Associations between Community-Acquired Pneumonia and Proton Pump Inhibitors in the Laryngeal/Voice-Disordered Population

Seth M. Cohen, Hui Jie Lee, David A. Leiman, Nelson Roy, Stephanie Misono

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Objectives: To examine the relationship between community-acquired pneumonia (CAP) and proton pump inhibitor (PPI) treatment among patients with laryngeal/voice disorders. Study Design: Retrospective cohort analysis. Setting: Large national administrative US claims database. Subjects and Methods: Patients were included if they were ≥18 years old; had outpatient treatment for a laryngeal/voice disorder from January 1, 2010, to December 31, 2014 (per International Classification of Diseases, Ninth Revision, Clinical Modification codes); had 12 months of continuous enrollment prior to the index date (ie, first diagnosis of laryngeal/voice disorder); had no preindex diagnosis of CAP; and had prescription claims captured from 1 year preindex to end of follow-up. Patient demographics, comorbid conditions, index laryngeal diagnosis, number of unique preindex patient encounters, and CAP diagnoses during the postindex 3 years were collected. Two models—a time-dependent Cox regression model and a propensity score–based approach with a marginal structural model—were separately performed for patients with and without pre–index date PPI prescriptions. Results: A total of 392,355 unique patients met inclusion criteria; 188,128 (47.9%) had a PPI prescription. The 3-year absolute risk for CAP was 4.0% and 5.3% among patients without and with preindex PPI use, respectively. For patients without and with pre–index date PPI use, the CAP occurrence for a person who had already received a PPI is 30% to 50% higher, respectively, than for a person who had not yet had a PPI but may receive one later. Conclusions: Patients without and with pre–index date PPI use experienced a roughly 30% to 50% increased likelihood of CAP, respectively, as compared with patients who had not had PPI prescriptions.

Original languageEnglish (US)
Pages (from-to)519-525
Number of pages7
JournalOtolaryngology - Head and Neck Surgery (United States)
Issue number3
StatePublished - Mar 1 2019

Bibliographical note

Funding Information:
Competing interests: Stephanie Misono, National Institutes of Health (NIH) research grant K23DC016335.

Funding Information:
Sponsorships: None. Funding source: This study was funded by the American Academy of Otolaryngology—Head and Neck Surgery. This study was made possible by grant UL1TR001117 from the National Center for Advancing Translational Sciences, a component of the NIH and the NIH Roadmap for Medical Research, as well as NIH grants ULI RR033183 and KL2 RR0333182. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the National Center for Advancing Translational Sciences or the NIH.

Publisher Copyright:
© American Academy of Otolaryngology–Head and Neck Surgery Foundation 2018.


  • adverse event
  • dysphonia
  • laryngeal disorders
  • larynx
  • pneumonia
  • proton pump inhibitor
  • voice
  • voice disorders


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