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Editor's Correspondence
May 9, 2011

Use of PPIs Are Not Associated With Mortality in Institutionalized Older People

Author Affiliations

Author Affiliations: Institute of Bone and Joint Research, University of Sydney (Mr Wilson and Drs March and Sambrook), and Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital (Drs Gnjidic and Hilmer), Sydney, Australia.

Arch Intern Med. 2011;171(9):866-867. doi:10.1001/archinternmed.2011.164

Bell et al1 published an insightful research letter in the Archives regarding the association of proton pump inhibitors (PPIs) and mortality among institutionalized older people. We wish to share the results of a similar analysis we conducted within a comparable population. We studied 602 participants from 51 different intermediate-level residential aged care facilities in Sydney, Australia, as part of a falls prevention study.2 At baseline, the mean (SD) age was 85.7 (6.4) years (range, 70-107 years), 70.9% were female, and 246 (40.9%) used a PPI. Over 1 year of follow-up, 62 participants (10.3%) died. The mortality rates were 11.0% (n = 27) and 9.8% (n = 35) among users and nonusers of PPIs, respectively (P = .37). There was similar use of nonsteroidal anti-inflammatory drugs (14.6% vs 12.4%; P = .42), low-dose aspirin (39.0% vs 32.6%; P = .10), and selective serotonin reuptake inhibitors (16.3% vs 13.2%; P = .29) among users and nonusers of PPIs. We observed no difference in mortality between users and nonusers of nonsteroidal anti-inflammatory drugs (10.0% vs 10.3%; P = .93), low-dose aspirin (11.3% vs 9.7%; P = .54), or selective serotonin reuptake inhibitors (6.9% vs 10.9%; P = .26). Adjusted Cox proportional models, similar to those used in the aforementioned study and shown in the Table found no association of PPI use with 1-year mortality (hazard ratio, 1.08; 95% confidence interval, 0.63-1.86).

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