Proton-Pump Inhibitors and Long-Term Risk of Community-Acquired Pneumonia in Older Adults.
Journal of the American Geriatrics Society
©2018 The Author(s). Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made
OBJECTIVES: To estimate associations between long-term use of proton pump inhibitors (PPIs) and pneumonia incidence in older adults in primary care. DESIGN: Longitudinal analyses of electronic medical records. SETTING: England PARTICIPANTS: Individuals aged 60 and older in primary care receiving PPIs for 1 year or longer (N=75,050) and age- and sex-matched controls (N=75,050). MEASUREMENTS: Net hazard ratios for pneumonia incidence in Year 2 of treatment were estimated using the prior event rate ratio (PERR), which adjusts for pneumonia incidence differences before initiation of treatment. Inverse probability weighted models adjusted for 78 demographic, disease, medication, and healthcare usage measures. RESULTS: During the second year after initiating treatment, PPIs were associated with greater hazard of incident pneumonia (PERR-adjusted hazard ratio=1.82, 95% confidence interval=1.27-2.54), accounting for pretreatment pneumonia rates. Estimates were similar across age and comorbidity subgroups. Similar results were also obtained from propensity score- and inverse probability-weighted models. CONCLUSION: In a large cohort of older adults in primary care, PPI prescription was associated with greater risk of pneumonia in the second year of treatment. Results were robust across alternative analysis approaches. Controversies about the validity of reported short-term harms of PPIs should not divert attention from potential long-term effects of PPI prescriptions on older adults.
The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the U.K. Department of Health. Financial Disclosure: This research was funded by National Institute for Health Research (NIHR) Grant PB‐PG‐0214‐3309. JM is supported by NIHR Doctoral Research Fellowship 2014–07–177. Conflict of Interest: A.B. is a former employee of Pfizer (until November 2012) and is currently employed by Alfasigma. Author Contributions: Dr. Zirk‐Sadowski and Dr. Ble had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Ble, Melzer, Zirk‐Sadowski. Acquisition and interpretation of data, drafting of manuscript, critical revision of manuscript for important intellectual content, approval of final draft submitted: all authors. Statistical analysis: Zirk‐Sadowski, Henley, Melzer, Ble.
This is the final version of the article. Available from Wiley via the DOI in this record.
Published online 20 April 2018
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