Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jun 19, 2023
Date Accepted: Aug 24, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Trajectories of controller use before and after asthma-related hospitalizations: A population-based study in children and adults
ABSTRACT
Background:
Inappropriate use of inhaled corticosteroids (ICS) for asthma impairs control and may lead to exacerbations, including asthma-related hospitalizations (ARHs). In prospective studies, ICS use peaks around ARH, but information on routine care utilization is limited.
Objective:
To distinguish ICS use typologies -trajectories- before and after ARHs, and their relationship with socio-demographic, disease and healthcare characteristics.
Methods:
A retrospective cohort study was performed using a 1% random sample of the French claims database. All patients hospitalized for asthma between 2013/01/01, and 2015/12/31 were classified as either children (aged 1-10 years) or adults (aged ≥11 years). Healthcare resource use was assessed between 24-12 months before an ARH. ICS use was computed with the Continuous Measures of Medication Acquisition (CMA) for the 4 quarters before and after an ARH. Group-based trajectory modelling differentiated the groups with similar ICS use.
Results:
Immediately after hospitalization, the average CMA7 rose by 34.9% (p=0.0007) in children and 26.9% (p=0.0016) in teens/adults (segmented regression analysis). The trend after hospitalization showed a significant decrease per quarter. Three and five trajectories were identified before ARHs in children and adults, respectively, versus five after ARHs for both groups. Trajectories were related to socio-demographic characteristics, in particular markers of social deprivation, and to potentially inappropriate healthcare, such as medical management and choice of therapy.
Conclusions:
In our population sample, ARHs had a marked, but transient, impact on ICS use. Along with overall trends, distinct trajectories were identified, related to specific patients and healthcare characteristics. Health services should prioritize an appropriate use of ICS in asthma.
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