Emulating a target trial of proton pump inhibitors and dementia risk using claims data.

Autor: Ahn N; Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Munich, Germany.; Chair of Epidemiology, University of Augsburg at University Hospital Augsburg, Augsburg, Germany., Nolde M; Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Munich, Germany.; Chair of Epidemiology, University of Augsburg at University Hospital Augsburg, Augsburg, Germany., Günter A; AOK Bayern, Munich, Germany., Güntner F; AOK Bayern, Munich, Germany., Gerlach R; Association of Statutory Health Insurance Physicians in Bavaria (Kassenärztliche Vereinigung Bayerns, KVB), Munich, Germany., Tauscher M; Association of Statutory Health Insurance Physicians in Bavaria (Kassenärztliche Vereinigung Bayerns, KVB), Munich, Germany., Amann U; Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany., Linseisen J; Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Munich, Germany.; Chair of Epidemiology, University of Augsburg at University Hospital Augsburg, Augsburg, Germany.; Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany., Meisinger C; Chair of Epidemiology, University of Augsburg at University Hospital Augsburg, Augsburg, Germany., Rückert-Eheberg IM; Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Munich, Germany.; Chair of Epidemiology, University of Augsburg at University Hospital Augsburg, Augsburg, Germany.; Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany., Baumeister SE; Institute of Health Services Research in Dentistry, University of Münster, Münster, Germany.
Jazyk: angličtina
Zdroj: European journal of neurology [Eur J Neurol] 2022 May; Vol. 29 (5), pp. 1335-1343. Date of Electronic Publication: 2022 Feb 25.
DOI: 10.1111/ene.15284
Abstrakt: Background and Purpose: Understanding the adverse effects of proton pump inhibitors (PPIs) is important due to their widespread use, but the available evidence for an increased dementia risk amongst patients taking PPIs is inconclusive. The present study aimed to estimate the causal effect of PPIs on the risk of dementia by target trial emulation and time-varying exposure modeling.
Methods: Using claims data of 2,698,176 insured people of a large German statutory health insurer, a target trial was conceptualized in which individuals aged 40 years and older were classified as PPI initiators or non-initiators between 2008 and 2018, and were followed until diagnosis of dementia, death, loss to follow-up or end of study. Incidence of dementia (International Classification of Diseases 10 codes F00, F01, F03, F05.1, G30, G31.0, G31.1, G31.9 and F02.8+G31.82) was defined applying a 1-year lag window. Weighted Cox models were used to estimate the effect of PPI initiation versus non-initiation on dementia risk and weighted pooled logistic regression was used to estimate the effect of time-varying use versus non-use.
Results: In all, 29,746 PPI initiators (4.4%) and 26,830 non-initiators (1.3%) were diagnosed with dementia. Comparing PPI initiation with no initiation, the hazard ratio for dementia was 1.54 (95% confidence interval 1.51-1.58). The hazard ratio for time-dependent PPI use versus non-use was 1.56 (95% confidence interval 1.50-1.63). Differentiated subtypes, including unspecified dementia, Alzheimer's disease and vascular dementia, showed increased risk by PPI initiation and time-varying PPI use.
Conclusions: This study suggests that PPI initiation and time-varying PPI use may increase overall dementia risk.
(© 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)
Databáze: MEDLINE
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