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Medical and non‐medical predictors of initiating long‐term use of proton pump inhibitors: a nationwide cohort study of first‐time users during a 10‐year period
Author(s) -
Haastrup P. F.,
Paulsen M. S.,
Christensen R. D.,
Søndergaard J.,
Hansen J. M.,
Jarbøl D. E.
Publication year - 2016
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.13649
Subject(s) - medicine , esomeprazole , rabeprazole , proton pump inhibitor , lansoprazole , incidence (geometry) , omeprazole , pantoprazole , medical prescription , cohort , logistic regression , cohort study , cyp2c19 , proportional hazards model , pediatrics , pharmacology , physics , cytochrome p450 , metabolism , optics
Summary Background Studies of the increasing use of proton pump inhibitors ( PPI s) have mainly focused on prevalent long‐term use and associations with gastrointestinal morbidity and comedication. Little is known about non‐medical characteristics of first‐time users of PPI , and predictors of initiating long‐term use of PPI s. Aims To describe medical and non‐medical characteristics of first‐time PPI users during a 10‐year period and to analyse predictors of initiation of long‐term use (>60 defined daily doses ( DDD s) within 6 months) of PPI s. Methods A nationwide cohort study of first‐time users of PPI . Data were collected from Danish national registers. Individuals redeeming their first prescription for a PPI (omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole) in 2001 and 2011 were identified. Redemption of more than 60 DDD s of PPI within 6 months defined long‐term use. Logistic regression models were used to determine the associations between previous diagnoses, comedication and socio‐economic characteristics and initiation of long‐term use of PPI s in 2011. Results From 2001 to 2011 incidence of first‐time users increased with an incidence rate ratio of 1.53 and mean quantity of PPI redeemed at first prescription increased by 44.6%. In 2011 a total of 37.6% redeemed >60 DDD s within 6 months, and 96% of the long‐term users did not have a diagnosis registered which indicated treatment. New onset long‐term use was significantly associated with low income and low educational level when adjusting for other predisposing variables. Conclusions Proton pump inhibitor treatment is increasingly initiated with larger quantities prescribed for indications that are unidentifiable from the registers. Morbidity and comedication seem to be the strongest predictors of new onset long‐term use of PPI s. However, there is also an independent social gradient.