The national burden of poorly controlled asthma, school absence and parental work loss among school-aged children in the United States

ABSTRACT

Objective: The degree of poorly controlled asthma and its association with missed school days and parental missed work days is not well understood. Methods: This was a retrospective analysis of missed school days and missed work days for school-aged children (SAC; aged 6–17) and their caregivers in the nationally representative 2007–2013 Medical Expenditure Panel Survey (MEPS). Indicators of poor asthma control included: exacerbation in previous 12 months; use of >3 canisters of short-acting beta agonist (SABA) in 3 months; and annual asthma-specific (AS) Emergency Department (ED) or inpatient (IP) visits. Negative binomial regression was used for missed school days, and a Heckman two-step selection model was used for missed work days. All analyses controlled for sociodemographics and other covariates. Results: There were 44,320 SAC in MEPS, of whom 5,890 had asthma. SAC with asthma and an indicator of poor control missed more school days than SAC without asthma: exacerbation (1.8 times more; p < 0.001); >3 canisters SABA (2.7 times more; p < 0.001) and ED/IP visit (3.8 times more; p < 0.001). The parents/caregivers of SAC with asthma and an exacerbation missed 1.2 times more work days (p < 0.05), while those with SAC with asthma and an ED/IP visit missed 1.8 times more work days (p < 0.01) than the parents of SAC without asthma. Conclusions: This study provides evidence of the significant national burden of poorly controlled asthma due to missed school and work days in the United States. More effective and creative asthma management strategies, with collaboration across clinical, community and school-based outreach, may help address this burden.

KEYWORDS:

• Adolescents
• asthma control
• children
• missed school
• missed work
• pediatric
• poor control

Declaration of interest

Dr. Ghushchyan has no conflicts of interest to disclose. Dr. Friedman is a senior partner in DataMed Solutions LLC, a company that performs consulting work in the pharmaceutical industry and whose clients include Novartis Pharmaceuticals Corporation. Dr. Navaratnam is a senior partner in DataMed Solutions LLC, a company that performs consulting work in the pharmaceutical industry and whose clients include Novartis Pharmaceuticals Corporation. Dr. Abhishek Kavati is an employee and stockholder of Novartis Pharmaceuticals Corporation. Dr. Ortiz is an employee and stockholder of Novartis Pharmaceuticals Corporation. Dr. Lanier has been intermittently (short term) a consultant for Novartis and Genentech. Dr. Lanier has done research projects of a multi-center double blind placebo controlled nature on Xolair. Dr. Lanier has been on the speaker bureau and spoken intermittently for both Novartis and Genentech. Dr. Lanier has no stock, nor does any member of his family. Dr. Lanier has never received any financial benefit or derived any profit from gains made by either company. Dr. Friedman is a senior partner in DataMed Solutions LLC, a company that performs consulting work in the pharmaceutical industry and whose clients include Novartis Pharmaceuticals Corporation. Dr. Navaratnam is a senior partner in DataMed Solutions LLC, a company that performs consulting work in the pharmaceutical industry and whose clients include Novartis Pharmaceuticals Corporation.

Funding

This study was funded by Novartis Pharmaceuticals, Inc. Dr. Sullivan received research funding from Novartis Pharmaceuticals Corporation for this research.