Centre for Experimental Medicine, Queen's University of Belfast, Belfast, Northern Ireland; National University of Ireland, Galway, Ireland.
National University of Ireland, Galway, Ireland; Centre for Public Health, Queen's University of Belfast, Belfast, Northern Ireland.
J Allergy Clin Immunol Pract. 2018 Nov-Dec;6(6):2014-2023.e2. doi: 10.1016/j.jaip.2018.04.008. Epub 2018 Apr 21.
Treatment of severe asthma may include high-dose systemic corticosteroid therapy, which is associated with substantial comorbidity. There is evidence to suggest that this burden is not evenly distributed across age, sex, and corticosteroid exposure levels.
To examine the associations between age, sex, comorbidity, and patterns of health care cost across groups differentiated by corticosteroid exposure.
Patients with severe asthma (n = 808) were matched by age and sex with patients with mild/moderate asthma (n = 3975) and nonasthma control subjects (n = 2412) from the Optimum Patient Care Research Database. Regression analysis was used to investigate the odds of a number of corticosteroid-induced comorbidities as it varied by cohort, age group, and sex. Prescribed drugs and publicly funded health care activity were monetized and annual costs per patient estimated.
Patients aged 60 years or younger with high oral corticosteroid (OCS) exposure had greater odds of osteopenia, osteoporosis, glaucoma, dyspeptic disorders, chronic kidney disease, cardiovascular disease, cataracts, hypertension, and obesity (P < .01) relative to those with mild/moderate asthma (low OCS exposure) as well as to those with no asthma. This difference in odds was much less evident in older patients. Sex-related differences for the odds of most comorbidities related to high-dose OCS were also observed. This differential pattern of comorbidity prevalence was reflected in mean health care costs per patient per year.
Results demonstrate important differential prevalence of corticosteroid-induced morbidity by age and sex, which is paralleled by differences in health care costs. This is important for clinicians in better understanding the risks of placing different age groups or sexes on systemic corticosteroids.
重度哮喘的治疗可能包括大剂量全身皮质类固醇治疗，这与大量合并症相关。有证据表明，这种负担在年龄、性别和皮质类固醇暴露水平上分布不均。
研究年龄、性别、合并症与通过皮质类固醇暴露分组的医疗保健费用模式之间的关系。
从 Optimum Patient Care Research Database 中，根据年龄和性别，将 808 名重度哮喘患者与轻度/中度哮喘患者（n=3975）和非哮喘对照患者（n=2412）相匹配。回归分析用于研究不同队列、年龄组和性别的皮质类固醇引起的合并症的几率差异。将处方药物和公共资助的医疗保健活动货币化，并估计每位患者的年度费用。
与轻度/中度哮喘（低 OCS 暴露）以及无哮喘患者相比，60 岁或以下高口服皮质类固醇（OCS）暴露的患者骨质疏松症、骨质疏松症、青光眼、消化不良疾病、慢性肾脏病、心血管疾病、白内障、高血压和肥胖症的几率更高（P<.01）。这种几率的差异在年龄较大的患者中不太明显。对于大多数与大剂量 OCS 相关的合并症的几率，也观察到了与性别相关的差异。这种常见疾病的流行模式差异反映在每位患者每年的平均医疗保健费用上。
研究结果表明，年龄和性别对皮质类固醇引起的发病率有重要的差异，这与医疗保健费用的差异相对应。这对于临床医生更好地理解将不同年龄组或性别置于全身皮质类固醇治疗的风险非常重要。
