adjOR=0.22 (95% CI: 0.09, 0.68) and adjOR=0.27 (95% CI: 0.1, 0.68), respectively]. Compared to patients with private insurance, those with public insurance or self-pay had significantly higher adjusted odds of having ≥1 ED visits but did not have different odds of hospitalizations or PICU admissions. Older patients had significantly lower adjusted odds of ED visits, hospitalizations, and PICU admission.

Conclusion: In an urban, minority, and under-resourced population of children and adolescents with asthma, a higher WAP was associated with significantly lower adjusted odds of PICU admissions but no difference in odds of ED visits or hospitalizations. This result suggests that obese pediatric patients with asthma may suffer less extreme asthma morbidity than their leaner peers. The cause of this association merits further investigation.