title: Burden of Obesity on Pediatric Inpatients with Acute Asthma Exacerbation in the United States.
abstract: Obesity and asthma are common health problems in the United States.
  
  
  
  The objective of this study was to evaluate the clinical and economic burdens of obesity on hospitalized children with acute asthma exacerbation in 2012.
  
  
  
  Hospital discharge records of patients aged 2 to 18 years with a diagnosis of asthma were obtained from the 2012 Kids' Inpatient Database, wherein the data were compiled by the Agency for Healthcare Research and Quality. The discharge records were weighted to estimate the number of hospitalizations because of asthma exacerbations in the United States. To classify whether the patient was obese or not, we used the International Classification of Diseases, Ninth Revision, Clinical Modification code 278.0x. We compared the odds of using noninvasive or invasive mechanical ventilation, mean total charges for inpatient service, and length of hospital stay between obese and nonobese patients.
  
  
  
  A total of 74,338 patient discharges were extracted. Of these, 3,494 discharges were excluded because of chronic medical conditions. Using discharge weight variables, we estimated a total of 100,157 hospitalizations with asthma exacerbations among children aged between 2 and 18 years in 2012. Obesity was significantly associated with higher odds of using mechanical ventilation (odds ratio 1.59, 95% CI 1.28-1.99), higher mean total hospital charges (adjusted difference: $1588, 95% CI $802-$2529), and longer mean length of hospital stay (0.24 days, 95% CI 0.17-0.32 days) compared with nonobesity.
  
  
  
  These findings suggest that obesity is a significant risk factor of severe asthma exacerbation that requires mechanical ventilation, and obesity is an economically complicating factor.
authors.affiliation: Quantitative Methods, Harvard T.H. Chan School of Public Health, Boston, Mass; Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan. Electronic address: sunning_dale@yahoo.co.jp.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Okubo
authors.affiliation: Quantitative Methods, Harvard T.H. Chan School of Public Health, Boston, Mass; Clinical Effectiveness, Harvard T.H. Chan School of Public Health, Boston, Mass.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Nochioka
authors.affiliation: Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hataya
authors.affiliation: Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sakakibara
authors.affiliation: Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Terakawa
authors.affiliation: Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass.
authors.forename: Marcia
authors.initials: M
authors.lastname: Testa
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000191:economics / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D009765:Obesity / Q000191:economics / Q000453:epidemiology*; D016017:Odds Ratio; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Asthma; Cost; Invasive; Obesity; Ventilation