Overall Prescriptions Down in US Kids

Veronica Hackethal, MD

May 15, 2018

Among US children and adolescents, overall use of prescription medications decreased between 1999 and 2014, according to a study published online May 15 in JAMA.

However, the results were not entirely clear-cut: use of some types of medications increased, whereas use of others decreased.

"The prevalence of asthma medication, [attention-deficit/hyperactivity disorder] medication, and contraceptive use increased among certain age groups, whereas use of antibiotics, antihistamines, and upper respiratory combination medications decreased," Craig M. Hales, MD, from the Centers for Disease Control and Prevention, Hyattsville, Maryland, and colleagues write.

Trends in prescription medication use can reflect larger issues related to the healthcare of children and teenagers. These include changing disease burden, especially with the growing problems of childhood obesity, diabetes, and hypertension. Also, medication use can reflect whether new guidelines have been adopted into clinical practice, and whether children are being prescribed appropriate treatments. Other factors of concern include access to healthcare and medications, as well as adverse drug events.

To evaluate the most recent trends in pediatric prescription drug use in the United States, researchers used data for the years 1999 to 2014 from the National Health and Nutrition Examination Survey, a nationally representative survey that takes place every 2 years. The analysis included 38,277 children and adolescents aged 0 to 19 years (mean age, 10 years; 49% girls). The researchers assessed trends in medication use for 1999 to 2002 compared with 2011 to 2014.

Overall use of any prescription medication in the past month decreased significantly from 24.6% to 21.9% (P = .04).

Use of two or more medications in the last month was less consistent. Results were significant only for children aged 0 to 23 months, whose use decreased from 25.5% to 17.4% (P < .001).

Use of any and two or more medications varied by age, race, insurance status, and health status.

The only race for which prescription drug use significantly increased was non-Hispanic blacks, whose use of any drug increased from 18.1% to 21.1% (P = .03). Use of two or more prescription medications also increased in this group, from 6.4% to 9.2% (P = .009).

Prescription drug use did not vary significantly by sex, household income, or education of the household head.

Use of eight classes of medications significantly increased. These included contraceptives among adolescent girls (from 4.6% to 8.8%; P < 0.001), proton pump inhibitors (from 0.2% to 0.7%; P = .004), as well as attention-deficit/hyperactivity disorder medications (from 2.8% to 3.5%; P = .02) and asthma medications (from 4.3% to 6.1%; P < .001).

Use of blood pressure and antidiabetic medications also increased, but the results were not significant.

Six medication classes significantly decreased. Antibiotic use decreased by almost half (from 8.4% to 4.5%; P < .001), and decreases were also seen for antihistamines (from 4.3% to 2.0%; P < .001) and upper respiratory combination drugs (from 2.3% to 0.5%; P < .001).

"Such an important, comprehensive update has not been performed for nearly a decade but is needed, given changes in child health and treatment recommendations," writes Gary L. Freed, MD, MPH, University of Michigan, Ann Arbor, in a linked editorial.

Whereas the results suggest some improvements in the care of children, they suggest little progress in certain areas. Still other findings are difficult to interpret. That may be partly a result of the limitations of an observational study of this nature. Researchers could not collect data on some variables, such as dosage and use of over-the-counter medications, which may explain some of the findings.

"Ultimately, the analyses conducted by Hales et al are interesting in the issues they raise but also frustrating in that the study limitations may not enable definitive conclusions to be drawn regarding those same issues," Freed writes.

In particular, prescriptions were higher for non-Hispanic whites compared with non-Hispanic black, Mexican-American, and Asian youths. What makes this finding "puzzling" is that the study also showed no differences by household income or education of the household head, but findings did vary by insurance status, Freed explains.

Also, some prescription antihistamines became available over-the-counter during this period, but the study could not include them. That raises the question: Was the drop in prescription antihistamine use real, or were prescription medications replaced by over-the-counter products?

Such questions lead Freed to conclude: "The findings...will require additional studies, using different data sources, to provide clarity in the clinical and policy implications of recent trends in medication use among children."

The National Center for Health Statistics and the Centers for Disease Control and Prevention sponsored the study. The authors and editorialist have disclosed no relevant financial relationships.

JAMA. Published online May 15, 2018.

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