Association Between Asthma Control Trajectories in Preschoolers and Disease Remission
Notice bibliographique
Résumé
In few studies have researchers characterized the relationship between the frequency (and severity) of early events and long-term disease evolution in preschoolers with asthma. The purpose of this study was to investigate if asthma control trajectories 2 years postdiagnosis in preschoolers were associated with subsequent disease remission and recurrence.The study included a population cohort in 4 Canadian provinces consisting of 48 687 children with asthma diagnosed before 5 years of age and born between 1990 and 2013 who had prolonged disease activity postdiagnosis.Prolonged disease activity was defined as ≥1 medical visits or medications for asthma every 6-month period for at least 4 of the 6 periods postdiagnosis. Remission was defined as 2 consecutive years without drug claims or medical visits for asthma. Asthma control trajectories were classified by using the validated Pharmacoepidemiologic Pediatric Asthma Control Index. Cox regression models within each Canadian province were used to estimate associations between asthma control trajectories and time to remission or recurrence, with children controlled 2 years postdiagnosis as a reference control category. Province specific hazard ratios (HRs) and 95% confidence intervals (CIs) were summarized by using random-effects meta-analysis.All suboptimal control trajectories were associated with a lower likelihood of remission, compared with that of children who were controlled throughout, with a pooled adjusted HR for remission of 0.51 (95% CI: 0.45 to 0.59) for those out of control throughout. An older age at diagnosis, atopy, and asthma diagnosis on the basis of hospitalization outside of the winter season were associated with a lower likelihood of remission. Suboptimal control trajectories were also associated with a higher likelihood of recurrence (HR: 1.17; 95% CI: 1.11 to 1.24), compared with children controlled throughout. Stratifying by sex or atopy did not significantly alter estimated HRs between trajectories. Girls in the study had higher recurrence rates than boys did. Children without atopy in early life were more likely to experience recurrence, compared with atopic children.In the 2 years after an asthma diagnosis in preschoolers, worse asthma control trajectories were associated with incrementally lower likelihoods of remission.With this study, the authors are the first to investigate the association between asthma control trajectories after a preschool diagnosis and remission. The asthma control trajectory in the 2 years after diagnosis in preschoolers appears to be an important predictor of both remission and recurrence, with poorer control associated with a lower likelihood of remission. With the study, the authors support previous studies in which researchers reported potential predictors of persistence, including older age at diagnosis, male sex, and diagnosis in a season other than winter.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,003 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».