Oral corticosteroid use, obesity, and ethnicity in children with asthma

Abstract

Objective: Comorbid asthma and obesity leads to poorer asthma outcomes, partially due to decreased response to controller medication. Increased oral steroid prescription, a marker of uncontrolled asthma, may follow. Little is known about this phenomenon among Latino children. Our objective was to determine whether obesity is associated with increased oral steroid prescription for children with asthma, and to assess potential disparities in these associations between Latino and non-Hispanic white children.

Methods: We examined electronic health record data from the ADVANCE national network of community health centers. The sample included 16,763 children aged 5–17 years with an asthma diagnosis and ≥1 ambulatory visit in ADVANCE clinics across 22 states between 2012 and 2017. Poisson regression analysis was used to examine the rate of oral steroid prescription overall and by ethnicity controlling for potential confounders.

Results: Among Latino children, those who were always overweight/obese at study visits had a 15% higher rate of receiving an oral steroid prescription than those who were never overweight/obese [rate ratio (RR) = 1.15, 95% CI 1.05–1.26]. A similar effect size was observed for non-Hispanic white children, though the relationship was not statistically significant (RR = 1.10, 95% CI: 0.92–1.33). The interactions between body mass index and ethnicity were not significant (sometimes overweight/obese p = 0.95, always overweight/obese p = 0.58), suggesting a lack of disparities in the association between obesity and oral steroid prescription by ethnicity.

Conclusions: Children with obesity received more oral steroid prescriptions than those at a healthy weight, which may be indicative of worse asthma control. We did not observe significant ethnic disparities.

Keywords:

• Asthma
• childhood obesity
• disparities
• ethnicity
• electronic health records

Acknowledgements

The research reported in this manuscript was conducted with the ADVANCE (Accelerating Data Value Across a National Community Health Center Network) Clinical Research Network, a partner of PCORnet®, the National-Patient Centered Clinical Network, an initiative of the Patient Centered outcomes Research Institute (PCORI). The ADVANCE network is led by OCHIN in partnership with the Health Choice Network, Fenway Health, Oregon Health and Science University, and the Robert Graham Center/Health Landscape. ADVANCE is funded through PCORI award number 13–060-4716.

Declaration of interest

The authors have no conflicts of interest to disclose.

Table A1. Variable definitions.

Table A2. Medications.

Table A3. Sensitivity analyses—stratified by number of visits and asthma severity.

Additional information

Funding

This work was supported by the NIH National Institute on Minority Health and Health Disparities under grant number R01MD011404; and the National Institute on Drug Abuse under grant number K23-DA037453.