title: Gastroprotective agent underuse in high-risk older daily nonsteroidal anti-inflammatory drug users over time.
abstract: OBJECTIVE
  To examine whether older adults taking nonsteroidal anti-inflammatory drugs (NSAIDs) decreased the underuse of gastroprotective agents over time.
  
  
  METHODS
  Before-and-after study.
  
  
  METHODS
  Health, Aging and Body Composition Study.
  
  
  METHODS
  Daily users of a NSAID (prescription and over the counter (OTC)) at visits in 2002-03 (preperiod; n = 404) and 2006-07 (postperiod; n = 172). The sample had a mean ± standard deviation age of 78.2 ± 2.7 at the preperiod visit and 81.9 ± 2.7 at the postperiod visit. The majority were white and female and had 12 or more years of education.
  
  
  METHODS
  Underusers were defined as persons taking nonselective NSAIDs who were at risk of peptic ulcer disease (PUD; because of current warfarin or glucocorticoid use or history of PUD) and not using a proton pump inhibitor (PPI) or persons taking cyclooxygenase 2 (COX-2) selective NSAIDs and aspirin who were at risk of PUD (having at least one risk factor) and not using a PPI.
  
  
  RESULTS
  Daily NSAID use decreased from 17.6% to 11.3% (P < .001), and gastroprotective agent underuse decreased from 23.5% to 15.1% (P = .008). Controlling for important covariates, having prescription insurance was somewhat protective against underuse in the preperiod (adjusted odds ratio (AOR) = 0.78, 95% confidence interval (CI) = 0.46-1.34; P = .37), but more so and significantly in the postperiod (AOR = 0.41, 95% CI = 0.18-0.93; P = .03). Having prescription insurance was more protective in the post- than in the preperiod (less gastroprotective agent underuse; adjusted ratio of OR = 0.53, 95% CI = 0.22-1.29; P = .16), but this increased protection was not statistically significant.
  
  
  CONCLUSIONS
  In older daily NSAID users at high risk of PUD, having prescription insurance and adequate gastroprotective use was more common in the post- than in the preperiod.
authors.affiliation: Division of Geriatric Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: Marcum
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hanlon
authors.forename: Elsa S
authors.initials: ES
authors.lastname: Strotmeyer
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.forename: Ronald I
authors.initials: RI
authors.lastname: Shorr
authors.forename: Eleanor M
authors.initials: EM
authors.lastname: Simonsick
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Bauer
authors.forename: Robert
authors.initials: R
authors.lastname: Boudreau
authors.forename: Julie M
authors.initials: JM
authors.lastname: Donohue
authors.forename: Subashan
authors.initials: S
authors.lastname: Perera
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000925:Anticoagulants / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects; D065187:Controlled Before-After Studies; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects; D005260:Female; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D008297:Male; D010437:Peptic Ulcer / Q000139:chemically induced / Q000517:prevention & control*; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D014859:Warfarin / Q000009:adverse effects
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D052246:Cyclooxygenase 2 Inhibitors; D054328:Proton Pump Inhibitors; D014859:Warfarin; D001241:Aspirin
keywords: gastroprotection; nonsteroidal anti-inflammatory drug; older adults