Association between time-variant prescribed oral glucocorticoids and incident infections
| Variable | Adjusted hazard ratio* (95% CI); infection type | ||||
|---|---|---|---|---|---|
| All-cause | Bacterial | Viral | Parasitic | Fungal | |
| Current use | 1.49 (1.44–1.53) | 1.70 (1.60–1.80) | 1.53 (1.44–1.62) | 1.50 (1.32–1.71) | 1.48 (1.39–1.57) |
| Current daily dose per 5 mg daily | 1.13 (1.12–1.14) | 1.16 (1.14–1.19) | 1.13 (1.11–1.15) | 1.14 (1.09–1.18) | 1.11 (1.09–1.14) |
| Current daily dose category, mg | |||||
| Nonuse (Ref.) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| >0.0–4.9 | 1.39 (1.34–1.45) | 1.58 (1.43–1.75) | 1.47 (1.34–1.62) | 1.41 (1.14–1.74) | 1.46 (1.34–1.59) |
| 5.0–14.9 | 1.46 (1.41–1.52) | 1.64 (1.51–1.78) | 1.46 (1.34–1.59) | 1.42 (1.21–1.68) | 1.41 (1.31–1.53) |
| 15.0–24.9 | 1.66 (1.55–1.77) | 1.95 (1.71–2.23) | 1.78 (1.54–2.06) | 1.87 (1.43–2.43) | 1.62 (1.42–1.85) |
| ≥25 | 2.30 (2.13–2.49) | 3.02 (2.51–3.63) | 2.28 (1.89–2.74) | 2.40 (1.70–3.40) | 2.10 (1.74–2.52) |
| Cumulative dose in last year (per 1000 mg) | 1.50 (1.49–1.52) | 1.53 (1.51–1.55) | 1.51 (1.50–1.53) | 1.52 (1.49–1.55) | 1.59 (1.57–1.61) |
| Cumulative dose in last year category, mg | |||||
| Nonuse (Ref.) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| >0.0–959.9 | 1.88 (1.84–1.92) | 2.17 (2.09–2.25) | 2.30 (2.22–2.37) | 2.43 (2.25–2.60) | 2.31 (2.23–2.39) |
| 960–3054.9 | 2.50 (2.47–2.54) | 2.85 (2.78–2.92) | 2.95 (2.88–3.02) | 3.12 (2.97–3.26) | 2.98 (2.91–3.04) |
| ≥3055 | 3.23 (3.19–3.28) | 3.69 (3.60–3.79) | 3.72 (3.63–3.81) | 3.90 (3.70–4.10) | 3.66 (3.56–3.75) |
| Total cumulative dose (per 1000 mg) | 1.01 (1.00–1.01) | 1.02 (1.01–1.02) | 1.01 (1.00–1.01) | 1.01 (1.00–1.02) | 1.00 (1.00–1.01) |
| Total cumulative dose category, mg | |||||
| Nonuse (Ref.) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| >0.0–959.9 | 1.08 (1.03–1.14) | 1.10 (0.98–1.23) | 1.08 (0.97–1.21) | 1.08 (0.86–1.36) | 1.07 (0.96–1.18) |
| 960–3054.9 | 1.01 (0.97–1.06) | 1.08 (0.98–1.20) | 0.96 (0.87–1.05) | 1.00 (0.81–1.23) | 1.07 (0.97–1.17) |
| 3055–7299.9 | 1.05 (1.00–1.09) | 1.10 (1.00–1.21) | 1.06 (0.97–1.16) | 1.08 (0.88–1.32) | 1.02 (0.93–1.13) |
| ≥7300 | 1.11 (1.06–1.17) | 1.36 (1.23–1.51) | 1.13 (1.02–1.25) | 1.17 (0.94–1.47) | 1.07 (0.96–1.19) |
Note: CI = confidence interval, Ref. = reference category.
↵* Hazard ratios from Cox proportional models adjusted for baseline age, sex, index of multiple deprivation, smoking status, ethnicity, body mass index, chronic inflammatory disease type, comorbidities (cardiovascular disease, diabetes, HIV, cancer, asthma, chronic obstructive pulmonary disease and renal disease), vaccination status (varicella zoster, pneumococcus and influenza), number of hospital admissions in last year, prescribed non-oral glucocorticoids, proton pump inhibitors and H2 antagonists, and time-variant use of disease-modifying antirheumatic drugs and nonsteroidal antiinflammatory drugs; the practice identifier was included as a random intercept to account for clustering effect.