Risk Factors for Nonattendance Among Children With Asthma: A Systematic Review and Meta-Analysis

IF 8.2 1区医学 Q1 ALLERGY Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2024-09-01 DOI:10.1016/j.jaip.2024.05.021

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Abstract

Background

Nonattendance at scheduled outpatient visits among children with asthma has been associated with an increased risk of acute asthma events and increased health care expenses. Specific risk factors for nonattendance have been suggested, but a comprehensive overview is lacking.

Objective

To investigate risk factors for nonattendance among children with asthma and assess whether nonattendance associates with acute events through a systematic review and meta-analysis.

Methods

The study (PROSPERO: CRD42023471893) was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines using the PubMed, Ovid MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Library databases and search terms “asthma/wheeze,” “child,” and “nonattendance.” Original peer-reviewed studies in English were included and evaluated for risk of bias using the Newcastle Ottawa scale. A meta-analysis was performed for all risk factors. Finally, we analyzed whether nonattendance was associated with the risk of acute events.

Results

A total of 17 studies encompassing 27,023 children with asthma were included. The meta-analysis was performed on 11 eligible studies, with 25,948 children, and identified the following risk factors for nonattendance; teenage versus preteen (odds ratio [OR] 1.26; 95% confidence interval [95% CI] 1.06–1.49; P < .01), non-White versus White ethnicity (OR 1.51; 95% CI 1.04–2.18; P = .03) and lower disease severity (OR 1.41; 95% CI 1.13–1.77; P < .01). There were no significant findings in the meta-analysis for insurance status, atopy, sex, or rural residence. Nonattendance associated with an increased risk of acute asthma events (OR 1.11; 95% CI 1.07–1.16; P < .01).

Conclusions

This systematic review and meta-analysis identified specific risk factors to facilitate the development of a strategy against nonattendance for pediatric patients with asthma. This is particularly important given nonattendance being associated with an increased risk of acute asthma.

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哮喘儿童旷课的风险因素：系统回顾与元分析》。

背景：哮喘患儿不按时门诊与急性哮喘事件风险增加和医疗费用增加有关。有人提出了不就诊的具体风险因素，但缺乏全面的概述：调查哮喘儿童不就诊的风险因素，并通过系统回顾和荟萃分析评估不就诊是否与急性事件有关：本研究（PROSPERO：CRD42023471893）根据系统综述和荟萃分析首选报告项目（PRISMA）指南进行，使用 PubMed、Ovid MEDLINE、Embase、ClinicalTrials.gov 和 Cochrane Library 数据库，检索词为 "哮喘/哮喘"、"儿童 "和 "不就诊"。收录了经同行评审的原创英文研究，并使用纽卡斯尔-渥太华量表对偏倚风险进行了评估。对所有风险因素进行了荟萃分析。最后，我们分析了未出席会议是否与急性事件风险相关：共纳入了 17 项研究，涉及 27,023 名哮喘患儿。荟萃分析对 11 项符合条件的研究（共 25,948 名儿童）进行了分析，并确定了以下不就诊的风险因素：十几岁与十几岁前（几率比 [OR] 1.26；95% 置信区间 [95% CI] 1.06-1.49；P < .01）、非白人与白种人（OR 1.51；95% CI 1.04-2.18；P = .03）以及疾病严重程度较低（OR 1.41；95% CI 1.13-1.77；P < .01）。在荟萃分析中，保险状况、特应性、性别或农村居住地均无明显发现。不就诊与急性哮喘事件风险增加有关（OR 1.11; 95% CI 1.07-1.16; P < .01）：这项系统回顾和荟萃分析确定了一些特定的风险因素，有助于为儿科哮喘患者制定预防不就诊的策略。鉴于不就诊与急性哮喘风险的增加有关，这一点尤为重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.