Association of Proton Pump Inhibitors Usage with Risk of Pneumonia in Dementia Patients.
OBJECTIVE
To determine the association between usages of proton pump inhibitors (PPIs) and subsequent risk of pneumonia in dementia patients.


METHODS
Retrospective cohort study.


METHODS
Taiwanese National Health Insurance Research Database.


METHODS
The study cohort consisted of 786 dementia patients with new PPI usage and 786 matched dementia patients without PPI usage.


METHODS
The study endpoint was defined as the occurrence of pneumonia. The Cox proportional hazard model was used to estimate the pneumonia risk. Defined daily dose methodology was applied to evaluate the cumulative and dose-response relationships of PPI.


RESULTS
Incidence of pneumonia was higher among patients with PPI usage (adjusted hazard ratio (HR) = 1.89; 95% CI = 1.51-2.37). Cox model analysis also demonstrated that age (adjusted HR = 1.05; 95% CI = 1.03-1.06), male gender (adjusted HR = 1.57; 95% CI = 1.25-1.98), underlying cerebrovascular disease (adjusted HR = 1.30; 95% CI = 1.04-1.62), chronic pulmonary disease (adjusted HR = 1.39; 95% CI = 1.09-1.76), congestive heart failure (adjusted HR = 1.54; 95% CI = 1.11-2.13), diabetes mellitus (adjusted HR = 1.54; 95% CI = 1.22-1.95), and usage of antipsychotics (adjusted HR = 1.29; 95% CI = 1.03-1.61) were independent risk factors for pneumonia. However, usage of cholinesterase inhibitors and histamine receptor-2 antagonists were shown to decrease pneumonia risk.


CONCLUSIONS
PPI usage in dementia patients is associated with an 89% increased risk of pneumonia.
Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.|Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.|Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
Sai-Wai
SW
Ho
Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.|Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
Ying-Hock
YH
Teng
Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.|Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
Shun-Fa
SF
Yang
School of Medicine, Chang Gung University, Taoyuan City, Taiwan.
Han-Wei
HW
Yeh
School of Medicine, Chang Gung University, Taoyuan City, Taiwan.
Yu-Hsun
YH
Wang
Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.|Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan.
Ming-Chih
MC
Chou
Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.|Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
Chao-Bin
CB
Yeh
D000367:Age Factors; D000368:Aged; D016208:Databases, Factual; D003704:Dementia / Q000150:complications*; D005260:Female; D006635:Histamine H2 Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D011014:Pneumonia / Q000139:chemically induced / Q000453:epidemiology*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013624:Taiwan / Q000453:epidemiology
D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors
dementia; pneumonia; population-based study; proton-pump inhibitors