2002年～2007年间参与商业保险的人群中未得到控制的哮喘：趋势、预测因素和费用
2010/09/14
摘要
目的：哮喘未得到控制，可导致某些可预防性疾病的发病增加，同时也增加了卫生资源的使用。本试验在一项较大的健康计划参与人群中，研究5年间未控制哮喘的趋势、预测因子和费用。
方法：对2000年中期至2007年中期哮喘患者的健康需求数据进行回顾性研究。患者年龄为1～56岁（54,653名患者年，28,595名患者）。哮喘未控制定义为12个月内≥2次口服激素或≥5次短效β2受体激动剂（SABA）或哮喘相关住院或急诊（ED）就诊。广义多元混合回归模型研究哮喘未控制的患者级和邻舍层面预测因子。比较哮喘控制和未控制患者的哮喘治疗相关费用。
结果：2002年至2003年间，39％的患者有≥1次的哮喘未控制事件发生，导致哮喘急救用药使用比率增加。哮喘相关住院和急诊就诊并不频繁。从2006年至2007年，哮喘未控制的百分比随着时间逐渐降至27％，可能与频繁使用SABA的比率降低相关。男性和≥24岁的成人患者具有较高的以用药为基础的哮喘未控制优势比，而毗邻地区的更多少数民族和较低教育程度的患者其哮喘相关急诊就诊和住院增加。有哮喘未控制事件的患者，其哮喘相关费用显著增加。
结论：本研究人群中，未控制哮喘的患者（主要表现为SABA过度使用）比率在5年内逐渐下降。一些个体和邻舍层面特征与哮喘未控制事件相关。临床医生和健康计划能鉴别高危患者，以便采取针对性的哮喘治疗策略，减少哮喘相关发病率和费用。
（陈欣 审校）
J Asthma. 2010 Jun;47(5):574-580.
Uncontrolled asthma in a commercially insured population from 2002 to 2007: trends, predictors, and costs
Sawicki GS, Vilk Y, Schatz M, Kleinman K, Abrams A, Madden J.
Division of Respiratory Diseases, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA. gregory.sawicki@childrens.harvard.edu
Abstract
OBJECTIVE: Uncontrolled asthma leads to preventable morbidity and increased health care utilization. The authors examined trends, predictors, and costs of uncontrolled asthma over 5 years in a large health plan population.
METHODS: The authors retrospectively examined administrative health claims data from mid-2000 to mid-2007 on patients with asthma aged 1 to 56 years (n = 54,653 patient-years, 28,595 unique patients). Uncontrolled asthma events were defined as > or =2 oral steroid fills or > or =5 short-acting beta(2)-agonist (SABA) fills over 12 months, or an asthma-related hospitalization or emergency department (ED) visit. Multivariate generalized mixed regression models determined patient- and neighborhood-level predictors for uncontrolled asthma events. The authors compared asthma-related costs for patients with and without uncontrolled asthma events.
RESULTS: In 2002-2003, 39% of patients had > or =1 uncontrolled asthma event. Most frequent were high use of rescue asthma medications. Asthma-related hospitalizations and ED visits were infrequent. The percentage having uncontrolled asthma events decreased significantly over time to 27% in 2006-2007, due to a decreased rate of frequent SABA fills. Males and adults > or =24 years had higher odds of medication-based uncontrolled asthma events, whereas residence in neighborhoods with more minorities and lower educational attainment was associated with ED visits or hospitalizations. Patients with uncontrolled asthma events had significantly higher asthma-related costs.
CONCLUSIONS: In this population, the proportion of patients with uncontrolled asthma, particularly as indicated by high SABA fills, decreased over a 5-year period. Several individual- and neighborhood-level characteristics were associated with uncontrolled asthma events. Clinicians and health plans can identify higher-risk patients in order to target asthma management strategies and reduce asthma-related morbidity and its associated costs.
J Asthma. 2010 Jun;47(5):574-80.
目的：哮喘未得到控制，可导致某些可预防性疾病的发病增加，同时也增加了卫生资源的使用。本试验在一项较大的健康计划参与人群中，研究5年间未控制哮喘的趋势、预测因子和费用。
方法：对2000年中期至2007年中期哮喘患者的健康需求数据进行回顾性研究。患者年龄为1～56岁（54,653名患者年，28,595名患者）。哮喘未控制定义为12个月内≥2次口服激素或≥5次短效β2受体激动剂（SABA）或哮喘相关住院或急诊（ED）就诊。广义多元混合回归模型研究哮喘未控制的患者级和邻舍层面预测因子。比较哮喘控制和未控制患者的哮喘治疗相关费用。
结果：2002年至2003年间，39％的患者有≥1次的哮喘未控制事件发生，导致哮喘急救用药使用比率增加。哮喘相关住院和急诊就诊并不频繁。从2006年至2007年，哮喘未控制的百分比随着时间逐渐降至27％，可能与频繁使用SABA的比率降低相关。男性和≥24岁的成人患者具有较高的以用药为基础的哮喘未控制优势比，而毗邻地区的更多少数民族和较低教育程度的患者其哮喘相关急诊就诊和住院增加。有哮喘未控制事件的患者，其哮喘相关费用显著增加。
结论：本研究人群中，未控制哮喘的患者（主要表现为SABA过度使用）比率在5年内逐渐下降。一些个体和邻舍层面特征与哮喘未控制事件相关。临床医生和健康计划能鉴别高危患者，以便采取针对性的哮喘治疗策略，减少哮喘相关发病率和费用。
（陈欣 审校）
J Asthma. 2010 Jun;47(5):574-580.
Uncontrolled asthma in a commercially insured population from 2002 to 2007: trends, predictors, and costs
Sawicki GS, Vilk Y, Schatz M, Kleinman K, Abrams A, Madden J.
Division of Respiratory Diseases, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA. gregory.sawicki@childrens.harvard.edu
Abstract
OBJECTIVE: Uncontrolled asthma leads to preventable morbidity and increased health care utilization. The authors examined trends, predictors, and costs of uncontrolled asthma over 5 years in a large health plan population.
METHODS: The authors retrospectively examined administrative health claims data from mid-2000 to mid-2007 on patients with asthma aged 1 to 56 years (n = 54,653 patient-years, 28,595 unique patients). Uncontrolled asthma events were defined as > or =2 oral steroid fills or > or =5 short-acting beta(2)-agonist (SABA) fills over 12 months, or an asthma-related hospitalization or emergency department (ED) visit. Multivariate generalized mixed regression models determined patient- and neighborhood-level predictors for uncontrolled asthma events. The authors compared asthma-related costs for patients with and without uncontrolled asthma events.
RESULTS: In 2002-2003, 39% of patients had > or =1 uncontrolled asthma event. Most frequent were high use of rescue asthma medications. Asthma-related hospitalizations and ED visits were infrequent. The percentage having uncontrolled asthma events decreased significantly over time to 27% in 2006-2007, due to a decreased rate of frequent SABA fills. Males and adults > or =24 years had higher odds of medication-based uncontrolled asthma events, whereas residence in neighborhoods with more minorities and lower educational attainment was associated with ED visits or hospitalizations. Patients with uncontrolled asthma events had significantly higher asthma-related costs.
CONCLUSIONS: In this population, the proportion of patients with uncontrolled asthma, particularly as indicated by high SABA fills, decreased over a 5-year period. Several individual- and neighborhood-level characteristics were associated with uncontrolled asthma events. Clinicians and health plans can identify higher-risk patients in order to target asthma management strategies and reduce asthma-related morbidity and its associated costs.
J Asthma. 2010 Jun;47(5):574-80.
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瑞典一项针对老年人的队列研究中死亡率、哮喘与健康相关生活质量的关系
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蒙特利尔儿童中与哮喘控制较差有关的家庭环境因素：基于人群的研究
