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Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study

OBJECTIVE: To estimate all cause mortality and cause specific mortality among patients taking proton pump inhibitors (PPIs). DESIGN: Longitudinal observational cohort study. SETTING: US Department of Veterans Affairs. PARTICIPANTS: New users of PPIs (n=157 625) or H2 blockers (n=56 842). MAIN OUTCOM...

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Autores principales: Xie, Yan, Bowe, Benjamin, Yan, Yan, Xian, Hong, Li, Tingting, Al-Aly, Ziyad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538974/
https://www.ncbi.nlm.nih.gov/pubmed/31147311
http://dx.doi.org/10.1136/bmj.l1580
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author Xie, Yan
Bowe, Benjamin
Yan, Yan
Xian, Hong
Li, Tingting
Al-Aly, Ziyad
author_facet Xie, Yan
Bowe, Benjamin
Yan, Yan
Xian, Hong
Li, Tingting
Al-Aly, Ziyad
author_sort Xie, Yan
collection PubMed
description OBJECTIVE: To estimate all cause mortality and cause specific mortality among patients taking proton pump inhibitors (PPIs). DESIGN: Longitudinal observational cohort study. SETTING: US Department of Veterans Affairs. PARTICIPANTS: New users of PPIs (n=157 625) or H2 blockers (n=56 842). MAIN OUTCOME MEASURES: All cause mortality and cause specific mortality associated with taking PPIs (values reported as number of attributable deaths per 1000 patients taking PPIs). RESULTS: There were 45.20 excess deaths (95% confidence interval 28.20 to 61.40) per 1000 patients taking PPIs. Circulatory system diseases (number of attributable deaths per 1000 patients taking PPIs 17.47, 95% confidence interval 5.47 to 28.80), neoplasms (12.94, 1.24 to 24.28), infectious and parasitic diseases (4.20, 1.57 to 7.02), and genitourinary system diseases (6.25, 3.22 to 9.24) were associated with taking PPIs. There was a graded relation between cumulative duration of PPI exposure and the risk of all cause mortality and death due to circulatory system diseases, neoplasms, and genitourinary system diseases. Analyses of subcauses of death suggested that taking PPIs was associated with an excess mortality due to cardiovascular disease (15.48, 5.02 to 25.19) and chronic kidney disease (4.19, 1.56 to 6.58). Among patients without documented indication for acid suppression drugs (n=116 377), taking PPIs was associated with an excess mortality due to cardiovascular disease (22.91, 11.89 to 33.57), chronic kidney disease (4.74, 1.53 to 8.05), and upper gastrointestinal cancer (3.12, 0.91 to 5.44). Formal interaction analyses suggested that the risk of death due to these subcauses was not modified by a history of cardiovascular disease, chronic kidney disease, or upper gastrointestinal cancer. Taking PPIs was not associated with an excess burden of transportation related mortality and death due to peptic ulcer disease (as negative outcome controls). CONCLUSIONS: Taking PPIs is associated with a small excess of cause specific mortality including death due to cardiovascular disease, chronic kidney disease, and upper gastrointestinal cancer. The burden was also observed in patients without an indication for PPI use. Heightened vigilance in the use of PPI may be warranted.
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spelling pubmed-65389742019-06-12 Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study Xie, Yan Bowe, Benjamin Yan, Yan Xian, Hong Li, Tingting Al-Aly, Ziyad BMJ Research OBJECTIVE: To estimate all cause mortality and cause specific mortality among patients taking proton pump inhibitors (PPIs). DESIGN: Longitudinal observational cohort study. SETTING: US Department of Veterans Affairs. PARTICIPANTS: New users of PPIs (n=157 625) or H2 blockers (n=56 842). MAIN OUTCOME MEASURES: All cause mortality and cause specific mortality associated with taking PPIs (values reported as number of attributable deaths per 1000 patients taking PPIs). RESULTS: There were 45.20 excess deaths (95% confidence interval 28.20 to 61.40) per 1000 patients taking PPIs. Circulatory system diseases (number of attributable deaths per 1000 patients taking PPIs 17.47, 95% confidence interval 5.47 to 28.80), neoplasms (12.94, 1.24 to 24.28), infectious and parasitic diseases (4.20, 1.57 to 7.02), and genitourinary system diseases (6.25, 3.22 to 9.24) were associated with taking PPIs. There was a graded relation between cumulative duration of PPI exposure and the risk of all cause mortality and death due to circulatory system diseases, neoplasms, and genitourinary system diseases. Analyses of subcauses of death suggested that taking PPIs was associated with an excess mortality due to cardiovascular disease (15.48, 5.02 to 25.19) and chronic kidney disease (4.19, 1.56 to 6.58). Among patients without documented indication for acid suppression drugs (n=116 377), taking PPIs was associated with an excess mortality due to cardiovascular disease (22.91, 11.89 to 33.57), chronic kidney disease (4.74, 1.53 to 8.05), and upper gastrointestinal cancer (3.12, 0.91 to 5.44). Formal interaction analyses suggested that the risk of death due to these subcauses was not modified by a history of cardiovascular disease, chronic kidney disease, or upper gastrointestinal cancer. Taking PPIs was not associated with an excess burden of transportation related mortality and death due to peptic ulcer disease (as negative outcome controls). CONCLUSIONS: Taking PPIs is associated with a small excess of cause specific mortality including death due to cardiovascular disease, chronic kidney disease, and upper gastrointestinal cancer. The burden was also observed in patients without an indication for PPI use. Heightened vigilance in the use of PPI may be warranted. BMJ Publishing Group Ltd. 2019-05-30 /pmc/articles/PMC6538974/ /pubmed/31147311 http://dx.doi.org/10.1136/bmj.l1580 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Research
Xie, Yan
Bowe, Benjamin
Yan, Yan
Xian, Hong
Li, Tingting
Al-Aly, Ziyad
Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study
title Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study
title_full Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study
title_fullStr Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study
title_full_unstemmed Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study
title_short Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study
title_sort estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among us veterans: cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538974/
https://www.ncbi.nlm.nih.gov/pubmed/31147311
http://dx.doi.org/10.1136/bmj.l1580
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