TY - JOUR
T1 - German regional variation of acute and high oral corticosteroid use for asthma
AU - Nan, Cassandra
AU - Schmidt, Olaf
AU - Lindner, Robert
AU - Ilgin, Yasemin
AU - Schultz, Thomas
AU - Hinsch Gylvin, Lykke
AU - Bleecker, Eugene R.
N1 - Publisher Copyright:
© 2021 AstraZeneca. Published with license by Taylor & Francis Group, LLC.
PY - 2022
Y1 - 2022
N2 - Objective: : To improve understanding of real-world asthma treatment and inform physician education, we evaluated regional variation in asthma prevalence and oral corticosteroid (OCS) use across Germany. Methods: : We developed a machine learning gradient-boosted tree model with IMS® Disease Analyzer electronic medical records, which cover 3% of German patients. This model had a 91% accuracy in predicting the presence of asthma and chronic obstructive pulmonary disease. We applied the model to the IMS® Longitudinal Prescription database, with 82% national coverage, to classify patients receiving treatment for airflow obstruction from October 2017–September 2018 in 63 regions in Germany. Results: : Of 2.4 million individuals under statutory health insurance predicted to have asthma, 13.7%, 18.7%, 36.5%, 29.4%, and 1.7% received treatment classified as Global Initiative for Asthma (GINA) Steps 1, 2, 3, 4, and 5, respectively. Approximately 7–15% of those at GINA Steps 1–4 and 35% at Step 5 treatment received ≥1 acute OCS prescription (duration <10 days). Of patients receiving GINA Steps 1–4 and Step 5 treatments, 1–3% and 86%, respectively, received ≥1 high-dosage OCS prescription. Cumulative OCS dosage and percentages of patients receiving OCS differed substantially across regions, and regions with lower OCS use had greater use of biologic therapies. Conclusions: : Both acute and high OCS use varied regionally across Germany, with overall use suggesting patients are considerable risk of adverse effects and long-term health consequences. Supplemental data for this article can be accessed at publisher’s website.
AB - Objective: : To improve understanding of real-world asthma treatment and inform physician education, we evaluated regional variation in asthma prevalence and oral corticosteroid (OCS) use across Germany. Methods: : We developed a machine learning gradient-boosted tree model with IMS® Disease Analyzer electronic medical records, which cover 3% of German patients. This model had a 91% accuracy in predicting the presence of asthma and chronic obstructive pulmonary disease. We applied the model to the IMS® Longitudinal Prescription database, with 82% national coverage, to classify patients receiving treatment for airflow obstruction from October 2017–September 2018 in 63 regions in Germany. Results: : Of 2.4 million individuals under statutory health insurance predicted to have asthma, 13.7%, 18.7%, 36.5%, 29.4%, and 1.7% received treatment classified as Global Initiative for Asthma (GINA) Steps 1, 2, 3, 4, and 5, respectively. Approximately 7–15% of those at GINA Steps 1–4 and 35% at Step 5 treatment received ≥1 acute OCS prescription (duration <10 days). Of patients receiving GINA Steps 1–4 and Step 5 treatments, 1–3% and 86%, respectively, received ≥1 high-dosage OCS prescription. Cumulative OCS dosage and percentages of patients receiving OCS differed substantially across regions, and regions with lower OCS use had greater use of biologic therapies. Conclusions: : Both acute and high OCS use varied regionally across Germany, with overall use suggesting patients are considerable risk of adverse effects and long-term health consequences. Supplemental data for this article can be accessed at publisher’s website.
KW - Germany
KW - bronchial disease
KW - medical informatics
KW - obstructive lung disease
KW - resource allocation
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U2 - 10.1080/02770903.2021.1878532
DO - 10.1080/02770903.2021.1878532
M3 - Article
C2 - 33492176
AN - SCOPUS:85100843658
SN - 0277-0903
VL - 59
SP - 791
EP - 800
JO - Journal of Asthma
JF - Journal of Asthma
IS - 4
ER -