Impact of the COVID-19 Pandemic on Infant and Pediatric Asthma: A Multi-Center Survey Using an Administrative Database in Japan

Background: Limited data are available on the relationship between infant and pediatric asthma and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Political limitations such as social distancing (mask wearing and staying at home) and school closure may affect the treatment behavior of pediatric asthma. To investigate the trends of treatment behavior in the field of pediatrics during the COVID-19 pandemic.Methods: This is a retrospective observational study using Diagnosis Procedure Combination (DPC) data from the Quality Indicator/Improvement Project (QIP) database. We identified children with asthma aged 15 years or younger who were patients from July 1, 2018, to June 30, 2020. The main outcome was a comparison between asthma patients' treatment behavior before the COVID-19 pandemic and during the COVID-19 pandemic.We statistically tested the admission volume changes based on the discharge date after adjusting for seasonality through a Fourier term using an interrupted time-series analysis.Findings: We identified 10,481 inpatients cases in 67 hospitals and 258,911 out-patients cases in 180 hospitals who were diagnosed with asthma. We performed an interrupted time-series (ITS) analysis for inpatients. The reduction in the number of patients during this period was estimated to be 232 (P=0.0012). In addition, ITS analysis was performed for patients aged <3 years. The reduced number of patients during this period was estimated to be 155 (P<0.001).Interpretation: We found that the number of pediatric asthma patients dramatically decreased during the COVID-19 pandemic. Social distancing and school closure also decreased the number of asthma attacks for infant patients. We need to continue research into the trends of pediatric asthma patients after the COVID-19 pandemic in Japan.Funding: This study was supported by JSPS KAKENHI Grant Number JP19H01075 from the Japan Society for the Promotion of Science and by the GAP Fund Program of Kyoto University to Yuichi Imanaka.Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: The study was conducted after obtaining approval from the Kyoto University Hospital Ethics committee of the Kyoto University Graduate School and Faculty of Medicine, according to the guidelines on medical and epidemiological research (No. R0135).