Patterns and Predictors of Hydroxyurea Use Among Californians Living With Sickle Cell Disease.

IF 0.9 4区 医学 Q4 HEMATOLOGY
Melinda Rushing, Sophia Horiuchi, Mariam Kayle, Sarah L Reeves, Alexander K Glaros, Susan Paulukonis
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Abstract

Hydroxyurea is the primary disease-modifying therapy for sickle cell disease (SCD), yet adherence is low. Our objective was to identify patterns and predictors of hydroxyurea adherence among Medicaid enrollees with SCD. Children and adults with SCD who received Medicaid benefits between 2009 and 2018 in California were included. Monthly hydroxyurea possession ratios were calculated using filled hydroxyurea prescriptions. Group-based trajectory modeling was applied to identify hydroxyurea possession trajectories and multinomial logistic regression modeling to evaluate predictors of hydroxyurea possession group membership: prior acute care visits due to VOCs, prescriber specialty, and participant sex and age. 713 participants (48% in the 0 to 17 age group, 50% male) had 3 distinct hydroxyurea possession groups: persistently high (n=263, 37%), moderate to low (n=253, 35%), and low to no possession (n=197, 28%). The 18 to 24 and 25+ age groups had greater odds of being in the moderate to low (OR: 2.62, 1.70) and low to no (OR: 3.60, 2.45) than the persistently high possession group compared with the 0 to 17 age group when adjusted for prior VOCs. Children had greater odds of being in the persistently high hydroxyurea possession group compared with young adults and adults, suggesting there are protective factors at this age that promotes better hydroxyurea adherence.

加州镰状细胞病患者羟基脲使用的模式和预测因素
羟基脲是镰状细胞病(SCD)的主要疾病改善疗法,但依从性较低。我们的目的是确定患有SCD的医疗补助参保者羟基脲依从性的模式和预测因素。在2009年至2018年期间在加利福尼亚州接受医疗补助福利的SCD儿童和成人也包括在内。每月羟基脲占有率计算用填充羟基脲处方。采用基于群体的轨迹模型来确定羟基脲持有轨迹,并采用多项逻辑回归模型来评估羟基脲持有群体成员的预测因素:因voc引起的急性护理就诊、处方医师专业、参与者的性别和年龄。713名参与者(48%为0 - 17岁年龄组,50%为男性)有3个不同的羟基脲持有组:持续高(n=263, 37%),中至低(n=253, 35%),低至无持有(n=197, 28%)。与0至17岁的人群相比,18至24岁和25岁以上的人群在调整之前的VOCs时,处于中低(OR: 2.62, 1.70)和低至零(OR: 3.60, 2.45)的几率高于持续高持有的人群。与年轻人和成年人相比,儿童在持续高羟基脲持有组中的几率更大,这表明在这个年龄段存在促进羟基脲更好依从性的保护因素。
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来源期刊
CiteScore
1.90
自引率
8.30%
发文量
415
审稿时长
2.5 months
期刊介绍: ​Journal of Pediatric Hematology/Oncology (JPHO) reports on major advances in the diagnosis and treatment of cancer and blood diseases in children. The journal publishes original research, commentaries, historical insights, and clinical and laboratory observations.
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