Clinical Gastroenterology and Hepatology
Volume 7, Issue 8 , Pages 855-861, August 2009

Sociodemographic Factors Influence Use of Proton Pump Inhibitors Among Users of Nonsteroidal Anti-Inflammatory Drugs

  • Ofke S. van Boxel

      Affiliations

    • Dept of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht
    • ,
  • Matthijs P. Hagenaars

      Affiliations

    • Achmea Health Insurance, Leiden, the Netherlands
    • ,
  • André J.P.M. Smout

      Affiliations

    • Dept of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht
    • ,
  • Peter D. Siersema

      Affiliations

    • Dept of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht
    • Corresponding Author InformationReprint requests Address requests for reprints to: Peter D. Siersema, MD, PhD, University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands. fax: (31) 88 7555533

published online 25 May 2009.

Background & Aims

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most frequently prescribed drugs. Although adequate gastroprotection is indicated in individuals at high risk for upper gastrointestinal complications, underutilization of preventive strategies has been demonstrated. We investigated the utilization of proton pump inhibitors (PPIs) in high risk, short term users of NSAIDs and assessed the association between sociodemographic factors and the rates at which PPIs are prescribed.

Methods

A retrospective study was conducted using data from 2.8 million individuals. Short term use was defined as an isolated period of NSAID use between 7 to 30 days. Logistic regression was performed to determine sociodemographic factors associated with PPI inhibitor use.

Results

A total of 155,825 short term users of NSAID were identified. Of these, 52,842 subjects (33.9%) had 1 or more risk factors; 56.1% of these subjects did not receive PPIs. Utilization was associated with sociodemographic factors of patients (such as older age [odds ratio (OR), 1.80; 95% confidence interval (CI), 1.64–1.99], female gender [OR, 1.14; 95% CI, 1.10–1.18], risk factors for upper gastrointestinal complications [OR, 3.72; 95% CI, 3.45–4.00]) and physicians (such as female gender [OR, 1.09; 95% CI, 1.03–1.14], practice in a deprived area [OR, 0.57; 95% CI, 0.53–0.61], or an urban area [OR, 0.86; 95% CI, 0.82–0.90]).

Conclusions

Adequate gastroprotection is not provided to more than 50% of short term users of NSAIDs who are at an increased risk for upper gastrointestinal complications. Utilization is associated with sociodemographic factors of patients and physicians.

Abbreviations used in this paper: CI, confidence interval, COX, cyclo-oxygenase, GI, gastrointestinal, GP, general practitioner, H2RAs, histamine-2 receptor antagonists, NSAIDs, nonsteroidal anti-inflammatory drugs, OR, odds ratio, PPI, proton pump inhibitor, PUB, perforation, peptic ulcer, or bleeding, SES, socioeconomic status, SSRIs, selective serotonin reuptake inhibitors

 

 Conflicts of interest The authors disclose no conflicts.

 Funding O. S. van Boxel is supported by an unrestricted grant from AstraZeneca, Zoetermeer, the Netherlands.

PII: S1542-3565(09)00446-7

doi:10.1016/j.cgh.2009.05.017

Clinical Gastroenterology and Hepatology
Volume 7, Issue 8 , Pages 855-861, August 2009