title: Incidence of outpatient physician claims for upper gastrointestinal symptoms among new users of celecoxib, ibuprofen, and naproxen in an insured population in the United States.
abstract: OBJECTIVE
  The aim of this study was to compare the risk of outpatient medical claims for UGI symptoms among new users of celecoxib versus ibuprofen, and naproxen.
  
  
  METHODS
  The study was conducted using LifeLink, an insurance claims database of approximately 1.8 million employees, dependents, and retirees in the United States. Patients newly treated with a prescription of celecoxib, ibuprofen, or naproxen between June 1, 1999, and June 30, 2001, were included. A patient with an upper GI (UGI) symptom was any individual with an outpatient physician claim for dyspepsia (ICD-9 = 536.8), abdominal pain (789.0), or nausea/vomiting (787.0). Incidence was determined using person-time analysis. Multivariate analyses were conducted using Poisson and Cox regression models.
  
  
  RESULTS
  The cohort consisted of patients prescribed celecoxib (n = 68,939), ibuprofen (n = 71,456), or naproxen (n = 50,014). At baseline, celecoxib users were older and more likely to have a history of UGI or cardiovascular conditions. The incidence rate of any UGI symptom was 0.46 per 1,000 patient-days for celecoxib, 0.70 for ibuprofen, and 0.62 for naproxen. After adjusting for confounding factors using Poisson regression, the ibuprofen rate was 48% higher than the celecoxib rate (incidence rate ratio (IRR) = 1.48; 95% CI = 1.39-1.58; p < 0.001), whereas the naproxen rate was 40% higher (IRR = 1.40; 95% CI = 1.31-1.49; p < 0.001). The association between drug use and UGI symptoms was confirmed by Cox regression analysis; the hazard ratios were 1.21 (95% CI = 1.13-1.29; p < 0.001) for ibuprofen and 1.15 (95% CI = 1.07-1.23; p < 0.001) for naproxen relative to celecoxib. Younger age, female sex, medical history of UGI, cardiovascular and renal conditions, and higher baseline average healthcare expenditures for the 12-month period preceding the index prescription were also significantly associated with an increased incidence of UGI symptoms.
  
  
  CONCLUSIONS
  Celecoxib use is associated with a significantly decreased risk of outpatient physician claims for UGI symptoms compared with commonly used prescription nonspecific nonsteroidal anti-inflammatory drugs.
authors.affiliation: Department of Medicine, Section of Digestive Diseases and Nutrition, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Jay L
authors.initials: JL
authors.lastname: Goldstein
authors.forename: Sean Z
authors.initials: SZ
authors.lastname: Zhao
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Burke
authors.forename: Ryan
authors.initials: R
authors.lastname: Palmer
authors.forename: Heather
authors.initials: H
authors.lastname: von Allmen
authors.forename: Scott C
authors.initials: SC
authors.lastname: Henderson
mesh_terms: D015746:Abdominal Pain / Q000139:chemically induced*; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000068579:Celecoxib; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects*; D004415:Dyspepsia / Q000139:chemically induced*; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000009:adverse effects*; D015994:Incidence; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009288:Naproxen / Q000009:adverse effects*; D009325:Nausea / Q000139:chemically induced*; D010045:Outpatients; D016012:Poisson Distribution; D016016:Proportional Hazards Models; D011720:Pyrazoles; D012307:Risk Factors; D013449:Sulfonamides / Q000009:adverse effects*; D014481:United States; D014839:Vomiting / Q000139:chemically induced*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D011720:Pyrazoles; D013449:Sulfonamides; D009288:Naproxen; D000068579:Celecoxib; D007052:Ibuprofen