The association between pre‐existing asthma and reduced risk of death among children and adolescents hospitalized with COVID‐19 in Brazil

• Published in: Pediatric pulmonology Vol. 58; no. 3; pp. 727 - 737
• Main Authors: Oliveira, Maria C. L., Colosimo, Enrico A., Vasconcelos, Mariana A., Martelli‐Júnior, Hercílio, Mak, Robert H., Silva, Ludmila R., Pinhati, Clara C., Simões e Silva, Ana C., Oliveira, Eduardo A.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-03-2023
• Subjects: Adolescent; Asthma; Asthma - epidemiology; Brazil - epidemiology; Child; children; Comorbidity; COVID-19; COVID-19 - epidemiology; Hospitalization; Humans; outcome; risk factors; SARS-CoV-2; Brazil; COVID-19; SARS-CoV-2; risk factors; asthma; children; outcome
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.26245

Objective
There have been conflicting reports on the relationship between asthma and COVID‐19 severity. This study aimed to compare the risk of death among children with asthma and healthy peers hospitalized due to COVID‐19.
Methods
We carried out an analysis of all pediatric patients 2–19 years of age with asthma and COVID‐19 registered in Influenza Epidemiological Surveillance Information System‐Gripe, a Brazilian nationwide surveillance database, between February 2020 and March 2022. The primary outcome was time to death, which was evaluated considering discharge as a competitive risk using the cumulative incidence function.
Results
Among 30,405 hospitalized children with COVID‐19, 21,340 (70.2%) had no comorbidities, 6444 (21.2%) had comorbidities other than asthma, 2165 (7.1%) had asthma, and 465 (1.5%) had asthma with other comorbidities. The estimated probability of a fatal outcome for each group was 4.1%, 14.9%, 2.1%, and 10.7%, respectively. After adjustment, children with asthma had a 60% reduction in the hazard of death than healthy peers (hazard ratio [HR] = 0.39, 95% confidence interval [CI], 0.29–0.53, p < 0.0001). Among children with asthma and no other comorbidities, two covariates were independently associated with in‐hospital mortality, age ≥12 years, HR = 4.0, 95% CI, 2.5–6.4), and low oxygen saturation at admission (HR = 2.3, 95% CI, 1.4–3.2).
Conclusion
Children with asthma and no comorbidities had a lower risk of death compared with healthy peers after controlling for clinical and demographic confounding factors.