Oral Glucocorticoids and Incident Treatment of Diabetes Mellitus, Hypertension, and Venous Thromboembolism in Children
Abstract Rates of incident treatment were quantified in this study for diabetes mellitus, hypertension, and venous thromboembolism (VTE) associated with oral glucocorticoid exposure in children aged 1–18 years. The retrospective cohort included more than 930,000 children diagnosed with autoimmune di...
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| Veröffentlicht in: | American journal of epidemiology 2021-03, Vol.190 (3), p.403-412 |
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| creator | Horton, Daniel B Xie, Fenglong Chen, Lang Mannion, Melissa L Curtis, Jeffrey R Strom, Brian L Beukelman, Timothy |
| description | Abstract
Rates of incident treatment were quantified in this study for diabetes mellitus, hypertension, and venous thromboembolism (VTE) associated with oral glucocorticoid exposure in children aged 1–18 years. The retrospective cohort included more than 930,000 children diagnosed with autoimmune diseases (namely, inflammatory bowel disease, juvenile idiopathic arthritis, or psoriasis) or a nonimmune comparator condition (attention-deficit/hyperactivity disorder) identified using US Medicaid claims (2000–2010). Associations of glucocorticoid dose per age- and sex-imputed weight with incident treated diabetes, hypertension, and VTE were estimated using Cox regression models. Crude rates were lowest for VTE (unexposed: 0.5/million person-days (95% confidence interval (CI): 0.4, 0.6); currently exposed: 15.6/million person-days (95% CI: 11.8, 20.1)) and highest for hypertension (unexposed: 6.7/million person-days (95% CI: 6.5, 7.0); currently exposed: 74.4/million person-days (95% CI: 65.7, 83.9)). Absolute rates for all outcomes were higher in unexposed and exposed children with autoimmune diseases compared with those with attention-deficit/hyperactivity disorder. Strong dose-dependent relationships were found between current glucocorticoid exposure and all outcomes (adjusted hazard ratios for high-dose glucocorticoids: for diabetes mellitus, 5.93 (95% CI: 3.94, 8.91); for hypertension, 19.13 (95% CI: 15.43, 23.73); for VTE, 16.16 (95% CI: 8.94, 29.22)). These results suggest strong relative risks, but low absolute risks, of newly treated VTE, diabetes, and especially hypertension in children taking high-dose oral glucocorticoids. |
| doi_str_mv | 10.1093/aje/kwaa197 |
| format | Article |
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Rates of incident treatment were quantified in this study for diabetes mellitus, hypertension, and venous thromboembolism (VTE) associated with oral glucocorticoid exposure in children aged 1–18 years. The retrospective cohort included more than 930,000 children diagnosed with autoimmune diseases (namely, inflammatory bowel disease, juvenile idiopathic arthritis, or psoriasis) or a nonimmune comparator condition (attention-deficit/hyperactivity disorder) identified using US Medicaid claims (2000–2010). Associations of glucocorticoid dose per age- and sex-imputed weight with incident treated diabetes, hypertension, and VTE were estimated using Cox regression models. Crude rates were lowest for VTE (unexposed: 0.5/million person-days (95% confidence interval (CI): 0.4, 0.6); currently exposed: 15.6/million person-days (95% CI: 11.8, 20.1)) and highest for hypertension (unexposed: 6.7/million person-days (95% CI: 6.5, 7.0); currently exposed: 74.4/million person-days (95% CI: 65.7, 83.9)). Absolute rates for all outcomes were higher in unexposed and exposed children with autoimmune diseases compared with those with attention-deficit/hyperactivity disorder. Strong dose-dependent relationships were found between current glucocorticoid exposure and all outcomes (adjusted hazard ratios for high-dose glucocorticoids: for diabetes mellitus, 5.93 (95% CI: 3.94, 8.91); for hypertension, 19.13 (95% CI: 15.43, 23.73); for VTE, 16.16 (95% CI: 8.94, 29.22)). These results suggest strong relative risks, but low absolute risks, of newly treated VTE, diabetes, and especially hypertension in children taking high-dose oral glucocorticoids.</description><identifier>ISSN: 0002-9262</identifier><identifier>EISSN: 1476-6256</identifier><identifier>DOI: 10.1093/aje/kwaa197</identifier><identifier>PMID: 32902632</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Adolescent ; Age ; Age Factors ; Arthritis ; Attention deficit hyperactivity disorder ; Autoimmune diseases ; Autoimmune Diseases - drug therapy ; Child ; Child, Preschool ; Children ; Cohort analysis ; Confidence intervals ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus - epidemiology ; Dosage ; Dose-Response Relationship, Drug ; Exposure ; Female ; Glucocorticoids ; Glucocorticoids - administration & dosage ; Glucocorticoids - adverse effects ; Glucocorticoids - therapeutic use ; Government programs ; Health services ; Humans ; Hyperactivity ; Hypertension ; Hypertension - epidemiology ; Infant ; Inflammatory bowel diseases ; Intestine ; Male ; Original Contribution ; Pediatrics ; Proportional Hazards Models ; Psoriasis ; Regression analysis ; Regression models ; Retrospective Studies ; Risk assessment ; Risk Factors ; Sex Factors ; Statistical analysis ; Thromboembolism ; Venous Thromboembolism - epidemiology</subject><ispartof>American journal of epidemiology, 2021-03, Vol.190 (3), p.403-412</ispartof><rights>The Author(s) 2020. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 2020</rights><rights>The Author(s) 2020. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c440t-f3f0a0d88d9812e950a0ba202a04b9d34ed9c7ec8f7435726093ff56d3db42be3</citedby><cites>FETCH-LOGICAL-c440t-f3f0a0d88d9812e950a0ba202a04b9d34ed9c7ec8f7435726093ff56d3db42be3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32902632$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Horton, Daniel B</creatorcontrib><creatorcontrib>Xie, Fenglong</creatorcontrib><creatorcontrib>Chen, Lang</creatorcontrib><creatorcontrib>Mannion, Melissa L</creatorcontrib><creatorcontrib>Curtis, Jeffrey R</creatorcontrib><creatorcontrib>Strom, Brian L</creatorcontrib><creatorcontrib>Beukelman, Timothy</creatorcontrib><title>Oral Glucocorticoids and Incident Treatment of Diabetes Mellitus, Hypertension, and Venous Thromboembolism in Children</title><title>American journal of epidemiology</title><addtitle>Am J Epidemiol</addtitle><description>Abstract
Rates of incident treatment were quantified in this study for diabetes mellitus, hypertension, and venous thromboembolism (VTE) associated with oral glucocorticoid exposure in children aged 1–18 years. The retrospective cohort included more than 930,000 children diagnosed with autoimmune diseases (namely, inflammatory bowel disease, juvenile idiopathic arthritis, or psoriasis) or a nonimmune comparator condition (attention-deficit/hyperactivity disorder) identified using US Medicaid claims (2000–2010). Associations of glucocorticoid dose per age- and sex-imputed weight with incident treated diabetes, hypertension, and VTE were estimated using Cox regression models. Crude rates were lowest for VTE (unexposed: 0.5/million person-days (95% confidence interval (CI): 0.4, 0.6); currently exposed: 15.6/million person-days (95% CI: 11.8, 20.1)) and highest for hypertension (unexposed: 6.7/million person-days (95% CI: 6.5, 7.0); currently exposed: 74.4/million person-days (95% CI: 65.7, 83.9)). Absolute rates for all outcomes were higher in unexposed and exposed children with autoimmune diseases compared with those with attention-deficit/hyperactivity disorder. Strong dose-dependent relationships were found between current glucocorticoid exposure and all outcomes (adjusted hazard ratios for high-dose glucocorticoids: for diabetes mellitus, 5.93 (95% CI: 3.94, 8.91); for hypertension, 19.13 (95% CI: 15.43, 23.73); for VTE, 16.16 (95% CI: 8.94, 29.22)). These results suggest strong relative risks, but low absolute risks, of newly treated VTE, diabetes, and especially hypertension in children taking high-dose oral glucocorticoids.</description><subject>Adolescent</subject><subject>Age</subject><subject>Age Factors</subject><subject>Arthritis</subject><subject>Attention deficit hyperactivity disorder</subject><subject>Autoimmune diseases</subject><subject>Autoimmune Diseases - drug therapy</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Cohort analysis</subject><subject>Confidence intervals</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Dosage</subject><subject>Dose-Response Relationship, Drug</subject><subject>Exposure</subject><subject>Female</subject><subject>Glucocorticoids</subject><subject>Glucocorticoids - administration & dosage</subject><subject>Glucocorticoids - adverse effects</subject><subject>Glucocorticoids - therapeutic use</subject><subject>Government programs</subject><subject>Health services</subject><subject>Humans</subject><subject>Hyperactivity</subject><subject>Hypertension</subject><subject>Hypertension - epidemiology</subject><subject>Infant</subject><subject>Inflammatory bowel diseases</subject><subject>Intestine</subject><subject>Male</subject><subject>Original Contribution</subject><subject>Pediatrics</subject><subject>Proportional Hazards Models</subject><subject>Psoriasis</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Retrospective Studies</subject><subject>Risk assessment</subject><subject>Risk Factors</subject><subject>Sex Factors</subject><subject>Statistical analysis</subject><subject>Thromboembolism</subject><subject>Venous Thromboembolism - epidemiology</subject><issn>0002-9262</issn><issn>1476-6256</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUlvFDEQhS0EIkPgxB1ZQuKSdFJeersgoQlZpKBcBq6W265mPHTbE7s7KP8eh5lEcMnBKkv-6tUrP0LeMzhh0IpTvcHTX7-1Zm39giyYrKui4mX1kiwAgBctr_gBeZPSBoCxtoTX5EDwFngl-ILc3UQ90IthNsGEODkTnE1Ue0uvvHEW_URXEfU0PtxCT8-c7nDCRL_hMLhpTsf08n6LcUKfXPDHf1t_oA9zoqt1DGMXMJ_BpZE6T5drN9iI_i151esh4bt9PSTfz7-ulpfF9c3F1fLLdWGkhKnoRQ8abNPYtmEcs3kNnebANciutUKibU2NpulrKcqaV_k_-r6srLCd5B2KQ_J5p7uduxGtyVvkfdU2ulHHexW0U_-_eLdWP8OdaqCpuIQs8HEvEMPtjGlSmzBHnz0rXjLBWCMly9TRjjIxpBSxf5rAQD2EpHJIah9Spj_8a-qJfUwlA592QJi3zyr9Af0ynig</recordid><startdate>20210301</startdate><enddate>20210301</enddate><creator>Horton, Daniel B</creator><creator>Xie, Fenglong</creator><creator>Chen, Lang</creator><creator>Mannion, Melissa L</creator><creator>Curtis, Jeffrey R</creator><creator>Strom, Brian L</creator><creator>Beukelman, Timothy</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T2</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>5PM</scope></search><sort><creationdate>20210301</creationdate><title>Oral Glucocorticoids and Incident Treatment of Diabetes Mellitus, Hypertension, and Venous Thromboembolism in Children</title><author>Horton, Daniel B ; Xie, Fenglong ; Chen, Lang ; Mannion, Melissa L ; Curtis, Jeffrey R ; Strom, Brian L ; Beukelman, Timothy</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c440t-f3f0a0d88d9812e950a0ba202a04b9d34ed9c7ec8f7435726093ff56d3db42be3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adolescent</topic><topic>Age</topic><topic>Age Factors</topic><topic>Arthritis</topic><topic>Attention deficit hyperactivity disorder</topic><topic>Autoimmune diseases</topic><topic>Autoimmune Diseases - drug therapy</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Cohort analysis</topic><topic>Confidence intervals</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetes Mellitus - epidemiology</topic><topic>Dosage</topic><topic>Dose-Response Relationship, Drug</topic><topic>Exposure</topic><topic>Female</topic><topic>Glucocorticoids</topic><topic>Glucocorticoids - administration & dosage</topic><topic>Glucocorticoids - adverse effects</topic><topic>Glucocorticoids - therapeutic use</topic><topic>Government programs</topic><topic>Health services</topic><topic>Humans</topic><topic>Hyperactivity</topic><topic>Hypertension</topic><topic>Hypertension - epidemiology</topic><topic>Infant</topic><topic>Inflammatory bowel diseases</topic><topic>Intestine</topic><topic>Male</topic><topic>Original Contribution</topic><topic>Pediatrics</topic><topic>Proportional Hazards Models</topic><topic>Psoriasis</topic><topic>Regression analysis</topic><topic>Regression models</topic><topic>Retrospective Studies</topic><topic>Risk assessment</topic><topic>Risk Factors</topic><topic>Sex Factors</topic><topic>Statistical analysis</topic><topic>Thromboembolism</topic><topic>Venous Thromboembolism - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Horton, Daniel B</creatorcontrib><creatorcontrib>Xie, Fenglong</creatorcontrib><creatorcontrib>Chen, Lang</creatorcontrib><creatorcontrib>Mannion, Melissa L</creatorcontrib><creatorcontrib>Curtis, Jeffrey R</creatorcontrib><creatorcontrib>Strom, Brian L</creatorcontrib><creatorcontrib>Beukelman, Timothy</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Horton, Daniel B</au><au>Xie, Fenglong</au><au>Chen, Lang</au><au>Mannion, Melissa L</au><au>Curtis, Jeffrey R</au><au>Strom, Brian L</au><au>Beukelman, Timothy</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Oral Glucocorticoids and Incident Treatment of Diabetes Mellitus, Hypertension, and Venous Thromboembolism in Children</atitle><jtitle>American journal of epidemiology</jtitle><addtitle>Am J Epidemiol</addtitle><date>2021-03-01</date><risdate>2021</risdate><volume>190</volume><issue>3</issue><spage>403</spage><epage>412</epage><pages>403-412</pages><issn>0002-9262</issn><eissn>1476-6256</eissn><abstract>Abstract
Rates of incident treatment were quantified in this study for diabetes mellitus, hypertension, and venous thromboembolism (VTE) associated with oral glucocorticoid exposure in children aged 1–18 years. The retrospective cohort included more than 930,000 children diagnosed with autoimmune diseases (namely, inflammatory bowel disease, juvenile idiopathic arthritis, or psoriasis) or a nonimmune comparator condition (attention-deficit/hyperactivity disorder) identified using US Medicaid claims (2000–2010). Associations of glucocorticoid dose per age- and sex-imputed weight with incident treated diabetes, hypertension, and VTE were estimated using Cox regression models. Crude rates were lowest for VTE (unexposed: 0.5/million person-days (95% confidence interval (CI): 0.4, 0.6); currently exposed: 15.6/million person-days (95% CI: 11.8, 20.1)) and highest for hypertension (unexposed: 6.7/million person-days (95% CI: 6.5, 7.0); currently exposed: 74.4/million person-days (95% CI: 65.7, 83.9)). Absolute rates for all outcomes were higher in unexposed and exposed children with autoimmune diseases compared with those with attention-deficit/hyperactivity disorder. Strong dose-dependent relationships were found between current glucocorticoid exposure and all outcomes (adjusted hazard ratios for high-dose glucocorticoids: for diabetes mellitus, 5.93 (95% CI: 3.94, 8.91); for hypertension, 19.13 (95% CI: 15.43, 23.73); for VTE, 16.16 (95% CI: 8.94, 29.22)). These results suggest strong relative risks, but low absolute risks, of newly treated VTE, diabetes, and especially hypertension in children taking high-dose oral glucocorticoids.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>32902632</pmid><doi>10.1093/aje/kwaa197</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Age Age Factors Arthritis Attention deficit hyperactivity disorder Autoimmune diseases Autoimmune Diseases - drug therapy Child Child, Preschool Children Cohort analysis Confidence intervals Diabetes Diabetes mellitus Diabetes Mellitus - epidemiology Dosage Dose-Response Relationship, Drug Exposure Female Glucocorticoids Glucocorticoids - administration & dosage Glucocorticoids - adverse effects Glucocorticoids - therapeutic use Government programs Health services Humans Hyperactivity Hypertension Hypertension - epidemiology Infant Inflammatory bowel diseases Intestine Male Original Contribution Pediatrics Proportional Hazards Models Psoriasis Regression analysis Regression models Retrospective Studies Risk assessment Risk Factors Sex Factors Statistical analysis Thromboembolism Venous Thromboembolism - epidemiology |
| title | Oral Glucocorticoids and Incident Treatment of Diabetes Mellitus, Hypertension, and Venous Thromboembolism in Children |
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