Cox Emily R, Halloran Donna R, Homan Sharon M, Welliver Sherry, Mager Douglas E
Express Scripts, Inc, St Louis, Missouri, USA.
Pediatrics. 2008 Nov;122(5):e1053-61. doi: 10.1542/peds.2008-0214.
Our goal was to estimate the quarterly prevalence of and evaluate trends for chronic medication use in children.
A cross-sectional study of ambulatory prescription claims data from 2002 to 2005 was conducted for a nationally representative sample of >3.5 million commercially insured children who were 5 to 19 years old. Prevalence of chronic medication use was measured quarterly for antihypertensives, antihyperlipidemics, type 2 antidiabetics, antidepressants, attention-deficit disorder and attention-deficit/hyperactivity disorder medications, and asthma-controller therapy.
First-quarter 2002 baseline prevalence of chronic medication use per 1000 child beneficiaries ranged from a high of 29.5 for antiasthmatics to a low of 0.27 for antihyperlipidemics. Except for asthma medication use, prevalence rates were higher for older teens aged 15 to 19 years. During the study period, the prevalence rate for type 2 antidiabetic agents doubled, driven by 166% and 135% increases in prevalence among females aged 10 to 14 and 15 to 19 years, respectively. Therapy classes with double-digit growth in prevalence of use were asthma medications (46.5%), attention-deficit disorder and attention-deficit/hyperactivity disorder medications (40.4%), and antihyperlipidemics (15%). Prevalence of use growth was more moderate for antihypertensives and antidepressants (1.8%). Rates of growth were dramatically higher among girls than boys for type 2 antidiabetics (147% vs 39%), attention-deficit disorder and attention-deficit/hyperactivity disorder medications (63% vs 33%), and antidepressants (7% vs -4%).
Prevalence of chronic medication use in children increased across all therapy classes evaluated. Additional study is needed into the factors influencing these trends, including growth in chronic disease risk factors, greater awareness and screening, and greater affinity toward early use of drug therapy in children.
我们的目标是估计儿童慢性药物使用的季度患病率并评估其趋势。
对2002年至2005年门诊处方索赔数据进行横断面研究,样本为全国范围内具有代表性的350多万名5至19岁的商业保险儿童。每季度测量抗高血压药、抗高血脂药、2型抗糖尿病药、抗抑郁药、注意力缺陷障碍和注意力缺陷/多动障碍药物以及哮喘控制疗法的慢性药物使用患病率。
2002年第一季度每1000名儿童受益人的慢性药物使用基线患病率从抗哮喘药的29.5(最高)到抗高血脂药的0.27(最低)不等。除哮喘药物使用外,15至19岁的青少年患病率更高。在研究期间,2型抗糖尿病药物的患病率翻了一番,10至14岁和15至19岁女性的患病率分别增加了166%和135%。使用率患病率呈两位数增长的治疗类别包括哮喘药物(46.5%)、注意力缺陷障碍和注意力缺陷/多动障碍药物(40.4%)以及抗高血脂药(15%)。抗高血压药和抗抑郁药的使用率增长较为温和(1.8%)。2型抗糖尿病药(147%对39%)、注意力缺陷障碍和注意力缺陷/多动障碍药物(63%对33%)以及抗抑郁药(7%对 -4%)在女孩中的增长率明显高于男孩。
在所评估的所有治疗类别中,儿童慢性药物使用的患病率均有所增加。需要进一步研究影响这些趋势的因素,包括慢性病风险因素的增加、更高的认识和筛查以及儿童对早期药物治疗的更高接受度。