质子泵抑制剂使用与社区获得性肺炎风险的关联中的混杂因素。
Confounding in the association of proton pump inhibitor use with risk of community-acquired pneumonia.
机构信息
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA.
出版信息
J Gen Intern Med. 2013 Feb;28(2):223-30. doi: 10.1007/s11606-012-2211-5. Epub 2012 Sep 7.
BACKGROUND
Use of proton pump inhibitors (PPIs) is associated with community-acquired pneumonia (CAP), an association which may be confounded by unobserved patient and prescriber characteristics.
OBJECTIVE
We assessed for confounding in the association between PPI use and CAP by using a 'falsification approach,' which estimated whether PPI use is also implausibly associated with other common medical conditions for which no known pathophysiologic link exists.
DESIGN
Retrospective claims-based cohort study.
SETTING
Six private U.S. health plans.
SUBJECTS
Individuals who filled at least one prescription for a PPI (N = 26,436) and those who never did (N = 28,054) over 11 years.
INTERVENTIONS
Multivariate linear regression of the association between a filled prescription for a PPI and a diagnosis of CAP in each 3-month quarter. In falsification analyses, we tested for implausible associations between PPI use in each quarter and rates of osteoarthritis, chest pain, urinary tract infection (UTI), deep venous thrombosis (DVT), skin infection, and rheumatoid arthritis. Independent variables included an indicator for whether a prescription for a PPI was filled in a given quarter, and quarterly indicators for various co-morbidities, age, income, geographic location, and marital status.
KEY RESULTS
Compared to nonusers, those ever using a PPI had higher adjusted rates of CAP in quarters in which no prescription was filled (68 vs. 61 cases per 10,000 persons, p < 0.001). Similar associations were noted for all conditions (e.g. chest pain, 336 vs. 282 cases, p < 0.001; UTI, 151 vs. 139 cases, p < 0.001). Among those ever using a PPI, quarters in which a prescription was filled were associated with higher adjusted rates of CAP (111 vs. 68 cases per 10,000, p < 0.001) and all other conditions (e.g. chest pain, 597 vs. 336 cases, p < 0.001; UTI, 186 vs. 151 cases, p < 0.001), compared to quarters in which no prescription was filled.
CONCLUSION
PPI use is associated with CAP, but also implausibly associated with common medical conditions. Observed associations between PPI use and CAP may be confounded.
背景
质子泵抑制剂 (PPI) 的使用与社区获得性肺炎 (CAP) 相关，这种关联可能因未观察到的患者和处方者特征而混杂。
目的
我们通过使用“验证方法”评估了 PPI 使用与 CAP 之间关联的混杂因素，该方法估计了 PPI 使用是否与其他无已知病理生理学联系的常见医疗状况不合理地相关。
设计
回顾性基于索赔的队列研究。
设置
美国六个私人健康计划。
受试者
在 11 年内至少服用过一次 PPI 处方 (N=26436) 和从未服用过的人 (N=28054)。
干预措施
在每个 3 个月的季度中，多元线性回归 PPI 处方与 CAP 诊断之间的关联。在验证分析中，我们测试了 PPI 使用与每个季度骨关节炎、胸痛、尿路感染 (UTI)、深静脉血栓形成 (DVT)、皮肤感染和类风湿性关节炎的发生率之间不合理的关联。自变量包括在给定季度是否开了 PPI 处方的指标，以及各种合并症、年龄、收入、地理位置和婚姻状况的季度指标。
主要结果
与非使用者相比，在没有处方的季度中，曾经使用过 PPI 的人 CAP 的调整后发生率更高 (每 10000 人 68 例 vs. 61 例，p<0.001)。所有条件下均观察到类似的关联(例如胸痛，336 例 vs. 282 例，p<0.001；UTI，151 例 vs. 139 例，p<0.001)。在曾经使用过 PPI 的人中，开具处方的季度与 CAP 的调整后更高的发生率相关 (每 10000 人 111 例 vs. 68 例，p<0.001) 以及所有其他疾病(例如胸痛，597 例 vs. 336 例，p<0.001；UTI，186 例 vs. 151 例，p<0.001)，与未开具处方的季度相比。
结论
PPI 的使用与 CAP 相关，但也与常见医疗状况不合理地相关。观察到的 PPI 使用与 CAP 之间的关联可能存在混杂。
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