Use of proton pump inhibitors and H2 blockers and risk of pneumonia in older adults: a population-based case-control study
Use of proton pump inhibitors and H2 blockers and risk of pneumonia in older adults: a population-based case-control study
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DOI：
10.1002/pds.1978
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发表时间：
2010-08-01
影响因子：
2.6
通讯作者：
Jackson, Lisa A.
中科院分区：
文献类型：
--
作者：
Dublin, Sascha;Walker, Rod L.;Jackson, Lisa A.
目的研究是否使用质子泵抑制剂（PPIs）和H2受体阻滞剂与肺炎risk.Methods增加相关，我们进行了一项以人群为基础的，嵌套的病例对照研究内组健康，一个综合的医疗保健服务系统。在社区居住的，免疫功能正常的65-94岁的成年人，我们确定了2000-2003年的门诊和住院社区获得性肺炎的ICD-9编码的推定病例，并验证了病历审查（N=1125）。选择对照组，与年龄、性别和日历年的病例相匹配（N=2235）。从计算机化药房记录中确定当前PPI或H2阻滞剂的使用情况。共病和其他特征通过病历审查确定。采用多变量条件logistic回归分析药物使用与肺炎风险之间的关系。我们进行了敏感性分析，仅使用行政和药房的数据，以评估这些结果如何不同于我们的primary results.Results的患病率PPI或H2受体阻滞剂的使用是21%（241/1125）的肺炎病例和16%（350/2235）的控制（调整后的比值比[OR] 1.03，95%CI 0.86-1.24，相比，不使用）。最近开始治疗的风险未增加。PPI使用的患病率在病例组为12%（132/1125），在对照组为7%（160/2235）（调整后OR 1.13，95% CI 0.88-1.44）。仅使用行政和药房数据的分析产生的风险估计远离零（调整OR 1.32，95%CI 1.17-1.49，目前PPI使用与不使用）。结论使用PPI和H2受体阻滞剂与老年人肺炎风险增加无关。在一些既往研究中观察到的风险增加可能反映了混杂因素。版权所有（C）2010约翰威利父子有限公司
Purpose To examine whether use of proton pump inhibitors (PPIs) and H2 blockers is associated with increased pneumonia risk.Methods We conducted a population-based, nested case-control study within Group Health, an integrated healthcare delivery system. Among community-dwelling, immunocompetent adults aged 65-94, we identified presumptive cases of ambulatory and hospitalized community-acquired pneumonia in 2000-2003 from ICD-9 codes and validated them by medical record review (N=1125). Controls were selected, matched to cases on age, sex, and calendar year (N=2235). Current PPI or H2 blocker use was ascertained from computerized pharmacy records. Comorbid illnesses and other characteristics were ascertained by medical record review. Multivariable conditional logistic regression was used to examine the association between medication use and pneumonia risk. We conducted sensitivity analyses using only administrative and pharmacy data to assess how these results differed from our primary results.Results The prevalence of PPI or H2 blocker use was 21% (241/1125) for pneumonia cases and 16% (350/2235) for controls (adjusted odds ratio [OR] 1.03,95% CI 0.86-1.24, compared to nonuse). No increased risk was seen for recent initiation. The prevalence of PPI use was 12% (132/1125) for cases and 7% (160/2235) for controls (adjusted OR 1.13, 95% CI 0.88-1.44). Analyses using only administrative and pharmacy data yielded risk estimates farther from the null (adjusted OR 1.32, 95% CI 1.17-1.49, for current PPI use versus nonuse).Conclusions Use of PPIs and H2 blockers is not associated with increased pneumonia risk in older adults. The increased risk observed in some prior studies may reflect confounding. Copyright (C) 2010 John Wiley & Sons, Ltd.