Title: Inhaled corticosteroid use in asthmatic children receiving Ohio Medicaid: trend analysis, 1997-2001.
Authors: Stevenson, Michelle D; Heaton, Pamela C; Moomaw, Charles J; Bean, Judy A; Ruddy, Richard M
Published In Ann Allergy Asthma Immunol, (2008 Jun)
Abstract: BACKGROUND: In 1997, national guidelines emphasized that inhaled corticosteroids (ICSs) are key therapy for individuals with all classes of persistent asthma, including children. OBJECTIVE: To examine the effect of these guidelines via time-trend analysis of ICS dispensation among children with asthma and Ohio Medicaid insurance. METHODS: A retrospective cross-sectional analysis by yearly cohorts was performed. From January 1, 1997, to December 31, 2001, all children from birth to the age of 18 years with 6 months of Ohio Medicaid enrollment or more, 1 or more asthma diagnoses associated with a provider claim, and 1 or more prescription claims for an asthma medication in a given calendar year were identified using claims data. The daily beclomethasone equivalent (BME) dose, the daily albuterol equivalent dose, and asthma-related health care use were calculated for each child within each yearly cohort. A time-trend regression analysis of subjects enrolled in all 5 years examined factors associated with BME. RESULTS: A total of 77,557 children met the study criteria. Among the 1,475 children enrolled during all 5 years, year of enrollment was a positive independent predictor of BME after adjustment for age, race, sex, systemic steroid bursts, albuterol equivalent dose, and health care use (P < .001). CONCLUSIONS: The daily BME dose significantly increased for children with asthma insured by Ohio Medicaid from 1997 to 2001. However, the percentages of children receiving both ICS and a therapeutic BME dose were alarmingly low. The mean BME dose was particularly low among children with 1 or more emergency department visits, no hospitalizations, and 3 or fewer physician visits for asthma per year, suggesting that broader efforts to target this group are needed.
PubMed ID: 18592816
MeSH Terms: Administration, Inhalation; Adolescent; Adrenal Cortex Hormones/administration & dosage; Adrenal Cortex Hormones/therapeutic use*; African Americans/statistics & numerical data; Ambulatory Care/statistics & numerical data; Asthma/diagnosis; Asthma/drug therapy*; Asthma/ethnology; Child; Child, Preschool; Cross-Sectional Studies; Drug Utilization/statistics & numerical data; Drug Utilization/trends; Emergency Service, Hospital/statistics & numerical data; European Continental Ancestry Group/statistics & numerical data; Female; Hospitalization/statistics & numerical data; Humans; Infant; Infant, Newborn; Male; Medicaid/statistics & numerical data*; Ohio; Regression Analysis; Retrospective Studies; Sex Factors; United States