Xie Luyu, Gelfand Andrew, Mathew Matthew S, Atem Folefac D, Srikanth Nimisha, Delclos George L, Messiah Sarah E
School of Public Health, University of Texas Health Science Center, Dallas Campus, Dallas, TX, 75390, USA.
Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, TX, USA.
Drugs Real World Outcomes. 2022 Dec;9(4):667-679. doi: 10.1007/s40801-022-00304-8. Epub 2022 Jun 8.
The reduction in adverse drug events is a priority in healthcare. Medications are frequently prescribed for asthmatic children, but epidemiological trends of adverse drug events related to anti-asthmatic medications have not been described in hospitalized children.
The objective of this study was to report incidence trends, risk factors, and healthcare utilization of adverse drug events related to anti-asthmatic medications by major drug classes in hospitalized children in the USA from 2000 to 2016.
A population-based temporal analysis included those aged 0-20 years who were hospitalized with asthma from the 2000 to 2016 Kids Inpatient Database. Age-stratified weighted temporal trends of the inpatient incidence of adverse drug events related to anti-asthmatic medications (i.e., corticosteroids and bronchodilators) were estimated. Stepwise multivariate logistic regression models generated risk factors for adverse drug events.
From 2000 to 2016, 12,640 out of 698,501 pediatric asthma discharges (1.7%) were associated with adverse drug events from anti-asthmatic medications. 0.83% were adverse drug events from corticosteroids, resulting in a 1.14-fold increase in the length of stay (days) and a 1.42-fold increase in hospitalization charges (dollars). The overall incidence (per 1000 discharges) of anti-asthmatic medication adverse drug events increased from 5.3 (95% confidence interval [CI] 4.6-6.1) in 2000 to 21.6 (95% CI 18.7-24.6) in 2016 (p-trend = 0.024). Children aged 0-4 years had the most dramatic increase in the incidence of bronchodilator adverse drug events from 0.2 (95% CI 0.1-0.4) to 19.3 (95% CI 15.2-23.4) [p-trend ≤ 0.001]. In general, discharges among asthmatic children with some comorbidities were associated with an approximately two to five times higher odds of adverse drug events.
The incidence of adverse drug events from common anti-asthmatic medications quadrupled over the past decade, particularly among preschool-age children who used bronchodilators, resulting in substantial increased healthcare costs. Those asthmatic children with complex medical conditions may benefit the most from adverse drug event monitoring.
减少药物不良事件是医疗保健的首要任务。哮喘儿童经常需要用药，但住院儿童中与抗哮喘药物相关的药物不良事件的流行病学趋势尚未得到描述。
本研究的目的是报告2000年至2016年美国住院儿童中与主要药物类别相关的抗哮喘药物不良事件的发生率趋势、危险因素和医疗保健利用情况。
基于人群的时间分析纳入了2000年至2016年儿童住院数据库中因哮喘住院的0至20岁儿童。估计了与抗哮喘药物（即皮质类固醇和支气管扩张剂）相关的药物不良事件住院发生率的年龄分层加权时间趋势。逐步多变量逻辑回归模型生成了药物不良事件的危险因素。
2000年至2016年，698,501例儿科哮喘出院病例中有12,640例（1.7%）与抗哮喘药物的药物不良事件相关。0.83%为皮质类固醇药物不良事件，导致住院时间（天）增加1.14倍，住院费用（美元）增加1.42倍。抗哮喘药物不良事件的总体发生率（每1000例出院病例）从2000年的5.3（95%置信区间[CI]4.6 - 6.1）增加到2016年的21.6（95%CI 18.7 - 24.6）（p趋势 = 0.024）。0至4岁儿童支气管扩张剂药物不良事件的发生率从0.2（95%CI 0.1 - 0.4）急剧增加到19.3（95%CI 15.2 - 23.4）[p趋势≤0.001]。一般来说，患有某些合并症的哮喘儿童出院与药物不良事件的几率高出约两到五倍相关。
在过去十年中，常见抗哮喘药物的药物不良事件发生率增加了四倍，特别是在使用支气管扩张剂的学龄前儿童中，导致医疗保健成本大幅增加。那些患有复杂医疗状况的哮喘儿童可能从药物不良事件监测中受益最大。
