1. A Retrospective Study of the Association of Obesity and Overweight with Admission Rate within York Hospital Emergency Department for Acute Asthma Exacerbations Corrie Bluett Department 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. Hypotheses H1: 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. Acknowledgments A 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 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) Male58 (47.5) 8.6 (3.3-19.1) Non-overweight50 (41.0) 2.0 (0.0-11.5) Non-obese75 (61.5) 4.0 (0.9-11.6) Overweight, not Obese25 (20.5) 8.0 (1.1-26.1) Overweight or Obese72 (59.0) 12.5 (6.5-22.3) Obese47 (38.5) 14.9 (7.1-28.0) -------------------------------------------------- Asthma Prevalence in the United States 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.wellspan.org/body.cfm