Research Letters

E vidence is accumulating in relation to adverse events associated with proton pump inhibitors (PPIs).Reports in the Archives have demonstrated an association with fractures, 1 Clostridium difficile infections, 2 and community-acquired pneumonia.3 Proton pump inhibitors may also attenuate the antiplatelet benefits of clopidogrel.4 Because frail older people often use PPIs and may be especially vulnerable, we investigated the association between PPIs and all-cause mortality in 2 cohorts of institutionalized people. Methods.We conducted post hoc analyses of data from 2 prospective cohort studies in Helsinki, Finland, that included (1) 1004 residents from 53 long-term care wards in September 2003 5 and (2) 425 residents 70 years or older in acute geriatric wards (n = 230) and in nursing homes (n=195) in 1999-2000.6 Data were extracted by trained nurses and geriatricians ( J.V.L. and K.H.P.).Only regular medication was included in the analyses.Mortality was extracted from national registers.Statistical analyses were performed using NCSS 2004 software (NCSS, Kaysville, Utah). 2 Tests and Cox proportional hazards models (hazard ratios [HRs] and 95% confidence intervals [CIs]) were used to investigate the association between PPIs and mortality.