Oral Glucocorticoids and Incident Treatment of Diabetes Mellitus, Hypertension, and Venous Thromboembolism in Children.
Rates of incident treatment were quantified in this study for diabetes mellitus, hypertension, and venous thromboembolism (VTE) associated with oral glucocorticoid exposure in children aged 1-18 years. The retrospective cohort included more than 930,000 children diagnosed with autoimmune diseases (namely, inflammatory bowel disease, juvenile idiopathic arthritis, or psoriasis) or a nonimmune comparator condition (attention-deficit/hyperactivity disorder) identified using US Medicaid claims (2000-2010). Associations of glucocorticoid dose per age- and sex-imputed weight with incident treated diabetes, hypertension, and VTE were estimated using Cox regression models. Crude rates were lowest for VTE (unexposed: 0.5/million person-days (95% confidence interval (CI): 0.4, 0.6); currently exposed: 15.6/million person-days (95% CI: 11.8, 20.1)) and highest for hypertension (unexposed: 6.7/million person-days (95% CI: 6.5, 7.0); currently exposed: 74.4/million person-days (95% CI: 65.7, 83.9)). Absolute rates for all outcomes were higher in unexposed and exposed children with autoimmune diseases compared with those with attention-deficit/hyperactivity disorder. Strong dose-dependent relationships were found between current glucocorticoid exposure and all outcomes (adjusted hazard ratios for high-dose glucocorticoids: for diabetes mellitus, 5.93 (95% CI: 3.94, 8.91); for hypertension, 19.13 (95% CI: 15.43, 23.73); for VTE, 16.16 (95% CI: 8.94, 29.22)). These results suggest strong relative risks, but low absolute risks, of newly treated VTE, diabetes, and especially hypertension in children taking high-dose oral glucocorticoids.
['Horton|Daniel B|DB|', 'Xie|Fenglong|F|', 'Chen|Lang|L|', 'Mannion|Melissa L|ML|', 'Curtis|Jeffrey R|JR|', 'Strom|Brian L|BL|', 'Beukelman|Timothy|T|']
D000293:Adolescent D000367:Age Factors D001327:Autoimmune Diseases D002648:Child D002675:Child, Preschool D003920:Diabetes Mellitus D004305:Dose-Response Relationship, Drug D005260:Female D005938:Glucocorticoids D006801:Humans D006973:Hypertension D007223:Infant D008297:Male D016016:Proportional Hazards Models D012189:Retrospective Studies D012307:Risk Factors D012737:Sex Factors D054556:Venous Thromboembolism
glucocorticoids diabetes mellitus hypertension venous thromboembolism cohort studies pediatrics pharmacoepidemiology