A Retrospective Study of the Association of Obesity and Overweight with Admission Rate within York Hospital

Emergency Department for Acute Asthma Exacerbations

Corrie BluettDepartment of Biological Sciences, York College of Pennsylvania

Introduction•Obesity and asthma greatly impact healthcare costs and are growing concerns among physicians.

•Asthma is considered one of the most common chronic diseases, affecting 4-8% of children, and contributes to increased hospital visitation and admission (Carroll, 2007)

•Some already known risk factors:•Frequent respiratory infections•Smoking•Allergies

•Importance- Asthma severity dictates the physician’s emergency treatment protocol and management of acute asthma exacerbation.

•Prior studies examined asthma severity and obesity in the adult population and determined there to be a correlation. Obese adults suffering with asthma have an increased rate of hospital admission (Hom et al. 2009).

•It is unknown whether a relationship exists between being overweight and hospital admission rates in children presenting in the Emergency Department with acute asthma exacerbations.

Objectives•To determine whether being overweight is a risk factor that increases the admission rate of acute asthma exacerbation patients.

•Examine whether York Hospital’s population of overweight early adolescent patients presenting to the ED with acute asthma exacerbation have a higher admission rate over non-overweight patients presenting similarly.

HypothesesH1: There is a difference in the admission rate of obese patients and non-obese patients.

H2:Overweight and obesity leads to additional risks for admission in patients with acute asthma exacerbations.

H3: There is no difference in obesity rate in regards to sex of asthma patients.

Methods

•Data was extracted using Cerner Database•Chart reviews included:

•Sex•Age•Weight•Height•Final Disposition

Literature Cited

•Carroll, C. et. al. 2006. Childhood obesity increase hospital admission for asthma. Chest 130(4): 136S-142S.

•Hom, J., Morley, E.J., Sasso, P., & Sinert, R. 2009. Body mass index and pediatric asthma outcomes. Pediatric Emergency Care 25: 569-571

Results (cont’d) Discussion•There was a lack of sufficient data available to calculate the BMI for all the asthma patients presenting to the ED.

•The number of overweight/obese and non-overweight males and females presenting in the ED with asthma was not significantly different.

•The admission rates in the York Hospital ED for primary diagnosis of asthma fell into the average range of 3-14% in hospitals worldwide (with exception of those with a BMI<25).

•The admission rates were significantly different when comparing the non-overweight with the obese(p-value=0.0276), non-obese with the obese(p-value=0.0439), and non-overweight & non-obese to the overweight(p-value=0.0461).

Future Research

•Increase the number of study sites to enhance sample size, include an urban catchment area, and enroll patients that represent more of general population.

•Advance to a prospective study to increase the number of patients with sufficient data.

AcknowledgmentsA special thanks to Dr. David Vega M.D. and Dr. Bradley

Rehnberg for all their help and guidance. Also to York Hospital for allowing me to perform my research.

Entire Patient Population

Presenting to ED between 2007-

2010

Patients Presenting in ED

with Asthma

Exclude Patients with an Age(x)

x<9,x>15

Exclude Patients with Insufficient

Data or 2° Diagnosis of

Asthma

Separate into 3 Groups-

Non-overweight (BMI<25)

Overweight (BMI 25-30)Obese (BMI>30)

Determine the Number of Males

and Females

Determine the Disposition of Patients in

Each Group

Perform Fischer’s Exact Test

•This retrospective analysis suggests that being overweight and obese may be risk factors for admission for early adolescent patients presenting to the emergency department with acute asthma exacerbations.

•There is a difference in the admission rate of obese patients and non-obese patients.

•There is no difference in the rate of asthmatic males and females with a BMI<25 and a BMI≥25.

Results

Total Admitted n (%) (%) (95%CI)-----------------------------------------------------------Female 64 (52.5) 7.8 (3.0-17.4) Male 58 (47.5) 8.6 (3.3-19.1)Non-overweight 50 (41.0) 2.0 (0.0-11.5)Non-obese 75 (61.5) 4.0 (0.9-11.6)Overweight, not Obese 25 (20.5) 8.0 (1.1-26.1)Overweight or Obese 72 (59.0) 12.5 (6.5-22.3)Obese 47 (38.5) 14.9 (7.1-28.0)--------------------------------------------------

Asthma Prevalence in

the United States

39%

41%

20%

Asthma Patientsn=122

Obese OverweightNon-overweight

70%

20%

10%

Admission Rates

Obese OverweightNon-overweight

BMI≥25 BMI<250

5

10

15

20

25

30

35

40

Number of Males and Females

MalesFemales

Nu

mb

er

of

Ind

ivid

uals

Figure 1. Admission rates of asthma patients presenting to the ED separated by BMI with 95% Confidence Intervals. The admission rates of non-obese to obese was significantly difference(p-value=0.0439, Fisher’s exact test), non-overweight &non-obese to overweight was significantly different(p-value=0.0461, Fisher’s exact test), and non-overweight & non-obese to obese was significantly different(p-value=0.0276).

Figure 2.The percentage of asthma patients presenting to the ED that are non-overweight, overweight, and obese based on BMI.

Figure 3.The proportion of admission rates for asthma patients presenting to the ED based on BMI.

Figure 4. Comparison between the number of males and females(BMI≥25) and males and females(BMI<25) presenting to the ED with asthma (p-value=0.3586, Fisher’s exact test)

Conclusions

http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm

http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm

http://www.wellspan.org/body.cfm