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Published on: August 7, 2017
Demographic predictors of leukotriene antagonist monotherapy among children with persistent asthma
Chang L Wu1, Annie L Andrews2, Ronald J Teufel2
1Division of Hospital Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
Insights
Children aged 5-13, rural, and Caucasian children were more likely to receive leukotriene receptor antagonist monotherapy (LTRAM) for persistent asthma. Further research is needed to understand prescribing patterns for optimal controller therapy.
Area of Science:
- Pediatric Pulmonology
- Pharmacotherapy
- Health Services Research
Background:
- Persistent asthma affects numerous children, necessitating effective controller therapies.
- Leukotriene receptor antagonist monotherapy (LTRAM) is a non-preferred controller option for pediatric persistent asthma.
- Understanding prescribing patterns for LTRAM is crucial for optimizing asthma management.
Purpose of the Study:
- To describe the characteristics of children with persistent asthma receiving LTRAM.
- To identify factors associated with the use of LTRAM versus inhaled corticosteroids (ICS).
Main Methods:
- Cross-sectional analysis of South Carolina Medicaid data (2007-2009) for children aged 2-18 with persistent asthma.
- Multivariable logistic regression to compare LTRAM use based on age, race, sex, HEDIS class, rurality, and disease severity.
- Negative binomial regression to compare healthcare utilization (albuterol, oral steroids, outpatient visits, ED visits, hospitalizations) between LTRAM and ICS users.
Main Results:
- Of 19,512 children studied, 12.9% received LTRAM and 73.5% received ICS.
- Children aged 5-13, Caucasian children, and rural children were significantly more likely to receive LTRAM (P < .01).
- LTRAM use was associated with lower albuterol, oral steroid, and outpatient visits compared to ICS, with no difference in ED visits or hospitalizations.
Conclusions:
- Age (5-13 years), Caucasian race, and rural residence are associated with higher likelihood of LTRAM use in pediatric persistent asthma.
- Investigating provider and patient factors influencing LTRAM prescribing patterns is essential for optimizing asthma controller therapy.
- These findings highlight potential disparities or specific patient profiles favoring LTRAM use.
Objective:
To describe the children with persistent asthma receiving non-preferred controller therapy in the form of leukotriene receptor antagonist monotherapy (LTRAM).
Study Design:
In this cross-sectional study, we analyzed 2007-2009 South Carolina Medicaid data of children aged 2- to 18 years with persistent asthma, defined by Healthcare Effectiveness Data and Information Set (HEDIS). Those without either LTRAM or inhaled corticosteroids (ICS) were excluded. With multivariable logistic regression modeling, we compared the outcome of LTRAM with the primary predictor of age and adjusted for covariates of race, sex, HEDIS class, rurality, and disease severity. We also used negative binomial regression to compare outcomes of albuterol and oral steroid claims, outpatient and emergency department visits, and hospitalizations with predictors of LTRAM vs ICS therapy.
Results:
A total of 19,512 patients with asthma aged 2- to 18-years were studied: 2658 (13.6%) without controllers were excluded, 2508 (12.9%) received LTRAM, and 14 346 (73.5%) received ICS. Age, race, rurality, and HEDIS classification were all significantly associated with LTRAM (all P < .01): 5- to 13-year-olds relative to children <5 years old (OR 1.46, 95% CI 1.30-1.64), Caucasians relative to African Americans (OR 1.40, 95% CI 1.27-1.53), and rural children relative to urban (OR 1.18, 95% CI 1.08-1.3) were all more likely to receive LTRAM. Albuterol, oral steroid, and outpatient visits were lower in LTRAM (P < .01). No difference was detected in emergency department visits or admissions.
Conclusions:
Children 5- to 13-years of age, rural children, and Caucasian children were more likely to receive LTRAM. Uncovering provider rationale and practices as well as patient influences on this prescribing pattern may be helpful in optimizing asthma controller therapy.
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