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Identifying preventable risk factors for hospitalised asthma in young Aboriginal children: a whole-population cohort study
  1. Bronwyn Brew1,2,
  2. Alison Gibberd3,
  3. Guy B Marks4,5,
  4. Natalie Strobel6,
  5. Clare Wendy Allen7,
  6. Louisa Jorm1,
  7. Georgina Chambers1,2,
  8. Sandra Eades8,
  9. Bridgette McNamara3
  1. 1Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
  2. 2School of Women's and Children's Health, University of New South Wales, Sydney, 2033, New South Wales, Australia
  3. 3Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
  4. 4Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
  5. 5South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
  6. 6Kurongkurl Katitjin, Edith Cowan University, Joondalup, Western Australia, Australia
  7. 7Children's Hospital Westmead, University of Sydney, Westmead, New South Wales, Australia
  8. 8Curtin Medical School, Curtin University, Perth, Western Australia, Australia
  1. Correspondence to Dr Bronwyn Brew, Centre for Big Data Research in Health, University of New South Wales, Sydney, 2033, NSW, Australia; b.haasdyk{at}


Background Australia has one of the highest rates of asthma worldwide. Indigenous children have a particularly high burden of risk determinants for asthma, yet little is known about the asthma risk profile in this population.

Aim To identify and quantify potentially preventable risk factors for hospitalised asthma in Australian Aboriginal children (1–4 years of age).

Methods Birth, hospital and emergency data for all Aboriginal children born 2003–2012 in Western Australia were linked (n=32 333). Asthma was identified from hospitalisation codes. ORs and population attributable fractions were calculated for maternal age at birth, remoteness, area-level disadvantage, prematurity, low birth weight, maternal smoking in pregnancy, mode of delivery, maternal trauma and hospitalisations for acute respiratory tract infection (ARTI) in the first year of life.

Results There were 705 (2.7%) children hospitalised at least once for asthma. Risk factors associated with asthma included: being hospitalised for an ARTI (OR 4.06, 95% CI 3.44 to 4.78), area-level disadvantage (OR 1.58, 95% CI 1.28 to 1.94), being born at <33 weeks’ gestation (OR 3.30, 95% CI 2.52 to 4.32) or birth weight <1500 g (OR 2.35, 95% CI 1.39 to 3.99). The proportion of asthma attributable to an ARTI was 31%, area-level disadvantage 18%, maternal smoking 5%, and low gestational age and birth weight were 3%–7%. We did not observe a higher risk of asthma in those children who were from remote areas.

Conclusion Improving care for pregnant Aboriginal women as well as for Aboriginal infants with ARTI may help reduce the burden of asthma in the Indigenous population.

  • asthma epidemiology
  • paediatric asthma
  • respiratory infection

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  • Contributors BM and BB conceived the idea for the study. BM, BB, GBM and AG were responsible for study design. BM, SE and LJ were responsible for the ethics approvals and original data set conception, design and linkage. BB was responsible for data analysis and drafting the article. BM and AG were responsible for data cleaning and consultation on analysis. All authors were responsible for interpretation of results, critical revision of the article and final approval of the version to be published.

  • Funding Funding for the Defying the Odds Study has been provided by National Health and Medical Research Council of Australia (NHMRC Project grant 1078214). This project is also part of the NHMRC Centre for Research Excellence in Aboriginal Adolescent and Child Health (GNT 1135273).

  • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Western Australian Aboriginal Health Ethics Committee (HREC 609), the WA Department of Health Human Ethics Committee (Migrated ID DOH-201530) and the University of Melbourne Medicine and Dentistry Human Ethics Sub-Committee (#1851158).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Please contact BM (senior author) regarding information about data access. In each case, a protocol and ethics amendment will be required.

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