在管理式医疗人群中，亚急性哮喘控制不佳是随后急性哮喘加重的预测指标。

Subacute lack of asthma control as a predictor of subsequent acute asthma exacerbation in a managed care population.

机构信息

HealthCore, Inc, 800 Delaware Ave, 5th Fl, Wilmington, DE 19801-1366, USA.

出版信息

Am J Manag Care. 2010 Feb;16(2):108-14.

PMID:20148615

Abstract

OBJECTIVE

To evaluate whether an assessment of subacute lack of asthma control (SALAC) predicts subsequent acute asthma exacerbation (AAE).

STUDY DESIGN

This retrospective administrative claims study used medical and pharmacy claims from the HealthCore Integrated Research Database to identify patients aged 6 to 64 years with asthma and having 3 years' continuous enrollment from January 1, 2003, through December 31, 2005.

METHODS

Study inclusion criteria were at least 2 outpatient visits or at least 1 hospitalization or emergency department (ED) visit with an asthma diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification code 493.xx) in at least 1 of 3 years (2003-2005). SALAC was defined as more than 4 asthma outpatient visits or more than 5 short-acting beta2-agonist (SABA) prescriptions per year, and AAE was defined as at least 1 hospitalization or ED visit with a primary asthma diagnosis or an oral corticosteroid burst prescription. Generalized estimating equations modeled the risk of subsequent-year AAE as a function of 2 sets of variables to determine the independent effect of prior-year SALAC and its components on subsequent-year AAE. The first set included age, sex, geographic region, prior year AAE, and prior-year SALAC. The second set included age, sex, geographic region, prior-year AAE, high prior-year SABA use, and frequent prior-year asthma outpatient visits.

RESULTS

Of 35,806 patients with asthma, 46.6% were male, and 35.8% were younger than 18 years. The mean annual prevalence of SALAC was 12.1%. Controlling for all other variables, the generalized estimating equation results indicate that prior-year SALAC is associated with a 60% increased risk of subsequent-year AAE (P <.001). Increased prior-year asthma outpatient visits and SABA use are associated with 34% and 85%, respectively, greater risks of subsequent-year AAE (P <.001 for both).

CONCLUSION

SALAC and its components can aid in predicting patients at risk for AAE.

摘要

目的

评估亚急性哮喘控制缺失（SALAC）评估是否可预测随后的急性哮喘加重（AAE）。

研究设计

本回顾性行政索赔研究使用医疗和药房索赔数据来自 HealthCore 综合研究数据库，以确定年龄在 6 至 64 岁之间、在 2003 年 1 月 1 日至 2005 年 12 月 31 日期间连续 3 年入组的哮喘患者。

方法

研究纳入标准为至少有 2 次门诊就诊或至少有 1 次住院或急诊（ED）就诊，其中至少有 1 次在 3 年（2003-2005 年）中的某一年有哮喘诊断（国际疾病分类，第九修订版，临床修正代码 493.xx）。SALAC 定义为每年超过 4 次哮喘门诊就诊或超过 5 次短效β2 激动剂（SABA）处方，AAE 定义为至少有 1 次住院或 ED 就诊，有原发性哮喘诊断或口服皮质类固醇冲击治疗处方。广义估计方程将下一年度 AAE 的风险建模为两个变量组的函数，以确定前一年 SALAC 及其组成部分对下一年度 AAE 的独立影响。第一组包括年龄、性别、地理位置、前一年 AAE 和前一年 SALAC。第二组包括年龄、性别、地理位置、前一年 AAE、前一年高 SABA 使用和前一年频繁哮喘门诊就诊。

结果

在 35806 名哮喘患者中，46.6%为男性，35.8%年龄小于 18 岁。每年 SALAC 的平均患病率为 12.1%。控制所有其他变量后，广义估计方程结果表明，前一年 SALAC 与下一年度 AAE 风险增加 60%相关（P<.001）。前一年哮喘门诊就诊次数和 SABA 使用次数增加分别与下一年度 AAE 风险增加 34%和 85%相关（均 P<.001）。