Associations between Community-Acquired Pneumonia and Proton Pump Inhibitors in the Laryngeal/Voice-Disordered Population

Objectives To examine the relationship between community-acquired pneumonia (CAP) and proton pump inhibitor (PPI) treatment among patients with laryngeal/voice disorders. Study Design Retrospective cohort analysis. Setting Large national administrative US claims database. Subjects and Methods Patien...

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Bibliographic Details
Published in:Otolaryngology-head and neck surgery 2019-03, Vol.160 (3), p.519-525
Main Authors: Cohen, Seth M., Lee, Hui-Jie, Leiman, David A., Roy, Nelson, Misono, Stephanie
Format: Article
Language:English
Subjects:
Adult
adverse event
Aged
Community-Acquired Infections
Databases, Factual
dysphonia
Female
Humans
laryngeal disorders
larynx
Male
Middle Aged
pneumonia
Pneumonia - epidemiology
Propensity Score
Proportional Hazards Models
proton pump inhibitor
Proton Pump Inhibitors - therapeutic use
Retrospective Studies
voice
voice disorders
Voice Disorders - complications
Voice Disorders - drug therapy
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Summary:Objectives To examine the relationship between community-acquired pneumonia (CAP) and proton pump inhibitor (PPI) treatment among patients with laryngeal/voice disorders. Study Design Retrospective cohort analysis. Setting Large national administrative US claims database. Subjects and Methods Patients were included if they were ≥18 years old; had outpatient treatment for a laryngeal/voice disorder from January 1, 2010, to December 31, 2014 (per International Classification of Diseases, Ninth Revision, Clinical Modification codes); had 12 months of continuous enrollment prior to the index date (ie, first diagnosis of laryngeal/voice disorder); had no preindex diagnosis of CAP; and had prescription claims captured from 1 year preindex to end of follow-up. Patient demographics, comorbid conditions, index laryngeal diagnosis, number of unique preindex patient encounters, and CAP diagnoses during the postindex 3 years were collected. Two models—a time-dependent Cox regression model and a propensity score–based approach with a marginal structural model—were separately performed for patients with and without pre–index date PPI prescriptions. Results A total of 392,355 unique patients met inclusion criteria; 188,128 (47.9%) had a PPI prescription. The 3-year absolute risk for CAP was 4.0% and 5.3% among patients without and with preindex PPI use, respectively. For patients without and with pre–index date PPI use, the CAP occurrence for a person who had already received a PPI is 30% to 50% higher, respectively, than for a person who had not yet had a PPI but may receive one later. Conclusions Patients without and with pre–index date PPI use experienced a roughly 30% to 50% increased likelihood of CAP, respectively, as compared with patients who had not had PPI prescriptions.
ISSN:0194-5998
1097-6817
DOI:10.1177/0194599818811292