Asthma prevalence found three times higher in children with disabilities, US study confirms
Asthma prevalence is significantly higher in children with disabilities compared to their typically developing peers, say researchers in a new study. They found that children who had at least one disability had almost three times higher odds of having reported current asthma conditions as compared with those that do not have a disability.
The analysis shows that about one in six children (approximately 16 percent) with a disability or developmental delay had simultaneous asthma versus about one in 16 (approximately six percent) children without any disability or delay, says the research team, including experts from the University of Texas Health Science Center at Houston; Children’s Health System of Texas; and the University of Texas Southwestern Medical Center.
“Overall asthma prevalence estimates were 10 percentage points higher in children with a disability versus children without a disability. Children with hearing loss had the greatest likelihood of having asthma, followed by those with cerebral palsy, and children with a learning disability. We also found that ethnic minority children had higher odds of dual asthma/disability diagnoses compared to their non-Hispanic white peers,” Sarah Messiah, PhD, MPH, a professor of epidemiology, human genetics and environmental sciences at UTHealth School of Public Health in Dallas, told MEA WorldWide (MEAWW).
Asthma is one of the most common chronic diseases in the world among children. Currently, six million children (approximately eight percent) living in the US are diagnosed with asthma, incurring $81.9 billion in annual health care expenditures. According to the US Centers for Disease Control and Prevention (CDC), estimates show that about one in six or about 17 percent of children aged three through 17 years have one or more developmental disabilities.
The population-based cross-sectional study encompassed a total of 71,811 families with children or adolescents aged 0 to 17 years, who participated in the 2016 and 2017 National Survey of Children’s Health. Data were collected from June 10, 2016, to February 10, 2017, for the 2016 survey and from August 10, 2017, to February 10, 2018, for the 2017 survey. Data were analyzed from September 20, 2019, to April 5, 2020.
The researchers analyzed how common asthma was among children with various developmental disabilities as compared to children without disabilities. Developmental disabilities are typically categorized as behavioral disorders, including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASD); motor disabilities, including cerebral palsy and seizure; vision, hearing, and speech disabilities; and cognitive disabilities, including intellectual disability and learning disability. Developmental delay is defined as not meeting growth milestones with unknown cause of the delay.
The analysis shows that 5,687 had asthma and 11,426 had at least 1 disability. The three most prevalent disabilities were ADHD, learning disabilities, and speech problems among study respondents representative of US children. Cerebral palsy was the least common disability. The prevalence of those reporting having at least two disabilities in one child varied by disability category. For example, 34 children with ADHD also had cerebral palsy, whereas 645 children with intellectual disability also reported having a learning disability.
The researchers found that the odds of asthma were significantly higher in children with a disability (odds ratio of 2.77), or delay (odds ratio of 2.22) versus typically growing children. Notably, the odds of simultaneous asthma increased the most – more than three-fold – among children with cerebral palsy or hearing loss, says the team. Subsequently, the odds of asthma was twice as high or nearly twice as high in children with versus without the following disabilities: behavioral disabilities consisting of ADHD (odds ratio of 2.36) and ASD (2.25), motor disability consisting of seizures (2.63); blindness (1.93) and speech problem (2.19), and cognitive disabilities consisting of intellectual disability (2.17). Overall asthma prevalence estimates were significantly higher in ethnic minority children versus non-Hispanic white children with a developmental disability (19.8% versus 12.6%).
“These results suggest that US children with various developmental disabilities or delay may have higher odds for developing asthma versus their typically developing peers,” says the study published in JAMA Network Open. It says, “Among children with at least 1 disability, 16.1% also reported a concurrent asthma condition, whereas 6.5% of children without disabilities had concurrent asthma. Specifically, the widest asthma prevalence disparity was seen among children with versus those without hearing loss (22.0% versus 7.7% respectively). Similarly, at least 1 in 5 children with cerebral palsy or a learning disability reported concurrent asthma versus approximately 1 in 12 children without cerebral palsy or a learning disability. Similar trends were also found among children with ADHD, ASD, developmental delay, intellectual disability, seizures, and speech problems.”
According to Dr Messiah, the findings suggest that asthma screening among patients with disabilities in pediatric healthcare settings may improve the quality of life and lessen the economic burden among families due to undiagnosed asthma. “This may be particularly true among those from ethnic minority backgrounds. It may also be important to screen very young asthmatic children for disabilities and delays, as temporality cannot be determined by the current data source and analytical approach,” she told MEAWW.
Commenting on what could be the possible reasons why children with various developmental disabilities or delays may have higher odds for developing asthma, Dr Messiah said that other studies have suggested that inflammation may be a link with asthma, especially among children with ADHD. “Specifically, ADHD patients have shown increased stress level leading to a neuroimmunological response that eventually triggers the co-occurrence of asthma. Genetic links or prenatal stress could be other possible explanations for the increased susceptibility of concurrent conditions,” Dr Messiah told MEAWW. She added, “Also, inhaled corticosteroids, a common pharmacological treatment for asthma, may cause neurological side effects that can be misclassified as ADHD in some patients. However, a large population-based study did not find asthma medications increased the odds of ADHD.”