Proton pump inhibitors are a group of drugs that reduce the amount of acid produced by your stomach. They are used to treat a number of conditions including indigestion and heartburn.
They are effective drugs and, as a result, are prescribed frequently by doctors. However, there are concerns that they are associated with serious negative health outcomes. Research studies have indicated that usage of proton pump inhibitors might increase the risk of fractures, dementia and other negative outcomes including death.
It is not entirely clear, however, whether proton pump inhibitors cause these negative health outcomes. It may be that these associations occur because people who are prescribed proton pump inhibitors have on average poorer health when they start treatment.
It is important that we investigate the effects of proton pump inhibitors in depth given that they are frequently prescribed and given that the negative health outcomes suggested to be associated with usage are serious.
In our study, we will investigate the relationship between proton pump inhibitors and risk of death. We will estimate the risk of death associated with usage of proton pump inhibitors overall and by cause of death.
Proton pump inhibitors (PPIs) have been associated with a range of adverse outcomes including death. It is likely that many of these associations are not causal but due to confounding. Concern about adverse effects may reduce prescribing of this important class of medications. Therefore, we will examine cause-specific mortality including outcomes unlikely to be causally associated with PPIs.
We will use a cohort study design to estimate the risk of death in new users of PPIs compared to new users of H2 receptor antagonists (H2RAs) and, in a secondary analysis, to non-users of acid suppression therapy.
The outcomes of interest are all-cause and cause-specific mortality. For cause-specific mortality we will include both broad categories of cause of death (i.e. neoplasms) and selected specific causes. We will include specific causes related to adverse events previously found to be associated with PPI usage (e.g. pneumonia) and control outcomes (e.g. liver cancer mortality), which may be associated with frailty, but which have not been previously linked to PPIs.
Inverse probability of treatment weighting by propensity score, calculated using logistic regression, will be used to control for confounding. Cox regression will be used to estimate the effect of PPI prescription on risk of death.
Ian Douglas - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Chris Frost - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Christopher Lee - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Corentin Ségalas - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Elizabeth Williamson - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Ikpemesi Olubor - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Isabel dos-Santos-Silva - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Jack Collis - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
John Tazare - Collaborator - GSK
Kathryn Mansfield - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Kevin Wing - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Krishnan Bhaskaran - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Laurie Tomlinson - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Liam Smeeth - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Peter Fisher - Collaborator - UCL Hospital
Stephen Evans - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation