Association between maternal schizophrenia and risk of serious asthma exacerbations in childhood

J G Pouget; E Cohen; J G Ray; A S Wilton; H K Brown; N R Saunders; C L Dennis; A C Holloway; K M Morrison; G E Hanley; T F Oberlander; A Bérard; K Tu; L C Barker; S N Vigod

doi:10.1016/j.schres.2024.11.008

Association between maternal schizophrenia and risk of serious asthma exacerbations in childhood

Schizophr Res. 2024 Dec 20:275:123-130. doi: 10.1016/j.schres.2024.11.008. Online ahead of print.

Authors

J G Pouget¹, E Cohen², J G Ray³, A S Wilton⁴, H K Brown⁵, N R Saunders², C L Dennis⁶, A C Holloway⁷, K M Morrison⁸, G E Hanley⁹, T F Oberlander¹⁰, A Bérard¹¹, K Tu¹², L C Barker¹³, S N Vigod¹⁴

Affiliations

¹ Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
² Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Hospital for Sick Children, Toronto, ON, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada.
³ ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada.
⁴ ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, ON, Canada.
⁵ ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada; Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada; Women's College Hospital and Research Institute, Toronto, ON, Canada.
⁶ Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Lawrence Bloomberg Faculty of Nursing, Toronto, ON, Canada.
⁷ Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
⁸ Department of Pediatrics, Centre for Metabolism, Obesity & Diabetes Research, McMaster University, Hamilton, ON, Canada.
⁹ Women's College Hospital and Research Institute, Toronto, ON, Canada; University of British Columbia, Vancouver, BC, Canada.
¹⁰ University of British Columbia, Vancouver, BC, Canada.
¹¹ Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Quebec, Canada; Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada.
¹² Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada; Toronto Western Hospital Family Health Team, University Health Network, Toronto, ON, Canada.
¹³ Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, ON, Canada; Women's College Hospital and Research Institute, Toronto, ON, Canada.
¹⁴ Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada; Women's College Hospital and Research Institute, Toronto, ON, Canada. Electronic address: [email protected].

PMID: 39708390
DOI: 10.1016/j.schres.2024.11.008

Abstract

Background and hypothesis: While maternal schizophrenia is linked to chronic childhood medical conditions, little is known about the risk of acute asthma exacerbations among children whose mothers have schizophrenia. This population-based study used health data for all of Ontario, Canada to evaluate whether having a mother with schizophrenia was associated with increased risk of asthma exacerbations.

Study design: The study cohort included 385,989 children diagnosed with asthma from age 2 years onward, followed from the time of their asthma diagnosis up to a maximum of age 19 years. Children whose biological mother was diagnosed with schizophrenia prior to the child's asthma diagnosis (n = 1407) were compared children whose mother was not (n = 384,582). Study outcomes were asthma-related hospitalization, and separately, asthma-related emergency department (ED) visit, each up to a maximum child age of 19 years. First exacerbations were evaluated using Cox proportional hazards models, and recurrent exacerbations by Andersen-Gill regression, adjusted for covariates.

Study results: First hospitalization for an asthma exacerbation occurred in 76 (6.9 per 1000 person-years) vs. 19,679 (5.4 per 1000 person-years) children with and without maternal schizophrenia (adjusted hazard ratio [aHR] 1.21, 95 % CI 0.97-1.51). For first asthma-related ED exacerbations, the rates were 25.1 vs. 20.7 per 100 person-years (aHR 1.06, 95 % CI 0.93-1.21). The adjusted rate ratio (aRR) for recurrent hospitalizations for asthma exacerbations was 1.27 (95 % CI 0.98-1.66), and 1.11 (95 % CI 0.94-1.31) for recurrent asthma-related ED exacerbations.

Conclusions: This study did not observe meaningful differences in acute care utilization for asthma exacerbations among children whose biological mothers had schizophrenia.