Association of allergic rhinitis, coronary heart disease, cerebrovascular disease, and all-cause mortality.

BACKGROUND: Inflammation is implicated in atherosclerotic cardiovascular disease. Allergic diseases also involve a systemic inflammatory state, which may potentiate cardiovascular disease. OBJECTIVE: To examine the association of allergic rhinitis, coronary heart disease (CHD), cerebrovascular disease (CVD), and all-cause mortality. METHODS: We conducted a retrospective, population-based, matched cohort study comparing the incidence of CHD, CVD, and all-cause mortality from January 1, 1999, through December 31, 2012, in patients with International Classification of Disease, Ninth Revision, documented allergic rhinitis matched 1:1 by age, sex, and ethnicity to a reference cohort without allergic rhinitis within Kaiser Permanente Southern California. Fully adjusted hazard ratios (HRs) were calculated. Further analyses for those with positive environmental allergen specific IgE (sIgE) test results within the allergic rhinitis cohort were also performed. RESULTS: Patients with physician-diagnosed allergic rhinitis (N = 110, 207 in matched cohort) had significantly lower risk for myocardial infarction (HR, 0.63; 95% confidence interval [CI], 0.59-0.67; P < .001), all CHD (HR, 0.81; 95% CI, 0.78-0.84; P < .001), CVD (HR, 0.67; 95% CI, 0.64-0.70; P < .001), and all-cause mortality (HR, 0.42; 95% CI, 0.40-0.43; P < .001). The results were similar after excluding patients with asthma. Patients with positive sIgE test result also had a decreased risk of all CHD (relative risk [RR], 0.87; 95% CI, 0.79-0.95; P = .003) but no association with cerebrovascular events (RR, 0.89; 95% CI, 0.77-1.02; P = .10) and all-cause mortality (RR, 1.16; 95% CI, 1.00-1.34; P = .06). CONCLUSION: We found that the presence of allergic rhinitis was associated with decreased CHD, CVD, and all-cause mortality. This decreased risk was more pronounced after excluding patients with asthma. Patients with positive sIgE test results also had decreased risk of CHD.

The HEDIS Medication Management for People with Asthma Measure is Not Related to Improved Asthma Outcomes.

BACKGROUND: A new Healthcare Effectiveness Data and Information Set (HEDIS) asthma quality-of-care measure designed to quantify patient adherence to asthma controller medication has been implemented. The relationship between this measure and asthma outcomes is unknown. OBJECTIVE: To examine the relationship between the HEDIS Medication Management for people with Asthma (MMA) measure and asthma outcomes. METHODS: Administrative data identified 30,040 patients who met HEDIS criteria for persistent asthma during 2012. These patients were classified as compliant or noncompliant with the MMA measure at the 75% and 50% threshold, respectively. The association between MMA compliance in 2012 and asthma outcomes in 2013 was determined. RESULTS: Patients who were 75% or 50% MMA compliant in 2012 showed no clinically meaningful difference in asthma-related hospitalizations, emergency department visits, or rescue inhaler dispensing in 2013 compared with those who were noncompliant. Stepwise comparison of patients who were 75% or more, 50% to 74%, and less than 50% MMA compliant showed no meaningful difference in asthma outcomes between groups. CONCLUSIONS: Compliance with the HEDIS MMA measure is not related to improvement in the asthma outcomes assessed (rescue inhaler dispensing, asthma-coded hospitalizations, or asthma-coded emergency department visits).