Different definitions in childhood asthma: how dependable is the dependent variable?
Open accessAbstract
There is abundant literature on how to select and statistically deal with predictors in prediction models. Less attention has been paid to the choice of the outcome. We assessed the impact of different asthma definitions on prevalence estimates and on the prediction model's performances. We searched PubMed and extracted data of definitions used to diagnose childhood asthma (between 6 and 18 yrs) in cohort studies. Next, using data from an ongoing cohort study (n = 186), we constructed and compared four prediction models which all predict asthma at age 6 yrs, using a fixed set of predictors and four different definitions in turn. We defined an area of clinical indecision (posterior probability between 25% and 60%) and calculated the number of children who remained inside this area. 122 papers yielded 60 different definitions. Prevalence estimates varied between 15.1% and 51.1% depending on the asthma definition used. The percentage of children whose posterior asthma probability was in the area of clinical indecision varied from 14.9% to 65.3%. Variation in definitions and its effect on the performance of prediction models may be another source of otherwise inexplicable variation in daily clinical decision making. More uniformity of operational asthma definitions seems needed.
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Agreement between four seemingly very similar and commonly used definitions of childhood asthma was overall relatively low (61%).
“As an example, the above study has shown that the agreement between four seemingly very similar and commonly used definitions was overall relatively low (61%)”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [17]
Well-over a third of children in a study could move from being considered asthma cases to controls depending on the definition used.
“and well-over a third of children in a study could move from being considered “asthma cases” to “controls” depending on the definition used (17).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [17]
As many as 60 different definitions of childhood asthma have been used across 122 published studies.
“Despite attempts to reach a consensus definition for epidemiological studies, as many as 60 different definitions of “childhood asthma” have been used across 122 published studies (17).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [17]
The multiplicity in the way the primary outcome is defined can have a substantial impact on the estimated prevalence and risk factors.
“Although some of these definitions may appear almost identical, the multiplicity in the way the primary outcome is defined can have a substantial impact on the estimated prevalence and risk factors.”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [17]
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- Authors
- Van Wonderen, K. E., Van Der Mark, L. B., Mohrs, J., Bindels, P. J. E., Van Aalderen, W. M. C., & Ter Riet, G.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Amsterdam Public Health (NL)
- ORCID
- Bindels, P.J.E.
- Venue
- European Respiratory Journal
- Publisher
- European Respiratory Society (ERS)
- Published
- 2009-12-23
- Volume
- 36
- Issue
- 1
- Pages
- 48-56
- ISSN
- 0903-1936 (ISSN-L)
- 1399-3003
- OpenAlex
- W2144150352
- Cited by
- 100
- References
- 30
- Citations by year
- 2025: 4 · 2024: 4 · 2023: 2 · 2022: 8 · 2021: 6 · 2020: 6 · 2019: 11 · 2018: 6 · 2017: 6 · 2016: 6 · 2015: 7 · 2014: 10 · 2013: 7 · 2012: 10
- FWCI
- 3.53
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Respiratory Journal (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- childhood asthma, asthma definition, outcome definitions, asthma prevalence, prediction model, posterior probability, asthma diagnosis, clinical decision-making
- MeSH terms
- Adolescent, Asthma, Child, Humans, Cohort Studies, Prevalence, Logistic Models
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