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Gastroprotective Agent Underuse in High‐Risk Older Daily Nonsteroidal Anti‐Inflammatory Drug Users over Time
Author(s) -
Marcum Zachary A.,
Hanlon Joseph T.,
Strotmeyer Elsa S.,
Newman Anne B.,
Shorr Ronald I.,
Simonsick Eleanor M.,
Bauer Douglas C.,
Boudreau Robert,
Donohue Julie M.,
Perera Subashan
Publication year - 2014
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13066
Subject(s) - medicine , nonsteroidal , drug , intensive care medicine , gerontology , pharmacology
Objectives To examine whether older adults taking nonsteroidal anti‐inflammatory drugs ( NSAID s) decreased the underuse of gastroprotective agents over time. Design Before‐and‐after study. Setting Health, Aging and Body Composition Study. Participants 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. Measurements Underusers were defined as persons taking nonselective NSAID s 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 NSAID s 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. Conclusion 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.