Centre for Translational Microbiome Research, Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Biomedicum A8, Solnavägen 9, 171 65, Stockholm, Sweden.
Department of Family Medicine and Population Health, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium.
Dig Dis Sci. 2023 Jun;68(6):2252-2263. doi: 10.1007/s10620-023-07820-9. Epub 2023 Jan 11.
Proton pump inhibitor (PPI) use has increased over the last decades and has been associated with multiple adverse events and potentially even overall survival.
We aimed to investigate the association between proton pump inhibitor maintenance use and all-cause and cause-specific mortality, addressing confounding by indication and duration of use.
This Swedish population-based cohort study included all adult (N = 935,236) PPI and histamine-2 receptor antagonist maintenance users (≥ 180 days use) during 2005-2014. Standardised mortality ratios (SMRs) and 95% confidence intervals were calculated for all-cause and cause-specific mortality comparing the risk among PPI/H2RA users to that of the Swedish background population, stratified by age, sex, calendar period, indication and duration of use. Multivariable Poisson regression models were used to compare PPI use to H2RA use, expressed as incidence rate ratios and 95% confidence intervals.
PPI and histamine-2 receptor antagonist use were associated with an increased risk of all-cause mortality (SMR = 1.35; 1.34-1.36; SMR = 1.31; 1.27-1.36, respectively). The highest SMRs were found in the youngest age groups. In direct comparison, PPI use showed a higher mortality risk than histamine-2 receptor antagonist use (incidence rate ratios = 1.42; 1.38-1.46). PPIs were related to increased cancer (SMR = 1.21; 1.20-1.22), and cardiovascular mortality (SMR = 1.36; 1.35-1.37). Increased SMRs were observed for most indications. Longer duration of use was associated with a higher mortality among PPI users but not among histamine-2 receptor antagonist users.
Maintenance PPI use was associated with an increased risk of all-cause and cause-specific mortality, and the risk increased with prolonged duration.
质子泵抑制剂（PPI）的使用在过去几十年中有所增加，并与多种不良事件甚至整体生存率相关。
我们旨在研究质子泵抑制剂维持治疗与全因和病因特异性死亡率之间的关联，同时解决适应证和使用时间的混杂因素。
本项基于人群的瑞典队列研究纳入了 2005 年至 2014 年期间所有（N=935236）接受质子泵抑制剂和组胺 2 受体拮抗剂（≥180 天）维持治疗的成年患者。通过比较 PPI/H2RA 使用者与瑞典背景人群的全因和病因特异性死亡率的标准化死亡率比（SMR）和 95%置信区间，按年龄、性别、日历时间、适应证和使用时间进行分层。采用多变量泊松回归模型比较 PPI 与 H2RA 的使用，结果表示为发病率比值和 95%置信区间。
PPI 和组胺 2 受体拮抗剂的使用与全因死亡率增加相关（SMR=1.35；1.34-1.36；SMR=1.31；1.27-1.36）。最高的 SMR 见于最年轻的年龄组。直接比较显示，PPI 治疗的死亡率风险高于组胺 2 受体拮抗剂（发病率比值=1.42；1.38-1.46）。PPIs 与癌症（SMR=1.21；1.20-1.22）和心血管死亡率（SMR=1.36；1.35-1.37）增加相关。大多数适应证与 SMR 增加相关。PPI 使用者的使用时间延长与死亡率增加相关，但组胺 2 受体拮抗剂使用者无此关联。
质子泵抑制剂维持治疗与全因和病因特异性死亡率增加相关，且风险随使用时间延长而增加。
