Prescription medication use in children and adolescents decreased from 1999 to 2014, according to a study published in JAMA.
Craig M. Hales, MD, from the National Center for Health Statistics, at the Centers for Disease Control and Prevention in Hyattsville, Maryland, and colleagues, identified US children and adolescents aged 0 to 19 years in the 1999-2014 National Health and Nutrition Examination Survey (NHANES), a serial cross-sectional, nationally representative survey of the civilian noninstitutionalized population. NHANES participants 18 years or older provided written consent, whereas parental permission was obtained for those younger than 18 years; children and adolescents aged 7 to 17 years also provided documented consent.
Participants 16 years or older answered questions about prescription medication use themselves; for those younger than 16 years or not able to answer questions themselves, a proxy respondent (usually a parent) provided this information. During the interview, survey participants were asked if they had taken any prescription medication in the past 30 days. If the answer was “yes,” the interviewer recorded the names of up to 20 prescription medications taken in the last 30 days directly from the medication container.
The prevalence of use of any prescription medication and 2 or more prescription medications was evaluated for 2011-2012 and 2013-2014 combined, by age group (0-23 months, 2-5 years, 6-11 years, and 12-19 years), sex, race and Hispanic origin, household income to poverty ratio, education level of the household head, insurance status, and current health status, because previous studies have shown different patterns of prescription medication use according to these characteristics.
Medications were categorized into therapeutic classes using the Multum Lexicon Plus drug database, which provided nested levels of classification. The following additional therapeutic classes were created: antibiotics (oral only), asthma medications, attention-deficit/hyperactivity disorder (ADHD) medications, antihypertensive agents, and narcotic-containing analgesics. Contraceptives were only included for female patients.
The sample comprised 38,277 children and adolescents aged 0 to 19 years (mean age, 10 years; 49% girls) from 1999 to 2014. A total of 10,706 study participants were included from 1999 to 2002 and 8,600 from 2011 to 2014. Overall, use of any prescription medication in the past 30 days decreased from 24.6% between 1999 and 2002 to 21.9% from 2011 to 2014. From 2011 to 2014, the most commonly used medication classes were asthma medications (6.1%), antibiotics (4.5%), ADHD medications (3.5%), topical agents (eg, dermatologic agents, nasal steroids) (3.5%), and antihistamines (2.0%). The researchers found significant linear trends in 14 of 39 therapeutic classes or subclasses, or in individual medications, with 8 showing increases, including asthma and ADHD medications and contraceptives, and 6 showing decreases, including antibiotics, antihistamines, and upper respiratory combination medications.
In an accompanying editorial, Gary L. Freed, MD, MPH, from the Department of Pediatrics, at the University of Michigan Medical School, stated, “Some of these trends likely signal potential improvements in the care of children, others may suggest little progress has been made, and yet others are difficult to interpret with certainty. Understanding the limitations of data from serial, cross-sectional studies not specifically designed to answer questions about medication use is essential to ensure children have the greatest likelihood to be best served by these research findings.”
- Hales CM, Kit BK, Gu Q, et al. Trends in prescription medication use among children and adolescents—United States, 1999-2014. JAMA. 2018;319:2009-2020. doi:10.1001/jama.2018.5690
- Freed, GL. Medication prescribing for children: progress and uncertainty. JAMA. 2018;319:1988-1989. doi:10.1001/jama.2018.5731