Association of Proton Pump Inhibitors Usage with Risk of Pneumonia in Dementia Patients

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<jats:title>Objectives</jats:title>
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To determine the association between usages of proton pump inhibitors (
<jats:styled-content style="fixed-case">PPI</jats:styled-content>
s) and subsequent risk of pneumonia in dementia patients.
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<jats:title>Design</jats:title>
<jats:p>Retrospective cohort study.</jats:p>
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<jats:title>Setting</jats:title>
<jats:p>Taiwanese National Health Insurance Research Database.</jats:p>
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<jats:title>Participants</jats:title>
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The study cohort consisted of 786 dementia patients with new
<jats:styled-content style="fixed-case">PPI</jats:styled-content>
usage and 786 matched dementia patients without
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usage.
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<jats:title>Measurements</jats:title>
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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
<jats:styled-content style="fixed-case">PPI</jats:styled-content>
.
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<jats:title>Results</jats:title>
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Incidence of pneumonia was higher among patients with
<jats:styled-content style="fixed-case">PPI</jats:styled-content>
usage (adjusted hazard ratio (
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) = 1.89; 95%
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= 1.51–2.37). Cox model analysis also demonstrated that age (adjusted
<jats:styled-content style="fixed-case">HR</jats:styled-content>
= 1.05; 95%
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= 1.03–1.06), male gender (adjusted
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= 1.57; 95%
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= 1.25–1.98), underlying cerebrovascular disease (adjusted
<jats:styled-content style="fixed-case">HR</jats:styled-content>
= 1.30; 95%
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= 1.04–1.62), chronic pulmonary disease (adjusted
<jats:styled-content style="fixed-case">HR</jats:styled-content>
= 1.39; 95%
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= 1.09–1.76), congestive heart failure (adjusted
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= 1.54; 95%
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= 1.11–2.13), diabetes mellitus (adjusted
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= 1.54; 95%
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= 1.22–1.95), and usage of antipsychotics (adjusted
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= 1.29; 95%
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= 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.
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<jats:title>Conclusion</jats:title>
<jats:p>
<jats:styled-content style="fixed-case">PPI</jats:styled-content>
usage in dementia patients is associated with an 89% increased risk of pneumonia.
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