German regional variation of acute and high oral corticosteroid use for asthma. (7th April 2022)

• Record Type: Journal Article
• Authors: Nan, Cassandra; Schmidt, Olaf; Lindner, Robert; Ilgin, Yasemin; Schultz, Thomas; Hinsch Gylvin, Lykke; Bleecker, Eugene R.
• Is Part Of: Journal of asthma. Volume 59:Number 4(2022)
• Page Start: 791
• Page End: 800
• Publication Date: 2022-04-07
• Subjects: Germany -- bronchial disease -- obstructive lung disease -- medical informatics -- resource allocation; Asthma -- Periodicals; 616.238005
• DOI: 10.1080/02770903.2021.1878532
• Languages: English
• ISSNs: 0277-0903

Abstract

Abstract: 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 .