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Lee, Tae Yoon (Harry)

University of British Columbia

Asthma is an early-onset chronic disease of airways. Despite active research on novel interventions for asthma prevention and care, there is a lack of research on the population and policy impact of such interventions. To address this knowledge gap, the overarching goal of this thesis was to develop the first reference policy model of asthma for Canada. The first two objectives of this thesis are data-driven studies to generate key evidence for the modeling work. First, to better understand current asthma trends, I investigated the long-term rates of severe asthma exacerbations (requiring hospital admissions) in Canada using a national hospitalization database. The age-standardized rate of asthma hospital admissions per 100,000 general population decreased substantially from 79.2 (95% confidence interval [CI]: 78.2,80.2) in 2002 to 32.7 (95% CI: 32.1,33.2) in 2017. A change-point regression analysis showed that the decline substantially plateaued since 2010. Next, I determined the impact of severe asthma exacerbations on the disease course using health administrative data from British Columbia (BC). I found that experiencing the first severe exacerbation was associated with an increase of 79% (95% CI: 11%,189%) in the rate of subsequent events in pediatric patients and of 188% (95% CI: 35%,515%) in adult patients. However, the effects of subsequent exacerbations were not as substantial. Combining the evidence from published studies and results from the first two objectives, the third objective was to develop and validate a reference policy model for lifetime exposures and asthma outcomes projection (LEAP). The LEAP model is an open-population discrete event simulation model calibrated to the Canadian population. It is an open-source, open-access platform consisting of the demographics, risk factors, asthma occurrence, asthma outcomes, and payoffs modules. For the last objective, I demonstrated the utility of the LEAP model by quantifying the impact of infant antibiotic use on the burden of pediatric asthma retrospectively between 2001 and 2017 in BC. During this period, infant antibiotic use declined by 71.5%. Compared with a counterfactual scenario of no decline, I found the observed decline potentially averted 37,213 (standard deviation: 5,370) person-years with asthma, saving $20 million (in 2024 CAD).

Text

2024-10-17

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/89425

Pharmaceutical Sciences

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/