Characteristics of Ambulatory Pediatric Visits in the United States (2006–2015) With or Without Off-Label Systemic Drug Orders
| Characteristic . | No Off-Label Drug Order, % (95% CI), N = 14 772 . | Off-Label Drug Order, % (95% CI), N = 12 833 . | OR . | aORa (95% CI) . | P . | % of Visits With Off-Label Ordersb (95% CI) . |
|---|---|---|---|---|---|---|
| Age group | ||||||
| <1 mo | 0.1 (0.1–0.3) | 0.7 (0.5–1.0) | 6.1 | 9.1 (4.5–18.3) | <.001 | 83 (73–92) |
| 1 mo to <2 y | 16.3 (15.4–17.4) | 17.5 (16.2–18.8) | 1.3 | 1.6 (1.4–1.8) | <.001 | 48.7 (46.4–51.1) |
| 2–5 y | 25.1 (24.0–26.3) | 22.4 (21.2–23.6) | 1.05 | 1.2 (1.05–1.3) | .005 | 42.4 (40.5–44.3) |
| 6–11 y | 31.4 (30.3–32.6) | 26.7 (25.5–28.0) | Reference | Reference | — | 39.2 (37.4–41.0) |
| 12–17 y | 27.0 (25.8–28.2) | 32.7 (31.2–34.3) | 1.4 | 1.3 (1.1–1.4) | <.001 | 44.1 (42.4–45.9) |
| Sex | ||||||
| Male | 46.8 (45.6–47.9) | 49.3 (47.9–50.7) | Reference | Reference | — | 43.1 (41.6–44.5) |
| Female | 53.2 (52.1–54.4) | 50.7 (49.3–52.1) | 1.1 | 1.2 (1.1–1.3) | <.001 | 46.3 (44.7–47.9) |
| Race and ethnicity | ||||||
| White, non-Hispanic | 64.2 (61.6–66.7) | 64.4 (61.6–67.2) | Reference | Reference | — | 45.0 (43.6–46.4) |
| African American, non-Hispanic | 11.1 (9.7–12.7) | 11.6 (10.1–13.2) | 1.04 | 0.95 (0.8–1.1) | .51 | 44.0 (41.0–46.9) |
| Hispanic | 18.8 (16.3–21.5) | 18.2 (15.7–21.1) | 0.97 | 0.9 (0.8–1.1) | .26 | 43.4 (40.6–46.1) |
| Other | 5.9 (5.1–6.9) | 5.8 (5.0–6.6) | 0.96 | 1.03 (0.9–1.2) | .72 | 45.6 (42.2–49.1) |
| Region | ||||||
| Northeast | 19.0 (16.8–21.5) | 16.6 (14.3–19.1) | Reference | Reference | — | 42.2 (39.4–45.1) |
| Midwest | 21.3 (18.3–24.7) | 19.4 (16.8–22.2) | 1.04 | 1.01 (0.9–1.2) | .91 | 42.4 (40.1–44.8) |
| South | 39.5 (35.7–43.5) | 44.7 (40.8–48.6) | 1.3 | 1.3 (1.1–1.5) | .002 | 47.4 (45.6–49.2) |
| West | 20.1 (17.0–23.7) | 19.3 (16.4–22.6) | 1.1 | 1.1 (0.9–1.3) | .49 | 43.6 (40.9–46.3) |
| Insurance | ||||||
| Private | 57.8 (55.0–60.7) | 55.2 (52.3–58.0) | Reference | Reference | — | 44.6 (43.1–46.0) |
| Public | 33.5 (30.7–36.5) | 35.3 (32.5–38.2) | 1.1 | 1.00 (0.9–1.1) | .97 | 44.5 (42.3–46.7) |
| Other or none | 8.6 (7.6–9.8) | 9.6 (8.3–11.0) | 1.2 | 1.04 (0.9–1.2) | .58 | 45.4 (42.5–48.4) |
| Clinical specialty | ||||||
| Primary care | 84.8 (83.1–86.4) | 77.5 (74.7–80.1) | Reference | Reference | — | 43.0 (41.6–44.5) |
| Medical subspecialty | 11.9 (10.4–13.6) | 17.0 (14.5–19.8) | 1.6 | 1.2 (1.1–1.4) | .007 | 47.4 (44.4–50.3) |
| Surgical subspecialty | 3.3 (2.8–3.8) | 5.5 (4.8–6.3) | 1.8 | 1.9 (1.6–2.2) | <.001 | 57.2 (53.8–60.7) |
| Total No. systemic drugs at visit | ||||||
| 1 | 77.6 (76.2–79.1) | 51.2 (49.3–53.2) | Reference | Reference | — | 35.7 (34.4–37.0) |
| 2 | 18.0 (16.9–19.2) | 30.1 (28.8–31.5) | 2.5 | 2.5 (2.3–2.8) | <.001 | 57.7 (55.5–59.9) |
| ≥3 | 4.3 (3.6–5.1) | 18.7 (17.1–20.3) | 6.6 | 6.3 (5.3–7.6) | <.001 | 76.9 (73.6–80.2) |
| Presence of chronic disease | ||||||
| Not present | 65.5 (63.9–67.0) | 56.8 (55.0–58.6) | Reference | Reference | — | 43.6 (42.0–45.1) |
| Present | 34.5 (33.0–36.1) | 43.2 (41.4–45.0) | 1.4 | 1.3 (1.1–1.4) | <.001 | 48.7 (46.9–50.5) |
| Year | ||||||
| 2006–2008 | 34.3 (31.5–37.2) | 28.6 (25.8–31.6) | Reference | Reference | — | 41.9 (39.9–44.0) |
| 2009–2011 | 34.1 (31.5–36.9) | 33.5 (30.3–36.8) | 1.2 | 1.1 (0.98–1.3) | .11 | 44.3 (42.1–46.6) |
| 2012–2015 | 31.6 (28.8–34.5) | 37.9 (34.7–41.3) | 1.4 | 1.3 (1.1–1.4) | <.001 | 47.2 (45.3–49.0) |
| Characteristic . | No Off-Label Drug Order, % (95% CI), N = 14 772 . | Off-Label Drug Order, % (95% CI), N = 12 833 . | OR . | aORa (95% CI) . | P . | % of Visits With Off-Label Ordersb (95% CI) . |
|---|---|---|---|---|---|---|
| Age group | ||||||
| <1 mo | 0.1 (0.1–0.3) | 0.7 (0.5–1.0) | 6.1 | 9.1 (4.5–18.3) | <.001 | 83 (73–92) |
| 1 mo to <2 y | 16.3 (15.4–17.4) | 17.5 (16.2–18.8) | 1.3 | 1.6 (1.4–1.8) | <.001 | 48.7 (46.4–51.1) |
| 2–5 y | 25.1 (24.0–26.3) | 22.4 (21.2–23.6) | 1.05 | 1.2 (1.05–1.3) | .005 | 42.4 (40.5–44.3) |
| 6–11 y | 31.4 (30.3–32.6) | 26.7 (25.5–28.0) | Reference | Reference | — | 39.2 (37.4–41.0) |
| 12–17 y | 27.0 (25.8–28.2) | 32.7 (31.2–34.3) | 1.4 | 1.3 (1.1–1.4) | <.001 | 44.1 (42.4–45.9) |
| Sex | ||||||
| Male | 46.8 (45.6–47.9) | 49.3 (47.9–50.7) | Reference | Reference | — | 43.1 (41.6–44.5) |
| Female | 53.2 (52.1–54.4) | 50.7 (49.3–52.1) | 1.1 | 1.2 (1.1–1.3) | <.001 | 46.3 (44.7–47.9) |
| Race and ethnicity | ||||||
| White, non-Hispanic | 64.2 (61.6–66.7) | 64.4 (61.6–67.2) | Reference | Reference | — | 45.0 (43.6–46.4) |
| African American, non-Hispanic | 11.1 (9.7–12.7) | 11.6 (10.1–13.2) | 1.04 | 0.95 (0.8–1.1) | .51 | 44.0 (41.0–46.9) |
| Hispanic | 18.8 (16.3–21.5) | 18.2 (15.7–21.1) | 0.97 | 0.9 (0.8–1.1) | .26 | 43.4 (40.6–46.1) |
| Other | 5.9 (5.1–6.9) | 5.8 (5.0–6.6) | 0.96 | 1.03 (0.9–1.2) | .72 | 45.6 (42.2–49.1) |
| Region | ||||||
| Northeast | 19.0 (16.8–21.5) | 16.6 (14.3–19.1) | Reference | Reference | — | 42.2 (39.4–45.1) |
| Midwest | 21.3 (18.3–24.7) | 19.4 (16.8–22.2) | 1.04 | 1.01 (0.9–1.2) | .91 | 42.4 (40.1–44.8) |
| South | 39.5 (35.7–43.5) | 44.7 (40.8–48.6) | 1.3 | 1.3 (1.1–1.5) | .002 | 47.4 (45.6–49.2) |
| West | 20.1 (17.0–23.7) | 19.3 (16.4–22.6) | 1.1 | 1.1 (0.9–1.3) | .49 | 43.6 (40.9–46.3) |
| Insurance | ||||||
| Private | 57.8 (55.0–60.7) | 55.2 (52.3–58.0) | Reference | Reference | — | 44.6 (43.1–46.0) |
| Public | 33.5 (30.7–36.5) | 35.3 (32.5–38.2) | 1.1 | 1.00 (0.9–1.1) | .97 | 44.5 (42.3–46.7) |
| Other or none | 8.6 (7.6–9.8) | 9.6 (8.3–11.0) | 1.2 | 1.04 (0.9–1.2) | .58 | 45.4 (42.5–48.4) |
| Clinical specialty | ||||||
| Primary care | 84.8 (83.1–86.4) | 77.5 (74.7–80.1) | Reference | Reference | — | 43.0 (41.6–44.5) |
| Medical subspecialty | 11.9 (10.4–13.6) | 17.0 (14.5–19.8) | 1.6 | 1.2 (1.1–1.4) | .007 | 47.4 (44.4–50.3) |
| Surgical subspecialty | 3.3 (2.8–3.8) | 5.5 (4.8–6.3) | 1.8 | 1.9 (1.6–2.2) | <.001 | 57.2 (53.8–60.7) |
| Total No. systemic drugs at visit | ||||||
| 1 | 77.6 (76.2–79.1) | 51.2 (49.3–53.2) | Reference | Reference | — | 35.7 (34.4–37.0) |
| 2 | 18.0 (16.9–19.2) | 30.1 (28.8–31.5) | 2.5 | 2.5 (2.3–2.8) | <.001 | 57.7 (55.5–59.9) |
| ≥3 | 4.3 (3.6–5.1) | 18.7 (17.1–20.3) | 6.6 | 6.3 (5.3–7.6) | <.001 | 76.9 (73.6–80.2) |
| Presence of chronic disease | ||||||
| Not present | 65.5 (63.9–67.0) | 56.8 (55.0–58.6) | Reference | Reference | — | 43.6 (42.0–45.1) |
| Present | 34.5 (33.0–36.1) | 43.2 (41.4–45.0) | 1.4 | 1.3 (1.1–1.4) | <.001 | 48.7 (46.9–50.5) |
| Year | ||||||
| 2006–2008 | 34.3 (31.5–37.2) | 28.6 (25.8–31.6) | Reference | Reference | — | 41.9 (39.9–44.0) |
| 2009–2011 | 34.1 (31.5–36.9) | 33.5 (30.3–36.8) | 1.2 | 1.1 (0.98–1.3) | .11 | 44.3 (42.1–46.6) |
| 2012–2015 | 31.6 (28.8–34.5) | 37.9 (34.7–41.3) | 1.4 | 1.3 (1.1–1.4) | <.001 | 47.2 (45.3–49.0) |
aOR, adjusted odds ratio; OR, unadjusted odds ratio; —, not applicable.
Multivariable logistic regression model adjusted for all covariates shown, accounting for sampling, clustering, and strata to produce nationally representative estimates.
Percentages based on model-based predictive margins, accounting for all other covariates.