Conference Coverage

ED visits higher among pediatric asthma patients with comorbid depression, anxiety


AT PAS 2018

– Children with asthma who have a comorbid diagnosis of anxiety or depression are significantly more likely to make asthma-related visits to the emergency department, compared with their peers who do not have a mental health condition, results from a large administrative data analysis showed.

“There has been a fair bit of research on how comorbid mental health conditions can affect health care utilization for asthma in adults, but few studies have examined how comorbid mental health conditions like anxiety or depression can affect children with asthma,” one of the study authors, Caroline Neel, said in an interview in advance of the Pediatric Academic Societies meeting.

Caroline Neel

Caroline Neel

In an effort to assess whether anxiety or depression is associated with asthma-related ED usage in pediatric patients, Ms. Neel, a clinical research coordinator in the department of pediatrics at the University of California, San Francisco, and her associates evaluated data from the Massachusetts All Payer Claims Database for 2014-2015. They used the technical specifications from the Pediatric Quality Measures Program to measure the rate of asthma-related ED visits. This measure identifies patients aged 2-21 years with asthma using ICD 9 and 10 codes and tracks ED utilization over the measurement year. Next, the researchers conducted univariate and multivariate analyses to assess the relationship between ED visit rate and an established diagnosis of comorbid anxiety or depression.

In all, the researchers identified 71,326 patients with asthma, with an overall rate of 16.3 ED visits per 100 child-years. Among these, children with a diagnosis of depression had significantly higher rates of ED visits (21.5 visits per 100 child-years; P less than .01), as did those with a diagnosis of anxiety (19.5 ED visits per 100 child-years; P less than .01). Being enrolled in a Medicaid managed care plan or Medicaid fee-for-service plan also increased the rates of asthma-related ED visits (20.3 and 21.5 ED visits per 100 child-years, respectively; P less than .01 for both associations.)

“We were surprised to see that anxiety and depression seemed to increase asthma emergency department visits as much as other medical chronic illnesses like cystic fibrosis or sickle cell disease, and that kids on Medicaid, who tend to be our poorer kids, also had an independent risk of going to the emergency department,” Ms. Neel said. “Having Medicaid as well as anxiety or depression were independently related to going to the emergency room for asthma, so the study suggests that some of our highest-risk kids for asthma have multiple different contributors to getting sick and needing to go to the emergency room for an asthma attack.”

She acknowledged certain limitations of the analysis, including its reliance on administrative claims data to identify whether or not children had a diagnosis of anxiety or depression. “This doesn’t necessarily identify all the kids who may have these mental health conditions, since sometimes providers are less likely to document a diagnosis of a mental health conditions for children,” she said. “However, we still saw a significant association between a comorbid mental health condition and emergency department use for asthma, despite the potential that mental health conditions may have been under reported.”

The study’s senior author was Naomi Bardach, MD. The researchers reported having no financial disclosures.

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