title: Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study.
abstract: ObjectiveTo determine the frequency of prescriptions for short term use of oral corticosteroids, and adverse events (sepsis, venous thromboembolism, fractures) associated with their use.DesignRetrospective cohort study and self controlled case series.SettingNationwide dataset of private insurance claims.ParticipantsAdults aged 18 to 64 years who were continuously enrolled from 2012 to 2014.Main outcome measuresRates 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.ResultsOf 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).ConclusionOne 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.
authors.affiliation: VA Center for Clinical Management Research, Ann Arbor, MI, USA awaljee@med.umich.edu.|University of Michigan Medical School, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.|University of Michigan Medical School, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Ann Arbor, MI, USA.|Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, MI, USA.
authors.forename: Akbar K
authors.initials: AK
authors.lastname: Waljee
authors.affiliation: University of Michigan Medical School, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.|Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, MI, USA.|University of Michigan Medical School, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI, USA.
authors.forename: Mary A M
authors.initials: MA
authors.lastname: Rogers
authors.affiliation: University of Michigan Medical School, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Lin
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Amit G
authors.initials: AG
authors.lastname: Singal
authors.affiliation: University of Michigan Medical School, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.|University of Michigan Medical School, Department of Ophthalmology and Visual Science, Ann Arbor, MI, USA.|University of Michigan School of Public Health, Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Stein
authors.affiliation: University of Michigan Medical School, Department of Internal Medicine, Division of Rheumatology, Ann Arbor, MI, USA.
authors.forename: Rory M
authors.initials: RM
authors.lastname: Marks
authors.affiliation: University of Michigan Medical School, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.|University of Michigan Medical School, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI, USA.|University of Michigan School of Public Health, Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA.
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
authors.affiliation: VA Center for Clinical Management Research, Ann Arbor, MI, USA.|University of Michigan Medical School, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.|Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, MI, USA.|University of Michigan Medical School, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA.
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
mesh_terms: D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects; D000328:Adult; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D064420:Drug-Related Side Effects and Adverse Reactions / Q000145:classification / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones