The frequency of asthma exacerbations and healthcare utilization in patients with asthma from the UK and USA

Asthma exacerbations are frequent in patients with severe disease. This report describes results from two retrospective cohort studies describing exacerbation frequency and risk, emergency department (ED)/hospital re-admissions, and asthma-related costs by asthma severity in the US and UK

Do case-only designs yield consistent results across design and different databases? A case study of hip fractures and benzodiazepines.

BACKGROUND: The case-crossover (CXO) and self-controlled case series (SCCS) designs are increasingly used in pharmacoepidemiology. In both, relative risk estimates are obtained within persons, implicitly controlling for time-fixed confounding variables. OBJECTIVES: To examine the consistency of relative risk estimates of hip/femur fractures (HFF) associated with the use of benzodiazepines (BZD) across case-only designs in two databases (DBs), when a common protocol was applied. METHODS: CXO and SCCS studies were conducted in BIFAP (Spain) and CPRD (UK). Exposure to BZD was divided into non-use, current, recent and past use. For CXO, odds ratios (OR; 95%CI) of current use versus non-use/past were estimated using conditional logistic regression adjusted for co-medications (AOR). For the SCCS, conditional Poisson regression was used to estimate incidence rate ratios (IRR; 95%CI) of current use versus non/past-use, adjusted for age. To investigate possible event-exposure dependence the relative risk in the 30 days prior to first BZD exposure was also evaluated. RESULTS: In the CXO current use of BZD was associated with an increased risk of HFF in both DBs, AORBIFAP = 1.47 (1.29-1.67) and AORCPRD = 1.55 (1.41-1.70). In the SCCS, IRRs for current exposure was 0.79 (0.72-0.86) in BIFAP and 1.21 (1.13-1.30) in CPRD. However, when we considered separately the 30-day pre-exposure period, the IRR for current period was 1.43 (1.31-1.57) in BIFAP and 1.37 (1.27-1.47) in CPRD. CONCLUSIONS: CXO designs yielded consistent results across DBs, while initial SCCS analyses did not. Accounting for event-exposure dependence, estimates derived from SCCS were more consistent across DBs and designs

Incidence, risk factors and re-exacerbation rate of severe asthma exacerbations in a multinational, multidatabase pediatric cohort study

Background: There are sparse real-world data on severe asthma exacerbations (SAE) in children. This multinational cohort study assessed the incidence of and risk factors for SAE and the incidence of asthma-related rehospitalization in children with asthma. Methods: Asthma patients 5-17 years old with ≥1 year of follow-up were identified in six European electronic databases from the Netherlands, Italy, the UK, Denmark and Spain in 2008-2013. Asthma was defined as ≥1 asthma-specific disease code within 3 months of prescriptions/dispensing of asthma medication. Severe asthma was defined as high-dosed inhaled corticosteroids plus a second controller. SAE was defined by systemic corticosteroids, emergency department visit and/or hospitalization all for reason of asthma. Risk factors for SAE were estimated by Poisson regression analyses. Results: The cohort consisted of 212 060 paediatric asthma patients contributing to 678 625 patient-years (PY). SAE rates ranged between 17 and 198/1000 PY and were higher in severe asthma and highest in severe asthma patients with a history of exacerbations. Prior SAE (incidence rate ratio 3-45) and younger age increased the SAE risk in all countries, whereas obesity, atopy and GERD were a risk factor in some but not all countries. Rehospitalization rates were up to 79% within 1 year. Conclusions: In a real-world setting, SAE rates were highest in children with severe asthma with a history of exacerbations. Many severe asthma patients were rehospitalized within 1 year. Asthma management focusing on prevention of SAE is important to reduce the burden of asthma

The characteristics and treatment patterns of patients with Parkinson's disease in the United States and United Kingdom: A retrospective cohort study.

ObjectivesThe objective of the study was to describe treatment patterns in patients newly diagnosed with Parkinson's disease (PD) in the United States (US) and the United Kingdom (UK).MethodsThis retrospective cohort study used the US IBM MarketScan database (2012-2017) and the UK Clinical Practice Research Datalink (CPRD) (2004-2015) database to describe treatment patterns in incident PD cases. Patients fulfilling the case definition of PD, ≥30 years, with a 2-year baseline period prior to the index date (date of PD diagnosis), and ≥90 days of follow-up were included in the study. Treatment was classified as monotherapy (one PD medication for ≥60 continuous days), polytherapy (at least two PD medications concurrently for ≥60 days), or untreated (no PD medication prescription). Treatment patterns described included type of medication, duration and outcome of treatment.ResultsThere were 11,280 patients in IBM MarketScan and 7775 patients in CPRD who fulfilled the study criteria. The proportion of treated patients was 62.4% (US) and 78.6% (UK). The majority of patients were prescribed monotherapy as first-line treatment (US: 85.2%, UK: 68.5%). Levodopa was the most frequently prescribed first-line medication (US: 70.1%, UK: 29.0%). There were 57.9% in the US and 23.8% in the UK who remained on the first monotherapy treatment till the end of the study.ConclusionThe study has highlighted the current treatment practices in the US and UK, and underscored differences in the two regions impacted by treatment policies and guidelines

Retrospective cohort analysis of healthcare claims in the United States characterising asthma exacerbations in paediatric patients

Background Asthma is the most common chronic disease in childhood and places a significant burden on public and private health systems. This retrospective cohort analysis utilised administrative healthcare claims data (US Clinformatics™ Multiplan database; compliant with the US Department of Health & Human Services Health Insurance Portability and Accountability Act) to characterise asthma exacerbations requiring intervention in a US paediatric patient population.Methods Patients aged > 1–17 years with a recorded asthma diagnosis and receiving treatment were identified in the US Clinformatics™ Multiplan database over a 9-year period (2004–2012). Both incident and prevalent cases of asthma were included, with the most recently recorded asthma diagnosis designated as the index date. The 12-month period following the index date was analysed for asthma exacerbations, defined as an event requiring treatment with systemic corticosteroid or resulting in an asthma-related hospitalisation or emergency department visit.Results Data from 734,114 children with asthma (41.5 % females, 58.5 % males) were analysed, of this cohort 34.4 % experienced ≥ 1 exacerbation during the follow-up period. The proportion who experienced ≥ 1 exacerbation increased from 28.9 % in 2004 to 36.3 % in 2012, based on the reported index date. Their mean annual exacerbation frequency was 1.4; 85.8 % of exacerbations were defined by systemic corticosteroids use. A consistent trend of increased exacerbation incidence in the fall and early winter was observed, in particular exacerbations defined by systemic corticosteroid use. A greater proportion of asthma-related hospitalisations were associated with younger age.Conclusions Approximately one-third of children experienced ≥ 1 exacerbation in real-world clinical practice. A targeted treatment approach with a focus on those with a history of recurrent exacerbations is recommended to improve asthma control. This targeted approach could also minimise the frequent systemic corticosteroid exposure particularly at an early age when side effects of systemic corticosteroids are more pronounced. Keywords: Asthma, Exacerbations, Paediatric, Systemic corticosteroid

The frequency of asthma exacerbations and healthcare utilization in patients with asthma from the UK and USA

Abstract Background Asthma exacerbations are frequent in patients with severe disease. This report describes results from two retrospective cohort studies describing exacerbation frequency and risk, emergency department (ED)/hospital re-admissions, and asthma-related costs by asthma severity in the US and UK. Methods Patients with asthma in the US-based Clinformatics™ DataMart Multiplan IMPACT (2010–2011; WEUSKOP7048) and the UK-based Clinical Practice Research Datalink (2009–2011; WEUSKOP7092) databases were categorized by disease severity (Global Initiative for Asthma [GINA]; Step and exacerbation history) during the 12 months pre-asthma medical code (index date). Outcomes included: frequency of exacerbations (asthma-related ED visit, hospitalization, or oral corticosteroid use with an asthma medical code recorded within ±2 weeks) 12 months post-index, asthma-related ED visits/hospitalization, and asthma-related costs 30 days post-index. Risk of a subsequent exacerbation was determined by proportional hazard model. Results Of the 222,817 and 211,807 patients with asthma included from the US and UK databases, respectively, 12.5 and 8.4% experienced ≥1 exacerbation during the follow-up period. Exacerbation frequency increased with disease severity. Among the 5,167 and 2,904 patients with an asthma-related ED visit/hospitalization in the US and UK databases, respectively, 9.2 and 4.7% had asthma-related re-admissions within 30 days. Asthma-related re-admission rates and costs increased with disease severity, approximately doubling between GINA Step 1 and 5 and in patients with ≥2 versus <2 exacerbations in the previous year. Risk of a subsequent exacerbation increased 32–35% for an exacerbation requiring ED visit/hospitalization versus oral corticosteroids. Conclusion Increased disease severity was associated with higher exacerbation frequency, ED/hospitalization re-admission, costs and risk of subsequent exacerbation, indicating that these patients require high-intensity post-exacerbation management

Additional file 1: Tables S1–S9. of The frequency of asthma exacerbations and healthcare utilization in patients with asthma from the UK and USA

Additional results for patient demographics and baseline characteristics, exacerbation rates, exacerbation risk, frequency of hospital re-admissions, healthcare utilization, medication utilization and healthcare costs. (DOC 304 kb

Do case-only designs yield consistent results between them and across different databases (DB)? Hip fractures associated with Benzodiazepines (BZD) as a case study

Background: The case crossover (CXO) and selfcontrolled case series designs (SCCS) are increasingly used in pharmacoepidemiology. In both designs relative risk estimates are obtained within persons rather than between persons thus implicitly controlling for fixed confounding variables. Objectives: To examine the consistency of relative risk estimates of hip/femur fractures (HF) associated with the use of BZD across case-only designs and across two different DB, when same protocol and analytical methods are applied. Methods: CXO and SCCS studies were carried out in BIFAP (Spain) and CPRD (UK). For the CXO, exposure to BZD was divided into non-use, current (up to 30 days after the end of last supply), and recent (1-60 days after). A case moment with four control moments (each 90 days apart) were defined from index date (HF); odds ratios (OR; 95%CI) of current use vs. non-use were estimated using conditional logistic regression with adjustment for co-medications (AOR). For the SCCS, exposure to BZD was divided similarly, but current use was subdivided into:1-30; 31-60; 61-182; 183-365; and >365 days. A conditional Poisson regression was used to estimate incidence rate ratios (IRR; 95%CI) of current use as compared to non-use, adjusted for age. To investigate possible event-exposure dependence we also evaluated the relative risk excluding a pre-exposure time of 30 days. Results: In the CXO current use of BZD was associated with an increased risk of HF in both DB, BIFAP [crude OR= 1.70 (1.50-1.92); AOR= 1.47 (1.29-1.67)] and CPRD [crude OR= 1.75 (1.60-1.92); AOR= 1.55 (1.41-1.67)]. In the SCCS IRRs for the first current period was 0.79 (0.68-0.92) in BIFAP and 1.42 (1.27-1.59) in CPRD. However, when we removed the 30 day pre-exposure period from non-use, the IRR for first current period was 1.40 (1.21-1.62) in BIFAP and 1.59 (1.42-1.78) in CPRD. Conclusions: CXO designs yielded consistent results across DB, while SCCS did not. However, once we accounted for the event-exposure dependence, estimates derived from SCCS were more consistent across DBs and with CXO results