Use of NSAIDs, COX-2 inhibitors, and acetaminophen and associated coprescriptions of gastroprotective agents in an elderly population.
OBJECTIVE
To identify determinants of cyclooxygenase 2 (COX-2) inhibitor versus nonsteroidal antiinflammatory drug (NSAIDs) or acetaminophen prescription in seniors; and to compare gastroprotective agent coprescriptions.


METHODS
Administrative medical records were obtained from the government of Quebec health insurance agency. Three cohorts were formed based on prescriptions at study entry: COX-2 inhibitors, NSAIDs, or acetaminophen. Logistic regressions were used to adjust for potential confounders.


RESULTS
We identified 42,267 patients taking COX-2 inhibitors, 8,235 taking NSAIDs, and 19,716 taking acetaminophen. Determinants of utilizing COX-2 inhibitors versus NSAIDs and versus acetaminophen, respectively, include: female gender (odds ratio [OR] 1.47; 95% confidence interval [95% CI] 1.39-1.55 and OR 1.17; 95% CI 1.12-1.22); musculoskeletal diseases (OR 1.87; 95% CI 1.76-2.00 and OR 2.20; 95% CI 2.10-2.31); and prior gastrointestinal hospitalization (OR 1.82; 95% CI 1.19-2.78 and OR 0.77; 95% CI 0.64-0.92). Gastroprotective agent coprescriptions were lower with COX-2 inhibitors than NSAIDs: OR 0.53; 95% CI 0.48-0.58.


CONCLUSIONS
COX-2 inhibitors were more commonly used than NSAIDs in patients with musculoskeletal diseases and those with prior gastrointestinal hospitalizations. Adjusted odds ratios showed a 47% decrease in gastroprotective agent coprescriptions with COX-2 inhibitors compared with NSAIDs.
Rahme
Elham
E
McGill University and McGill University Health Center, Montreal, Quebec, Canada. elham.rahme@mcgill.ca
Marentette
Michael A
MA
Kong
Sheldon X
SX
Lelorier
Jacques
J
D000082:Acetaminophen / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D015331:Cohort Studies; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007527:Isoenzymes / Q000037:antagonists & inhibitors; D016015:Logistic Models; D008297:Male; D008565:Membrane Proteins; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011451:Prostaglandin-Endoperoxide Synthases; D011792:Quebec; D012307:Risk Factors
D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D008565:Membrane Proteins; D000082:Acetaminophen; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases