title: A population based historical cohort study of the mortality associated with nabumetone, Arthrotec, diclofenac, and naproxen.
abstract: OBJECTIVE
  To identify the unbiased differences in all cause mortality among populations using 4 non-steroidal antiinflammatory drugs (NSAID): nabumetone, Arthrotec, diclofenac plus a cytoprotective agent dispensed separately (diclofenac+), and naproxen.
  
  
  METHODS
  We performed a population based historical cohort study using linked data from several provincial health care databases. Logistic regression was used to produce estimates of the mortality associated with the study drugs unbiased by known confounders. The entire population of the province of Saskatchewan, Canada entitled to drug plan benefits in 1995 was eligible (approximately 91% of 1 million people). Participants were identified if they filled a prescription for one of the 4 study NSAID (18,424 individuals). They were then followed forward in time for 6 months to determine all cause mortality.
  
  
  RESULTS
  Compared to nabumetone, the adjusted odds of death for participants taking Arthrotec was 1.4 (95% confidence interval, CI: 0.9-2.1), for diclofenac+ 2.0 (1.3-3.1), and naproxen 3.0 (1.9-4.6).
  
  
  CONCLUSIONS
  The multivariate analysis showed patients taking nabumetone and Arthrotec had significantly lower mortality than those taking other study drugs. Nabumetone had 1/3 to 1/5 the mortality associated with the diclofenac+ and naproxen groups. It appears that inherent gastroprotective strategies in the study NSAID may translate into decreased mortality at the population level.
authors.affiliation: Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Alberta, Canada. ashworth@cha.ab.ca
authors.forename: Nigel L
authors.initials: NL
authors.lastname: Ashworth
authors.forename: Paul M
authors.initials: PM
authors.lastname: Peloso
authors.forename: Nazeem
authors.initials: N
authors.lastname: Muhajarine
authors.forename: Maryrose
authors.initials: M
authors.lastname: Stang
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002074:Butanones / Q000009:adverse effects; D002423:Cause of Death; D002908:Chronic Disease / Q000401:mortality*; D015331:Cohort Studies; D004008:Diclofenac / Q000009:adverse effects; D004338:Drug Combinations; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016595:Misoprostol / Q000009:adverse effects; D000077430:Nabumetone; D009288:Naproxen / Q000009:adverse effects; D012306:Risk; D012525:Saskatchewan / Q000453:epidemiology; D015996:Survival Rate
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; C078133:Arthrotec; D002074:Butanones; D004338:Drug Combinations; D016595:Misoprostol; D004008:Diclofenac; D009288:Naproxen; D000077430:Nabumetone