Disability and Risk of Asthma in young adults : A Nationwide Population-Based Cohort Study

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However, the association between disability and asthma risk remains understudied in young adults. Methods We conducted a retrospective cohort study using data from the Korean National Health Information Database, including 5,369,424 adults aged 20 to 39 years who underwent health screening between 2009 and 2012. Incident asthma was identified using diagnostic codes, and multivariable Cox proportional hazards models were employed to assess its association with disability after adjusting for key demographic and clinical factors. Results Among 5,369,424 participants, 1.5% had a registered disability. During a median follow-up of 11.5 years, individuals with disabilities had modestly increased risk of developing asthma compared to those without disabilities (adjusted hazard ratio, 1.14; 95% confidence interval, 1.11–1.16). Stratified analyses showed elevated asthma risk in those with epilepsy, mental disorders, physical disabilities, and visual impairment, while autism spectrum disorder was associated with reduced risk. Conclusion Disability in young adults is associated with a modest increase in risk of incident asthma, with risk varying by disability type. These findings highlight the importance of inclusive health surveillance and further research into the underlying mechanisms. Trial registration Not applicable. asthma disability young adults epidemiology incidence Figures Figure 1 Introduction Asthma is a common chronic inflammatory airway disease that can develop at any age and is a major contributor to global morbidity and healthcare burden [1]. Although it is well recognized as a childhood-onset condition, increasing attention has been directed toward its high and rising incidence in young adults—a life stage generally considered to be characterized by good health and peak social productivity [2]. This growing concern highlights the importance of identifying and addressing modifiable risk factors specific to this population. While the pathogenesis of asthma is highly complex and heterogeneous, involving genetic, environmental, and immunological factors [3], increasing evidence suggests a role for social determinants of health, including disability status, that may influence both the development and progression of asthma [4]. In particular, young adults with disabilities may represent a uniquely vulnerable group due to disproportionately high rates of underlying health conditions such as obesity, difficulties with medication adherence without assistance, and overall younger age at diagnosis when compared to non-disabled populations [5]. Notably, several studies have demonstrated that children with disabilities, such as developmental delays, learning disabilities, or hearing and speech impairments, are at greater risk of developing asthma compared to their peers without disabilities [4, 6]. Multiple mechanisms have been proposed to explain this relationship. For instance, systemic hypoxia related to hearing loss has been suggested as a potential contributor to asthma pathophysiology [7]. In children with attention-deficit/hyperactivity disorder, chronic inflammation and elevated stress responses may increase susceptibility to asthma [8]. In addition, acute nonischemic hypoxia during asthma exacerbations has been postulated as a possible biological link between asthma and motor disabilities, such as seizure or cerebral palsy [9, 10]. However, most existing studies were limited by small sample sizes, cross-sectional designs, or a narrow focus on specific subgroups, making it difficult to draw generalizable conclusions regarding asthma risk in adults with disabilities [4, 6]. Moreover, little is known about this relationship in young adults with disabilities, who represent a growing and often underserved population. In this retrospective cohort study using nationwide health insurance claims and disability registration data, we aimed to investigate the association between disability and the risk of incident asthma in a large population of Korean adults aged 20 to 39 years. Furthermore, we performed stratified analyses to explore whether specific disability types are differentially associated with asthma development. Methods Data source This retrospective cohort study utilized the Korean National Health Information database, which covers nearly 97% of the Korean population [11]. Administered by the National Health Insurance Service (NHIS), the country’s sole national health insurer, the dataset includes disease diagnoses categorized according to the 10th revision of the International Classification of Diseases (ICD-10), demographic variables, economic factors, healthcare utilization (outpatient department visits, emergency room visits, hospitalization, and intensive care unit admission), health screening results (smoking status, alcohol consumption, and daily physical activity), medical treatments and procedures, and mortality data provided by Statistics Korea, an initiative of the Korean Ministry of Strategy and Finance. Study population From the NHIS database, a total of 6,891,401 individuals aged 20 to 39 years who underwent health screening between 2009 and 2012 were initially identified. After excluding 563,314 individuals with missing screening data and 2,409 individuals who died within one year of follow-up, 911,974 individuals with at least one healthcare utilization record for asthma (ICD-10: J45–J46) were also excluded. Among the remaining 5,413,704 individuals, an additional 44,280 were excluded based on a one-year of lag period. The final cohort comprised 5,369,424 individuals ( Supplementary Figure 1 ). This study was approved by the Institutional Review Board of Samsung Medical Center (IRB No. 2025-05-130). Informed consent was waived as we used a deidentified dataset. This study was conducted in accordance with the principles of the Declaration of Helsinki. Exposure: Disability The Korea National Disability Registration System (KNDRS), established in 1989, had registered approximately 2.645 million individuals as of 2021, accounting for about 5.1% of the total population [12]. The system legally defines 15 distinct types of disabilities, broadly categorized into physical and mental disabilities. Physical disabilities include impairments of external or internal bodily functions, while mental disabilities encompass developmental and psychiatric impairments. The 15 current disability types include impairments of the extremities, vision, hearing, speech and language, as well as disabilities due to brain injury, facial deformity, renal failure, heart disease, liver disease, respiratory disorders, ostomy, epilepsy, intellectual disability, autism, and mental disorders. In this study, disability types and severity were extracted from the KNDRS database for analysis. Outcome: Newly diagnosed Asthma The outcome was incident asthma, defined as three or more outpatient department visits with the corresponding diagnosis of asthma, coded under ICD-10 J45–J46 during the follow-up period [13-15]. Covariates Data on basic demographic characteristics (age and sex), health-related behaviors (smoking status and alcohol consumption), and comorbidities were obtained from the study dataset. Body mass index (BMI) was calculated as weight in kilograms divided by the square of height in meters (kg/m²). Alcohol consumption was categorized as none, mild (daily alcohol intake >0 and 0 and <20 g for women), or moderate (daily alcohol intake ≥30 g for men and ≥20 g for women). Comorbidities were defined based on clinical measurements, medication use, and diagnostic codes, as follows: Diabetes mellitus was defined as a fasting plasma glucose level ≥126 mg/dL or use of antidiabetic medications, along with ICD-10 codes E10–E14. Hypertension was defined as a systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or current use of antihypertensive medications in conjunction with relevant ICD-10 codes (I10–I13, I15). Dyslipidemia was defined as a total cholesterol level ≥240 mg/dL or use of lipid-lowering agents with ICD code E78. Atopy was defined as having ICD-10 code L20 with three or more outpatient visits or at least one hospitalization within one year. Allergic rhinitis was defined using ICD-10 codes J30.1–J30.4 with three or more outpatient visits or at least one hospitalization during the same period. Statistical analysis Descriptive statistics are presented as number (percentage) for categorical variables and as mean ± standard deviation for continuous variables. Group comparisons between individuals with and without disability were performed using the χ 2 test for categorical variables and the t-test for continuous variables. Multivariable Cox proportional hazards regression models were employed to investigate the association between disability and the incidence of asthma. Covariates adjusted for in the models included age, sex, BMI, household income level, smoking status, alcohol use, regular physical activity, atopy, and allergic rhinitis, considering the potential association of those factors with asthma [16, 17]. Subgroup analyses were further performed based on disability type. All statistical analyses were conducted using SAS software (SAS Institute Inc., Cary, NC, USA). Results Baseline characteristics Baseline demographic and health-related characteristics are presented in Table 1 . The study included 5,369,424 individuals, of whom 80,466 (1.5%) reported having a disability. Overall, the mean age was approximately 31 years, and over 60% were male. Compared to those without disability, individuals with disability were slightly older (32.25 vs. 30.73 years, P < .0001), more likely to be male (81.5% vs. 61.3%, P < .0001), and had a higher mean BMI (23.89 vs. 23.01 kg/m², P < .0001). The disability group had a higher rate of current smoking with ≥10 pack-years (19.8% vs. 13.5%) and a higher proportion of non-drinkers (43.4% vs. 36.7%), while mild alcohol consumption was more common among those without disability (53.2% vs. 45.2%) ( P < .0001 for both). Comorbidities including diabetes mellitus (3.9% vs. 1.9%), hypertension (13.1% vs. 7.6%), and dyslipidemia (9.3% vs. 6.8%) were significantly more prevalent in the disability group ( P < .0001 for all). Additionally, atopy (0.43% vs. 0.37%, P = .0075) and allergic rhinitis (3.8% vs. 3.4%, P < .0001) were also more frequent in the disability group. Disability and Asthma development The association between disability and the incidence of asthma is detailed in Table 2 . During a median follow-up period of 11.5 years (interquartile range, 10.1–12.2 years), approximately 10.28% of individuals with disabilities developed asthma, similar to the incidence observed among those without disabilities (10.35%). The unadjusted hazard ratio (HR) for asthma in individuals with disability was 1.00 (95% confidence interval [CI], 0.98–1.02), whereas the adjusted HR was 1.14 (95% CI, 1.11–1.16), after controlling for age, sex, BMI, household income level, smoking status, alcohol use, regular physical activity, atopy, and allergic rhinitis. When stratified by disability severity, individuals with mild disability (n = 52,003) showed an adjusted HR of 1.17 (95% CI, 1.14–1.20), while those with severe disability (n = 28,463) had an adjusted HR of 1.07 (95% CI, 1.03–1.11), indicating a modest but statistically significant increased risk of asthma in both groups compared with individuals without disability. These findings are further illustrated by the Kaplan–Meier survival curves shown in Figure 1 , which demonstrate a consistent pattern. Disability subtypes and Asthma development Table 3 presents a stratified analysis based on disability subtypes. Of the 15 subtypes examined, four showed a significantly higher risk of asthma compared to those without disabilities. Notably, individuals with epilepsy had a significantly increased adjusted HR of 1.38 (95% CI, 1.06–1.80) and mental disorders (HR, 1.19; 95% CI, 1.05–1.35) also showed elevated risks. Individuals with physical impairment had an adjusted HR of 1.18 (95% CI, 1.15–1.22) and those with visual impairment had an adjusted HR of 1.09 (95% CI, 1.03–1.16). In contrast, autism spectrum disorder was associated with a reduced risk of asthma (adjusted HR, 0.49; 95% CI, 0.31–0.77). Other subtypes, including brain injury disability, hearing and speech impairment, intellectual disability, renal or cardiac disorder, hepatic disorder, facial disability, and enterostomy or urostomy, did not show statistically significant associations. Individuals with respiratory disorder exhibited the highest incidence rate (22.11 per 1,000 pack year) and an elevated unadjusted HR (2.55; 95% CI, 1.11–5.88), though the adjusted HR did not reach statistical significance (2.36; 95% CI, 0.98–5.68), likely due to the small sample size (n = 23). Discussion In this large, nationwide cohort of Korean young adults, approximately 1.5% were identified as having a registered disability, and 10.3% of these individuals developed asthma over a median follow-up of 11.5 years. After adjusting for demographic, behavioral, and clinical factors, disability status was associated with increased risk of incident asthma; both mild and severe disabilities contributed to this risk, with a greater increase observed in the mild disability group. Subgroup analyses revealed that several specific types of disability, including epilepsy, mental disorders, physical impairments, and visual impairments were associated with higher asthma risk, whereas autism spectrum disorder was associated with reduced risk. Prior studies have reported the concurrent prevalence of asthma with various developmental disabilities and delays among children and adolescents [6, 18, 19]. Recent research in United States pediatric populations indicates that asthma risk is nearly three times higher in children with disabilities and twice as high in those with developmental delays compared to typically growing children [4]. Despite the limited large-scale evidence in adult populations, especially in early adulthood, our findings build on pediatric research by highlighting similar patterns in young adults, a group often overlooked in disability-related asthma studies. Patients with epilepsy also exhibited increased risk of developing asthma in our study, with an adjusted HR of 1.38. This finding is consistent with previous findings indicating that individuals diagnosed with epilepsy at ages 0–10 and 31–40 are at elevated risk for subsequent asthma [20]. Additionally, prior research reported that individuals with a history of seizures had an adjusted odds ratio of 2.43 (95% CI, 1.52–3.89) for developing asthma [4]. Chronic respiratory problems are also well-documented among children with neurological impairments [10]. One potential shared mechanism linking epilepsy and asthma is chronic inflammation, which has also been implicated in the bidirectional relationship between mental disorders and asthma. Elevated levels of cytokines have been associated with both chronic neuroinflammation and neuronal damage in epilepsy [21], and these inflammatory mediators are overexpressed in the asthmatic bronchial epithelium [22]. This suggests that cytokine-driven inflammatory pathways may represent a crucial common mechanism underlying both conditions. In the present study, individuals with mental disorders demonstrated increased risk of developing asthma with an adjusted HR of 1.19. This finding aligns with previous evidence suggesting a bidirectional relationship between asthma and mental health conditions [23]. A prior diagnosis of mental illness has been associated with elevated hazard ratios for developing asthma ranging from 1.06 (95% CI, 1.00–1.12) for developmental disorders to 2.33 (95% CI, 2.28–2.39) for substance use disorders [23]. Although the underlying mechanisms are not yet fully understood, several shared pathophysiological pathways have been proposed. Both asthma and mental disorders are linked to chronic inflammation, with elevated levels of cytokines and increased expression of cytokine-related receptors in the peripheral blood and cerebrospinal fluid [24]. They also share common environmental exposures, including air pollution and smoking, as well as genetic susceptibilities [25]. Moreover, increasing evidence suggests that psychosocial factors play a role in asthma pathophysiology. Studies have shown that negative affect and acute stress may exacerbate airway inflammation, as reflected by increased levels of fractional exhaled nitric oxide, and are associated with declines in lung function among adults with asthma [26]. In addition, autonomic nervous system dysregulation, which is commonly observed in depression, has been implicated in asthma, with the parasympathetic branch contributing to bronchoconstriction and autonomic nervous system abnormalities linked to bronchodilator resistance and airway hyperresponsiveness [27]. In our study, young adults with physical impairments showed 1.18-fold increased risk of asthma compared to those without disabilities. In the KNDRS database, physical impairments comprise disabilities of the extremities, including conditions such as limb dysfunction and spinal disorders [12]. According to previous studies in pediatric populations, spine and thoracic cage deformities, such as scoliosis, have been linked to a high prevalence of ventilatory defects. More than half of children with these deformities exhibit obstructive, restrictive, or mixed ventilatory patterns, with obstructive lung disease reported in approximately 30% and asthma diagnosed in about one-third of those with reduced FEV₁/FVC ratios or decreased FEV₁ [28, 29]. The mechanisms underlying airway obstruction may include compression of a mainstem bronchus by distorted spinal and mediastinal structures, resulting in reduced expiratory flow and increased airway resistance [30, 31]. Additional contributing factors include chronic airway inflammation caused by impaired clearance of secretions [32], and pulmonary hypoplasia due to thoracic deformities during periods of rapid lung growth, as reflected by reduced alveolar development and decreased number of pulmonary vessels [33, 34]. Also, individuals with visual impairments exhibited 1.09-fold higher risk of developing asthma compared to those without disabilities. In a previous study conducted in a United States pediatric population, children with blindness had a significantly higher likelihood of asthma, with an adjusted odds ratio of 1.61 (95% confidence interval, 1.06 to 2.45) [4]. In contrast, studies in adult populations have reported increased risk of visual impairment among individuals with asthma [35, 36], but research examining the risk of asthma among individuals with preexisting visual impairments remains limited. Moreover, the biological mechanisms underlying the increased risk of asthma in this population remain poorly understood and will require further investigation. Our findings have important public health implications, suggesting that young adults with disabilities may be at increased risk for developing asthma. The importance of identifying asthma across all age groups has been increasingly recognized. In particular, early diagnosis in childhood is critical, as children with asthma frequently experience an accelerated decline in lung function during early adulthood [37]. Early recognition and intervention have been associated with improved quality of life, enhanced daily functioning, and a reduction in acute exacerbations and overall health care utilization [38, 39]. Furthermore, a recent study demonstrated that identifying adults in the community who exhibit respiratory symptoms without a formal asthma diagnosis and providing them with timely specialist-directed care can result in a significant reduction in subsequent healthcare usage for respiratory conditions [40]. These findings support the integration of routine surveillance for respiratory symptoms and early diagnostic assessments, including pulmonary function testing, into standard clinical care. Such strategies may be particularly valuable for young adults with disabilities, who appear to represent a population at elevated risk. This study has several strengths, including the use of a large and nationally representative dataset that covers nearly the entire Korean population, comprehensive classification of disability type and severity, and an extended duration of follow-up (over ten years). However, certain limitations should be acknowledged. First, asthma diagnoses were based on claims data, which may not accurately reflect disease severity or level of symptom control. Second, unmeasured confounders, such as environmental factors, genetic predisposition, or variability in treatment adherence, may have influenced the observed associations. Third, because this dataset is derived from a single country’s healthcare infrastructure, the findings may have limited generalizability to other populations. Disability in young adults is associated with increased risk of incident asthma, with variation by disability type. These findings underscore the need for inclusive health monitoring and targeted research to elucidate the mechanisms linking disability and respiratory health in different age groups. Declarations Ethics approval and consent to participate This study was approved by the Institutional Review Board of Samsung Medical Center (IRB No. 2025-05-130). The requirement for informed consent was waived by the Institutional Review Board of Samsung Medical Center because this study used deidentified nationwide claims data. Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are available from the Korean National Health Insurance Service, but restrictions apply to the availability of these data. Competing interests The authors declare that they have no competing interests. Funding None. Trial registration Not applicable. References Yuan L, Tao J, Wang J, She W, Zou Y, Li R, Ma Y, Sun C, Bi S, Wei S et al. Global, regional, national burden of asthma from 1990 to 2021, with projections of incidence to 2050: a systematic analysis of the global burden of disease study 2021. EClinicalMedicine 2025, 80:103051. Yang CH, Lv JJ, Li XY, Yang XT, Yin MY. 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Baseline characteristics of the study population Total (N = 5,369,424) Disability No (n = 5,288,958) Yes (n = 80,466) P value Age, years 30.75 ± 4.98 30.73 ± 4.97 32.25 ± 4.98 <.0001 20-29 2,316,311 (43.14) 2,292,889 (43.35) 23,422 (29.11) <.0001 30-39 3,053,113 (56.86) 2,996,069 (56.65) 57,044 (70.89) Sex, Male 3,306,895 (61.59) 3,241,285 (61.28) 65,610 (81.54) <.0001 Body mass index, kg/m 2 23.02 ± 3.6 23.01 ± 3.59 23.89 ± 3.91 <.0001 <18.5 400,760 (7.46) 395,863 (7.48) 4,897 (6.09) <23 2,495,458 (46.48) 2,465,568 (46.62) 29,890 (37.15) <25 1,041,130 (19.39) 1,024,402 (19.37) 16,728 (20.79) ≥25 1,432,076 (26.67) 1,403,125 (26.53) 28,951 (35.98) Smoking status <.0001 Never smoker 2,861,111 (53.29) 2,823,738 (53.39) 37,373 (46.45) Ex smoker, <10 pack years 429,818 (8) 423,274 (8) 6,544 (8.13) Ex smoker, ≥10 pack years 126,265 (2.35) 123,286 (2.33) 2,979 (3.7) Current smoker, <10 pack years 1,224,167 (22.8) 1,206,553 (22.81) 17,614 (21.89) Current smoker, ≥10 pack years 728,063 (13.56) 712,107 (13.46) 15,956 (19.83) Alcohol consumption <.0001 None 1,973,340 (36.75) 1,938,430 (36.65) 34,910 (43.38) Mild 2,850,904 (53.1) 2,814,534 (53.22) 36,370 (45.2) Moderate 545,180 (10.15) 535,994 (10.13) 9,186 (11.42) Income, the lowest 25% 1,136,638 (21.17) 1,108,727 (20.96) 27,911 (34.69) <.0001 Regular exercise * 694,235 (12.93) 681,598 (12.98) 12,637 (15.7) <.0001 Comorbidities Diabetes mellitus 104,034 (1.94) 100,920 (1.91) 3,114 (3.87) <.0001 Hypertension 410,424 (7.64) 399,879 (7.56) 10,545 (13.1) <.0001 Dyslipidemia 365,652 (6.81) 358,158 (6.77) 7,494 (9.31) <.0001 Atopy 20,086 (0.37) 19,739 (0.37) 347 (0.43) 0.0075 Allergic rhinitis 180,632 (3.36) 177,577 (3.36) 3,055 (3.8) <.0001 * Regular exercise, mid-term exercise ≥ 5 days or vigorous exercise ≥ 3 days in a week. Table 2. The association between disability and risk of asthma development Number of subjects Number with asthma IR per 1,000 PY Unadjusted HR (95% CI) Adjusted HR * (95% CI) Without disability 5,288,958 547,525 9.65 1 (Reference) 1 (Reference) With disability 80,466 8,271 9.67 1 (0.98–1.02) 1.14 (1.11–1.16) Mild 52,003 5,375 9.62 1 (0.97–1.03) 1.17 (1.14–1.20) Severe 28,463 2,896 9.76 1 (0.96–1.04) 1.07 (1.03–1.11) * Adjusted for age, sex, body mass index, household income level, smoking status, alcohol use, regular physical activity, atopy, and allergic rhinitis Abbreviations: IR = incidence rate, PY = person-years, HR = hazard ratio, CI = confidence interval. Table 3. Incidence rates and hazard ratios for asthma according to disability status and subtype Number of subjects Number with asthma IR per 1,000 PY Unadjusted HR (95% CI) Adjusted HR * (95% CI) Without disability 5,288,958 547,525 9.65 1 (Reference) 1 (Reference) Disability subtypes Physical impairment 45,707 4,745 9.66 1.01 (0.98–1.03) 1.18 (1.15–1.22) Brain injury disability 2,661 269 9.69 1.00 (0.88–1.12) 1.09 (0.97–1.23) Visual impairment 10,060 997 9.24 0.96 (0.90–1.02) 1.09 (1.03–1.16) Hearing impairment 5,873 629 9.93 1.03 (0.96–1.12) 1.07 (0.99–1.16) Speech impairment 905 92 9.45 0.99 (0.80–1.21) 1.12 (0.91–1.37) Intellectual disability 10,391 1,046 9.85 1.00 (0.94–1.07) 1.06 (0.99–1.12) Autism spectrum disorder 413 18 4.18 0.44 (0.28–0.69) 0.49 (0.31–0.77) Mental disorder 2,104 239 11.44 1.16 (1.02–1.32) 1.19 (1.05–1.35) Renal disorder 1,145 105 8.78 0.90 (0.75–1.09) 0.93 (0.77–1.13) Cardiac disorder 184 20 10.46 1.08 (0.70–1.67) 1.14 (0.73–1.76) Respiratory disorder 23 5 22.11 2.55 (1.11–5.88) 2.36 (0.98–5.68) Hepatic disorder 79 10 12.57 1.30 (0.70–2.41) 1.43 (0.77–2.66) Facial disability 278 29 9.86 1.02 (0.71–1.46) 1.12 (0.78–1.62) Enterostomy or urostomy 204 13 6.31 0.64 (0.37–1.10) 0.73 (0.43–1.26) Epilepsy 439 54 12.38 1.27 (0.98–1.66) 1.38 (1.06–1.80) * Adjusted for age, sex, body mass index, household income level, smoking status, alcohol use, regular physical activity, atopy, and allergic rhinitis Abbreviations: IR = incidence rate, PY = person-years, HR = hazard ratio, CI = confidence interval. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFigure.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 19 May, 2026 Reviews received at journal 08 May, 2026 Reviewers agreed at journal 05 May, 2026 Reviewers agreed at journal 09 Apr, 2026 Reviews received at journal 06 Apr, 2026 Reviewers agreed at journal 06 Apr, 2026 Reviewers invited by journal 28 Mar, 2026 Editor invited by journal 16 Mar, 2026 Editor assigned by journal 13 Mar, 2026 Submission checks completed at journal 13 Mar, 2026 First submitted to journal 01 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9001727","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":615113188,"identity":"9085ed13-5581-4ea5-a2d4-d777e1e54df1","order_by":0,"name":"Sungmin Zo","email":"","orcid":"","institution":"Korea University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Sungmin","middleName":"","lastName":"Zo","suffix":""},{"id":615113189,"identity":"172556ee-8065-4dcc-b2b3-c9da2219a132","order_by":1,"name":"In Young Cho","email":"","orcid":"","institution":"Samsung Medical Center","correspondingAuthor":false,"prefix":"","firstName":"In","middleName":"Young","lastName":"Cho","suffix":""},{"id":615113191,"identity":"d1f35486-db50-43fa-9f34-c54e83bcde8e","order_by":2,"name":"Kyungdo Han","email":"","orcid":"","institution":"Soongsil University","correspondingAuthor":false,"prefix":"","firstName":"Kyungdo","middleName":"","lastName":"Han","suffix":""},{"id":615113192,"identity":"cb7a6533-f798-4872-a2a0-9e28b81fe1d2","order_by":3,"name":"Dong Wook Shin","email":"","orcid":"","institution":"Samsung Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Dong","middleName":"Wook","lastName":"Shin","suffix":""},{"id":615113193,"identity":"b9892454-12de-4c8a-ac3a-ab91a5047f52","order_by":4,"name":"Hyun Lee","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYJACZjjrA8laGGeQrIWZhxjl5uyn06QLau7IGxzvMXxsu8MusV/6AOOHjzm4tVj25G6TnnHsmeGGM2eMjXPPJCfO7Etglpy5DbcWgwNALTxshxk33Mgxk85tYzY2OMPAxsyLT8v5t0At/w7bb7j/xkzasq3e2J6glhtAW3jbDiduuMFjJs3YdljOgIeglrebrXn7DifPPJNWbNjbdlxO4gxjM36/nM/deJvn22HbvuOHNz742VbNw9/DfPDDRzxa4EDhAIcBlMnYQIR6IJBvYH9AnMpRMApGwSgYcQAAqTZSDbF2rjYAAAAASUVORK5CYII=","orcid":"","institution":"Hanyang University Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Hyun","middleName":"","lastName":"Lee","suffix":""}],"badges":[],"createdAt":"2026-03-01 13:23:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9001727/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9001727/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106058091,"identity":"a87710ed-f0ff-4cbf-aa53-9a27e9a259fa","added_by":"auto","created_at":"2026-04-03 02:16:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":438203,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier curves for the asthma development according to the presence or absence of disability in young adults\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-9001727/v1/6b11fe0936e33cd05e120f6a.png"},{"id":106094694,"identity":"56ec1327-39a7-4fad-a026-544624032b94","added_by":"auto","created_at":"2026-04-03 11:43:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1198428,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9001727/v1/aa58b016-63b6-47ec-95a7-3fc3a102218b.pdf"},{"id":106058090,"identity":"46d09cc5-ee0f-40a9-86d9-2be361c1115a","added_by":"auto","created_at":"2026-04-03 02:16:01","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":35054,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFigure.docx","url":"https://assets-eu.researchsquare.com/files/rs-9001727/v1/ab71ac60699de7d4bbcd8f43.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Disability and Risk of Asthma in young adults : A Nationwide Population-Based Cohort Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAsthma is a common chronic inflammatory airway disease that can develop at any age and is a major contributor to global morbidity and healthcare burden [1]. Although it is well recognized as a childhood-onset condition, increasing attention has been directed toward its high and rising incidence in young adults—a life stage generally considered to be characterized by good health and peak social productivity [2]. This growing concern highlights the importance of identifying and addressing modifiable risk factors specific to this population.\u003c/p\u003e\n\u003cp\u003eWhile the pathogenesis of asthma is highly complex and heterogeneous, involving genetic, environmental, and immunological factors [3], increasing evidence suggests a role for social determinants of health, including disability status, that may influence both the development and progression of asthma [4]. In particular, young adults with disabilities may represent a uniquely vulnerable group due to disproportionately high rates of underlying health conditions such as obesity, difficulties with medication adherence without assistance, and overall younger age at diagnosis when compared to non-disabled populations [5]. Notably, several studies have demonstrated that children with disabilities, such as developmental delays, learning disabilities, or hearing and speech impairments, are at greater risk of developing asthma compared to their peers without disabilities [4, 6]. Multiple mechanisms have been proposed to explain this relationship. For instance, systemic hypoxia related to hearing loss has been suggested as a potential contributor to asthma pathophysiology [7]. In children with attention-deficit/hyperactivity disorder, chronic inflammation and elevated stress responses may increase susceptibility to asthma [8]. In addition, acute nonischemic hypoxia during asthma exacerbations has been postulated as a possible biological link between asthma and motor disabilities, such as seizure or cerebral palsy [9, 10]. However, most existing studies were limited by small sample sizes, cross-sectional designs, or a narrow focus on specific subgroups, making it difficult to draw generalizable conclusions regarding asthma risk in adults with disabilities [4, 6]. Moreover, little is known about this relationship in young adults with disabilities, who represent a growing and often underserved population.\u003c/p\u003e\n\u003cp\u003eIn this retrospective cohort study using nationwide health insurance claims and disability registration data, we aimed to investigate the association between disability and the risk of incident asthma in a large population of Korean adults aged 20 to 39 years. Furthermore, we performed stratified analyses to explore whether specific disability types are differentially associated with asthma development.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData source\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective cohort study utilized the Korean National Health Information database, which covers nearly 97% of the Korean population [11]. Administered by the National Health Insurance Service (NHIS), the country’s sole national health insurer, the dataset includes disease diagnoses categorized according to the 10th revision of the International Classification of Diseases (ICD-10), demographic variables, economic factors, healthcare utilization (outpatient department visits, emergency room visits, hospitalization, and intensive care unit admission), health screening results (smoking status, alcohol consumption, and daily physical activity), medical treatments and procedures, and mortality data provided by Statistics Korea, an initiative of the Korean Ministry of Strategy and Finance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy population\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom the NHIS database, a total of 6,891,401 individuals aged 20 to 39 years who underwent health screening between 2009 and 2012 were initially identified. After excluding 563,314 individuals with missing screening data and 2,409 individuals who died within one year of follow-up, 911,974 individuals with at least one healthcare utilization record for asthma (ICD-10: J45–J46) were also excluded. Among the remaining 5,413,704 individuals, an additional 44,280 were excluded based on a one-year of lag period. The final cohort comprised 5,369,424 individuals (\u003cstrong\u003eSupplementary\u003c/strong\u003e \u003cstrong\u003eFigure 1\u003c/strong\u003e). This study was approved by the Institutional Review Board of Samsung Medical Center (IRB No. 2025-05-130). Informed consent was waived as we used a deidentified dataset. This study was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eExposure: Disability\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Korea National Disability Registration System (KNDRS), established in 1989, had registered approximately 2.645 million individuals as of 2021, accounting for about 5.1% of the total population [12]. The system legally defines 15 distinct types of disabilities, broadly categorized into physical and mental disabilities. Physical disabilities include impairments of external or internal bodily functions, while mental disabilities encompass developmental and psychiatric impairments. The 15 current disability types include impairments of the extremities, vision, hearing, speech and language, as well as disabilities due to brain injury, facial deformity, renal failure, heart disease, liver disease, respiratory disorders, ostomy, epilepsy, intellectual disability, autism, and mental disorders. In this study, disability types and severity were extracted from the KNDRS database for analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eOutcome: Newly diagnosed Asthma\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe outcome was incident asthma, defined as three or more outpatient department visits with the corresponding diagnosis of asthma, coded under ICD-10 J45–J46 during the follow-up period [13-15].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCovariates\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData on basic demographic characteristics (age and sex), health-related behaviors (smoking status and alcohol consumption), and comorbidities were obtained from the study dataset. Body mass index (BMI) was calculated as weight in kilograms divided by the square of height in meters (kg/m²). Alcohol consumption was categorized as none, mild (daily alcohol intake \u0026gt;0 and \u0026lt;30 g for men, \u0026gt;0 and \u0026lt;20 g for women), or moderate (daily alcohol intake ≥30 g for men and ≥20 g for women).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eComorbidities were defined based on clinical measurements, medication use, and diagnostic codes, as follows: Diabetes mellitus was defined as a fasting plasma glucose level ≥126 mg/dL or use of antidiabetic medications, along with ICD-10 codes E10–E14. Hypertension was defined as a systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or current use of antihypertensive medications in conjunction with relevant ICD-10 codes (I10–I13, I15). Dyslipidemia was defined as a total cholesterol level ≥240 mg/dL or use of lipid-lowering agents with ICD code E78. Atopy was defined as having ICD-10 code L20 with three or more outpatient visits or at least one hospitalization within one year. Allergic rhinitis was defined using ICD-10 codes J30.1–J30.4 with three or more outpatient visits or at least one hospitalization during the same period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics are presented as number (percentage) for categorical variables and as mean ± standard deviation for continuous variables. Group comparisons between individuals with and without disability were performed using the χ\u003csup\u003e2\u003c/sup\u003e test for categorical variables and the t-test for continuous variables. Multivariable Cox proportional hazards regression models were employed to investigate the association between disability and the incidence of asthma. Covariates adjusted for in the models included age, sex, BMI, household income level, smoking status, alcohol use, regular physical activity, atopy, and allergic rhinitis, considering the potential association of those factors with asthma [16, 17]. Subgroup analyses were further performed based on disability type. All statistical analyses were conducted using SAS software (SAS Institute Inc., Cary, NC, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eBaseline characteristics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBaseline demographic and health-related characteristics are presented in \u003cstrong\u003eTable 1\u003c/strong\u003e. The study included 5,369,424 individuals, of whom 80,466 (1.5%) reported having a disability. Overall, the mean age was approximately 31 years, and over 60% were male. Compared to those without disability, individuals with disability were slightly older (32.25 vs. 30.73 years, \u003cem\u003eP\u003c/em\u003e \u0026lt; .0001), more likely to be male (81.5% vs. 61.3%, \u003cem\u003eP\u003c/em\u003e \u0026lt; .0001), and had a higher mean BMI (23.89 vs. 23.01 kg/m², \u003cem\u003eP\u003c/em\u003e \u0026lt; .0001). The disability group had a higher rate of current smoking with ≥10 pack-years (19.8% vs. 13.5%) and a higher proportion of non-drinkers (43.4% vs. 36.7%), while mild alcohol consumption was more common among those without disability (53.2% vs. 45.2%) (\u003cem\u003eP\u003c/em\u003e \u0026lt; .0001 for both). Comorbidities including diabetes mellitus (3.9% vs. 1.9%), hypertension (13.1% vs. 7.6%), and dyslipidemia (9.3% vs. 6.8%) were significantly more prevalent in the disability group (\u003cem\u003eP\u003c/em\u003e \u0026lt; .0001 for all). Additionally, atopy (0.43% vs. 0.37%, \u003cem\u003eP\u003c/em\u003e = .0075) and allergic rhinitis (3.8% vs. 3.4%, \u003cem\u003eP\u003c/em\u003e \u0026lt; .0001) were also more frequent in the disability group.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDisability and Asthma development\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe association between disability and the incidence of asthma is detailed in \u003cstrong\u003eTable 2\u003c/strong\u003e. During a median follow-up period of 11.5 years (interquartile range, 10.1–12.2 years), approximately 10.28% of individuals with disabilities developed asthma, similar to the incidence observed among those without disabilities (10.35%). The unadjusted hazard ratio (HR) for asthma in individuals with disability was 1.00 (95% confidence interval [CI], 0.98–1.02), whereas the adjusted HR was 1.14 (95% CI, 1.11–1.16), after controlling for age, sex, BMI, household income level, smoking status, alcohol use, regular physical activity, atopy, and allergic rhinitis. When stratified by disability severity, individuals with mild disability (n = 52,003) showed an adjusted HR of 1.17 (95% CI, 1.14–1.20), while those with severe disability (n = 28,463) had an adjusted HR of 1.07 (95% CI, 1.03–1.11), indicating a modest but statistically significant increased risk of asthma in both groups compared with individuals without disability. These findings are further illustrated by the Kaplan–Meier survival curves shown in \u003cstrong\u003eFigure 1\u003c/strong\u003e, which demonstrate a consistent pattern.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDisability subtypes and Asthma development\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e presents a stratified analysis based on disability subtypes. Of the 15 subtypes examined, four showed a significantly higher risk of asthma compared to those without disabilities. Notably, individuals with epilepsy had a significantly increased adjusted HR of 1.38 (95% CI, 1.06–1.80) and mental disorders (HR, 1.19; 95% CI, 1.05–1.35) also showed elevated risks. Individuals with physical impairment had an adjusted HR of 1.18 (95% CI, 1.15–1.22) and those with visual impairment had an adjusted HR of 1.09 (95% CI, 1.03–1.16). In contrast, autism spectrum disorder was associated with a reduced risk of asthma (adjusted HR, 0.49; 95% CI, 0.31–0.77). Other subtypes, including brain injury disability, hearing and speech impairment, intellectual disability, renal or cardiac disorder, hepatic disorder, facial disability, and enterostomy or urostomy, did not show statistically significant associations. Individuals with respiratory disorder exhibited the highest incidence rate (22.11 per 1,000 pack year) and an elevated unadjusted HR (2.55; 95% CI, 1.11–5.88), though the adjusted HR did not reach statistical significance (2.36; 95% CI, 0.98–5.68), likely due to the small sample size (n = 23).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this large, nationwide cohort of Korean young adults, approximately 1.5% were identified as having a registered disability, and 10.3% of these individuals developed asthma over a median follow-up of 11.5 years. After adjusting for demographic, behavioral, and clinical factors, disability status was associated with increased risk of incident asthma; both mild and severe disabilities contributed to this risk, with a greater increase observed in the mild disability group. Subgroup analyses revealed that several specific types of disability, including epilepsy, mental disorders, physical impairments, and visual impairments were associated with higher asthma risk, whereas autism spectrum disorder was associated with reduced risk.\u003c/p\u003e\n\u003cp\u003ePrior studies have reported the concurrent prevalence of asthma with various developmental disabilities and delays among children and adolescents [6, 18, 19]. Recent research in United States pediatric populations indicates that asthma risk is nearly three times higher in children with disabilities and twice as high in those with developmental delays compared to typically growing children [4]. Despite the limited large-scale evidence in adult populations, especially in early adulthood, our findings build on pediatric research by highlighting similar patterns in young adults, a group often overlooked in disability-related asthma studies.\u003c/p\u003e\n\u003cp\u003ePatients with epilepsy also exhibited increased risk of developing asthma in our study, with an adjusted HR of 1.38. This finding is consistent with previous findings indicating that individuals diagnosed with epilepsy at ages 0–10 and 31–40 are at elevated risk for subsequent asthma [20]. Additionally, prior research reported that individuals with a history of seizures had an adjusted odds ratio of 2.43 (95% CI, 1.52–3.89) for developing asthma [4]. Chronic respiratory problems are also well-documented among children with neurological impairments [10]. One potential shared mechanism linking epilepsy and asthma is chronic inflammation, which has also been implicated in the bidirectional relationship between mental disorders and asthma. Elevated levels of cytokines have been associated with both chronic neuroinflammation and neuronal damage in epilepsy [21], and these inflammatory mediators are overexpressed in the asthmatic bronchial epithelium [22]. This suggests that cytokine-driven inflammatory pathways may represent a crucial common mechanism underlying both conditions.\u003c/p\u003e\n\u003cp\u003eIn the present study, individuals with mental disorders demonstrated increased risk of developing asthma with an adjusted HR of 1.19. This finding aligns with previous evidence suggesting a bidirectional relationship between asthma and mental health conditions [23]. A prior diagnosis of mental illness has been associated with elevated hazard ratios for developing asthma ranging from 1.06 (95% CI, 1.00–1.12) for developmental disorders to 2.33 (95% CI, 2.28–2.39) for substance use disorders [23]. Although the underlying mechanisms are not yet fully understood, several shared pathophysiological pathways have been proposed. Both asthma and mental disorders are linked to chronic inflammation, with elevated levels of cytokines and increased expression of cytokine-related receptors in the peripheral blood and cerebrospinal fluid [24]. They also share common environmental exposures, including air pollution and smoking, as well as genetic susceptibilities [25]. Moreover, increasing evidence suggests that psychosocial factors play a role in asthma pathophysiology. Studies have shown that negative affect and acute stress may exacerbate airway inflammation, as reflected by increased levels of fractional exhaled nitric oxide, and are associated with declines in lung function among adults with asthma [26]. In addition, autonomic nervous system dysregulation, which is commonly observed in depression, has been implicated in asthma, with the parasympathetic branch contributing to bronchoconstriction and autonomic nervous system abnormalities linked to bronchodilator resistance and airway hyperresponsiveness [27].\u003c/p\u003e\n\u003cp\u003eIn our study, young adults with physical impairments showed 1.18-fold increased risk of asthma compared to those without disabilities. In the KNDRS database, physical impairments comprise disabilities of the extremities, including conditions such as limb dysfunction and spinal disorders [12].\u0026nbsp;According to previous studies in pediatric populations, spine and thoracic cage deformities, such as scoliosis, have been linked to a high prevalence of ventilatory defects. More than half of children with these deformities exhibit obstructive, restrictive, or mixed ventilatory patterns, with obstructive lung disease reported in approximately 30% and asthma diagnosed in about one-third of those with reduced FEV₁/FVC ratios or decreased FEV₁\u0026nbsp;[28, 29]. The mechanisms underlying airway obstruction may include compression of a mainstem bronchus by distorted spinal and mediastinal structures, resulting in reduced expiratory flow and increased airway resistance\u0026nbsp;[30, 31]. Additional contributing factors include chronic airway inflammation caused by impaired clearance of secretions\u0026nbsp;[32], and pulmonary hypoplasia due to thoracic deformities during periods of rapid lung growth, as reflected by reduced alveolar development and decreased number of pulmonary vessels\u0026nbsp;[33, 34].\u003c/p\u003e\n\u003cp\u003eAlso, individuals with visual impairments exhibited 1.09-fold higher risk of developing asthma compared to those without disabilities. In a previous study conducted in a United States pediatric population, children with blindness had a significantly higher likelihood of asthma, with an adjusted odds ratio of 1.61 (95% confidence interval, 1.06 to 2.45) [4]. In contrast, studies in adult populations have reported increased risk of visual impairment among individuals with asthma [35, 36], but research examining the risk of asthma among individuals with preexisting visual impairments remains limited. Moreover, the biological mechanisms underlying the increased risk of asthma in this population remain poorly understood and will require further investigation.\u003c/p\u003e\n\u003cp\u003eOur findings have important public health implications, suggesting that young adults with disabilities may be at increased risk for developing asthma. The importance of identifying asthma across all age groups has been increasingly recognized. In particular, early diagnosis in childhood is critical, as children with asthma frequently experience an accelerated decline in lung function during early adulthood [37]. Early recognition and intervention have been associated with improved quality of life, enhanced daily functioning, and a reduction in acute exacerbations and overall health care utilization [38, 39]. Furthermore, a recent study demonstrated that identifying adults in the community who exhibit respiratory symptoms without a formal asthma diagnosis and providing them with timely specialist-directed care can result in a significant reduction in subsequent healthcare usage for respiratory conditions [40]. These findings support the integration of routine surveillance for respiratory symptoms and early diagnostic assessments, including pulmonary function testing, into standard clinical care. Such strategies may be particularly valuable for young adults with disabilities, who appear to represent a population at elevated risk.\u003c/p\u003e\n\u003cp\u003eThis study has several strengths, including the use of a large and nationally representative dataset that covers nearly the entire Korean population, comprehensive classification of disability type and severity, and an extended duration of follow-up (over ten years). However, certain limitations should be acknowledged. First, asthma diagnoses were based on claims data, which may not accurately reflect disease severity or level of symptom control. Second, unmeasured confounders, such as environmental factors, genetic predisposition, or variability in treatment adherence, may have influenced the observed associations. Third, because this dataset is derived from a single country’s healthcare infrastructure, the findings may have limited generalizability to other populations.\u003c/p\u003e\n\u003cp\u003eDisability in young adults is associated with increased risk of incident asthma, with variation by disability type. These findings underscore the need for inclusive health monitoring and targeted research to elucidate the mechanisms linking disability and respiratory health in different age groups.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board of Samsung Medical Center (IRB No. 2025-05-130). The requirement for informed consent was waived by the Institutional Review Board of Samsung Medical Center because this study used deidentified nationwide claims data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the Korean National Health Insurance Service, but restrictions apply to the availability of these data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eYuan L, Tao J, Wang J, She W, Zou Y, Li R, Ma Y, Sun C, Bi S, Wei S et al. Global, regional, national burden of asthma from 1990 to 2021, with projections of incidence to 2050: a systematic analysis of the global burden of disease study 2021. \u003cem\u003eEClinicalMedicine\u003c/em\u003e 2025, 80:103051.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang CH, Lv JJ, Li XY, Yang XT, Yin MY. Global burden of asthma in young adults in 204 countries and territories, 1990\u0026ndash;2019: Systematic analysis of the Global burden of disease study 2019. Prev Med Rep. 2024;37:102531.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHizawa N. The understanding of asthma pathogenesis in the era of precision medicine. Allergol Int. 2023;72(1):3\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXie L, Gelfand A, Delclos GL, Atem FD, Kohl HW 3rd, Messiah SE. Estimated Prevalence of Asthma in US Children With Developmental Disabilities. JAMA Netw Open. 2020;3(6):e207728.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMastebroek M, Everlo NCM, Cuypers M, Bischoff E, Schalk BWM. Asthma and COPD management of patients with intellectual disabilities in general practice. NPJ Prim Care Respir Med. 2024;34(1):15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArif AA, Korgaonkar P. The association of childhood asthma with mental health and developmental comorbidities in low-income families. J Asthma. 2016;53(3):277\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKilic T, Karatas E, Toplu Y, Koc A, Bulam N, Kaya O. Evaluation of auditory functions in patients with asthma. Eur Rev Med Pharmacol Sci. 2014;18(18):2615\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou RY, Wang JJ, Sun JC, You Y, Ying JN, Han XM. Attention deficit hyperactivity disorder may be a highly inflammation and immune-associated disease (Review). 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Epidemiol Health. 2023;45:e2023053.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim T, Choi H, Lee H, Han K, Park DW, Park TS, Moon JY, Kim TH, Sohn JW, Yoon HJ, et al. Impact of Allergic Disease on the Risk of Mycobacterial Disease. J Allergy Clin Immunol Pract. 2023;11(9):2830\u0026ndash;e28382834.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee H, Kim BG, Jeong CY, Park DW, Park TS, Moon JY, Kim TH, Sohn JW, Yoon HJ, Kim JS, et al. Long-Term Impacts of COVID-19 on Severe Exacerbation and Mortality in Adult Asthma: A Nationwide Population-Based Cohort Study. J Allergy Clin Immunol Pract. 2024;12(7):1783\u0026ndash;e17931784.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim SH, Lee H, Jung JH, Kim BG, Park DW, Park TS, Moon JY, Kim TH, Sohn JW, Yoon HJ, et al. Asthma Increases Long-Term Risk of Death by Suicide: A Nationwide Population-Based Cohort Study. J Allergy Clin Immunol Pract. 2025;13(3):559\u0026ndash;e567553.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim BG, Lee H, Yeom SW, Jeong CY, Park DW, Park TS, Moon JY, Kim TH, Sohn JW, Yoon HJ, et al. Increased Risk of New-Onset Asthma After COVID-19: A Nationwide Population-Based Cohort Study. J Allergy Clin Immunol Pract. 2024;12(1):120\u0026ndash;e132125.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee H, Ryu J, Nam E, Chung SJ, Yeo Y, Park DW, Park TS, Moon JY, Kim TH, Sohn JW et al. Increased mortality in patients with corticosteroid-dependent asthma: a nationwide population-based study. Eur Respir J 2019, 54(5).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlackman JA, Gurka MJ. Developmental and behavioral comorbidities of asthma in children. J Dev Behav Pediatr. 2007;28(2):92\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKotey S, Ertel K, Whitcomb B. Co-occurrence of autism and asthma in a nationally-representative sample of children in the United States. J Autism Dev Disord. 2014;44(12):3083\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiang KL, Kuo FC, Lee JY, Huang CY. Association of epilepsy and asthma: a population-based retrospective cohort study. PeerJ. 2018;6:e4792.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMao LY, Ding J, Peng WF, Ma Y, Zhang YH, Fan W, Wang X. Interictal interleukin-17A levels are elevated and correlate with seizure severity of epilepsy patients. Epilepsia. 2013;54(9):e142\u0026ndash;145.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartinez-Nunez RT, Bondanese VP, Louafi F, Francisco-Garcia AS, Rupani H, Bedke N, Holgate S, Howarth PH, Davies DE, Sanchez-Elsner T. A microRNA network dysregulated in asthma controls IL-6 production in bronchial epithelial cells. PLoS ONE. 2014;9(10):e111659.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu X, Plana-Ripoll O, McGrath JJ, Petersen LV, Dharmage SC, Momen NC. Bidirectional Associations Between Asthma and Types of Mental Disorders. J Allergy Clin Immunol Pract. 2023;11(3):799\u0026ndash;e808714.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang M, Qin P, Yang X. Comorbidity between depression and asthma via immune-inflammatory pathways: a meta-analysis. J Affect Disord. 2014;166:22\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVon Mutius E. Gene-environment interactions in asthma. J Allergy Clin Immunol. 2009;123(1):3\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRitz T, Ayala ES, Trueba AF, Vance CD, Auchus RJ. Acute stress-induced increases in exhaled nitric oxide in asthma and their association with endogenous cortisol. Am J Respir Crit Care Med. 2011;183(1):26\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLewis MJ, Short AL, Lewis KE. Autonomic nervous system control of the cardiovascular and respiratory systems in asthma. Respir Med. 2006;100(10):1688\u0026ndash;705.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRedding GJ, Hurn H, White KK, Bompadre V, Emerson J, Garza RZ, Anigian K, Waldhausen J, Krengel W, Joshi A. Persistence and Progression of Airway Obstruction in Children With Early Onset Scoliosis. J Pediatr Orthop. 2020;40(4):190\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcPhail GL, Ehsan Z, Howells SA, Boesch RP, Fenchel MC, Szczesniak R, Jain V, Agabegi S, Sturm P, Wall E, et al. Obstructive lung disease in children with idiopathic scoliosis. J Pediatr. 2015;166(4):1018\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQiabi M, Chagnon K, Beaupr\u0026eacute; A, Hercun J, Rakovich G. Scoliosis and bronchial obstruction. Can Respir J. 2015;22(4):206\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcPhail GL, Howells SA, Boesch RP, Wood RE, Ednick M, Chini BA, Jain V, Agabegi S, Sturm P, Wall E, et al. Obstructive lung disease is common in children with syndromic and congenital scoliosis: a preliminary study. J Pediatr Orthop. 2013;33(8):781\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoyer J, Amin N, Taddonio R, Dozor AJ. Evidence of airway obstruction in children with idiopathic scoliosis. Chest. 1996;109(6):1532\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGillingham BL, Fan RA, Akbarnia BA. Early onset idiopathic scoliosis. J Am Acad Orthop Surg. 2006;14(2):101\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePraud J-P, Canet E. Chest wall function and dysfunction. Kendig's Disorders of the Respiratory Tract in Children. edn.: Elsevier; 2006. pp. 733\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu M, Zheng K, Cao Y, Wang J, Yin Q, Li T, Guo Y, Xue X, Pan X, Yang Y. Asthma and eye diseases in middle-aged and elderly Chinese: A comprehensive analysis of CHARLS data. Med (Baltim). 2024;103(43):e40306.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiong K, Mao H, Zhang Q, Lei C, Liang Y. Associations between vision impairment and multimorbidity among older Chinese adults: results from the China health and retirement longitudinal study. BMC Geriatr. 2023;23(1):688.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcGeachie MJ, Yates KP, Zhou X, Guo F, Sternberg AL, Van Natta ML, Wise RA, Szefler SJ, Sharma S, Kho AT, et al. Patterns of Growth and Decline in Lung Function in Persistent Childhood Asthma. N Engl J Med. 2016;374(19):1842\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarmsen L, Ulrik CS, Porsbjerg C, Thomsen SF, Holst C, Backer V. Airway hyperresponsiveness and development of lung function in adolescence and adulthood. Respir Med. 2014;108(5):752\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLanz MJ, Gilbert I, Szefler SJ, Murphy KR. Can early intervention in pediatric asthma improve long-term outcomes? A question that needs an answer. Pediatr Pulmonol. 2019;54(3):348\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAaron SD, Vandemheen KL, Whitmore GA, Bergeron C, Boulet LP, C\u0026ocirc;t\u0026eacute; A, McIvor RA, Penz E, Field SK, Lemi\u0026egrave;re C, et al. Early Diagnosis and Treatment of COPD and Asthma - A Randomized, Controlled Trial. N Engl J Med. 2024;390(22):2061\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Baseline characteristics of the study population\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"910\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"3\" style=\"width: 190px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(N = 5,369,424)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" colspan=\"3\" style=\"width: 464px;\"\u003e\n \u003cp\u003eDisability\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\" style=\"width: 166px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003e(n = 5,288,958)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\" style=\"width: 166px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003e(n = 80,466)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\" style=\"width: 131px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e30.75 \u0026plusmn; 4.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e30.73 \u0026plusmn; 4.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e32.25 \u0026plusmn; 4.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003e20-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e2,316,311 (43.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e2,292,889 (43.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e23,422 (29.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003e30-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e3,053,113 (56.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e2,996,069 (56.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e57,044 (70.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eSex, Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e3,306,895 (61.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e3,241,285 (61.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e65,610 (81.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eBody mass index, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e23.02 \u0026plusmn; 3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e23.01 \u0026plusmn; 3.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e23.89 \u0026plusmn; 3.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003e\u0026lt;18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e400,760 (7.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e395,863 (7.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e4,897 (6.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003e\u0026lt;23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e2,495,458 (46.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e2,465,568 (46.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e29,890 (37.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003e\u0026lt;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e1,041,130 (19.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e1,024,402 (19.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e16,728 (20.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003e\u0026ge;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e1,432,076 (26.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e1,403,125 (26.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e28,951 (35.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eSmoking status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eNever smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e2,861,111 (53.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e2,823,738 (53.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e37,373 (46.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eEx smoker, \u0026lt;10 pack years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e429,818 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e423,274 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e6,544 (8.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eEx smoker, \u0026ge;10 pack years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e126,265 (2.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e123,286 (2.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e2,979 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eCurrent smoker, \u0026lt;10 pack years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e1,224,167 (22.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e1,206,553 (22.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e17,614 (21.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eCurrent smoker, \u0026ge;10 pack years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e728,063 (13.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e712,107 (13.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e15,956 (19.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eAlcohol consumption\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e1,973,340 (36.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e1,938,430 (36.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e34,910 (43.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e2,850,904 (53.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e2,814,534 (53.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e36,370 (45.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e545,180 (10.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e535,994 (10.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e9,186 (11.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eIncome, the lowest 25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e1,136,638 (21.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e1,108,727 (20.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e27,911 (34.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eRegular exercise\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e694,235 (12.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e681,598 (12.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e12,637 (15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eComorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e104,034 (1.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e100,920 (1.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e3,114 (3.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e410,424 (7.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e399,879 (7.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e10,545 (13.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eDyslipidemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e365,652 (6.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e358,158 (6.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e7,494 (9.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eAtopy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e20,086 (0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e19,739 (0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e347 (0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e0.0075\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 257px;\"\u003e\n \u003cp\u003eAllergic rhinitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 190px;\"\u003e\n \u003cp\u003e180,632 (3.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e177,577 (3.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 166px;\"\u003e\n \u003cp\u003e3,055 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e*\u003c/sup\u003eRegular exercise, mid-term exercise \u0026ge; 5 days or vigorous exercise \u0026ge; 3 days in a week.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. The association between disability and risk of asthma development\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"916\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eNumber of subjects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003eNumber with asthma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eIR per 1,000 PY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 181px;\"\u003e\n \u003cp\u003eUnadjusted HR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eAdjusted HR\u003csup\u003e*\u003c/sup\u003e (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eWithout disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e5,288,958\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e547,525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e9.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 181px;\"\u003e\n \u003cp\u003e1 (Reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e1 (Reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eWith disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e80,466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e8,271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e9.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 181px;\"\u003e\n \u003cp\u003e1 (0.98\u0026ndash;1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e1.14 (1.11\u0026ndash;1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e52,003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e5,375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e9.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 181px;\"\u003e\n \u003cp\u003e1 (0.97\u0026ndash;1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e1.17 (1.14\u0026ndash;1.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e28,463\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e2,896\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e9.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 181px;\"\u003e\n \u003cp\u003e1 (0.96\u0026ndash;1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e1.07 (1.03\u0026ndash;1.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e*\u003c/sup\u003eAdjusted for age, sex, body mass index, household income level, smoking status, alcohol use, regular physical activity, atopy, and allergic rhinitis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAbbreviations:\u003c/em\u003e\u003c/strong\u003e IR = incidence rate, PY = person-years, HR = hazard ratio, CI = confidence interval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Incidence rates and hazard ratios for asthma according to disability status and subtype\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"916\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 237px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eNumber of subjects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eNumber with asthma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eIR per\u003c/p\u003e\n \u003cp\u003e1,000 PY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eUnadjusted HR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eAdjusted HR\u003csup\u003e*\u003c/sup\u003e (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 237px;\"\u003e\n \u003cp\u003eWithout disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e5,288,958\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e547,525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e9.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1 (Reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1 (Reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 237px;\"\u003e\n \u003cp\u003eDisability subtypes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 237px;\"\u003e\n \u003cp\u003ePhysical impairment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e45,707\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e4,745\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e9.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.01 (0.98\u0026ndash;1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.18 (1.15\u0026ndash;1.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 237px;\"\u003e\n \u003cp\u003eBrain injury disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e2,661\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e9.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.00 (0.88\u0026ndash;1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.09 (0.97\u0026ndash;1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 237px;\"\u003e\n \u003cp\u003eVisual impairment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e10,060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e997\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e9.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e0.96 (0.90\u0026ndash;1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.09 (1.03\u0026ndash;1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 237px;\"\u003e\n \u003cp\u003eHearing impairment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e5,873\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e629\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e9.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.03 (0.96\u0026ndash;1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.07 (0.99\u0026ndash;1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 237px;\"\u003e\n \u003cp\u003eSpeech impairment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e905\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e9.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e0.99 (0.80\u0026ndash;1.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.12 (0.91\u0026ndash;1.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 237px;\"\u003e\n \u003cp\u003eIntellectual disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e10,391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e1,046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e9.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.00 (0.94\u0026ndash;1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.06 (0.99\u0026ndash;1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 237px;\"\u003e\n \u003cp\u003eAutism spectrum disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e4.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e0.44 (0.28\u0026ndash;0.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e0.49 (0.31\u0026ndash;0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 237px;\"\u003e\n \u003cp\u003eMental disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e2,104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e11.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.16 (1.02\u0026ndash;1.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.19 (1.05\u0026ndash;1.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 237px;\"\u003e\n \u003cp\u003eRenal disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e1,145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e8.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e0.90 (0.75\u0026ndash;1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e0.93 (0.77\u0026ndash;1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 237px;\"\u003e\n \u003cp\u003eCardiac disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e10.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.08 (0.70\u0026ndash;1.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.14 (0.73\u0026ndash;1.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 237px;\"\u003e\n \u003cp\u003eRespiratory disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e22.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e2.55 (1.11\u0026ndash;5.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e2.36 (0.98\u0026ndash;5.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 237px;\"\u003e\n \u003cp\u003eHepatic disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e12.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.30 (0.70\u0026ndash;2.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.43 (0.77\u0026ndash;2.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 237px;\"\u003e\n \u003cp\u003eFacial disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e9.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.02 (0.71\u0026ndash;1.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.12 (0.78\u0026ndash;1.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 237px;\"\u003e\n \u003cp\u003eEnterostomy or urostomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e6.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e0.64 (0.37\u0026ndash;1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e0.73 (0.43\u0026ndash;1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 237px;\"\u003e\n \u003cp\u003eEpilepsy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e439\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e12.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.27 (0.98\u0026ndash;1.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e1.38 (1.06\u0026ndash;1.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e*\u003c/sup\u003eAdjusted for age, sex, body mass index, household income level, smoking status, alcohol use, regular physical activity, atopy, and allergic rhinitis\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAbbreviations:\u003c/em\u003e\u003c/strong\u003e IR = incidence rate, PY = person-years, HR = hazard ratio, CI = confidence interval.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"asthma, disability, young adults, epidemiology, incidence","lastPublishedDoi":"10.21203/rs.3.rs-9001727/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9001727/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAsthma is a common chronic airway disease influenced by various factors, including emerging evidence suggesting the role of disability. However, the association between disability and asthma risk remains understudied in young adults.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a retrospective cohort study using data from the Korean National Health Information Database, including 5,369,424 adults aged 20 to 39 years who underwent health screening between 2009 and 2012. Incident asthma was identified using diagnostic codes, and multivariable Cox proportional hazards models were employed to assess its association with disability after adjusting for key demographic and clinical factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong 5,369,424 participants, 1.5% had a registered disability. During a median follow-up of 11.5 years, individuals with disabilities had modestly increased risk of developing asthma compared to those without disabilities (adjusted hazard ratio, 1.14; 95% confidence interval, 1.11–1.16). Stratified analyses showed elevated asthma risk in those with epilepsy, mental disorders, physical disabilities, and visual impairment, while autism spectrum disorder was associated with reduced risk.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDisability in young adults is associated with a modest increase in risk of incident asthma, with risk varying by disability type. These findings highlight the importance of inclusive health surveillance and further research into the underlying mechanisms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Disability and Risk of Asthma in young adults : A Nationwide Population-Based Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-03 02:15:57","doi":"10.21203/rs.3.rs-9001727/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-19T08:37:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-08T14:57:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"46786511593921122837603052254434044772","date":"2026-05-06T00:16:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"207837642597988455522772960671533823360","date":"2026-04-09T04:16:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-07T01:13:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"299077107932998956280103145822140563817","date":"2026-04-07T00:56:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-29T00:16:29+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-16T05:37:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-13T13:21:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-13T13:21:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-03-01T13:13:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c5412118-bf19-459d-89f9-a0408be26ef3","owner":[],"postedDate":"April 3rd, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-19T08:37:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-08T14:57:49+00:00","index":137,"fulltext":""},{"type":"reviewerAgreed","content":"46786511593921122837603052254434044772","date":"2026-05-06T00:16:54+00:00","index":135,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-19T08:53:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-03 02:15:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9001727","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9001727","identity":"rs-9001727","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}