Abraham N S, Castillo D L, Hartman C
Houston Center for Quality of Care & Utilization Studies, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX 77030, USA.
Aliment Pharmacol Ther. 2008 Jul;28(1):97-106. doi: 10.1111/j.1365-2036.2008.03706.x. Epub 2008 Apr 7.
Upper gastrointestinal events (UGIE), myocardial infarction (MI) and cerebrovascular accident (CVA) are known morbidities among recent NSAID users.
To assess all-cause mortality following UGIE, MI or CVA among recent NSAID users.
Veterans >65 prescribed an NSAID at any Veterans Affairs (VA) facility were identified using prescription fill data and their records linked to a merged VA-Medicare database. Each person-day was assessed for NSAID, coxib or proton pump inhibitor (PPI) exposure. Incidence density ratios and hazard rates of death were calculated following UGIE, MI and CVA adjusting for demographics, co-morbidity, prescription channeling, geographic location and pharmacological covariates.
Among 474 495 patients [97.8% male; 85.3% white; 73.9 years (s.d. 5.6)], death followed at a rate of 5.5 per 1000 person-years (95% CI: 5.4-5.6) post-UGIE, 17.7 per 1000 person-years (95% CI: 17.5-17.9) post-MI and 21.8 per 1000 person-years (95% CI: 21.6-22.0) post-CVA. CVA was associated with greatest risk of death [hazard ratio (HR) 12.4; 95% CI: 10.9-14.3] followed by MI (HR 10.7; 95% CI: 9.2-11.6) and UGIE (HR 3.3; 95% CI: 2.8-3.9). Predictors of mortality were advancing age and co-morbidity, increased use of coxibs and failure to ensure adequate gastroprotection.
Among elderly veterans with recent NSAID use, an UGIE, MI or CVA is a clinically relevant premorbid event.
上消化道事件（UGIE）、心肌梗死（MI）和脑血管意外（CVA）是近期使用非甾体抗炎药（NSAID）患者中已知的发病情况。
评估近期使用NSAID患者发生UGIE、MI或CVA后的全因死亡率。
利用处方配药数据识别出在任何退伍军人事务（VA）机构中开具了NSAID处方的65岁以上退伍军人，并将他们的记录与合并的VA - 医疗保险数据库相链接。对每个人 - 日评估NSAID、环氧化酶 - 2抑制剂（coxib）或质子泵抑制剂（PPI）的暴露情况。在调整人口统计学、合并症、处方渠道、地理位置和药理学协变量后，计算UGIE、MI和CVA后死亡的发病密度比和风险率。
在474495例患者中[97.8%为男性；85.3%为白人；73.9岁（标准差5.6）]，UGIE后死亡率为每1000人 - 年5.5例（95%可信区间：5.4 - 5.6），MI后为每1000人 - 年17.7例（95%可信区间：17.5 - 17.9），CVA后为每1000人 - 年21.8例（95%可信区间：21.6 - 22.0）。CVA与最高死亡风险相关[风险比（HR）12.4；95%可信区间：10.9 - 14.3]，其次是MI（HR 10.7；95%可信区间：9.2 - 11.6）和UGIE（HR 3.3；95%可信区间：2.8 - 3.9）。死亡率的预测因素是年龄增长和合并症、coxibs使用增加以及未能确保充分的胃保护。
在近期使用NSAID的老年退伍军人中，UGIE、MI或CVA是具有临床相关性的病前事件。
