Cohort studycited by the Tayebat archiveabstract only checked A-PPI-13 standard review
PPIs and death risk (veterans)
Risk of death among users of Proton Pump Inhibitors: a longitudinal observational cohort study of United States veterans.
Overview
Xie Y et al.. BMJ Open 2017 · PMID 28676480 · DOI 10.1136/bmjopen-2016-015735
PPI users had about 15–34% higher hazard of death depending on method.
Does the study support the specific claim? Partly · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
All-cause mortality.
- How was the study done?
Veterans cohort.
- How many people, animals or samples were studied?
349,312.
- What was actually found?
Higher hazard of death.
- How large was the observed effect?
HR 1.16–1.34.
- What do the results mean in everyday life?
Association only.
- What are the study's limitations?
Confounding.
- What does it say about Elawady's specific claim?
Partly supports.
- Do the results apply to Germany and Europe?
Moderate.
- What can explicitly not be concluded from this study?
Causation.
Scientific in-depth review
1. Full reference
- Authors
- Xie Y, Bowe B, Li T, Xian H, Yan Y, Al-Aly Z
- Journal
- BMJ Open
- Year
- 2017
- Identifier
- PMID 28676480 DOI 10.1136/bmjopen-2016-015735 · PMC5642790
- Verification
- verified – PubMed E-utilities efetch, 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Competing interests: None declared.
2. Research question
Is PPI use associated with all-cause mortality?
3. Study design and population
- Study design
- Cohort study – Longitudinal cohort, US Veterans Affairs
- Population
New users of PPI or H2 blockers; plus PPI vs no PPI cohorts
- Country
USA
- Period
median 5.71 years
- Sample size
349,312 primary cohort
- Inclusion and exclusion criteria
see abstract
4. Methods and endpoints
- Exposure / intervention
PPI use
- Comparator
H2-blocker use; no PPI
- Endpoints
Death
- Statistical methods
Cox models, hdPS, 2SRI, PS matching
5. Actual results
- Results
PPI vs H2 HR 1.25 (1.23–1.28); hdPS 1.16; 2SRI 1.21; PS-matched 1.34; PPI vs no PPI 1.15; without GI conditions HR 1.24.
- Absolute risks
not reported in abstract
- Authors' conclusion
Results suggest excess risk of death among PPI users; limit use to medical indication.
6. Strengths
- Large
- Multiple analytic methods
7. Weaknesses
- Observational
- Same database as A-PPI-12 (not independent)
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Overlaps with A-PPI-12; residual confounding.
9. Assessment of the statistical interpretation
Modest relative risks from observational data; see bias notes.
10. Relevance to the specific claim
11. Independent contrary findings
Brown 2021 (I-PPI-02); COMPASS (I-PPI-01).
12. Transferability to Germany and Europe
High: European (Swedish, UK, Dutch, German) data show similar associations; PPIs are widely used in Germany.
13. Overall methodological judgement
Association; not independent of A-PPI-12.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | high |
| Directness | direct |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | mixed |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | essentially correct but incomplete |
14. Open questions
15. Linked fact checks
Use by the Tayebat archive
Note: according to the archive, the studies were compiled by the archive operators. Whether Dr. Elawady himself cited this study is not established.
- What the archive says about the study
Listed in the archive bibliography of the acid-blockers rule without its own interpretation; used implicitly to support the rule summary ('long-term suppression turns against the body: CKD, bacterial overgrowth, C. difficile, pneumonia, B12 and magnesium deficiency, hip fractures, microbiome change, excess mortality').
- A. What was actually studied?
Is PPI use associated with all-cause mortality?
- B. What did the authors find?
PPI vs H2 HR 1.25 (1.23–1.28); hdPS 1.16; 2SRI 1.21; PS-matched 1.34; PPI vs no PPI 1.15; without GI conditions HR 1.24.
- C. What conclusions do the authors themselves draw?
Results suggest excess risk of death among PPI users; limit use to medical indication.
- D. What does the archive derive from it?
Supports excess mortality.
- E. Is this derivation scientifically justified?
As association.
- Adequacy of the interpretation (by the archive)
- essentially correct but incomplete