National Center for Health Insurance Research, Tehran, Iran.
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Front Public Health. 2023 Dec 18;11:1280434. doi: 10.3389/fpubh.2023.1280434. eCollection 2023.
Different medication prescription patterns have been associated with varying course of disease and outcomes in COVID-19. Health claims data is a rich source of information on disease treatment and outcomes. We aimed to investigate drug prescription patterns and their association with mortality and hospitalization via insurance data for a relatively long period of the pandemic in Iran.
We retrieved hospitalized patients' data from Iran Health Insurance Organization (IHIO) spanning 26 months (2020-2022) nationwide. Included were patients with ICD-10 codes U07.1/U07.2 for confirmed/suspected COVID-19. A case was defined as a single hospitalization event for an individual patient. Multiple hospitalizations of a patient within a 30-day interval were aggregated into a single case, while hospitalizations with intervals exceeding 30 days were treated as independent cases. The Anatomical Therapeutic Chemical (ATC) was used for medications classification. The two main study outcomes were general and intensive care unit (ICU) hospitalization periods and mortality. Besides, various demographic and clinical associate factors were analyzed to derive the associations with medication prescription patterns and study outcomes using accelerated failure time (AFT) and logistic regression models.
During the 26 months of the study period, 1,113,678 admissions with COVID-19 diagnosis at hospitals working in company with IHIO were recorded. 917,198 cases were detected from the database, among which 51.91% were females and 48.09% were males. Among the main groups of medications, antithrombotics (55.84% [95% CI: 55.74-55.94]), corticosteroids (54.14% [54.04-54.24]), and antibiotics (42.22% [42.12-42.32]) were the top used medications among cases with COVID-19. Investigation of the duration of hospitalization based on main medication groups showed antithrombotics (adjusted median ratio = 0.94 [0.94-0.95]) were significantly associated with shorter periods of overall hospitalization. Also, antithrombotics (adjusted odds ratio = 0.74 [95%CI, 0.73-0.76]), corticosteroids (0.97 [0.95-0.99]), antivirals (0.82 [0.80-0.83]), and ACE inhibitor/ARB (0.79 [0.77-0.80]) were significantly associated with lower mortality.
Over 2 years of investigation, antithrombotics, corticosteroids, and antibiotics were the top medications for hospitalized patients with COVID-19. Trends in medication prescription varied based on various factors across the country. Medication prescriptions could potentially significantly impact the trends of mortality and hospitalization during epidemics, thereby affecting both health and economic burdens.
不同的药物处方模式与 COVID-19 的疾病进程和结果有关。健康索赔数据是了解疾病治疗和结果的丰富信息来源。我们旨在通过伊朗大流行期间相对较长时间的保险数据调查药物处方模式及其与死亡率和住院治疗的关联。
我们从伊朗健康保险组织（IHIO）检索了全国范围内 26 个月（2020-2022 年）住院患者的数据。包括 ICD-10 代码 U07.1/U07.2 确诊/疑似 COVID-19 的患者。病例定义为单个住院患者的单次住院事件。在 30 天间隔内对同一患者的多次住院进行了汇总，而间隔超过 30 天的住院则被视为独立病例。使用解剖治疗化学（ATC）对药物进行分类。两个主要的研究结果是普通病房和重症监护病房（ICU）的住院时间和死亡率。此外，使用加速失效时间（AFT）和逻辑回归模型分析了各种人口统计学和临床相关因素，以得出与药物处方模式和研究结果的关联。
在研究期间的 26 个月中，在与 IHIO 合作的医院中记录了 1113678 例 COVID-19 诊断的住院患者。从数据库中检测到 917198 例病例，其中 51.91%为女性，48.09%为男性。在主要药物组中，抗血栓药物（55.84%[95%CI：55.74-55.94%]）、皮质类固醇（54.14%[54.04-54.24%]）和抗生素（42.22%[42.12-42.32%]）是 COVID-19 患者中使用最多的药物。基于主要药物组调查住院时间发现，抗血栓药物（调整后的中位数比值=0.94[0.94-0.95]）与整体住院时间缩短显著相关。此外，抗血栓药物（调整后的优势比=0.74[95%CI，0.73-0.76]）、皮质类固醇（0.97[0.95-0.99]）、抗病毒药物（0.82[0.80-0.83]）和 ACE 抑制剂/ARB（0.79[0.77-0.80]）与较低的死亡率显著相关。
在 2 年多的调查中，抗血栓药物、皮质类固醇和抗生素是 COVID-19 住院患者的主要药物。全国各地的药物处方趋势因各种因素而异。药物处方可能会显著影响大流行期间的死亡率和住院治疗趋势，从而影响健康和经济负担。
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