Association of Severe Bronchiolitis during Infancy with Childhood Asthma Development: An Analysis of the ECHO Consortium

Makiko Nanishi; Aruna Chandran; Xiuhong Li; Joseph B Stanford; Akram N Alshawabkeh; Judy L Aschner; Dana Dabelea; Anne L Dunlop; Amy J Elliott; James E Gern; Tina Hartert; Julie Herbstman; Gurjit K Khurana Hershey; Alison E Hipwell; Margaret R Karagas; Catherine J Karr; Leslie D Leve; Augusto A Litonjua; Cindy T McEvoy; Rachel L Miller; Emily Oken; T Michael O'Shea; Nigel Paneth; Scott T Weiss; Robert O Wright; Rosalind J Wright; Kecia N Carroll; Xueying Zhang; Qi Zhao; Edward Zoratti; Carlos A Camargo Jr; Kohei Hasegawa; Environmental Influences on Child Health Outcomes (ECHO) Investigators

doi:10.3390/biomedicines11010023

Association of Severe Bronchiolitis during Infancy with Childhood Asthma Development: An Analysis of the ECHO Consortium

Biomedicines. 2022 Dec 22;11(1):23. doi: 10.3390/biomedicines11010023.

Authors

Makiko Nanishi¹, Aruna Chandran², Xiuhong Li², Joseph B Stanford³, Akram N Alshawabkeh⁴, Judy L Aschner⁵, Dana Dabelea⁶, Anne L Dunlop⁷, Amy J Elliott⁸, James E Gern⁹, Tina Hartert¹⁰, Julie Herbstman¹¹, Gurjit K Khurana Hershey¹², Alison E Hipwell¹³, Margaret R Karagas¹⁴, Catherine J Karr^{15

16

17}, Leslie D Leve¹⁸, Augusto A Litonjua¹⁹, Cindy T McEvoy²⁰, Rachel L Miller²¹, Emily Oken²², T Michael O'Shea²³, Nigel Paneth²⁴, Scott T Weiss²⁵, Robert O Wright²⁶, Rosalind J Wright²⁶, Kecia N Carroll²⁶, Xueying Zhang²⁶, Qi Zhao²⁷, Edward Zoratti²⁸, Carlos A Camargo Jr¹, Kohei Hasegawa¹; Environmental Influences on Child Health Outcomes (ECHO) Investigators

Affiliations

¹ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21218, USA.
³ Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT 84112, USA.
⁴ Department of Civil and Environmental Engineering, Northeastern University, Boston, MA 02115, USA.
⁵ Departments of Pediatrics, Hackensack Meridian School of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
⁶ Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
⁷ Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA 30307, USA.
⁸ Avera Research Institute & Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD 57069, USA.
⁹ Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA.
¹⁰ Departments of Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
¹¹ Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10027, USA.
¹² Division of Asthma Research, Cincinnati Children's Hospital, Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45221, USA.
¹³ Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15260, USA.
¹⁴ Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH 03756, USA.
¹⁵ Department of Epidemiology, University of Washington, Seattle, WA 98195, USA.
¹⁶ Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA.
¹⁷ Department of Pediatrics, University of Washington, Seattle, WA 98195, USA.
¹⁸ Prevention Science Institute, University of Oregon, Eugene, OR 97403, USA.
¹⁹ Division of Pediatric Pulmonary Medicine, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY 14642, USA.
²⁰ Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA.
²¹ Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine, New York, NY 10029, USA.
²² Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA.
²³ Division of Neonatal-Perinatal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559, USA.
²⁴ Departments of Epidemiology and Biostatistics and Pediatrics and Human Development, Michigan State University, College of Human Medicine, East Lansing, MI 49503, USA.
²⁵ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
²⁶ Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
²⁷ Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN 38163, USA.
²⁸ Department of Medicine, Henry Ford Health, Detroit, MI 48202, USA.

Abstract

Objective: Many studies have shown that severe (hospitalized) bronchiolitis during infancy is a risk factor for developing childhood asthma. However, the population subgroups at the highest risk remain unclear. Using large nationwide pediatric cohort data, namely the NIH Environmental influences on Child Health Outcomes (ECHO) Program, we aimed to quantify the longitudinal relationship of bronchiolitis hospitalization during infancy with asthma in a generalizable dataset and to examine potential heterogeneity in terms of major demographics and clinical factors. Methods: We analyzed data from infants (age <12 months) enrolled in one of the 53 prospective cohort studies in the ECHO Program during 2001−2021. The exposure was bronchiolitis hospitalization during infancy. The outcome was a diagnosis of asthma by a physician by age 12 years. We examined their longitudinal association and determined the potential effect modifications of major demographic factors. Results: The analytic cohort consisted of 11,762 infants, 10% of whom had bronchiolitis hospitalization. Overall, 15% subsequently developed asthma. In the Cox proportional hazards model adjusting for 10 patient-level factors, compared with the no-bronchiolitis hospitalization group, the bronchiolitis hospitalization group had a significantly higher rate of asthma (14% vs. 24%, HR = 2.77, 95%CI = 2.24−3.43, p < 0.001). There was significant heterogeneity by race and ethnicity (Pinteraction = 0.02). The magnitude of the association was greater in non-Hispanic White (HR = 3.77, 95%CI = 2.74−5.18, p < 0.001) and non-Hispanic Black (HR = 2.39, 95%CI = 1.60−3.56; p < 0.001) infants, compared with Hispanic infants (HR = 1.51, 95%CI = 0.77−2.95, p = 0.23). Conclusions: According to the nationwide cohort data, infants hospitalized with bronchiolitis are at a higher risk for asthma, with quantitative heterogeneity in different racial and ethnic groups.

Keywords: asthma; bronchiolitis; children; cohort; generalizability; heterogeneity.

Abstract

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