TY - JOUR
T1 - International variation in severe exacerbation rates in patients with severe asthma
AU - Lee, Tae Yoon
AU - Price, David
AU - Yadav, Chandra Prakash
AU - Roy, Rupsa
AU - Mien, Laura Lim Huey
AU - Wang, Eileen
AU - Wechsler, Michael E
AU - Jackson, David J
AU - Busby, John
AU - Heaney, Liam G
AU - Pfeffer, Paul E
AU - Mahboub, Bassam
AU - Perng Steve, Diahn-Warng
AU - Cosio, Borja G
AU - Perez-de-Llano, Luis
AU - Al-Lehebi, Riyad
AU - Larenas-Linnemann, Désirée
AU - Al-Ahmad, Mona
AU - Rhee, Chin Kook
AU - Iwanaga, Takashi
AU - Heffler, Enrico
AU - Canonica, Giorgio Walter
AU - Costello, Richard
AU - Papadopoulos, Nikolaos G
AU - Papaioannou, Andriana I
AU - Porsbjerg, Celeste M
AU - Torres-Duque, Carlos A
AU - Christoff, George C
AU - Popov, Todor A
AU - Hew, Mark
AU - Peters, Matthew
AU - Gibson, Peter G
AU - Maspero, Jorge
AU - Bergeron, Celine
AU - Cerda, Saraid
AU - Contreras Contreras, Elvia Angelica
AU - Chen, Wenjia
AU - Sadatsafavi, Mohsen
N1 - Copyright © 2024. Published by Elsevier Inc.
PY - 2024/2/21
Y1 - 2024/2/21
N2 - BACKGROUND: Exacerbation frequency strongly influences treatment choices in patients with severe asthma.RESEARCH QUESTION: What is the extent of the variability of exacerbation rate across countries and its implications in disease management?STUDY DESIGN AND METHODS: We retrieved data from the International Severe Asthma Registry, an international observational cohort of patients with a clinical diagnosis of severe asthma. We identified patients aged ≥ 18 years who did not initiate any biologics prior to baseline visit. A severe exacerbation was defined as the use of oral corticosteroids for ≥ 3 days or asthma-related hospitalization/ED visit. A series of negative binomial models were applied to estimate country-specific severe exacerbation rates during 365 days of follow-up, starting from a naive model with country as the only variable to an adjusted model with country as a random-effect term and patient and disease characteristics as independent variables.RESULTS: The final sample included 7,510 patients from 17 countries (56% from the United States), contributing to 1,939 severe exacerbations (0.27/person-year). There was large between-country variation in observed severe exacerbation rate (minimum, 0.04 [Argentina]; maximum, 0.88 [Saudi Arabia]; interquartile range, 0.13-0.54), which remained substantial after adjusting for patient characteristics and sampling variability (interquartile range, 0.16-0.39).INTERPRETATION: Individuals with similar patient characteristics but coming from different jurisdictions have varied severe exacerbation risks, even after controlling for patient and disease characteristics. This suggests unknown patient factors or system-level variations at play. Disease management guidelines should recognize such between-country variability. Risk prediction models that are calibrated for each jurisdiction will be needed to optimize treatment strategies.
AB - BACKGROUND: Exacerbation frequency strongly influences treatment choices in patients with severe asthma.RESEARCH QUESTION: What is the extent of the variability of exacerbation rate across countries and its implications in disease management?STUDY DESIGN AND METHODS: We retrieved data from the International Severe Asthma Registry, an international observational cohort of patients with a clinical diagnosis of severe asthma. We identified patients aged ≥ 18 years who did not initiate any biologics prior to baseline visit. A severe exacerbation was defined as the use of oral corticosteroids for ≥ 3 days or asthma-related hospitalization/ED visit. A series of negative binomial models were applied to estimate country-specific severe exacerbation rates during 365 days of follow-up, starting from a naive model with country as the only variable to an adjusted model with country as a random-effect term and patient and disease characteristics as independent variables.RESULTS: The final sample included 7,510 patients from 17 countries (56% from the United States), contributing to 1,939 severe exacerbations (0.27/person-year). There was large between-country variation in observed severe exacerbation rate (minimum, 0.04 [Argentina]; maximum, 0.88 [Saudi Arabia]; interquartile range, 0.13-0.54), which remained substantial after adjusting for patient characteristics and sampling variability (interquartile range, 0.16-0.39).INTERPRETATION: Individuals with similar patient characteristics but coming from different jurisdictions have varied severe exacerbation risks, even after controlling for patient and disease characteristics. This suggests unknown patient factors or system-level variations at play. Disease management guidelines should recognize such between-country variability. Risk prediction models that are calibrated for each jurisdiction will be needed to optimize treatment strategies.
UR - http://www.scopus.com/inward/record.url?scp=85195571623&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2024.02.029
DO - 10.1016/j.chest.2024.02.029
M3 - Journal article
C2 - 38395297
SN - 0012-3692
JO - Chest
JF - Chest
ER -