Impact of the COVID-19 Pandemic on Healthcare Utilization Rates and Obesity in Urban Minority Children With High Asthma Disease Burden: A Retrospective Cohort Study.

Abstract

Background: The COVID-19 pandemic caused dramatic changes in daily routines, healthcare access, and utilization in children with asthma, particularly urban minority children with poorly controlled asthma.

Objectives: In this study, we aimed to elucidate changes in healthcare utilization, lung function, and weight as a result of the COVID-19 "shutdown" in patients followed at the Pediatric Asthma Center at the Children's Hospital at Montefiore.

Study design: We conducted a retrospective cohort study including children aged 2-21 with physician-diagnosed persistent asthma. We compared healthcare utilization, lung function, asthma control, and weight changes before and after the COVID-19 lockdown (March 16, 2020 to June 1, 2020).

Results: This study included 101 children (61% Hispanic, 28% Black) with an average age of 9.2 (±4.7) years. There was a statistically significant decrease in hospitalization rates, emergency department visits, oral steroid use, urgent care visits and office visits pre- and post-COVID-19 shutdown, which was associated with improvement in asthma control (p < 0.001) but there was no significant improvement in lung function. Obesity rates increased overall from 29.7% to 43.9%, but weight gain did not differ based on asthma severity. Weight gain was disproportionally higher in a small sub-population of patients who needed step-up therapy.

Conclusion: Inner-city children with high asthma morbidity saw a significant reduction in healthcare utilization during the COVID-19 pandemic, with improved asthma control but no change in spirometry results. Despite an increase in obesity rates overall, weight changes did not differ across asthma severities, suggesting increase in obesity was not mediated by asthma severity.