PittsburghV1, Ncbi, Checkpoint, bibRecord, 003892

Gastroprotective Agent Underuse in High-Risk Older Daily Non-Steroidal Anti-Inflammatory Drug Users Over Time

Identifieur interne : 003892 ( Ncbi/Checkpoint ); précédent : 003891; suivant : 003893

Gastroprotective Agent Underuse in High-Risk Older Daily Non-Steroidal Anti-Inflammatory Drug Users Over Time

Auteurs : Zachary A. Marcum [États-Unis] ; Joseph T. Hanlon [États-Unis] ; Elsa S. Strotmeyer [États-Unis] ; Anne B. Newman [États-Unis] ; Ronald I. Shorr [États-Unis] ; Eleanor M. Simonsick [États-Unis] ; Douglas C. Bauer [États-Unis] ; Robert Boudreau [États-Unis] ; Julie M. Donohue [États-Unis] ; Subashan Perera [États-Unis]

Source :

Journal of the American Geriatrics Society [ 0002-8614 ] ; 2014.

RBID : PMC:4206578

Descripteurs français

English descriptors

KwdEn :
- Aged, Aged, 80 and over, Anti-Inflammatory Agents, Non-Steroidal (adverse effects), Anticoagulants (adverse effects), Aspirin (adverse effects), Controlled Before-After Studies, Cyclooxygenase 2 Inhibitors (adverse effects), Female, Humans, Insurance, Pharmaceutical Services, Male, Peptic Ulcer (chemically induced), Peptic Ulcer (prevention & control), Prospective Studies, Proton Pump Inhibitors (therapeutic use), Warfarin (adverse effects).
MESH :
- chemical , adverse effects : Anti-Inflammatory Agents, Non-Steroidal, Anticoagulants, Aspirin, Cyclooxygenase 2 Inhibitors, Warfarin.
- chemically induced : Peptic Ulcer.
- prevention & control : Peptic Ulcer.
- chemical , therapeutic use : Proton Pump Inhibitors.
- Aged, Aged, 80 and over, Controlled Before-After Studies, Female, Humans, Insurance, Pharmaceutical Services, Male, Prospective Studies.

Abstract

Background/ Objectives

Non-steroidal anti-inflammatory drug (NSAID) use is a major risk factor for peptic ulcer disease (PUD) in older adults; thus, a gastroprotective agent is recommended in high-risk patients. This study of older daily NSAID users examined whether gastroprotective agent underuse decreased over time.

Design

Before-after study.

Setting

Health, Aging and Body Composition study.

Participants

Daily users of an NSAID (prescription and over-the-counter [OTC]) at the 2002–03 (pre-period; n=404) and 2006–07 (post-period; n=172) visits. The sample had a mean (standard deviation [±SD]) age of 78.2 [±2.7] years and 81.9 [±2.7] years at the visits, respectively. The majority were white, women and with ≥12 years of education.

Measurements

Underusers were defined as: (1) persons taking non-selective NSAIDs at risk of PUD (due to current warfarin or glucocorticoid use, or history of PUD) and not using a proton pump inhibitor, or (2) COX-2 selective NSAID users taking aspirin at risk of PUD (i.e., having at least one risk factor) and not using a proton pump inhibitor.

Results

Daily NSAID use decreased from 17.6% to 11.3% (p<0.001), and gastroprotective agent underuse decreased from 23.5% and 15.1% (p=0.008) over time. Controlling for important covariates, having prescription insurance was somewhat protective from underuse in the pre-period (adjusted odds ratio [AOR] 0.78, 95% confidence interval [CI] 0.46–1.34; p=0.37), but more so and significantly in the post-period (AOR 0.41, 95% CI 0.18–0.93; p=0.03). Over time, having prescription insurance was more protective in the post versus pre-period (i.e., less gastroprotective agent underuse; adjusted ratio of OR 0.53, 95% CI 0.22–1.29; p=0.16), but this increased protection was not statistically significant.

Conclusion

Among high-risk older daily NSAID users, having prescription insurance and adequate gastroprotective use was more common in the post than in the pre-period.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4206578

DOI: 10.1111/jgs.13066
PubMed: 25284702
PubMed Central: 4206578

Affiliations:

Links to Exploration step

PMC:4206578

Le document en format XML

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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term>
<term>Aged, 80 and over</term>
<term>Anti-Inflammatory Agents, Non-Steroidal (adverse effects)</term>
<term>Anticoagulants (adverse effects)</term>
<term>Aspirin (adverse effects)</term>
<term>Controlled Before-After Studies</term>
<term>Cyclooxygenase 2 Inhibitors (adverse effects)</term>
<term>Female</term>
<term>Humans</term>
<term>Insurance, Pharmaceutical Services</term>
<term>Male</term>
<term>Peptic Ulcer (chemically induced)</term>
<term>Peptic Ulcer (prevention & control)</term>
<term>Prospective Studies</term>
<term>Proton Pump Inhibitors (therapeutic use)</term>
<term>Warfarin (adverse effects)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Acide acétylsalicylique (effets indésirables)</term>
<term>Anti-inflammatoires non stéroïdiens (effets indésirables)</term>
<term>Anticoagulants (effets indésirables)</term>
<term>Assurance prestations pharmaceutiques</term>
<term>Femelle</term>
<term>Humains</term>
<term>Inhibiteurs de la cyclooxygénase 2 (effets indésirables)</term>
<term>Inhibiteurs de la pompe à protons (usage thérapeutique)</term>
<term>Mâle</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
<term>Ulcère peptique ()</term>
<term>Warfarine (effets indésirables)</term>
<term>Études contrôlées avant-après</term>
<term>Études prospectives</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Anti-Inflammatory Agents, Non-Steroidal</term>
<term>Anticoagulants</term>
<term>Aspirin</term>
<term>Cyclooxygenase 2 Inhibitors</term>
<term>Warfarin</term>
</keywords>
<keywords scheme="MESH" qualifier="chemically induced" xml:lang="en"><term>Peptic Ulcer</term>
</keywords>
<keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Acide acétylsalicylique</term>
<term>Anti-inflammatoires non stéroïdiens</term>
<term>Anticoagulants</term>
<term>Inhibiteurs de la cyclooxygénase 2</term>
<term>Warfarine</term>
</keywords>
<keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Peptic Ulcer</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Proton Pump Inhibitors</term>
</keywords>
<keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Inhibiteurs de la pompe à protons</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Aged</term>
<term>Aged, 80 and over</term>
<term>Controlled Before-After Studies</term>
<term>Female</term>
<term>Humans</term>
<term>Insurance, Pharmaceutical Services</term>
<term>Male</term>
<term>Prospective Studies</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Assurance prestations pharmaceutiques</term>
<term>Femelle</term>
<term>Humains</term>
<term>Mâle</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
<term>Ulcère peptique</term>
<term>Études contrôlées avant-après</term>
<term>Études prospectives</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background/ Objectives</title>
<p id="P1">Non-steroidal anti-inflammatory drug (NSAID) use is a major risk factor for peptic ulcer disease (PUD) in older adults; thus, a gastroprotective agent is recommended in high-risk patients. This study of older daily NSAID users examined whether gastroprotective agent underuse decreased over time.</p>
</sec>
<sec id="S2"><title>Design</title>
<p id="P2">Before-after study.</p>
</sec>
<sec id="S3"><title>Setting</title>
<p id="P3">Health, Aging and Body Composition study.</p>
</sec>
<sec id="S4"><title>Participants</title>
<p id="P4">Daily users of an NSAID (prescription and over-the-counter [OTC]) at the 2002–03 (pre-period; n=404) and 2006–07 (post-period; n=172) visits. The sample had a mean (standard deviation [±SD]) age of 78.2 [±2.7] years and 81.9 [±2.7] years at the visits, respectively. The majority were white, women and with ≥12 years of education.</p>
</sec>
<sec id="S5"><title>Measurements</title>
<p id="P5">Underusers were defined as: (1) persons taking non-selective NSAIDs at risk of PUD (due to current warfarin or glucocorticoid use, or history of PUD) and not using a proton pump inhibitor, or (2) COX-2 selective NSAID users taking aspirin at risk of PUD (i.e., having at least one risk factor) and not using a proton pump inhibitor.</p>
</sec>
<sec id="S6"><title>Results</title>
<p id="P6">Daily NSAID use decreased from 17.6% to 11.3% (p<0.001), and gastroprotective agent underuse decreased from 23.5% and 15.1% (p=0.008) over time. Controlling for important covariates, having prescription insurance was somewhat protective from underuse in the pre-period (adjusted odds ratio [AOR] 0.78, 95% confidence interval [CI] 0.46–1.34; p=0.37), but more so and significantly in the post-period (AOR 0.41, 95% CI 0.18–0.93; p=0.03). Over time, having prescription insurance was more protective in the post versus pre-period (i.e., less gastroprotective agent underuse; adjusted ratio of OR 0.53, 95% CI 0.22–1.29; p=0.16), but this increased protection was not statistically significant.</p>
</sec>
<sec id="S7"><title>Conclusion</title>
<p id="P7">Among high-risk older daily NSAID users, having prescription insurance and adequate gastroprotective use was more common in the post than in the pre-period.</p>
</sec>
</div>
</front>
</TEI>
<affiliations><list><country><li>États-Unis</li>
</country>
<region><li>Californie</li>
<li>Floride</li>
<li>Maryland</li>
<li>Pennsylvanie</li>
</region>
<settlement><li>Pittsburgh</li>
</settlement>
<orgName><li>Université de Pittsburgh</li>
</orgName>
</list>
<tree><country name="États-Unis"><region name="Pennsylvanie"><name sortKey="Marcum, Zachary A" sort="Marcum, Zachary A" uniqKey="Marcum Z" first="Zachary A." last="Marcum">Zachary A. Marcum</name>
</region>
<name sortKey="Bauer, Douglas C" sort="Bauer, Douglas C" uniqKey="Bauer D" first="Douglas C." last="Bauer">Douglas C. Bauer</name>
<name sortKey="Boudreau, Robert" sort="Boudreau, Robert" uniqKey="Boudreau R" first="Robert" last="Boudreau">Robert Boudreau</name>
<name sortKey="Donohue, Julie M" sort="Donohue, Julie M" uniqKey="Donohue J" first="Julie M." last="Donohue">Julie M. Donohue</name>
<name sortKey="Hanlon, Joseph T" sort="Hanlon, Joseph T" uniqKey="Hanlon J" first="Joseph T." last="Hanlon">Joseph T. Hanlon</name>
<name sortKey="Hanlon, Joseph T" sort="Hanlon, Joseph T" uniqKey="Hanlon J" first="Joseph T." last="Hanlon">Joseph T. Hanlon</name>
<name sortKey="Hanlon, Joseph T" sort="Hanlon, Joseph T" uniqKey="Hanlon J" first="Joseph T." last="Hanlon">Joseph T. Hanlon</name>
<name sortKey="Hanlon, Joseph T" sort="Hanlon, Joseph T" uniqKey="Hanlon J" first="Joseph T." last="Hanlon">Joseph T. Hanlon</name>
<name sortKey="Newman, Anne B" sort="Newman, Anne B" uniqKey="Newman A" first="Anne B." last="Newman">Anne B. Newman</name>
<name sortKey="Newman, Anne B" sort="Newman, Anne B" uniqKey="Newman A" first="Anne B." last="Newman">Anne B. Newman</name>
<name sortKey="Perera, Subashan" sort="Perera, Subashan" uniqKey="Perera S" first="Subashan" last="Perera">Subashan Perera</name>
<name sortKey="Perera, Subashan" sort="Perera, Subashan" uniqKey="Perera S" first="Subashan" last="Perera">Subashan Perera</name>
<name sortKey="Shorr, Ronald I" sort="Shorr, Ronald I" uniqKey="Shorr R" first="Ronald I." last="Shorr">Ronald I. Shorr</name>
<name sortKey="Simonsick, Eleanor M" sort="Simonsick, Eleanor M" uniqKey="Simonsick E" first="Eleanor M." last="Simonsick">Eleanor M. Simonsick</name>
<name sortKey="Strotmeyer, Elsa S" sort="Strotmeyer, Elsa S" uniqKey="Strotmeyer E" first="Elsa S." last="Strotmeyer">Elsa S. Strotmeyer</name>
</country>
</tree>
</affiliations>
</record>

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Gastroprotective Agent Underuse in High-Risk Older Daily Non-Steroidal Anti-Inflammatory Drug Users Over Time

Gastroprotective Agent Underuse in High-Risk Older Daily Non-Steroidal Anti-Inflammatory Drug Users Over Time

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