Table 1.
Baseline characteristics of the study sample
| Patient cohort | High Dose CS (HD) |
Medium Dose CS (MD) |
Low Dose CS (LD) |
No-steroid Dose (NS) |
p- value (HD vs. LD) |
p- value (MD vs. LD) |
p- value (NS vs. LD) |
||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| (N = 163) | (N = 1,127) | (N = 6,717) | (N = 10,611) | ||||||||
| Age Group (n, %) | |||||||||||
| 18–34 years | 46 | 28.2% | 249 | 22.1% | 978 | 14.6% | 1,505 | 14.2% | † | * | † |
| 35–44 years | 35 | 21.5% | 283 | 25.1% | 1,648 | 24.5% | 2,408 | 22.7% | |||
| 45–54 years | 47 | 28.8% | 369 | 32.7% | 2,426 | 36.1% | 3,764 | 35.5% | |||
| 55–64 years | 34 | 20.9% | 221 | 19.6% | 1,642 | 24.4% | 2,890 | 27.2% | |||
| 65+ years | 1 | 0.6% | 5 | 0.4% | 23 | 0.3% | 44 | 0.4% | |||
| Age (years) | |||||||||||
| Mean ± SD | 43.3 ± 12.4 | 44.1 ± 11.4 | 46.3 ± 10.5 | 46.9 ± 10.7 | † | * | † | ||||
|
Gender, (n, %) Female |
143 | 87.7% | 987 | 87.6% | 6,190 | 92.2% | 9,523 | 89.7% | † | * | * |
|
Health Plan Type (n, %) |
|||||||||||
| Consumer-directed | 0 | 0.0% | 9 | 0.8% | 23 | 0.3% | 50 | 0.5% | † | * | |
| HMO | 24 | 14.7% | 193 | 17.1% | 925 | 13.8% | 1,797 | 16.9% | |||
| Indemnity | 5 | 3.1% | 31 | 2.8% | 165 | 2.5% | 356 | 3.4% | |||
| POS | 10 | 6.1% | 53 | 4.7% | 239 | 3.6% | 455 | 4.3% | |||
| PPO | 121 | 74.2% | 833 | 73.9% | 5,300 | 78.9% | 7,837 | 73.9% | |||
| Other/Unknown | 3 | 1.8% | 8 | 0.7% | 65 | 1.0% | 116 | 1.1% | |||
| Payer Type (n, %) | |||||||||||
| Commercial | 89 | 54.6% | 647 | 57.4% | 3,886 | 57.9% | 6,064 | 57.1% | † | ||
| Medicaid | 9 | 5.5% | 57 | 5.1% | 264 | 3.9% | 565 | 5.3% | |||
| Medicare | 1 | 0.6% | 8 | 0.7% | 36 | 0.5% | 60 | 0.6% | |||
| Self-insured | 61 | 37.4% | 410 | 36.4% | 2,496 | 37.2% | 3,845 | 36.2% | |||
| Other/Unknown | 3 | 1.8% | 5 | 0.4% | 35 | 0.5% | 77 | 0.7% | |||
| Region (n, %) | |||||||||||
| Northeast | 39 | 23.9% | 284 | 25.2% | 1,576 | 23.5% | 3,018 | 28.4% | † | * | |
| Midwest | 48 | 29.4% | 279 | 24.8% | 1,603 | 23.9% | 2,856 | 26.9% | |||
| South | 63 | 38.7% | 425 | 37.7% | 2,917 | 43.4% | 3,536 | 33.3% | |||
| West | 13 | 8.0% | 139 | 12.3% | 621 | 9.2% | 1,201 | 11.3% | |||
| Index Year (n, %) | |||||||||||
| 2008 | 60 | 36.8% | 450 | 39.9% | 2,787 | 41.5% | 4,861 | 45.8% | * | ||
| 2009 | 26 | 16.0% | 179 | 15.9% | 1,045 | 15.6% | 1,754 | 16.5% | |||
| 2010 | 32 | 19.6% | 165 | 14.6% | 939 | 14.0% | 1,392 | 13.1% | |||
| 2011 | 20 | 12.3% | 156 | 13.8% | 874 | 13.0% | 1,227 | 11.6% | |||
| 2012 | 16 | 9.8% | 117 | 10.4% | 711 | 10.6% | 913 | 8.6% | |||
| 2013 | 9 | 5.5% | 60 | 5.3% | 361 | 5.4% | 464 | 4.4% | |||
|
Physician Specialty (n, %) |
|||||||||||
| Rheumatologist | 31 | 19.0% | 231 | 20.5% | 1,450 | 21.6% | 2,075 | 19.6% | † | ||
| Cardiologist | 1 | 0.6% | 2 | 0.2% | 28 | 0.4% | 45 | 0.4% | |||
| Pulmonologist | 0 | 0.0% | 7 | 0.6% | 14 | 0.2% | 21 | 0.2% | † | ||
| Nephrologist | 4 | 2.5% | 24 | 2.1% | 49 | 0.7% | 90 | 0.8% | † | * | |
| Hematologist | 1 | 0.6% | 0 | 0.0% | 4 | 0.1% | 5 | 0.0% | |||
| Neurologist | 0 | 0.0% | 6 | 0.5% | 21 | 0.3% | 25 | 0.2% | |||
| Primary Care** | 36 | 22.1% | 205 | 18.2% | 1,459 | 21.7% | 2,048 | 19.3% | † | † | |
| Other | 90 | 55.2% | 652 | 57.9% | 3,692 | 55.0% | 6,302 | 59.4% | * | ||
|
Rheumatology Visit (n, %) |
29 | 17.8% | 220 | 19.5% | 1,414 | 21.1% | 1,756 | 16.5% | * | ||
| PCP Visit (n, %) | 78 | 47.9% | 537 | 47.6% | 3,542 | 52.7% | 4,634 | 43.7% | † | * | |
|
Hematology Visit (n, %) |
0 | 0.0% | 8 | 0.7% | 31 | 0.5% | 37 | 0.3% | |||
|
Nephrology Visit (n, %) |
7 | 4.3% | 36 | 3.2% | 126 | 1.9% | 199 | 1.9% | † | † | |
|
Charlson Comorbidity Index (CCI) Score (n, %) |
|||||||||||
| 0 | 72 | 44.2% | 461 | 40.9% | 2,966 | 44.2% | 5,006 | 47.2% | † | † | |
| 1 | 54 | 33.1% | 406 | 36.0% | 2,526 | 37.6% | 3,793 | 35.7% | |||
| 2 | 16 | 9.8% | 136 | 12.1% | 725 | 10.8% | 1,006 | 9.5% | |||
| 3+ | 21 | 12.9% | 124 | 11.0% | 500 | 7.4% | 806 | 7.6% | |||
| Mean + SD | 1.0 + 1.2 | 1.0 + 1.2 | 0.9 + 1.1 | 0.8 + 1.1 | * | † | |||||
|
Comorbidities of Interest: (n, %) |
|||||||||||
| Cardiovascular disease |
30 | 18.4% | 178 | 15.8% | 910 | 13.5% | 1,147 | 10.8% | † | * | |
| Stroke | 6 | 3.7% | 40 | 3.5% | 193 | 2.9% | 283 | 2.7% | |||
| Myocardial infarction | 4 | 2.5% | 16 | 1.4% | 73 | 1.1% | 101 | 1.0% | |||
| Peripheral vascular disease |
12 | 7.4% | 85 | 7.5% | 465 | 6.9% | 663 | 6.2% | |||
| Cerebrovascular disease |
6 | 3.7% | 37 | 3.3% | 190 | 2.8% | 290 | 2.7% | |||
| Osteoporosis | 5 | 3.1% | 30 | 2.7% | 233 | 3.5% | 422 | 4.0% | |||
| Infection | 71 | 43.6% | 467 | 41.4% | 2,951 | 43.9% | 3,829 | 36.1% | * | ||
| Diabetes | 13 | 8.0% | 90 | 8.0% | 461 | 6.9% | 809 | 7.6% | |||
| Hypertension | 39 | 23.9% | 285 | 25.3% | 1,659 | 24.7% | 2,525 | 23.8% | |||
| Renal disease | 21 | 12.9% | 115 | 10.2% | 269 | 4.0% | 470 | 4.4% | * | * | |
|
Pre-index (6-month) Total Medical Costs |
|||||||||||
| Mean ± SD | $11,977 ± $47,389 |
$9,467 + $27,462 |
$5,997 + $22,541 |
$5,195 + $21,958 |
† | * | † | ||||
| Median | $2,248 | $2,308 | $1,944 | $1,441 | † | * | |||||
|
Pre-index (6-month) Total Pharmacy Costs |
|||||||||||
| Mean + SD | $1,504 + $3,499 |
$1,612 + $3,376 |
$1,620 + $2,984 |
$1,207 + $2,865 |
* | ||||||
| Median | $373 | $411 | $630 | $345 | † | * | * | ||||
|
Concomitant Medications: (n, %) |
|||||||||||
| Corticosteroids | 0 | 0.0% | 0 | 0.0% | 7 | 0.1% | 4 | 0.0% | |||
| NSAIDs | 26 | 16.0% | 286 | 25.4% | 1853 | 27.6% | 1965 | 18.5% | † | * | |
| Anti-malarials | 36 | 22.1% | 277 | 24.6% | 2245 | 33.4% | 3338 | 31.5% | † | * | † |
| Immunosuppressants | 9 | 5.5% | 70 | 6.2% | 251 | 3.7% | 285 | 2.7% | † | * | |
| Cyclophosphamide | 0 | 0.0% | 2 | 0.2% | 1 | 0.0% | 1 | 0.0% | |||
| Mycophenolate mofetil |
7 | 4.3% | 36 | 3.2% | 129 | 1.9% | 159 | 1.5% | † | † | † |
Abbreviations. HMO=Health Maintenance Organization, PPO=Preferred Provider Organization, POS=Point of Service, NSAIDs=Nonsteroidal Anti-Inflammatory Drugs
*
=p<0.0001
†
=p<0.05
**
Primary care: primary care physician/family physician/general practitioner, internal medicine physician