Kim Bo Hee, Ha Eun Kyo, Yoo Hana, Lee Soonchul, Rha Yeong Ho, Han Man Yong, Kim Ju Hee
Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea.
Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2024 Mar 11;39(9):e95. doi: 10.3346/jkms.2024.39.e95.
Tracking national croup trends can provide important insights for childhood health management. This study aimed to analyze the incidence and drug prescription trends in Korean children over a two-decade period.
This population-based study encompassed 479,783 children aged < 5 years from 2002-2019, utilizing the National Health Insurance Service-National Sample Cohort. We identified participants with a primary croup diagnosis who were admitted to or visited the emergency room. Age-specific and age-adjusted incidence rates/10,000 person-years were calculated. We assessed using orthogonal polynomial contrasts and stratified by various factors (sex, age, residential area, economic status, comorbidities, and healthcare facility types). We observed changes in the use of five medications: inhaled steroids, systemic steroids, inhaled epinephrine, antibiotics, and short-acting bronchodilators. Generalized binomial logistic regression was used to analyze factors influencing prescription strategies.
In 2002, the croup-related visits were 16.1/10,000 person-years, increasing to 98.3 in 2019 ( for trend < 0.001). This trend persisted, regardless of age, sex, region, and economic status. Children with comorbid atopic dermatitis or asthma maintained consistent croup rates, while those without comorbidities increased. Treatment trends showed decreasing antibiotic (73-47%) and oxygen use (21.3-3.4%), with increasing nebulized epinephrine (9.3-41.5%) and multiple drug prescriptions (67.8-80.3%). Primary care centers exhibited a greater increase in prescription usage and hospitalization duration than did tertiary healthcare institutions.
Over the past two decades, croup incidence has risen, accompanied by increased epinephrine use and decreased antibiotic prescriptions. Longer hospitalization and higher medication use were mainly observed in primary care facilities.
追踪全国性的哮吼趋势可为儿童健康管理提供重要见解。本研究旨在分析20年间韩国儿童的发病率及药物处方趋势。
这项基于人群的研究纳入了2002年至2019年期间479783名5岁以下儿童，利用了国民健康保险服务-全国样本队列。我们确定了因哮吼初诊而入住或前往急诊室的参与者。计算了特定年龄和年龄调整后的发病率/每10000人年。我们使用正交多项式对比进行评估，并按各种因素（性别、年龄、居住地区、经济状况、合并症和医疗机构类型）进行分层。我们观察了五种药物使用情况的变化：吸入性类固醇、全身性类固醇、吸入性肾上腺素、抗生素和短效支气管扩张剂。使用广义二项逻辑回归分析影响处方策略的因素。
2002年，与哮吼相关的就诊率为每10000人年16.1次，到2019年增至98.3次（趋势P<0.001）。无论年龄、性别、地区和经济状况如何，这一趋势都持续存在。患有特应性皮炎或哮喘合并症的儿童哮吼发病率保持稳定，而无合并症的儿童发病率上升。治疗趋势显示抗生素使用减少（73% - 47%）和吸氧使用减少（21.3% - 3.4%），而雾化肾上腺素使用增加（9.3% - 41.5%）和多种药物处方增加（67.8% - 80.3%）。初级保健中心的处方使用和住院时间的增加幅度大于三级医疗机构。
在过去二十年中，哮吼发病率上升，同时肾上腺素使用增加，抗生素处方减少。住院时间延长和药物使用增加主要出现在初级保健机构。
