背景:哮喘是一种慢性疾病,通常需要药物来控制。多重用药仍然是药物依从性的主要问题;然而,其在哮喘患者中的证据有限.
目的:评估美国成人哮喘患者多重用药的患病率和决定因素及其与哮喘控制的关系。
方法:使用来自2005-2020年国家健康和营养检查调查(NHANES)的数据来估计多重用药的加权患病率。选定的变量,包括人口统计,合并症,处方药,和哮喘相关的不良事件,是从NHANES中提取的。进行多变量逻辑回归以确定与多重用药相关的因素。另外两组多变量逻辑回归模型用于进一步评估多重用药和哮喘相关不良事件之间的关联:一个用于哮喘发作,另一个用于哮喘相关的急诊室就诊。
结果:从2005年到2020年,在有和没有哮喘的成年人中,多重用药的患病率分别为34.3%和14.1%,分别。特点,包括年龄较大(P<0.01),非西班牙裔黑人(P<0.01),医疗保险覆盖率(P<0.01),就诊次数(P<0.01),多重合并症(P<0.01)与多重用药有关。多重用药与哮喘发作风险增加相关(OR,1.38;95%CI,1.08-1.76)和哮喘相关急诊室就诊(OR,1.46;95%CI,1.09-1.94)在成人哮喘患者中。在服用至少一种哮喘药物的患者中,哮喘发作和哮喘相关ER访视的风险在有和没有多重用药的患者之间没有差异.
结论:在美国,大约三分之一的哮喘成人经历了多重用药。差异存在于几个特征中,强调在弱势人群中采取适当护理和政策的必要性。需要进一步验证复方对哮喘控制的影响。
BACKGROUND: Asthma is a chronic disease that often requires medication for control.
Polypharmacy remains a major issue to medication adherence; however, its evidence among patients with asthma is limited.
OBJECTIVE: To evaluate the prevalence and determinants of
polypharmacy and its associations with asthma control among adults with asthma in the United States.
METHODS: Data from the 2005-2020 National Health and Nutrition Examination Survey (NHANES) were used to estimate the weighted prevalence of polypharmacy. Selected variables, including demographics, comorbidities, prescription medications, and asthma-related adverse events, were extracted from the NHANES. Multivariable logistic regression was conducted to identify factors associated with
polypharmacy. Another two sets of multivariable logistic regression models were employed to further assess the association between polypharmacy and asthma-related adverse events: one for asthma attacks and the other for asthma-related emergency room visits.
RESULTS: From 2005 to 2020,
polypharmacy prevalence was 34.3% and 14.1% among adults with and without asthma, respectively. Characteristics, including older age (P<0.01), non-Hispanic blacks (P<0.01), health insurance coverage (P<0.01), number of healthcare visits (P<0.01), and multiple comorbidities (P<0.01) were associated with polypharmacy. Polypharmacy was associated with increased risks of having asthma attacks (OR, 1.38; 95% CI, 1.08-1.76) and asthma-related emergency room visits (OR, 1.46; 95% CI, 1.09-1.94) among adults with asthma. Among patients taking at least one asthma medication, risks of asthma attacks and asthma-related ER visits did not differ between those with and without polypharmacy.
CONCLUSIONS: Approximately one in three adults with asthma experienced polypharmacy in the United States. Disparities existed in several characteristics, highlighting the necessity for appropriate care and policies among vulnerable populations. Further validation on the impact of
polypharmacy on asthma control is required.