Community acquired pneumonia incidence before and after proton pump inhibitor prescription: population based study
Objective To examine the risk of community acquired pneumonia before and after prescription of proton pump inhibitor (PPI) and assess whether unmeasured confounding explains this association. Design Cohort study and self controlled case series. Setting Clinical Practice Research Datalink (1990...
| Main Authors: | , , |
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| Format: | Article |
| Published: |
BMJ Publishing Group
2016
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| Online Access: | https://eprints.nottingham.ac.uk/38842/ |
| _version_ | 1848795703474651136 |
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| author | Othman, Fatmah Crooks, Colin J. Card, Timothy R. |
| author_facet | Othman, Fatmah Crooks, Colin J. Card, Timothy R. |
| author_sort | Othman, Fatmah |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Objective
To examine the risk of community acquired pneumonia before and after prescription of proton pump inhibitor (PPI) and assess whether unmeasured confounding explains this association.
Design
Cohort study and self controlled case series.
Setting
Clinical Practice Research Datalink (1990 to 2013) in UK.
Participants
Adult patients with a new prescription for a PPI individually matched with controls.
Main outcome measures
Association of community acquired pneumonia with PPI prescription estimated by three methods: a multivariable Cox model comparing risk in PPI exposed patients with controls, corrected for potential confounders; a self controlled case series; and a prior event rate ratio (PERR) analysis over the 12 month periods before and after the first PPI prescription.
Results
160 000 new PPI users were examined. The adjusted Cox regression showed a risk of community acquired pneumonia 1.67 (95% confidence interval 1.55 to 1.79) times higher for patients exposed to PPI than for controls. In the self controlled case series, among 48 451 PPI exposed patients with a record of community acquired pneumonia, the incidence rate ratio was 1.19 (95% confidence interval 1.14 to 1.25) in the 30 days after PPI prescription but was higher in the 30 days before a PPI prescription (1.92, 1.84 to 2.00). The Cox regressions for prior event rate ratio similarly showed a greater increase in community acquired pneumonia in the year before than the year after PPI prescription, such that the analysis showed a reduced relative risk of pneumonia associated with PPI use (prior event rate ratio 0.91, 95% confidence interval 0.83 to 0.99).
Conclusion
The association between the use of PPIs and risk of community acquired pneumonia is likely to be due entirely to confounding factors. |
| first_indexed | 2025-11-14T19:36:18Z |
| format | Article |
| id | nottingham-38842 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:36:18Z |
| publishDate | 2016 |
| publisher | BMJ Publishing Group |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-388422020-05-04T18:21:08Z https://eprints.nottingham.ac.uk/38842/ Community acquired pneumonia incidence before and after proton pump inhibitor prescription: population based study Othman, Fatmah Crooks, Colin J. Card, Timothy R. Objective To examine the risk of community acquired pneumonia before and after prescription of proton pump inhibitor (PPI) and assess whether unmeasured confounding explains this association. Design Cohort study and self controlled case series. Setting Clinical Practice Research Datalink (1990 to 2013) in UK. Participants Adult patients with a new prescription for a PPI individually matched with controls. Main outcome measures Association of community acquired pneumonia with PPI prescription estimated by three methods: a multivariable Cox model comparing risk in PPI exposed patients with controls, corrected for potential confounders; a self controlled case series; and a prior event rate ratio (PERR) analysis over the 12 month periods before and after the first PPI prescription. Results 160 000 new PPI users were examined. The adjusted Cox regression showed a risk of community acquired pneumonia 1.67 (95% confidence interval 1.55 to 1.79) times higher for patients exposed to PPI than for controls. In the self controlled case series, among 48 451 PPI exposed patients with a record of community acquired pneumonia, the incidence rate ratio was 1.19 (95% confidence interval 1.14 to 1.25) in the 30 days after PPI prescription but was higher in the 30 days before a PPI prescription (1.92, 1.84 to 2.00). The Cox regressions for prior event rate ratio similarly showed a greater increase in community acquired pneumonia in the year before than the year after PPI prescription, such that the analysis showed a reduced relative risk of pneumonia associated with PPI use (prior event rate ratio 0.91, 95% confidence interval 0.83 to 0.99). Conclusion The association between the use of PPIs and risk of community acquired pneumonia is likely to be due entirely to confounding factors. BMJ Publishing Group 2016-11-15 Article PeerReviewed Othman, Fatmah, Crooks, Colin J. and Card, Timothy R. (2016) Community acquired pneumonia incidence before and after proton pump inhibitor prescription: population based study. BMJ, 355 . i5813/1-i5813/9. ISSN 1756-1833 http://www.bmj.com/content/355/bmj.i5813 doi:10.1136/bmj.i5813 doi:10.1136/bmj.i5813 |
| spellingShingle | Othman, Fatmah Crooks, Colin J. Card, Timothy R. Community acquired pneumonia incidence before and after proton pump inhibitor prescription: population based study |
| title | Community acquired pneumonia incidence before and after proton pump inhibitor prescription: population based study |
| title_full | Community acquired pneumonia incidence before and after proton pump inhibitor prescription: population based study |
| title_fullStr | Community acquired pneumonia incidence before and after proton pump inhibitor prescription: population based study |
| title_full_unstemmed | Community acquired pneumonia incidence before and after proton pump inhibitor prescription: population based study |
| title_short | Community acquired pneumonia incidence before and after proton pump inhibitor prescription: population based study |
| title_sort | community acquired pneumonia incidence before and after proton pump inhibitor prescription: population based study |
| url | https://eprints.nottingham.ac.uk/38842/ https://eprints.nottingham.ac.uk/38842/ https://eprints.nottingham.ac.uk/38842/ |