S3292 Increased Admissions From Side Effects Reported With Therapeutic Use of Acid Suppression Medications: A Nationwide Inpatient Database Analysis of the Last Two Decades

Abstract

INTRODUCTION: Increased awareness has been placed on potential side effects of Proton pump inhibitors (PPIs) and its safety profile due to publication bias towards retrospective studies showing potential associations. The International Classification of Diseases (ICD) coding of drug adverse effects yields valuable evidence. We aimed to quantify and analyze the trends in documentation of the admissions related to acid suppression medication adverse effects. METHODS: We utilized the National Inpatient Sample Database to analyze longitudinal trends related to all hospitalizations due to acid suppression medication causing adverse effects in therapeutic use (ICD-9 E943.0) between 1993 and 2014 in the US. Similar query was also made for antidiarrheal agents (ICD-9 E943.5) and laxatives (ICD-9 E943.2, E943.3). Trends in admission, discharge rates and payor were analyzed. RESULTS: The total number of reported admissions related to adverse effects of acid suppression medications nationwide were 1,009 with a discharge rate of 0.4 per 100,000 in 1993, which declined to 696 annual admissions and a discharge rate of 0.2 per 100,000 by 2003. An increase was observed until 2014, with 2,640 admissions and 0.8 discharge rate in 2014 (Figure 1). The number of admissions/years increased by 279% from 1993 to 2014. For admitted patients, average age was 65-84 years old, and 57.39% were females (Figure 2). Most of the discharges were covered under Medicare (52.3%), followed by private insurance (30.1%). In the year 2014, secondary diagnosis coded along with PPI adverse effects were chronic kidney disease, urinary tract infection, and fracture of unspecified bone. CONCLUSION: Our findings show that the number of admissions reported due to acid suppression medication adverse effects in the US has increased over the past two decades. This increase became prominent starting in the early 2000s, which coincides with the wider implementation of electronic medical records in the US. However similar trend was not observed in documentation of side-effects of anti-diarrheal agents and laxatives suggesting that the coding of adverse effects related to acid suppression medications might have been driven by publication bias of multiple studies showing associations of potential side effects related to these medications. Given recent updates with prospective studies showing well tolerance of these medications, outside of slightly increased risk of enteric infection, the accuracy of these codes should be evaluated.Figure 1.: Rate of Admission for Adverse Effects in Therapeutic Use.Figure 2.: Age Group Distribution of Admissions due to Adverse Effects of Acid Suppression Medication in Therapeutic Use in 2014.