Prevalence of long-term oral glucocorticoid prescriptions in the UK over the past 20 years
Prevalence of long-term oral glucocorticoid prescriptions in the UK over the past 20 years
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DOI：
10.1093/rheumatology/ker017
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发表时间：
2011-11-01
期刊：
影响因子：
5.5
通讯作者：
Nazareth, Irwin
中科院分区：
文献类型：
--
作者：
Fardet, Laurence;Petersen, Irene;Nazareth, Irwin
Objective.评估过去20年中长期（即>= 3个月）口服糖皮质激素（GC）处方的趋势。获得了1989年1月至2008年12月期间注册的英国成人患者的数据，这些患者的一般做法有助于健康改善网络（THIN）数据库。在整个人群中，特别是在RA、PMR/GCA、哮喘、慢性阻塞性肺疾病（COPD）、克罗恩病和溃疡性结肠炎（UC）患者中，评估了长期口服GC处方的年度患病率。在20年期间的趋势估计使用性别和年龄调整泊松回归模型。在26 035 154人年的随访期间，平均0.75%（95%CI 0.74，0.75）的研究人群在任何时间点接受了长期口服GC治疗。这一比例从1989年的0.59%（0.52，0.67）上升到2008年的0.79%（0.78，0.80）。RA患者的长期处方量显着增加[从10.3%（8.7，11.9）增加到13.6%（12.9，14.2）]和PMR/GCA患者[从57.6%（53.3，62.0）增加到66.5%（65.2，67.7）]，哮喘、COPD和克罗恩病患者的长期处方量减少，而UC患者的长期处方量保持稳定。然而，当仅考虑偶发病例时，我们发现RA和UC患者GC的使用减少[比值比分别为0.97（95%CI 0.96，0.97）和0.94（95%CI 0.93，0.96）/年]。在过去的20年里，长期口服GC处方增加了34%。然而，新诊断为RA、克罗恩病或UC的患者接受长期GC处方的可能性低于有长期病史的患者，这表明医生的做法发生了变化。
Objective. To assess trends in long-term (i.e. >= 3 months) oral glucocorticoid ( GC) prescriptions over the past 20 years.Methods. Data of UK adult patients registered between January 1989 and December 2008 with general practices contributing to The Health Improvement Network (THIN) database were obtained. The annual prevalence of long-term oral GC prescriptions was assessed in the whole population and specifically in people with RA, PMR/GCA, asthma, chronic obstructive pulmonary disease (COPD), Crohn's disease and ulcerative colitis (UC). Trends over the 20-year period were estimated using sex- and age-adjusted Poisson regression models.Results. During the 26 035 154 person-years of follow-up, an average of 0.75% (95% CI 0.74, 0.75) of the study population was prescribed long-term oral GC therapy at any time point. This rose from 0.59% (0.52, 0.67) in 1989 to 0.79% (0.78, 0.80) in 2008. Long-term prescriptions significantly increased in patients with RA [from 10.3% (8.7, 11.9) to 13.6% (12.9, 14.2)] and PMR/GCA [from 57.6% (53.3, 62.0) to 66.5% (65.2, 67.7)], decreased in patients with asthma, COPD and Crohn's disease and remained stable in patients with UC. However, when only incident cases were considered, we found a decreased use of GCs in patients with RA and UC [odds ratio 0.97 (95% CI 0.96, 0.97) and 0.94 (95% CI 0.93, 0.96) per increasing year, respectively].Conclusion. Over the past 20 years, long-term oral GC prescriptions have increased by 34%. Patients newly diagnosed with RA, Crohn's disease or UC are, however, less likely to receive long-term GC prescriptions than patients with a long past medical history of the disease, suggesting changes in physicians' practice.