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Preventive asthma medication discontinuation among children enrolled in fee-for-service Medicaid
David E Capo-Ramos1, Catherine Duran, Alan E Simon
1Infant, Child & Women's Health Statistics Branch (ICWHSB), Office of Analysis & Epidemiology (OAE), National Center for Health Statistics (NCHS) , Centers for Disease Control & Prevention (CDC), Hyattsville, MD , USA and.
Insights
Over 60% of children in Medicaid/CHIP discontinued asthma medications within 90 days. Minorities and disadvantaged children faced higher risks, highlighting needs for improved pediatric asthma management.
Area of Science:
- Pediatric Asthma Management
- Health Services Research
- Public Health Policy
Background:
- Preventive asthma medication discontinuation in children enrolled in Medicaid and the Children's Health Insurance Program (CHIP) is linked to adverse health outcomes.
- Local studies indicate significant issues, necessitating a broader assessment of discontinuation trends and risk factors.
Purpose of the Study:
- To assess the time-to-discontinuation of preventive asthma medications among fee-for-service Medicaid/CHIP child beneficiaries.
- To identify demographic and clinical risk factors associated with medication non-adherence in this population.
Main Methods:
- Utilized data from the National Health Interview Survey (1997-2005) linked with Medicaid-Analytic-eXtract claims (1999-2008) for children aged 2-17 with Medicaid/CHIP coverage.
- Employed multivariate Cox proportional-hazards models to analyze time-to-discontinuation, considering demographic variables and specific medication regimens (inhaled corticosteroids, long-acting beta-agonists, etc.).
Main Results:
- A significant 63% of children discontinued preventive asthma medications within 90 days of their first prescription.
- Higher discontinuation hazards were observed in adolescents, toddlers, Hispanic children, non-Hispanic Black children, and those from households with fewer adults or lower caregiver educational attainment.
- Discontinuation rates were substantially higher for children on inhaled corticosteroids alone or other preventive medications compared to those on combined inhaled corticosteroids and leukotriene modifiers.
Conclusions:
- More than 60% of children in fee-for-service Medicaid/CHIP discontinue essential preventive asthma medications within 90 days.
- Minority children and those from socioeconomically disadvantaged households are at increased risk of discontinuation.
- These findings underscore the need to refine pediatric asthma guidelines to address adherence challenges in vulnerable populations.
Objective:
Local-area studies demonstrate that preventive asthma medication discontinuation among Medicaid and Children's-Health-Insurance-Program (CHIP) enrolled children leads to adverse outcomes. We assessed time-to-discontinuation for preventive asthma medication and its risk factors among fee-for-service Medicaid/CHIP child beneficiaries.
Methods:
National-Health-Interview-Survey participants (1997-2005) with ≥1 Medicaid- or CHIP-paid claims when 2-17 years old (n = 4262) were linked to Medicaid-Analytic-eXtract claims (1999-2008). Multivariate Cox proportional-hazards models to assess time-to-discontinuation (i.e. failing to refill prescriptions <30 d after previous supplies ran out) included demographic factors and medication regimen (inhaled corticosteroids [ICS], long-acting β2-agonists, leukotriene modifiers, mast cell stabilizers, and monoclonal antibodies).
Results:
Sixty-three percent discontinued preventive asthma medications by 90 d after the first prescription. Adolescents and toddlers had slightly higher hazards of discontinuation (adjusted hazard ratios [aHR], 1.13; 95% CI, 1.05-1.23; and 1.12; 1.03-1.21, respectively) versus 5-11-year-olds, as did Hispanics (aHR, 1.24; 1.13-1.35) and non-Hispanic blacks (aHR, 1.17; 1.07-1.28) versus non-Hispanic whites, children in households with one adult and ≥3 children (aHR, 1.17; 1.05-1.30) versus multiple adults and ≤2 children, and children with caregivers' educational-attainment ≤12th grade (aHR, 1.11; 1.02-1.20) versus caregivers with some college. Compared to regimens including both ICS and leukotriene modifiers, discontinuation was greater for those on ICS without leukotriene modifiers or on other preventive asthma medications (aHR, 1.67; 1.56-1.80; and 2.23; 1.78-2.80, respectively).
Conclusion:
More than 60% of children enrolled in fee-for-service Medicaid/CHIP discontinued preventive asthma medications by 90 d. Risk was increased for minorities and children from disadvantaged households. Understanding these factors may inform future pediatric asthma guidelines.
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