Capo-Ramos David E, Duran Catherine, Simon Alan E, Akinbami Lara J, Schoendorf Kenneth C
Infant, Child & Women's Health Statistics Branch (ICWHSB), Office of Analysis & Epidemiology (OAE), National Center for Health Statistics (NCHS) , Centers for Disease Control & Prevention (CDC), Hyattsville, MD , USA and.
J Asthma. 2014 Aug;51(6):618-26. doi: 10.3109/02770903.2014.895010. Epub 2014 Mar 20.
Local-area studies demonstrate that preventive asthma medication discontinuation among Medicaid and Children's-Health-Insurance-Program (CHIP) enrolled children leads to adverse outcomes. We assessed time-to-discontinuation for preventive asthma medication and its risk factors among fee-for-service Medicaid/CHIP child beneficiaries.
National-Health-Interview-Survey participants (1997-2005) with ≥1 Medicaid- or CHIP-paid claims when 2-17 years old (n = 4262) were linked to Medicaid-Analytic-eXtract claims (1999-2008). Multivariate Cox proportional-hazards models to assess time-to-discontinuation (i.e. failing to refill prescriptions <30 d after previous supplies ran out) included demographic factors and medication regimen (inhaled corticosteroids [ICS], long-acting β2-agonists, leukotriene modifiers, mast cell stabilizers, and monoclonal antibodies).
Sixty-three percent discontinued preventive asthma medications by 90 d after the first prescription. Adolescents and toddlers had slightly higher hazards of discontinuation (adjusted hazard ratios [aHR], 1.13; 95% CI, 1.05-1.23; and 1.12; 1.03-1.21, respectively) versus 5-11-year-olds, as did Hispanics (aHR, 1.24; 1.13-1.35) and non-Hispanic blacks (aHR, 1.17; 1.07-1.28) versus non-Hispanic whites, children in households with one adult and ≥3 children (aHR, 1.17; 1.05-1.30) versus multiple adults and ≤2 children, and children with caregivers' educational-attainment ≤12th grade (aHR, 1.11; 1.02-1.20) versus caregivers with some college. Compared to regimens including both ICS and leukotriene modifiers, discontinuation was greater for those on ICS without leukotriene modifiers or on other preventive asthma medications (aHR, 1.67; 1.56-1.80; and 2.23; 1.78-2.80, respectively).
More than 60% of children enrolled in fee-for-service Medicaid/CHIP discontinued preventive asthma medications by 90 d. Risk was increased for minorities and children from disadvantaged households. Understanding these factors may inform future pediatric asthma guidelines.
局部地区研究表明，医疗补助计划（Medicaid）和儿童健康保险计划（CHIP）参保儿童停用预防性哮喘药物会导致不良后果。我们评估了按服务收费的Medicaid/CHIP儿童受益人群中预防性哮喘药物的停药时间及其风险因素。
将1997 - 2005年参加国民健康访谈调查且2 - 17岁时有≥1次Medicaid或CHIP付费理赔记录的参与者（n = 4262）与Medicaid分析提取物理赔数据（1999 - 2008年）进行关联。用于评估停药时间（即上次药物用完后<30天未重新配药）的多变量Cox比例风险模型纳入了人口统计学因素和药物治疗方案（吸入性糖皮质激素[ICS]、长效β2受体激动剂、白三烯调节剂、肥大细胞稳定剂和单克隆抗体）。
63%的儿童在首次处方后90天内停用了预防性哮喘药物。与5 - 11岁儿童相比，青少年和幼儿的停药风险略高（调整后风险比[aHR]分别为1.13；95%置信区间[CI]为1.05 - 1.23；以及1.12；1.03 - 1.21），西班牙裔儿童（aHR为1.24；1.13 - 1.35）和非西班牙裔黑人儿童（aHR为1.17；1.07 - 1.28）相对于非西班牙裔白人儿童、有一名成年人且≥3个孩子的家庭中的儿童（aHR为1.17；1.05 - 1.30）相对于多个成年人且≤2个孩子的家庭中的儿童，以及照顾者教育程度≤12年级的儿童（aHR为1.11；1.02 - 1.20）相对于有大学学历照顾者的儿童，停药风险也更高。与包括ICS和白三烯调节剂的治疗方案相比，仅使用ICS而无白三烯调节剂或使用其他预防性哮喘药物的儿童停药率更高（aHR分别为1.67；1.56 - 1.80；以及2.23；1.78 - 2.80）。
超过60%的按服务收费的Medicaid/CHIP参保儿童在90天内停用了预防性哮喘药物。少数族裔和来自弱势家庭的儿童风险增加。了解这些因素可能为未来的儿科哮喘指南提供参考。
