Impact analysis of infant antibiotic exposure on the burden of asthma: a simulation modeling study

BackgroundInfant antibiotic use is associated with increased risk of asthma. We examined the population impact of antibiotic exposure in the first year of life on the burden of pediatric asthma in British Columbia, Canada, using simulation modeling.MethodsWe performed a Bayesian meta-analysis of emp...

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Main Authors: Tae Yoon Lee, John Petkau, Ariana Saatchi, Fawziah Marra, Stuart E. Turvey, Hannah Lishman, David M. Patrick, Jacquelyn J. Cragg, Kate M. Johnson, Mohsen Sadatsafavi
Format: Article
Language:English
Published: Frontiers Media S.A. 2024-12-01
Series:Frontiers in Allergy
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Online Access:https://www.frontiersin.org/articles/10.3389/falgy.2024.1491985/full
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author Tae Yoon Lee
Tae Yoon Lee
John Petkau
Ariana Saatchi
Fawziah Marra
Stuart E. Turvey
Hannah Lishman
David M. Patrick
Jacquelyn J. Cragg
Kate M. Johnson
Kate M. Johnson
Kate M. Johnson
Mohsen Sadatsafavi
Mohsen Sadatsafavi
author_facet Tae Yoon Lee
Tae Yoon Lee
John Petkau
Ariana Saatchi
Fawziah Marra
Stuart E. Turvey
Hannah Lishman
David M. Patrick
Jacquelyn J. Cragg
Kate M. Johnson
Kate M. Johnson
Kate M. Johnson
Mohsen Sadatsafavi
Mohsen Sadatsafavi
author_sort Tae Yoon Lee
collection DOAJ
description BackgroundInfant antibiotic use is associated with increased risk of asthma. We examined the population impact of antibiotic exposure in the first year of life on the burden of pediatric asthma in British Columbia, Canada, using simulation modeling.MethodsWe performed a Bayesian meta-analysis of empirical studies to construct dose-response equations between antibiotic exposure in the first year of life and pediatric (<19 years of age) asthma. We used administrative health data to document trends in infant (<1 year of age) antibiotic use in British Columbia during 2001 and 2018 (the study period). An independently developed microsimulation model of asthma was utilized to estimate asthma-related outcomes under three scenarios pertaining to the trends in antibiotic use during the study period: (1) observed trends, (2) flat trend in which the prescription rate remained at the 2001 value, and (3) intermediate trends midway between these two. We reported cumulative person-years with asthma, cumulative asthma incidence, and cumulative asthma exacerbations among the pediatric population during the study period.ResultsThere were 773,160 live births during the study period, with an average antibiotic prescription rate of 523 per 1,000 infants in the first year of life. The prescription rate decreased by 71.5% during the study period. In Scenario 1, there were 1,982,861 person-years with asthma, 183,392 asthma incident cases, and 383,072 exacerbations. Had the antibiotic exposure remained at the 2001 values (Scenario 2), there would have been additional 37,213 person-years with asthma, 10,053 asthma incident cases, and 23,280 exacerbations. Had the decline been half of the observed trend (Scenario 3), there would have been additional 20,318 person-years with asthma, 5,486 asthma incident cases, and 12,728 exacerbations. At least 80% of the excess burden in each outcome was attributable to the younger pediatric population of <10 years of age.ConclusionsThe decline in infant antibiotic exposure has resulted in a substantial reduction in the burden of asthma in British Columbia. Such benefits should be considered when evaluating the value proposition of initiatives aimed at reducing unnecessary antibiotic exposure in early life.
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spelling doaj-art-c9dcf35504f140889f5a616e707f527b2024-12-23T06:39:00ZengFrontiers Media S.A.Frontiers in Allergy2673-61012024-12-01510.3389/falgy.2024.14919851491985Impact analysis of infant antibiotic exposure on the burden of asthma: a simulation modeling studyTae Yoon Lee0Tae Yoon Lee1John Petkau2Ariana Saatchi3Fawziah Marra4Stuart E. Turvey5Hannah Lishman6David M. Patrick7Jacquelyn J. Cragg8Kate M. Johnson9Kate M. Johnson10Kate M. Johnson11Mohsen Sadatsafavi12Mohsen Sadatsafavi13Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, CanadaCollaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, CanadaDepartment of Statistics, Faculty of Science, University of British Columbia, Vancouver, BC, CanadaCollaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, CanadaCollaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, CanadaDivision of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia and British Columbia’s Children’s Hospital, Vancouver, BC, CanadaCommunity Antimicrobial Stewardship, BC Centre for Disease Control, Vancouver, BC, CanadaSchool of Population and Public Health, University of British Columbia and BC Centre for Disease Control, Vancouver, BC, CanadaCollaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, CanadaRespiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, CanadaCollaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, CanadaDivision of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, CanadaRespiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, CanadaCollaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, CanadaBackgroundInfant antibiotic use is associated with increased risk of asthma. We examined the population impact of antibiotic exposure in the first year of life on the burden of pediatric asthma in British Columbia, Canada, using simulation modeling.MethodsWe performed a Bayesian meta-analysis of empirical studies to construct dose-response equations between antibiotic exposure in the first year of life and pediatric (<19 years of age) asthma. We used administrative health data to document trends in infant (<1 year of age) antibiotic use in British Columbia during 2001 and 2018 (the study period). An independently developed microsimulation model of asthma was utilized to estimate asthma-related outcomes under three scenarios pertaining to the trends in antibiotic use during the study period: (1) observed trends, (2) flat trend in which the prescription rate remained at the 2001 value, and (3) intermediate trends midway between these two. We reported cumulative person-years with asthma, cumulative asthma incidence, and cumulative asthma exacerbations among the pediatric population during the study period.ResultsThere were 773,160 live births during the study period, with an average antibiotic prescription rate of 523 per 1,000 infants in the first year of life. The prescription rate decreased by 71.5% during the study period. In Scenario 1, there were 1,982,861 person-years with asthma, 183,392 asthma incident cases, and 383,072 exacerbations. Had the antibiotic exposure remained at the 2001 values (Scenario 2), there would have been additional 37,213 person-years with asthma, 10,053 asthma incident cases, and 23,280 exacerbations. Had the decline been half of the observed trend (Scenario 3), there would have been additional 20,318 person-years with asthma, 5,486 asthma incident cases, and 12,728 exacerbations. At least 80% of the excess burden in each outcome was attributable to the younger pediatric population of <10 years of age.ConclusionsThe decline in infant antibiotic exposure has resulted in a substantial reduction in the burden of asthma in British Columbia. Such benefits should be considered when evaluating the value proposition of initiatives aimed at reducing unnecessary antibiotic exposure in early life.https://www.frontiersin.org/articles/10.3389/falgy.2024.1491985/fullasthmaantibioticsearly lifeprojectionsimulation modeling
spellingShingle Tae Yoon Lee
Tae Yoon Lee
John Petkau
Ariana Saatchi
Fawziah Marra
Stuart E. Turvey
Hannah Lishman
David M. Patrick
Jacquelyn J. Cragg
Kate M. Johnson
Kate M. Johnson
Kate M. Johnson
Mohsen Sadatsafavi
Mohsen Sadatsafavi
Impact analysis of infant antibiotic exposure on the burden of asthma: a simulation modeling study
Frontiers in Allergy
asthma
antibiotics
early life
projection
simulation modeling
title Impact analysis of infant antibiotic exposure on the burden of asthma: a simulation modeling study
title_full Impact analysis of infant antibiotic exposure on the burden of asthma: a simulation modeling study
title_fullStr Impact analysis of infant antibiotic exposure on the burden of asthma: a simulation modeling study
title_full_unstemmed Impact analysis of infant antibiotic exposure on the burden of asthma: a simulation modeling study
title_short Impact analysis of infant antibiotic exposure on the burden of asthma: a simulation modeling study
title_sort impact analysis of infant antibiotic exposure on the burden of asthma a simulation modeling study
topic asthma
antibiotics
early life
projection
simulation modeling
url https://www.frontiersin.org/articles/10.3389/falgy.2024.1491985/full
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