LAUSR

This study quantified rates of incident treatment for diabetes mellitus, hypertension, and venous thromboembolism (VTE) associated with oral glucocorticoid exposure in children ages 1-18. The retrospective cohort included >930,000 children diagnosed with autoimmune diseases (inflammatory bowel disease, juvenile idiopathic arthritis, or psoriasis) or a non-immune comparator condition (attention-deficit/hyperactivity disorder) identified using US Medicaid claims (2000-2010). Associations of glucocorticoid dose per age-/sex-imputed weight with incident treated diabetes, hypertension, and VTE were estimated using Cox regression models. Crude rates were lowest for VTE (unexposed: 0.5/million person-days [95% CI 0.4, 0.6]; currently exposed: 15.6/million person-days [95% CI 11.8, 20.1]) and highest for hypertension (unexposed: 6.7/million person-days [95% CI 6.5, 7.0]; currently exposed: 74.4/million person-days [95% CI 65.7, 83.9]). Absolute rates for all outcomes were higher in unexposed and exposed children with autoimmune diseases compared to those with attention-deficit/hyperactivity disorder. Strong dose-dependent relationships were found between current glucocorticoid exposure and all outcomes (adjusted hazard ratios for high-dose glucocorticoids: diabetes mellitus 5.93 [95% confidence intervals (CI) 3.94, 8.91]; hypertension 19.13 [95% CI 15.43, 23.73]; VTE 16.16 [95% CI 8.94, 29.22]). These results suggest strong relative risks, but low absolute risks, of newly treated VTE, diabetes, and especially hypertension in children taking high-dose oral glucocorticoids.