Childhood asthma diagnoses declined during the COVID-19 pandemic in the United States

Background Prior studies have documented declines in pediatric asthma exacerbations and asthma-related health care utilization during the COVID-19 pandemic, but less is known about the incidence of asthma during the pandemic. Methods We conducted a retrospective cohort study of children under age 18 without a prior diagnosis of asthma within a large US commercial claims database. Incident asthma was defined using a combination of diagnosis codes, location of services, and medication dispensing. Crude quarterly rates of asthma diagnosis per 1000 children were calculated, and the incidence rate ratio and 95% confidence interval were estimated for newly diagnosed asthma during versus before the pandemic using negative binomial regression, adjusted for age, sex, region, and season. Results Compared with 3 years prior to the pandemic, crude incident diagnosis rates of asthma decreased by 52% across the first four quarters of the US pandemic. The covariate-adjusted pandemic-associated incidence rate ratio was 0.47 (95% confidence interval 0.43, 0.51). Conclusions New diagnoses of childhood asthma in the US declined by half during the first year of the pandemic. These findings raise important questions whether pandemic-related changes in infectious or other triggers truly altered the incidence of childhood asthma beyond the well-described disruptions in healthcare access.

Automated summary

Prior studies have shown a decrease in pediatric asthma exacerbations and asthma-related healthcare utilization during the COVID-19 pandemic, but there is limited information on the incidence of asthma during this period. This retrospective cohort study examined children under 18 without prior asthma diagnosis in a large US commercial claims database. New diagnoses of childhood asthma in the US declined by 52% during the first year of the pandemic compared to the previous 3 years. These findings raise questions about whether pandemic-related changes in triggers affected the incidence of childhood asthma independent of disruptions in healthcare access.