A longitudinal examination of the asthma medication ratio in children

The asthma medication ratio (AMR) (number of controller medications / [number of controller medications + number of rescue medications]) can be calculated using claims data. This measure has not previously been studied longitudinally. Our objective is to conduct a longitudinal examination of the AMR in a large national cohort of children with asthma.

Retrospective analysis of pharmacy and medical claims data.

Using 2013-2014 TruvenHealth MarketScan data, we identified children with asthma. Beginning with the month of first controller claim, we calculated an AMR for each rolling 3-month period and each rolling 6-month period and examined the proportion who had AMRs classified as low-risk (≥0.5), high-risk (<0.5), and missing for each period. Using logistic regression, we tested how a rolling AMR predicted a child's hospitalization or emergency department (ED) visit for asthma.

We identified 197,316 patients aged 2 to 17 years with a claim for a controller. AMRs were relatively stable over time, with the majority of patients remaining in the same AMR category through a 12-month period. Using both the rolling 3-month and 6-month AMRs, a higher proportion of patients with high-risk AMRs (9.6% and 9.5%, respectively) had an ED visit or hospitalization compared with patients with low-risk (5.0% and 5.7%) and missing (3.5% and 3.2%) AMRs (P <.0001). Using logistic regression, the 3-month AMR is more strongly associated with subsequent ED visit or hospitalization than the 6-month AMR.

AMR-based risk assignment is relatively stable over time. Three-month AMR calculation periods appear to provide the most accurate assessment of risk. Children with missing AMRs likely have inactive asthma and are at the lowest risk for emergent asthma visits.