Medication use in normal weight and overweight children in a nationally representative sample of Canadian children
School of Public Health, University of Alberta, 350 University Terrace, Edmonton, Alberta, Canada. Archives of Disease in Childhood
(Impact Factor: 2.9).
07/2012; 97(9):842-7. DOI: 10.1136/archdischild-2011-301195
As overweight and obese children are more likely to develop serious medical conditions, they incur higher doctor and hospital costs compared to their normal weight counterparts. Consequently, the differential healthcare costs between obese and normal weight children may be even greater if medication use is considered.
To compare medication use between normal weight and overweight children in a nationally representative sample from Canada.
Data from the Canadian Health Measures Survey 2007/2009, a cross-sectional survey assessing indicators of health and wellness in Canadians, was used in the current study. The analysis included 2087 children and adolescents between 6-19 years of age with valid measures of body mass index (BMI). Poisson/negative binomial regression was used to examine the association between weight status and the number of medications taken in the last month.
For 6-11 year olds, the frequency of prescription, over-the-counter and natural health product (NHP) medication use did not differ between normal weight and overweight/obese children. For 12-19 year olds, overweight/obese children used prescription medication significantly more often than their normal weight peers (adjusted incidence rate ratio (IRR), 1.59; 95% CI 1.19 to 2.14), whereas for NHP the opposite was the case (adjusted IRR, 0.52; 95% CI 0.32 to 0.82). These children also used nervous system and respiratory medications more frequently than their normal weight peers.
The findings of the present study suggest that the differential usage of prescription drugs among overweight/obese children underline the need to develop effective obesity prevention programmes and policies that may reduce the health and economic burden of childhood obesity.
Available from: Rubab G. Arim
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ABSTRACT: Background Few studies have examined the potential of linked administrative data for research on child health. This analysis describes the application of a non-categorical survey-based tool, the Children with Special Health Care Needs (CSHCN) Screener, to administrative data. Data and methods Five Screener items were applied to data from Population Data British Columbia. Hospital admissions and demographic and community characteristics of a cohort of children aged 6 to 10 in 2006 were examined to validate the use of these items. Results Overall, 17.5% of children were identified as CSHCN. An estimated 14% of children used more medical care and 5.2% had more functional limitations than is usual for children of the same age; 3.3% were prescribed long-term medication; 1.9% needed/received treatment or counselling; and 0.1% needed/received special therapy. Boys were more likely than girls to be identified as CSHCN. Interpretation With some limitations, the CSHCN Screener can be applied to Canadian administrative health data.
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ABSTRACT: Obesity affects nearly one-sixth of US children and results in alterations to body composition and physiology that can affect drug disposition, possibly leading to therapeutic failure or toxic side effects. The depth of available literature regarding obesity's effect on drug safety, pharmacokinetics, and dosing in obese children is unknown.
To perform a systematic literature review describing the current evidence of the effect of obesity on drug disposition in children.
We searched the MEDLINE, Cochrane, and EMBASE databases (January 1, 1970-December 31, 2012) and included studies if they contained data on drug clearance, volume of distribution, or drug concentration in obese children (aged ≤18 years). We compared exposure and weight-normalized volume of distribution and clearance between obese and nonobese children. We explored the association between drug physicochemical properties and clearance and volume of distribution.
Twenty studies met the inclusion criteria and contained pharmacokinetic data for 21 drugs. The median number of obese children studied per drug was 10 (range, 1-112) and ages ranged from newborn to 29 years (1 study described pharmacokinetics in children and adults together). Dosing schema varied and were either a fixed dose (6 [29%]) or based on body weight (10 [48%]) and body surface area (4 [19%]). Clinically significant pharmacokinetic alterations were observed in obese children for 65% (11 of 17) of the studied drugs. Pharmacokinetic alterations resulted in substantial differences in exposure between obese and nonobese children for 38% (5 of 13) of the drugs. We found no association between drug lipophilicity or Biopharmaceutical Drug Disposition Classification System class and changes in volume of distribution or clearance due to obesity.
Consensus is lacking on the most appropriate weight-based dosing strategy for obese children. Prospective pharmacokinetic trials in obese children are needed to ensure therapeutic efficacy and enhance drug safety.
Available from: Francesca Solmi
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ABSTRACT: Increasing rates of childhood obesity have been suggested as a possible cause for the increasing prevalence of chronic conditions among adults and children. Few studies have examined whether obese children are more likely to use medications than normal weight children. We investigate this association in the UK.
A panel study with repeated observations at ages 5, 7 and 11.
A general population sample drawn from the Millennium Cohort Study, a UK-based birth cohort.
A sample of 9667 children.
Our primary outcomes were crude and adjusted probabilities of taking any regular medications and the number of medications among overweight and obese children compared with normal weight children. Our secondary outcome was the distribution of medication use by therapeutic classification across body mass index (BMI) groups.
Obese children were more likely to use any medication (marginal effect (ME)=0.02, 95% CI 0.01 to 0.03) and to use more medications (ME=0.08, 95% CI 0.04 to 0.12) than normal weight children. Obese children used more medications for respiratory conditions than those of other BMI groups.
Obese children are more likely to use regular medications and have comorbid conditions, even at young ages. This suggests that the cost of prescriptions should be considered when evaluating the economic burden of childhood obesity and that preventative strategies to reduce childhood obesity could be cost-effective in the short as well as in the long term. While more research is needed, both clinicians and policymakers should be aware of these findings when planning prevention and treatment strategies.
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