Age and Sex Associations with Systemic Corticosteroid-Induced Morbidity in Asthma

BACKGROUND: 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, gender and corticosteroid exposure levels.

OBJECTIVE: Examine the associations between age, gender, comorbidity, and patterns of healthcare cost across groups differentiated by corticosteroid exposure.

METHODS: Patients with severe asthma (n=808) were matched by age and gender to patients with mild/moderate asthma (n=3,975) and non-asthma control subjects (n=2,412) from the Optimum Patient Care Research Database (OPCRD). Regression analysis was used to investigate the odds of a number of corticosteroid-induced comorbidities as it varied by cohort, age-group, and gender. Prescribed drugs and publicly funded healthcare activity were monetised and annual costs per patient estimated.

RESULTS: Patients aged 60 years or less 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 < 0.01) relative both to those with mild/moderate asthma (low OCS exposure) and to non-asthmatics. This difference in odds was much less evident in older patients. Gender-related differences for the odds of most comorbidities related to high dose OCS was also observed. This differential pattern of comorbidity prevalence was reflected in mean healthcare costs per patient per year.

CONCLUSION: Results demonstrate important differential prevalence of corticosteroid-induced morbidity by age and gender which is paralleled by differences in healthcare costs. This is important for clinicians in better understanding the risks of placing different age-groups or genders on systemic corticosteroids.