Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study
By A. Waljee, M. Rogers, Paul Lin, Amit G. Singal, J. Stein, Rory M. Marks, J. Ayanian, B. Nallamothu. British medical journal, 2017
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Objective To determine the frequency of prescriptions for short term use of oral corticosteroids, and adverse events (sepsis, venous thromboembolism, fractures) associated with their use. Design Retrospective cohort study and self controlled case series. Setting Nationwide dataset of private insurance claims. Participants Adults aged 18 to 64 years who were continuously enrolled from 2012 to 2014. Main outcome measures Rates of short term use of oral corticosteroids defined as less than 30 days duration. Incidence rates of adverse events in corticosteroid users and non-users. Incidence rate ratios for adverse events within 30 day and 31-90 day risk periods after drug initiation. Results Of 1 548 945 adults, 327 452 (21.1%) received at least one outpatient prescription for short term use of oral corticosteroids over the three year period. Use was more frequent among older patients, women, and white adults, with significant regional variation (all P<0.001). The most common indications for use were upper respiratory tract infections, spinal conditions, and allergies. Prescriptions were provided by a diverse range of specialties. Within 30 days of drug initiation, there was an increase in rates of sepsis (incidence rate ratio 5.30, 95% confidence interval 3.80 to 7.41), venous thromboembolism (3.33, 2.78 to 3.99), and fracture (1.87, 1.69 to 2.07), which diminished over the subsequent 31-90 days. The increased risk persisted at prednisone equivalent doses of less than 20 mg/day (incidence rate ratio 4.02 for sepsis, 3.61 for venous thromboembolism, and 1.83 for fracture; all P<0.001). Conclusion One in five American adults in a commercially insured plan were given prescriptions for short term use of oral corticosteroids during a three year period, with an associated increased risk of adverse events.
Subfields: Economics and Econometrics, General Health Professions, Psychiatry and Mental health
View Paper: https://www.semanticscholar.org/paper/244abdddfa3b74229ea019c109ddfef7854af630
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Citations in the corpus
- Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children (2020, background): “These effects may be under-appreciated in critically ill patients but can contribute to worse outcomes (319).”
- Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America (2019, background): “Side effects of corticosteroids (on the order of 240 mg of hydrocortisone per day) include significant increases in hyperglycemia requiring therapy and possible higher secondary infection rates (178, 179).”
- Global Initiative for Asthma Strategy 2021: Executive Summary and Rationale for Key Changes (2021, positive): “38 (cid:4) Even occasional short courses of OCS (e.g., four to fi ve courses over 7 yr [i.e., less than one course per year]), are associated with signi fi cant short-term risks 39 and cumulative risks of long-term adverse effects such as osteoporosis and diabetes.”