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Impact of Cumulative Corticosteroid Dosage on Preventable Hospitalization among Taiwanese Patients with Ankylosing Spondylitis and Inflammatory Bowel Disease

Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
Section of Plastic Surgery, University of Michigan, Ann Arbor, MI 48109, USA
Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
Authors to whom correspondence should be addressed.
Denotes that these authors contributed equally.
J. Clin. Med. 2019, 8(5), 614;
Received: 4 March 2019 / Revised: 22 April 2019 / Accepted: 29 April 2019 / Published: 7 May 2019
(This article belongs to the Section Epidemiology & Public Health)
Background: Corticosteroids are commonly prescribed for autoimmune conditions, but their impact on preventable hospitalization rates is unclear. This study sought to investigate the effect of corticosteroid use on hospitalization for ambulatory care sensitive conditions among Taiwanese patients with ankylosing spondylitis (AS) or inflammatory bowel disease (IBD). Methods: This was a retrospective cohort study using adults in the Taiwan National Health Insurance Research database receiving a new diagnosis of AS (n = 40,747) or IBD (n = 4290) between January 2002 and June 2013. Our main outcome measure was odds of preventable hospitalization for eight ambulatory care-sensitive conditions defined by the Agency for Healthcare Research and Quality. Results: In the first quarter (three months) following diagnosis, corticosteroid usage was common among patients with AS and IBD (18.5% and 30%, respectively). For every 100 mg increase in corticosteroid dose per quarter, adjusted odds of preventable hospitalization in the following quarter increased by 5.5% for patients with AS (aOR = 1.055, 95% CI 1.037–1.074) and 6.4% for those with IBD (aOR = 1.064, 95% CI 1.046–1.082). Conclusions: Relatively low doses of corticosteroids significantly increase AS and IBD patients’ short-term odds of hospitalization for ambulatory care-sensitive conditions. As recommended by current clinical guidelines, physicians should use corticosteroids sparingly in these populations, and prioritize initiation/escalation of disease-modifying anti-rheumatic drugs for long-term management. If corticosteroids cannot be avoided, patients may require monitoring and/or prophylaxis for corticosteroid-associated comorbidities (e.g., diabetes) which can result in preventable hospitalizations. View Full-Text
Keywords: autoimmune disease; preventable hospitalization; corticosteroid autoimmune disease; preventable hospitalization; corticosteroid
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Wallace, B.I.; Harris, C.A.; Wang, L.; Liu, M.; Chen, J.-S.; Kuo, C.-F.; Chung, K.C. Impact of Cumulative Corticosteroid Dosage on Preventable Hospitalization among Taiwanese Patients with Ankylosing Spondylitis and Inflammatory Bowel Disease. J. Clin. Med. 2019, 8, 614.

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