Published Online: January 2016
Asthma exacerbations contribute to a substantial portion of the burden of asthma, accounting for 2 million emergency department (ED) visits and 330,000 hospitalizations in the US each year. Although national surveys have reported the sex differences in asthma, there have been no recent nationwide studies that examine sex differences in hospitalization risk in ED patients.
In a recent report. in The Journal of Allergy Clinical Immunology: In Practice, Goto et al evaluated sex differences in the risk of hospitalization in children and adults presenting to the US EDs with asthma exacerbation, by using data from the 2010-2012 Nationwide Emergency Department Sample. Authors identified all ED visits for younger children (aged 4-11 years), older children (aged 12-17 years), and adults (aged 18-54 years), and examined the association of sex with risk of hospitalization.
During 2010-2012, the authors estimated that there were 4.3 million ED visits for asthma exacerbations in the US. In younger children presenting to the ED with asthma exacerbations, the hospitalization rate was higher in girls than boys (10.8% vs. 10.3%; P=0.003). By contrast, in older children, the hospitalization rate was lower in girls than boys (6.5% vs. 6.9%; P=0.04). These results did not change materially in the multivariable models. In adults, the hospitalization rate was higher in women than men (13.6% vs. 10.1%; P<0.001). After adjustment for patient-level characteristics and calendar year, this association was meaningfully attenuated but remained statistically significant (adjusted OR, 1.07; 95% CI, 1.02-1.11).
There are substantial unadjusted sex differences among adults such that women are disproportionately hospitalized following ED visits for asthma exacerbations. However, this burden appears to be largely explained by patient characteristics that are associated with both sex and hospitalization risk. The residual difference in hospitalization risk should encourage researchers to further investigate the mechanisms by which sex (female vs. male) affects acute asthma morbidity.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.