Lifestyle factors among proton pump inhibitor users and nonusers: a cross-sectional study in a population-based setting

Frederik Hvid-Jensen,¹ Rikke B Nielsen,² Lars Pedersen,² Peter Funch-Jensen,³ Asbjørn Mohr Drewes,⁴ Finn B Larsen,⁵ Reimar W Thomsen<sup>2

1</sup>Department of Surgical Gastroenterology L, Aarhus University Hospital, Aarhus, ²Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, ³Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, ⁴Mech-Sense Centre, Department of Gastroenterology, Aarhus University Hospital, Aalborg, ⁵Public Health and Quality Improvement, Central Denmark Region, Denmark

Purpose: Lifestyle factors may influence observed associations between proton pump inhibitor (PPI) usage and health outcomes. The aim of the study reported here was to examine characteristics and differences in lifestyle among PPI users and nonusers.
Methods: This cross-sectional study utilized data from a 2006 population-based health survey of 21,637 persons in the Central Danish Region. All persons using prescribed PPIs were identified through linkage to a population-based prescription database. Biometric measures and prevalence of smoking, excessive alcohol consumption, diet, and physical exercise were analyzed, comparing PPI users with nonusers.
Results: Among 10,129 (46.8%) male and 11,508 (53.2%) female survey respondents, 1,356 (13.4%) males and 1,691 (14.7%) females reported ever use of PPIs. PPI users were more obese (16.7%) than nonusers (13.1%), with an age- and sex-standardized prevalence ratio (PR) of 1.3 (95% confidence interval [CI]: 1.2–1.4). The prevalence of smokers was also higher in the PPI group (26.2% vs 22.3% [PR =1.2, 95% CI: 1.1–1.3]), as was the prevalence of ex-smokers (41.0% vs 32.0% [PR =1.2, 95% CI: 1.1–1.2]). Unhealthy diet was slightly more common among PPI users than among nonusers (15.4% vs 13.0%), with a PR of 1.2 (95% CI: 1.1–1.3). Physical exercise level and alcohol consumption were similar in the two groups. Hospital-diagnosed comorbidity was observed in 35% of PPI users (a Charlson Comorbidity Index score of 1 or more) compared with only 15% among nonusers.
Conclusion: PPI users are more obese, smoke more, and have significantly more comorbidities than PPI nonusers. These data are important when evaluating unmeasured confounding in observational studies of PPI effects.

Keywords: PPI, obesity, smoking, reflux, population-based, gastroesophageal reflux