Observational studyBMJ open2017
Risk of death among users of Proton Pump Inhibitors: a longitudinal observational cohort study of United States veterans.
Observational study in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 103 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
103 citing papers in PubMed, 8 syntheses or guidelines pooled it.
- Pooled it
- Proton pump inhibitors associated with an increased risk of mortality in elderly: a systematic review and meta-analysis.European journal of clinical pharmacology · 2024Pooled it
- Acid-suppressive agents and survival outcomes in patients with cancer: a systematic review and meta-analysis.International journal of clinical oncology · 2021Pooled it
- Effect of famotidine on hospitalized patients with COVID-19: A systematic review and meta-analysis.PloS one · 2021Pooled it
- Do proton pump inhibitors increase mortality? A systematic review and in-depth analysis of the evidence.Pharmacology research & perspectives · 2020Pooled it
- Proton pump inhibitors and risk of liver cancer and mortality in patients with chronic liver disease: a systematic review and meta-analysis.European journal of clinical pharmacology · 2020Pooled it
- Pooled it
- Associations of Proton-Pump Inhibitors and H2 Receptor Antagonists with Chronic Kidney Disease: A Meta-Analysis.Digestive diseases and sciences · 2017Pooled it
- The Mortality Risk of Proton Pump Inhibitors in 1.9 Million US Seniors: An Extended Cox Survival Analysis.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2022Trial
- Lansoprazole for persistent throat symptoms in secondary care: the TOPPITS RCT.Health technology assessment (Winchester, England) · 2021Trial
- Proton pump inhibitor use after kidney transplantation and graft outcomes: A matched national cohort study.Medicine · 2026Article
- Evolving landscape of potassium-competitive acid blockers: toward disease-specific use beyond acid suppression.Journal of gastroenterology · 2026Review
- Glucagon-like peptide-1 receptor agonists and risk of substance use disorders among US veterans with type 2 diabetes: cohort study.BMJ (Clinical research ed.) · 2026Article
- Association of Proton Pump Inhibitor Use with Cancer in Patients Undergoing Maintenance Hemodialysis: A Population-Based Cohort Study.Journal of clinical medicine · 2026Article
- Hypomagnesemia Associated with Omeprazole Use in Patients Treated with Platinum Derivatives: An Exploratory Randomized Placebo-Controlled Clinical Trial.The Canadian journal of hospital pharmacy · 2026Article
- Systematic analysis of proton pump inhibitors-related adverse reactions using the FDA adverse event reporting system database.PloS one · 2026Article
- Proton pump inhibitor use and cardiovascular risk, all-cause, and cardiovascular mortality across baseline eGFR categories: a longitudinal study.Renal failure · 2025Article
- Longitudinal trajectories unravel the complex interplay of medication, cardiovascular events, chronic kidney disease, and mortality.Scientific reports · 2025Article
- Review
- Knowledge, Attitudes, and Practices of Community Pharmacists Regarding Proton Pump Inhibitor (PPI) Use: A Cross-Sectional Study.Healthcare (Basel, Switzerland) · 2025Article
43 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveProton pump inhibitors (PPIs) are widely used, and their use is associated with increased risk of adverse events. However, whether PPI use is associated with excess risk of death is unknown. We aimed to examine the association between PPI use and risk of all-cause mortality.
designLongitudinal observational cohort study.
settingUS Department of Veterans Affairs.
participantsPrimary cohort of new users of PPI or histamine H2 receptor antagonists (H2 blockers) (n=349 312); additional cohorts included PPI versus no PPI (n=3 288 092) and PPI versus no PPI and no H2 blockers (n=2 887 030).
main outcome measuresRisk of death.
resultsOver a median follow-up of 5.71 years (IQR 5.11-6.37), PPI use was associated with increased risk of death compared with H2 blockers use (HR 1.25, CI 1.23 to 1.28). Risk of death associated with PPI use was higher in analyses adjusted for high-dimensional propensity score (HR 1.16, CI 1.13 to 1.18), in two-stage residual inclusion estimation (HR 1.21, CI 1.16 to 1.26) and in 1:1 time-dependent propensity score-matched cohort (HR 1.34, CI 1.29 to 1.39). The risk of death was increased when considering PPI use versus no PPI (HR 1.15, CI 1.14 to 1.15), and PPI use versus no PPI and no H2 blockers (HR 1.23, CI 1.22 to 1.24). Risk of death associated with PPI use was increased among participants without gastrointestinal conditions: PPI versus H2 blockers (HR 1.24, CI 1.21 to 1.27), PPI use versus no PPI (HR 1.19, CI 1.18 to 1.20) and PPI use versus no PPI and no H2 blockers (HR 1.22, CI 1.21 to 1.23). Among new PPI users, there was a graded association between the duration of exposure and the risk of death.
conclusionsThe results suggest excess risk of death among PPI users; risk is also increased among those without gastrointestinal conditions and with prolonged duration of use. Limiting PPI use and duration to instances where it is medically indicated may be warranted.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.