title: Asthma outcomes in children and adolescents with multiple morbidities: Findings from the National Health Interview Survey.
abstract: BACKGROUND
  More Americans are managing multiple chronic conditions (MCCs), and trends are particularly alarming in youth.
  
  
  OBJECTIVE
  The purpose of this study was to examine the prevalence and distribution of 9 chronic conditions in children and adolescents with and without asthma, and adverse asthma outcomes associated with having MCCs.
  
  
  METHODS
  Cross-sectional interview data from the National Health Interview Survey were analyzed (N = 66,790) between 2007 and 2012 in youth 0 to 17 years of age. Bivariate analysis methods and multivariate generalized linear regression were used to examine associations.
  
  
  RESULTS
  Five percent of children with asthma had 1 or more coexisting health conditions. The prevalence of 1 or more comorbidities was greater among those with asthma than those without (5.07% [95% CI: 4.5-5.6] vs. 2.73% [95% CI: 2.6-2.9]). Those with asthma were twice as likely to have co-occurring hypertension (prevalence ratio [PR] = 2.2 [95% CI: 1.5-3.2]) and arthritis (PR = 2.7 [95% CI: 1.8-4.0]) compared with those without asthma. Every additional chronic condition with asthma was associated with a greater likelihood of an asthma attack (PR = 1.1 [95% CI: 1.0-1.2]), all-cause emergency department visits (PR = 1.3 [95% CI: 1.1-1.5]), and missed school days (PR = 2.3 [95% CI: 1.7-3.2]).
  
  
  CONCLUSIONS
  Children and adolescents with asthma in the US who suffer from MCCs have increased asthma symptoms, missed school days, and all-cause emergency department visits. Further research on optimal management strategies for this group is needed.
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Mich. Electronic address: minalrp@umich.edu.
authors.forename: Minal R
authors.initials: MR
authors.lastname: Patel
authors.affiliation: Center for Managing Chronic Disease, University of Michigan, Ann Arbor, Mich; St Joseph Mercy Hospital, Ann Arbor, Mich.
authors.forename: Harvey L
authors.initials: HL
authors.lastname: Leo
authors.affiliation: Center for Managing Chronic Disease, University of Michigan, Ann Arbor, Mich; Department of Internal Medicine, University of Michigan, Ann Arbor, Mich.
authors.forename: Alan P
authors.initials: AP
authors.lastname: Baptist
authors.affiliation: Department of Biostatistics, University of Michigan, Ann Arbor, Mich.
authors.forename: Yanyun
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Center for Managing Chronic Disease, University of Michigan, Ann Arbor, Mich.
authors.forename: Randall W
authors.initials: RW
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D001168:Arthritis / Q000453:epidemiology* / Q000208:ethnology / Q000503:physiopathology; D001249:Asthma / Q000453:epidemiology* / Q000208:ethnology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004638:Emergency Treatment / Q000706:statistics & numerical data; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000208:ethnology / Q000503:physiopathology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D044469:Racial Groups; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
keywords: Outcomes; asthma; comorbidity; epidemiology; pediatrics