| Title:
|
Burden of Pertussis in Individuals with a Diagnosis of Asthma: A Retrospective Database Study in England |
| Abstract:
|
PURPOSE: The impact of pertussis in individuals with asthma is not fully understood. We estimated the incidence health care resource utilization (HCRU) and direct medical costs (DMC) of pertussis in patients with asthma. PATIENTS AND METHODS: In this retrospective cohort study the incidence rate of pertussis (identified using diagnostic codes) among individuals aged 50 years with an asthma diagnosis was assessed during 20092018 using Clinical Practice Research Datalink and Hospital Episode Statistics databases. HCRU and DMC were compared between patients with diagnoses of asthma and pertussis (asthma+/pertussis+) and propensity score-matched patients with a diagnosis of asthma without pertussis (asthma+/pertussis) in the months around the pertussis diagnosis (6 to +11). RESULTS: Among 687105 individuals 346 had a reported pertussis event (incidence rate: 9.6/100000 person-years of follow-up; 95% confidence interval: 8.610.7). HCRU and DMC were assessed among 314 asthma+/pertussis+ patients and 1256 matched asthma+/pertussis controls. Baseline HCRU was similar in both cohorts but increases were observed in the asthma+/pertussis+ cohort from 6 to 1 month before to 25 months after diagnosis. Rates of accident and emergency visits general practitioner (GP)/nurse visits and GP prescriptions were 4.3- 3.1- and 1.3-fold respectively in the asthma+/pertussis+ vs asthma+/pertussis cohorts during the month before diagnosis; GP/nurse visit rates were 2.0- and 1.2-fold during 02 and 25 months after diagnosis respectively (all p<0.001). DMC was 1.9- and 1.6-fold during the month before and 2 months from diagnosis respectively in the asthma+/pertussis+ vs asthma+/pertussis cohorts (both p<0.001). During months 1 to +11 DMC in the asthma+/pertussis+ cohort was 370 higher than in the asthma+/pertussis controls. CONCLUSION: A pertussis diagnosis among adults aged 50 years with asthma resulted in significant increases in HCRU and DMC across several months around diagnosis suggesting lengthy diagnosis times and highlighting the need for prevention strategies. |
| Published:
|
2022-01-11 |
| Journal:
|
J Asthma Allergy |
| DOI:
|
10.2147/jaa.s335960 |
| DOI_URL:
|
http://doi.org/10.2147/jaa.s335960 |
| Author Name:
|
Bhavsar Amit |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/bhavsar_amit |
| Author Name:
|
Aris Emmanuel |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/aris_emmanuel |
| Author Name:
|
Harrington Lauriane |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/harrington_lauriane |
| Author Name:
|
Simeone Jason C |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/simeone_jason_c |
| Author Name:
|
Ramond Anna |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/ramond_anna |
| Author Name:
|
Lambrelli Dimitra |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/lambrelli_dimitra |
| Author Name:
|
Papi Alberto |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/papi_alberto |
| Author Name:
|
Boulet Louis Philippe |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/boulet_louis_philippe |
| Author Name:
|
Meszaros Kinga |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/meszaros_kinga |
| Author Name:
|
Jamet Nicolas |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/jamet_nicolas |
| Author Name:
|
Sergerie Yan |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/sergerie_yan |
| Author Name:
|
Mukherjee Piyali |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/mukherjee_piyali |
| sha:
|
207e2b8f45ab6a4a44fe5fe027362619bfa1b477 |
| license:
|
cc-by-nc |
| license_url:
|
https://creativecommons.org/licenses/by-nc/4.0/ |
| source_x:
|
PMC |
| source_x_url:
|
https://www.ncbi.nlm.nih.gov/pubmed/ |
| pubmed_id:
|
35046668 |
| pubmed_id_url:
|
https://www.ncbi.nlm.nih.gov/pubmed/35046668 |
| pmcid:
|
PMC8760990 |
| pmcid_url:
|
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8760990 |
| url:
|
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8760990/ |
| has_full_text:
|
TRUE |
| Keywords Extracted from Text Content:
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| Extracted Text Content in Record:
|
First 5000 Characters:The impact of pertussis in individuals with asthma is not fully understood. We estimated the incidence, health care resource utilization (HCRU), and direct medical costs (DMC) of pertussis in patients with asthma. Patients and Methods: In this retrospective cohort study, the incidence rate of pertussis (identified using diagnostic codes) among individuals aged ≥50 years with an asthma diagnosis was assessed during 2009-2018 using Clinical Practice Research Datalink and Hospital Episode Statistics databases. HCRU and DMC were compared -between patients with diagnoses of asthma and pertussis (asthma+/pertussis+) and propensity score-matched patients with a diagnosis of asthma without pertussis (asthma+/pertussis-) -in the months around the pertussis diagnosis (-6 to +11). Results: Among 687,105 individuals, 346 had a reported pertussis event (incidence rate: 9.6/ 100,000 person-years of follow-up; 95% confidence interval: 8.6-10.7). HCRU and DMC were assessed among 314 asthma+/pertussis+ patients and 1256 matched asthma+/pertussiscontrols. Baseline HCRU was similar in both cohorts, but increases were observed in the asthma+/pertussis+ cohort from -6 to -1 month before to 2-5 months after diagnosis. Rates of accident and emergency visits, general practitioner (GP)/nurse visits, and GP prescriptions were 4.3-, 3.1-, and 1.3-fold, respectively, in the asthma+/pertussis+ vs asthma+/pertussiscohorts during the month before diagnosis; GP/nurse visit rates were 2.0-and 1.2-fold during 0-2 and 2-5 months after diagnosis, respectively (all p<0.001). DMC was 1.9-and 1.6-fold during the month before and 2 months from diagnosis, respectively, in the asthma+/pertussis + vs asthma+/pertussis-cohorts (both p<0.001). During months -1 to +11, DMC in the asthma+/pertussis+ cohort was £370 higher than in the asthma+/pertussis-controls. Conclusion: A pertussis diagnosis among adults aged ≥50 years with asthma resulted in significant increases in HCRU and DMC across several months around diagnosis, suggesting lengthy diagnosis times and highlighting the need for prevention strategies.
Why Was the Study Done?
• Pertussis (whooping cough) is a highly contagious respiratory bacterial infection.
Individuals with asthma appear to be at higher risk of pertussis diagnosis than people without asthma. • What happens when people with asthma get pertussis is unclear.
What Did the Researchers Do and Find?
• Among individuals with a diagnosis of asthma who were aged ≥50 years, there were approximately 10 pertussis cases diagnosed per 100,000 people per year (in England during 2009-2018), with a maximum of 21 per 100,000 in 2012. • In the month before the pertussis diagnosis, patients with diagnoses of asthma and pertussis (asthma+/pertussis+) had more general practitioner/nurse visits and accident and emergency visits and received more prescriptions (particularly for asthma medications and antibiotics) than patients with a diagnosis of asthma without pertussis (asthma +/pertussis-). • During the 5 months from the pertussis diagnosis, asthma +/pertussis+ patients continued to have more general practitioner/nurse visits than asthma+/pertussis-patients. • This increase in health care use around a pertussis diagnosis resulted in significant increases in health care costs. • The overall health care costs associated with an episode of pertussis among individuals aged ≥50 years with a diagnosis of asthma were £370.
What do These Results Mean?
Pertussis (also known as whooping cough) is a highly contagious respiratory infection commonly caused by Bordetella pertussis. 1 It is characterized by paroxysmal cough, posttussive vomiting, inspiratory whooping, and absence of fever in adults. 2 It can also result in complications such as urinary incontinence, sinusitis, and pneumonia, especially among older adults. 3 Pertussis is often perceived as a childhood illness, 4 but only around one third of pertussis notifications in England in 2019 were in children aged 0-14 years, with another third in individuals aged 15-44 years, and the remaining third in adults aged ≥45 years. 5 The overall incidence of laboratory confirmed pertussis cases across all age groups in England in 2019 was 7 per 100,000 population 6 (approximately 5 notifications per 100,000 among those aged ≥45 years), 5, 7 but seroprevalence studies from Europe indicate that the true rate of pertussis infection could be hundreds or even thousands of times higher than the reported incidence. [8] [9] [10] Data from patients with chronic obstructive pulmonary disease (COPD) in England also support this under-recognition, as the rate of diagnosed pertussis was approximately 5 per 100,000 in 2013, 11 but a seroprevalence study in the same year indicated that 5.8% of COPD patients had antibody levels indicative of exposure to B. pertussis in the past year. 12 Pertussis is particularly under-recognized or misdiagnosed in adults, 13, 14 possibly because health care providers often view pertussis as a chil |
| Keywords Extracted from PMC Text:
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| Extracted PMC Text Content in Record:
|
First 5000 Characters:Why Was the Study Done?
Pertussis (whooping cough) is a highly contagious respiratory bacterial infection. Individuals with asthma appear to be at higher risk of pertussis diagnosis than people without asthma.What happens when people with asthma get pertussis is unclear.
What Did the Researchers Do and Find?
Among individuals with a diagnosis of asthma who were aged ≥50 years, there were approximately 10 pertussis cases diagnosed per 100,000 people per year (in England during 2009–2018), with a maximum of 21 per 100,000 in 2012.In the month before the pertussis diagnosis, patients with diagnoses of asthma and pertussis (asthma+/pertussis+) had more general practitioner/nurse visits and accident and emergency visits and received more prescriptions (particularly for asthma medications and antibiotics) than patients with a diagnosis of asthma without pertussis (asthma+/pertussis–).During the 5 months from the pertussis diagnosis, asthma+/pertussis+ patients continued to have more general practitioner/nurse visits than asthma+/pertussis– patients.This increase in health care use around a pertussis diagnosis resulted in significant increases in health care costs.The overall health care costs associated with an episode of pertussis among individuals aged ≥50 years with a diagnosis of asthma were £370.
What do These Results Mean?
These results highlight the need for increased awareness of pertussis infection among older adults with a diagnosis of asthma, and the need to consider preventive measures in this population.
Pertussis (also known as whooping cough) is a highly contagious respiratory infection commonly caused by Bordetella pertussis.1 It is characterized by paroxysmal cough, post-tussive vomiting, inspiratory whooping, and absence of fever in adults.2 It can also result in complications such as urinary incontinence, sinusitis, and pneumonia, especially among older adults.3 Pertussis is often perceived as a childhood illness,4 but only around one third of pertussis notifications in England in 2019 were in children aged 0–14 years, with another third in individuals aged 15–44 years, and the remaining third in adults aged ≥45 years.5 The overall incidence of laboratory confirmed pertussis cases across all age groups in England in 2019 was 7 per 100,000 population6 (approximately 5 notifications per 100,000 among those aged ≥45 years),5,7 but seroprevalence studies from Europe indicate that the true rate of pertussis infection could be hundreds or even thousands of times higher than the reported incidence.8–10 Data from patients with chronic obstructive pulmonary disease (COPD) in England also support this under-recognition, as the rate of diagnosed pertussis was approximately 5 per 100,000 in 2013,11 but a seroprevalence study in the same year indicated that 5.8% of COPD patients had antibody levels indicative of exposure to B. pertussis in the past year.12 Pertussis is particularly under-recognized or misdiagnosed in adults,13,14 possibly because health care providers often view pertussis as a childhood disease,15 instead suspecting acute bronchitis or simply "cough",16 also because adults can be asymptomatic17 or present with mild or atypical symptoms.18
Asthma affects approximately 7% of adults in the United Kingdom (UK) based on data from 2016.19 Individuals with asthma appear to be at increased risk of pertussis18,20,21 and hospitalization after a pertussis diagnosis.21 For example, in a United States (US) database study, the incidence of diagnosed pertussis was 27 vs 7 per 100,000 person-years (PY) among people aged ≥11 years with asthma vs matched people without asthma or COPD.21 In an Australian cohort study of adults aged ≥45 years, pertussis incidences were approximately 160 vs 90 per 100,000 PY for those with vs without asthma.20 In a US study, hospitalized pertussis patients were approximately three times more likely to have asthma than the overall population.22 In a Canadian study, patients with asthma and pertussis had a longer period of paroxysmal coughing and more nights of disturbed sleep than people with pertussis without asthma.3 Most also had to increase their use of bronchodilators.3 Patients with asthma or COPD have also been reported to incur higher health care resource utilization (HCRU) and direct medical costs (DMC)21 than those with pertussis alone. Among adults with COPD, a diagnosis of pertussis has been associated with higher HCRU and DMC,11 but the additional burden of asthma and pertussis compared to asthma alone has not yet been studied.
The objectives of the current study were to: (1) estimate the incidence rate of reported pertussis among individuals aged ≥50 years with a history of asthma in England (during 2009–2018) and (2) compare HCRU and DMC among patients with diagnoses of asthma and pertussis (asthma+/pertussis+) and those with a diagnosis of asthma without pertussis (asthma+/pertussis–).
Data from the primary care Clinical Practice Research Datalink (CPRD) GOLD and |
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