PM2058: Mental Health Outcomes in Pediatric Asthma Patients: A 10 Year Real World Analysis Using a Large Database Approach

Background: Asthma is one of the most common chronic childhood illness in the United States, accounting for significant morbidity and health care utilization. Prior studies have demonstrated correlations between childhood asthma diagnoses and poor mental health outcomes. However, there are few population-based studies quantifying this risk.

Methods: The IBM MarketScan private insurance claims database was used to identify children (5-18yo) admitted to the hospital with between 2007 and 2016. Time-to-event analysis was performed to compare mental health outcomes of PTSD, depression, anxiety, and adjustment disorder among children admitted with asthma to those admitted for uncomplicated appendicitis, cystic fibrosis (CF), and those treated in the outpatient setting for asthma and CF. Uncomplicated appendicitis was selected as a control-group representing similar aged children with a single, uncomplicated hospitalization.

Results: 1,820,016 children with asthma, cystic fibrosis, and appendicitis were identified in the database. Among the 26,295 children with asthma-related hospital admissions, 3.31% developed a subsequent mental health diagnosis (PTSD, depression, anxiety, or adjustment disorder). When adjusted for patient demographics including sex, age, and number of healthcare exposures, children admitted for asthma were at increased risk of developing a mental health diagnosis compared to the control group of children with uncomplicated appendicitis (HR 1.642, p< 0.001). Children with asthma treated in the outpatient setting and children admitted for CF were also at an increased risk of developing a mental health diagnosis relative to the uncomplicated appendicitis cohort (HR 1.251, p< 0.001 and HR 1.316, p=0.003 respectively). There was no significant difference in risk between children with CF without hospitalization compared to patients with uncomplicated appendicitis (HR 1.056, p=0.205). Children admitted with asthma were the only group with a significantly increased risk of developing PTSD (HR 3.155, p = 0.028).

Conclusion: Children with asthma requiring hospital admission are at increased risk of developing mental health conditions compared to patients admitted for cystic fibrosis or uncomplicated appendicitis. They are also at increased risk of developing mental health diagnoses compared with children treated in the outpatient setting for cystic fibrosis or asthma. Early identification of vulnerable children at risk for worse mental health outcomes may offer the potential to provide these children with more timely mental health intervention and treatment.