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

Objectives: To determine the association between usages of proton pump inhibitors (PPIs) and subsequent risk of pneumonia in dementia patients. Design: Retrospective cohort study. Setting: Taiwanese National Health Insurance Research Database. Participants: The study cohort consisted of 786 dementia patients with new PPI usage and 786 matched dementia patients without PPI usage. Measurements: 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. Conclusion: PPI usage in dementia patients is associated with an 89% increased risk of pneumonia.