title: Effect of nonsteroidal anti-inflammatory drug use on the rate of gastrointestinal hospitalizations among people living in long-term care.
abstract: OBJECTIVE
  Gastrointestinal (GI) complications are the most-common serious adverse reactions associated with nonsteroidal anti-inflammatory drugs (NSAIDs). We quantified the effect of specific NSAIDs on the rate of GI hospitalizations among older people living in long-term care.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  All Medicare/Medicaid certified nursing homes in four states (Maine, Minnesota, New York, and South Dakota).
  
  
  METHODS
  We identified 125,516 newly admitted residents from a database of all residents (1992-1996) of all Medicare/Medicaid certified nursing homes in four states. Using the federally mandated Minimum Data Set, which includes information on all drugs received (prescription and over-the-counter), we identified patients who received at least one prescription for aspirin (n = 19,101) or NSAIDs (n = 9,777). The control population consisted of all institutionalized persons who did not receive these drugs.
  
  
  METHODS
  From Health Care Financing Administration inpatient claims, we identified the first hospitalization for GI perforation, ulcer, or hemorrhage that occurred during the year of follow up (ICD9-CM discharge codes: 531-534, 578). Cox proportional hazards models provided adjusted estimates of rate ratios.
  
  
  RESULTS
  NSAID exposure increased the GI-event-related hospitalization rate in both men (rate ratios (RR) = 2.64; 95% confidence interval (CI) = 1.17-5.99) and women (RR = 3.23; 95% CI = 1.85-5.65). The rate of GI hospitalizations for both men and women taking sulindac, naproxen, or indomethacin was higher than for nonusers. The risk of GI-event-related hospitalizations was greatest among women exposed to diflunisal (RR = 6.08; 95% CI = 2.27-16.26) or oxaprozin (RR = 6.03; 95% CI = 2.49-14.58).
  
  
  CONCLUSIONS
  Despite the high background rate of GI events, most NSAIDs increased the risk of GI hospitalization. Careful attention to choice of agent and dosing is needed in prescribing NSAIDs in this frail, older population.
authors.affiliation: Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island 02912, USA.
authors.forename: K L
authors.initials: KL
authors.lastname: Lapane
authors.forename: J J
authors.initials: JJ
authors.lastname: Spooner
authors.forename: L
authors.initials: L
authors.lastname: Mucha
authors.forename: W L
authors.initials: WL
authors.lastname: Straus
mesh_terms: D017677:Age Distribution; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D014487:Centers for Medicare and Medicaid Services, U.S.; D016208:Databases, Factual; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000191:economics / Q000453:epidemiology; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000706:statistics & numerical data; D008281:Maine / Q000453:epidemiology; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008910:Minnesota / Q000453:epidemiology; D009518:New York / Q000453:epidemiology; D009735:Nursing Homes / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013023:South Dakota / Q000453:epidemiology; D014481:United States
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal