PMID- 28715344
OWN - NLM
STAT- MEDLINE
DCOM- 20170720
LR  - 20240327
IS  - 1756-1833 (Electronic)
IS  - 0959-8138 (Print)
IS  - 0959-8138 (Linking)
VI  - 355
DP  - 2016 Nov 15
TI  - Community acquired pneumonia incidence before and after proton pump inhibitor 
      prescription: population based study.
PG  - i5813
LID - 10.1136/bmj.i5813 [doi]
LID - i5813
AB  - 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.
CI  - 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.
FAU - Othman, Fatmah
AU  - Othman F
AD  - Department of Epidemiology and Public Health, University of Nottingham, 
      Nottingham NG5 1PB, UK msxfo1@nottingham.ac.uk.
AD  - Department of Basic Medical Sciences, King Saud bin Abdulaziz University for 
      Health Sciences, Saudi Arabia.
FAU - Crooks, Colin J
AU  - Crooks CJ
AD  - Department of Epidemiology and Public Health, University of Nottingham, 
      Nottingham NG5 1PB, UK.
FAU - Card, Timothy R
AU  - Card TR
AD  - Department of Epidemiology and Public Health, University of Nottingham, 
      Nottingham NG5 1PB, UK.
AD  - NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham 
      University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
LA  - eng
PT  - Journal Article
DEP - 20161115
PL  - England
TA  - BMJ
JT  - BMJ (Clinical research ed.)
JID - 8900488
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
CIN - BMJ. 2016 Nov 17;355:i6041. PMID: 27856465
MH  - Case-Control Studies
MH  - Cohort Studies
MH  - Community-Acquired Infections/epidemiology
MH  - Databases, Factual
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Multivariate Analysis
MH  - Pneumonia/*epidemiology
MH  - Proportional Hazards Models
MH  - Proton Pump Inhibitors/*adverse effects/therapeutic use
MH  - Risk
MH  - Time Factors
MH  - United Kingdom
PMC - PMC5110150
COIS- Competing interests: All authors have completed the ICMJE uniform disclosure form 
      at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding 
      author) and declare that: FO has received a scholarship award from King Saud bin 
      Abdulaziz University for Health Sciences, Saudi Arabia, which sponsors her 
      studies at the University of Nottingham; no financial relationships with any 
      organisations that might have an interest in the submitted work in the previous 
      three years; no other relationships or activities that could appear to have 
      influenced the submitted work .
EDAT- 2017/07/18 06:00
MHDA- 2017/07/21 06:00
PMCR- 2016/01/01
CRDT- 2017/07/18 06:00
PHST- 2017/07/18 06:00 [entrez]
PHST- 2017/07/18 06:00 [pubmed]
PHST- 2017/07/21 06:00 [medline]
PHST- 2016/01/01 00:00 [pmc-release]
AID - othf033912 [pii]
AID - 10.1136/bmj.i5813 [doi]
PST - epublish
SO  - BMJ. 2016 Nov 15;355:i5813. doi: 10.1136/bmj.i5813.