Trends in seasonal pollen and asthma-related morbidity among adults and children in a U.S. high-density urban center, 2001-2020

OBJECTIVE

To analyze the long-term trends in pollen counts and asthma-related emergency department visits (AREDV) in adult and pediatric populations in the Bronx.

METHODS

Daily values of adult and pediatric AREDV were retrospectively obtained from three major Bronx hospitals using ICD-10 codes and pollen counts were obtained from the Armonk station from 2001-2020. Wilcoxon Ranked Sum was applied to compare median values, while Spearman correlation was employed to examine the association between these variables, for both decades and each season.

RESULTS

The median value of pediatric AREDV increased by 200% from the 1st to 2nd decade (p < 0.001) and AREDV peak shifted from predominantly the spring season in the 1st decade to the fall and winter seasons in the 2nd decade. Seasonal patterns were consistent over 20 years with summer AREDV lower than all other seasons (9 vs. 17 per day) (p < 0.001). Spring tree pollen peaks were correlated with AREDV peaks (rho = 0.34) (p < 0.001). Tree pollen exceeding 100 grains/m³ corresponded to a median of 19.0 AREDVs while all other tree pollen (0 - 99 grains/m³) corresponded to a median of 15.0 AREDVs (p < 0.001). AREDVs sharply declined in 2020, coinciding with the emergence of COVID-19.

CONCLUSIONS

Pollen and AREDVs peak earlier in the spring and are more strongly interconnected, while asthma rates among children are rapidly rising, particularly in the fall and winter. These findings can advise targeted awareness campaigns for better management of asthma related morbidity.

Low Amount and Intensity of Leisure-time Physical Activity in Asian Indian Adults

PURPOSE

We sought to describe leisure-time, aerobic, and muscle strengthening physical activity (PA) patterns in U.S. Asian Indians, in comparison to other races/ethnicities.

DESIGN, SETTING, AND SAMPLE

We utilized the 2011-2018 National Health Interview Surveys, a set of cross-sectional, nationally representative surveys of the U.S. noninstitutionalized population. Our study population included 257 652 adults who answered PA questions.

MEASURES

PA was classified per 2008 U.S. guidelines and continuously per estimated metabolic equivalents (METs). Race was classified into White, Black, Asian Indian, Other Asian, and American Indian/Alaskan Native/Multiracial.

ANALYSIS

We used survey design-adjusted, multivariable logistic regression to determine odds of sufficient and highly active physical activity levels, adjusting for predisposing, enabling, need, and health care service factors as guided by the Anderson Model. We also used linear regression to determine racial differences in average MET-minutes/week. Analysis was additionally stratified by comorbidity status.

RESULTS

While Asian Indians (N = 3049) demonstrated similar odds of sufficient aerobic PA as Whites (aOR [95% CI]: .97 [.88,1.07]), Asian Indians had 22% lower odds of meeting highly active aerobic PA levels (.78 [.71,0.87]) and 18% lower odds of meeting sufficient muscle strengthening PA levels (.82 [.73,0.91]). This translated to an average 172 (95% CI: 45 300) fewer MET-minutes. Furthermore, this decrease in MET-minutes/week was especially apparent in those without hypertension (β[95% CI]: -164 [-314,-15]) without diabetes (-185 [-319,-52]), and low/normal BMI (-422 [-623,-222]).

CONCLUSION

Asian Indians, especially those without comorbidities, are less likely to engage in high-intensity physical activity than Whites.

Racial/Ethnic Differences in Leisure-Time Physical Activity Among United States Adults With and Without Diabetes

Background: Physical activity (PA) is a key lifestyle recommendation for diabetes mellitus (DM) prevention and management. The purpose of this study was to describe the patterns of leisure-time, aerobic & muscle-strengthening PAs across races/ethnicities and DM status.

Methods: We included 91,386 adults ≥18 years from the 2011–2018 National Health Interview Surveys who were able to participate in light-moderate PA. Aerobic PA was classified per 2008 guidelines as inactive (0 minutes/week [min/wk] of moderate or vigorous activity), insufficiently active (0–150 moderate-equivalent min/wk, defined as sum of moderate-level and 2*vigorous-level PA), sufficiently active (150–300 moderate-equivalent min/wk), and highly active (>300 min/wk of moderate-level PA, >150 min/wk of vigorous-level PA, or >300 moderate-equivalent min/wk). We also classified aerobic PA continuously in terms of metabolic equivalents (METs; 4 METs for moderate and 8 METs for vigorous PA). Muscle-strengthening PA was dichotomized into ≥3 times/wk (adequate) and <3 times/wk (inadequate). Race/ethnicity was categorized as non-Hispanic White (NHW), non-Hispanic Black (NHB), Asian Indian (AI), Other Asian (OA), and Hispanic/Other (H/O). We used self-reported DM-stratified multivariable logistic and linear regression to assess racial/ethnic differences in PA. All analyses accounted for the survey design and weights to obtain nationally representative estimates.

Results: Among the 91,386 participants, 45,676 (53%) were male, 11,835 (10%) were ≥65 years, and 5,106 (5.2%) had DM. Asian groups had lower adequate muscle-strengthening PA than others (%[SE]: NHW, 35[0.3]%; NHB, 35[0.7]%; AI, 27[1.6]%; OA, 30[1.3]%; H/O, 34[0.8]%; p<0.0001). AIs also had a lower proportion of ‘highly active’ individuals (%[SE]: NHW, 67[0.2]%; NHB, 65[0.7]%; AI, 57[1.8]%; OA, 61[1.5]%; H/O, 67[0.8]%; p<0.0001). Non-DM AIs had mean (SE) 622 (133) lower METs than NHWs (covariate adjusted mean METs [SE]: NHW, 3,568 [305]; NHB, 3,873 [309]; AI, 2,946 [333]; OA, 3,107 [321]; H/O, 3,736 [325]; p<0.001). This difference was also present in those with DM (adjusted mean METs [SE]: NHW, 2,231 [314]; NHB, 2,231 [379]; AI, 1,366 [456]; OA, 1,847 [495]; H/O, 2,454 [401]; p=0.013). Non-DM AIs and OAs had ~30% lower odds of being at least ‘sufficiently active’ relative to NHWs (aOR [95% CI]: AI, 0.70 [0.56, 0.87]; OA, 0.72 [0.61, 0.85]). All races/ethnicities had lower odds of adequate muscle-strengthening PA compared to NHWs (aOR [95% CI]: NHB, 0.94 [0.90, 0.99]; AI, 0.68 [0.60, 0.79]; OA, 0.75 [0.68, 0.84]; H/O, 0.73 [0.69, 0.77]). These inverse associations persisted in DM-diagnosed OAs, but not AIs.

Conclusion: Among those with and without DM, there exist racial/ethnic differences in strength-related and aerobic activities. Asian groups may benefit from aggressive counseling and PA interventions to both prevent and manage DM.

Impact of Technology-Based Interventions on Patient-Reported Outcomes in Asthma: A Systematic Review

BACKGROUND

Technology-based interventions (TBIs) can improve asthma management by facilitating patient education, symptom monitoring, environmental trigger control, comorbid condition management, and medication adherence. Collecting patient-reported outcomes (PROs) can identify effective interventions and ensure patient-centered care, but it is unclear which TBIs have been formally evaluated using PROs.

OBJECTIVES

We aim to: (1) identify the TBIs that have been evaluated in clinical trials using PROs; (2) identify the most commonly used PROs in these trials; and (3) determine the impact of TBIs on PROs in the management of chronic asthma.

METHODS

We searched the PubMed and Clinicaltrials.gov databases for studies published in English between January 2000 and February 2020 using the following search criteria: "asthma," "IT-based interventions," "information technology," "technology," "dyspnea," "patient reported outcomes," "PROs," "telehealth," "telemedicine," and "mobile devices." Two independent reviewers screened the studies and determined study inclusion. Studies were examined for the types of interventions used, the types of PROs collected, and outcomes.

RESULTS

The final analysis included 14 clinical trials with either 1, 2, or 3 arms. Five different types of TBIs were identified, most commonly involving multimedia education. Four different categories of PROs were identified, most commonly involving treatment self-efficacy. Positive outcomes in at least 1 PRO domain were reported in 12 of 14 studies. Pooled meta-analysis was not possible due to the heterogeneity of PRO instruments across studies.

CONCLUSION

TBIs improve PROs overall in patients with asthma. Future trials investigating TBIs should include standardized PROs as endpoints to better clarify this relationship.