{"doi":"10.1101/2021.07.20.21260871","title":"Asthma and the Risk of SARS-CoV-2 Infection Among Children and Adolescents","abstract":"Importance: More than 4 million SARS-COV-2 infections have occurred among children and adolescents in the United States. Risk factors for SARS-CoV-2 infection among children remain poorly defined. Objective: To evaluate the association between asthma and the risk of SARS-CoV-2 infection among children. Design: Retrospective cohort study Setting: A large, integrated health system in central North Carolina. Participants: Children 5 to 17 years of age with a Durham County address and at least one health care encounter in the Duke University Health System between March 1, 2017, and February 28, 2020. Exposure: Diagnosis of asthma Main Outcomes and Measures: The primary outcome was SARS-CoV-2 infection identified by PCR testing of a respiratory sample collected between March 1, 2020, and October 31, 2020. We matched children with asthma 1:1 to children without asthma using propensity scores and used Poisson regression to evaluate the association between asthma and the risk of SARS-CoV-2 infection. We assessed for effect modification of this association by inhaled corticosteroid prescription and comorbid atopic diseases. Results: Of 49,455 children, 6,515 (13%) met criteria for a diagnosis of asthma; all children with asthma were matched to a control child without asthma for a final cohort of 13,030 children. Median (interquartile range) age was 11.0 (8.0, 14.0) years, 56% were male, and 78% were non-White. A diagnosis of asthma was associated with a decreased risk of SARS-CoV-2 infection [risk ratio (RR): 0.67, 95% confidence interval (CI): 0.49-0.92]. This association tended to be stronger in children with asthma who were prescribed inhaled corticosteroids (RR: 0.60, 95% CI: 0.38-0.94) or who had comorbid atopic diseases (RR: 0.59, 95% CI: 0.39-0.88). Of the 66 children with asthma who developed SARS-CoV-2 infection, none required hospitalization for COVID-19. Conclusions and Relevance: Children with asthma had a lower risk of SARS-CoV-2 infection, particularly children prescribed an inhaled corticosteroid or with comorbid atopic diseases. Further studies are needed to explore the complex relationship between asthma, inhaled corticosteroids, and SARS-CoV-2.","journal":"medRxiv","year":2021,"id":216719,"datarank":0.24141568686511508,"base_score":1.6094379124341003,"endowment":1.6094379124341003,"self_citation_contribution":0.24141568686511508,"citation_network_contribution":0.0,"self_endowment_contribution":0.24141568686511508,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.7909,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":325723,"name":"Jillian H. Hurst","orcid":"0000-0001-5079-9920","position":1,"is_corresponding":false},{"id":325729,"name":"Congwen Zhao","orcid":"0000-0002-8540-6880","position":2,"is_corresponding":false},{"id":7143,"name":"Benjamin A. Goldstein","orcid":"0000-0001-5261-3632","position":3,"is_corresponding":false},{"id":292955,"name":"Laine Thomas","orcid":"0000-0002-5340-8742","position":4,"is_corresponding":false},{"id":409652,"name":"Jason E. Lang","orcid":"0000-0001-9115-5312","position":5,"is_corresponding":false},{"id":322359,"name":"Matthew S. Kelly","orcid":"0000-0001-8819-2315","position":6,"is_corresponding":false},{"id":813679,"name":"Saahithi Rao","orcid":null,"position":0,"is_corresponding":true}],"reference_count":41,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:53:15.868165Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}