Patterns of Lipid Lowering Therapy among Children Ages 8-20 Years

Objectives Pediatric guidelines in 2008 and 2011 recommended lipid lowering therapy in children ≥8 years of age with high-risk cardiovascular conditions, such as familial hypercholesterolemia (FH). Our objective was to describe the patterns and predictors of lipid lowering therapy initiation in comm...

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Bibliographic Details
Published in:The Journal of pediatrics 2015-07, Vol.167 (1), p.113-119.e1
Main Authors: Joyce, Nina, MPH, Wellenius, Gregory A., ScD, Dore, David D., PharmD, PhD, Newburger, Jane W., MD, MPH, Zachariah, Justin P., MD, MPH
Format: Article
Language:English
Subjects:
Adolescent
Adult
Age Factors
Ambulatory Care - utilization
Case-Control Studies
Child
Databases, Factual
Diabetes Mellitus - drug therapy
Diabetes Mellitus - epidemiology
Drug Prescriptions - statistics & numerical data
Dyslipidemias - drug therapy
Dyslipidemias - epidemiology
Female
Humans
Hyperlipoproteinemia Type II - drug therapy
Hyperlipoproteinemia Type II - epidemiology
Hypertension - drug therapy
Hypertension - epidemiology
Hypolipidemic Agents - therapeutic use
Insurance Claim Review
Male
Obesity - drug therapy
Obesity - epidemiology
Pediatrics
Sex Factors
United States - epidemiology
Young Adult
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Summary:Objectives Pediatric guidelines in 2008 and 2011 recommended lipid lowering therapy in children ≥8 years of age with high-risk cardiovascular conditions, such as familial hypercholesterolemia (FH). Our objective was to describe the patterns and predictors of lipid lowering therapy initiation in commercially insured children between 2005 and 2010. Study design Using commercial health plan data on children ages 8-20 years from 2004-2010, we estimated rates of lipid lowering therapy initiation overall and stratified by age. Using a nested case-control design, we used multivariable logistic regression to identify temporal, demographic, clinical, and health utilization characteristics associated with lipid lowering therapy initiation. Results Among >13 million children, 665 initiated lipid lowering therapy for an incidence rate 2.6/100 000 person-years (PY). Incidence rates were highest in 2005 (4.1/100 000 PY) and 2008 (3.9/100 000 PY), with no discernable secular trend. Rates of lipid lowering therapy initiation were significantly greater in children ≥15 years of age (OR 2.9 [95% CI 5.2-13.0]), males (2.1 [1.7-2.4]), and those with a diagnosis of FH (165.2 [129.0-211.6]), other dyslipidemia (175.5 [143.2-215.3]), diabetes type I (7.7 [4.7-12.4]), diabetes type II (13.6 [8.5-21.7]), hypertension (8.1 [4.9-13.3]), obesity (7.8 [4.7-12.7]), and ≥5 outpatient visits (1.5 [1.2-1.7]), and children with dispensing of ≥2 nonlipid lowering therapy prescriptions were less likely to initiate lipid lowering therapy (0.2 [0.2-0.3]). Conclusions Despite new guidelines, lipid lowering therapy initiation in children is low and has not increased through 2010. Although diagnosis of FH and other dyslipidemias was associated with higher probability of lipid lowering therapy initiation, our findings suggest lipid lowering therapy is underutilized in this population given the prevalence of these disorders.
ISSN:0022-3476
1097-6833
DOI:10.1016/j.jpeds.2015.04.004