253 - Changes in State-Level Prevalence of Childhood Asthma in the United States, in the Context of Population-Level COVID-19 Illness Burden and Public Health Mitigation Strategies

Poster Number: 253
Publication Number: 253.2129

Background: In the initial phase of the COVID-19 pandemic, asthma was a risk factor for COVID-19 infection and severity in adults. However, public health mitigation efforts in 2020 were associated with lower rates of emergency visits and hospitalizations for asthma among children. As the pandemic continued and COVID-19 vaccines became available in 2020-21, it is not clear whether population-level childhood asthma prevalence has been associated with burden of COVID-19 illness or with mitigation efforts such as vaccination and mask mandates.

Objective: To examine state-level childhood asthma prevalence during 2020-21 compared with 2018-19, and whether prevalence was associated with state-level COVID-19 mortality for all ages, completion of COVID-19 primary vaccination series among adults and children, and facemask mandates.

Design/Methods: We used publicly available state-level data: parent-reported asthma prevalence in their children (Nat'l Survey of Children’s Health, 2018-19 and 2020-21 datasets); age-adjusted COVID-19 mortality rates for all ages (CDC; 2020 & 2021); population proportion 5+ years old who completed the COVID-19 primary vaccination series by January 2022 (CDC); and requirements for facemasks in enclosed spaces through mid-2021 (Kaiser Family Fdn). We calculated a change score for childhood asthma prevalence and conducted t-tests, pairwise Pearson correlations and linear regression analyses.

Results: Overall, state-level prevalence of childhood asthma decreased from 7.77% (SD +/-1.54) in 2018-19 to 6.93% (+/-1.39) in 2020-21 (p <.0001), for an absolute mean change score of -0.85% (+/-1.26). The mean state-level COVID-19 mortality rate was 80.3 (SD +/-30.2) per 100,000 population in 2020, and 99.3 (SD +/-33.9) in 2021. The mean state-level COVID-19 primary series vaccination rate was 72.3% (SD +/-10.3). In mid-2021, 20 states and DC had facemask mandates. COVID-19 vaccination rates were inversely correlated with COVID-19 mortality rate in 2021 (r=-.75; p<.0001) but not in 2020 (r=-.20; p=.16), and were positively correlated with mask mandates (r=+.49; p<.0005). Change in state-level childhood asthma prevalence was associated with COVID-19 vaccination rates: with each 1 point increase in vaccination rate in persons 5+ years old, childhood asthma prevalence decreased by .04 percentage points (p <.05). Change in asthma prevalence was not significantly associated with contemporaneous COVID-19 mortality rates or facemask requirements.

Conclusion(s): Population-level COVID-19 vaccination may be associated with reductions in childhood asthma prevalence, which merits further assessment in more recent years.