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Purpose: To identify both the treatment patterns for constipation and the associations between treatment and other variables across age groups.
Methods: This was a retrospective cross-sectional study on the trends in pharmacologic and nonpharmacologic constipation treatments across age groups utilizing data from the National Ambulatory Medical Care Survey (NAMCS), 2000-2009. Treatment patterns for constipation alone, IBS-C alone, and opioid-induced constipation were considered. Information collected for each visit included demographics, physician specialty, nonpharmacologic (i.e., diet, behavior changes) and pharmacologic constipation therapies, concurrent medications, comorbidities, and procedures. Statistical sampling weights were used to obtain estimates representative of the US population. Separate analyses were performed for each combination of age group and type of constipation. Differences between time periods were tested by weighted logistic regression models and used to test for associations with treatments.
Results: From 2000 through 2009, there were 89.6 million visits for constipation and IBS-C: 63.4 million for constipation alone, 28.2 million for IBS-C alone, and 3.7 million for opioid-induced constipation. For all visits, there was a decrease in combination therapy for persons < 18 years (from 29-16%, p<0.05) and an increase in medication monotherapy for all (from 15-23%, p<0.01). For constipation, there was an overall decrease in combination therapy (from 17-11%, p<0.05), an increase in medication monotherapy (from 21-29%, p<0.05) and age group differences in prescribing of specific medications. For IBS-C, there was a significant increase in tegaserod over time (from 6-27%, p<0.05). For opioid-induced constipation, there were no significant changes over time. Age, gender, race, ethnicity, payer source, physician specialty and region were all found to be associated with treatment choice.
Conclusion: Patterns in constipation treatment were significantly influenced by many factors. Overall changes in treatment over time included a decrease in combination therapy for persons age <18 years and an increase in medication monotherapy for all.