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

Luke E Barry, Ciaran O'Neill, Chris Patterson, Joan Sweeney, David Price, Liam G Heaney (Corresponding Author)

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Abstract

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.

Original languageEnglish
Pages (from-to)2014-2023.e2
Number of pages10
JournalThe journal of allergy and clinical immunology. In practice
Volume6
Issue number6
Early online date21 Apr 2018
DOIs
Publication statusPublished - 30 Nov 2018

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Adrenal Cortex Hormones
Asthma
Morbidity
Comorbidity
Health Care Costs
Age Groups
Metabolic Bone Diseases
Chronic Renal Insufficiency
Glaucoma
Cataract
Osteoporosis
Patient Care
Cardiovascular Diseases
Obesity
Regression Analysis
Databases
Hypertension
Delivery of Health Care
Costs and Cost Analysis
Therapeutics

Keywords

  • Asthma
  • corticosteroid
  • comorbidity
  • economic
  • age
  • gender

Cite this

Age and Sex Associations with Systemic Corticosteroid-Induced Morbidity in Asthma. / Barry, Luke E; O'Neill, Ciaran; Patterson, Chris; Sweeney, Joan; Price, David; Heaney, Liam G (Corresponding Author).

In: The journal of allergy and clinical immunology. In practice, Vol. 6, No. 6, 30.11.2018, p. 2014-2023.e2.

Research output: Contribution to journalArticle

Barry, Luke E ; O'Neill, Ciaran ; Patterson, Chris ; Sweeney, Joan ; Price, David ; Heaney, Liam G. / Age and Sex Associations with Systemic Corticosteroid-Induced Morbidity in Asthma. In: The journal of allergy and clinical immunology. In practice. 2018 ; Vol. 6, No. 6. pp. 2014-2023.e2.
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abstract = "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.",
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T1 - Age and Sex Associations with Systemic Corticosteroid-Induced Morbidity in Asthma

AU - Barry, Luke E

AU - O'Neill, Ciaran

AU - Patterson, Chris

AU - Sweeney, Joan

AU - Price, David

AU - Heaney, Liam G

N1 - Funding: The study dataset was supported by the Respiratory Effectiveness Group through their academic partnership with Optimum Patient Care. Ciaran O'Neill was funded under a HRB Research Leader Award (RL/13/16).

PY - 2018/11/30

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N2 - 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.

AB - 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.

KW - Asthma

KW - corticosteroid

KW - comorbidity

KW - economic

KW - age

KW - gender

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M3 - Article

VL - 6

SP - 2014-2023.e2

JO - The Journal of Allergy and Clinical Immunology: In Practice

JF - The Journal of Allergy and Clinical Immunology: In Practice

SN - 2213-2198

IS - 6

ER -