Abstract：
OBJECTIVE: To estimate the strength of association between exposure to selected classes of prescribed medications and the risk of developing iron deficiency anaemia (IDA), specifically considering oral anticoagulants (OACs), antidepressants, antiplatelet agents, proton pump inhibitors (PPIs) and non-steroidal anti-inflammatories.
METHODS: A case-control study involving the analysis of community repeat prescriptions among subjects referred with IDA, and unmatched controls referred as gastroenterology fast-tracks for other indications. Multivariable logistic regression modelling was used to calculate ORs for the association between IDA presentation and each medication class, adjusted for age, sex and coprescribing. For those classes showing significance, it was also used to calculate risk differences between those in the IDA group with or without haemorrhagic lesions on investigation.
RESULTS: A total of 1210 cases were analysed-409 in the IDA group, and 801 in the control group. Significant associations were identified between presentation with IDA and long-term exposure to PPIs (OR 3.29, 95% CI: 2.47 to 4.41, p<0.001) and to OACs (OR 2.04, 95% CI: 1.29 to 3.24, p=0.002). IDA was not associated with long-term exposure to any of the other three drug classes. In contrast to the relationship with PPIs, the association with OACs was primarily in the IDA sub-group with haemorrhagic lesions.
CONCLUSIONS: Long-term exposure to PPIs and OACs are independently associated with the risk of developing IDA. There are grounds for considering that these associations may be causal, though the underlying mechanisms probably differ.
METHODS: A case-control study involving the analysis of community repeat prescriptions among subjects referred with IDA, and unmatched controls referred as gastroenterology fast-tracks for other indications. Multivariable logistic regression modelling was used to calculate ORs for the association between IDA presentation and each medication class, adjusted for age, sex and coprescribing. For those classes showing significance, it was also used to calculate risk differences between those in the IDA group with or without haemorrhagic lesions on investigation.
RESULTS: A total of 1210 cases were analysed-409 in the IDA group, and 801 in the control group. Significant associations were identified between presentation with IDA and long-term exposure to PPIs (OR 3.29, 95% CI: 2.47 to 4.41, p<0.001) and to OACs (OR 2.04, 95% CI: 1.29 to 3.24, p=0.002). IDA was not associated with long-term exposure to any of the other three drug classes. In contrast to the relationship with PPIs, the association with OACs was primarily in the IDA sub-group with haemorrhagic lesions.
CONCLUSIONS: Long-term exposure to PPIs and OACs are independently associated with the risk of developing IDA. There are grounds for considering that these associations may be causal, though the underlying mechanisms probably differ.
摘要：
目的：评估暴露于选定类别的处方药与发生缺铁性贫血（IDA）的风险之间的关联强度，特别考虑口服抗凝剂（OAC），抗抑郁药,抗血小板药,质子泵抑制剂（PPI）和非甾体抗炎药。
方法：一项病例对照研究，涉及IDA患者中社区重复处方的分析，和无与伦比的对照被称为胃肠病学其他适应症的快速通道。使用多变量逻辑回归模型来计算IDA表现与每个药物类别之间的关联的OR。根据年龄调整，性和共同处方。对于那些显示意义的课程，它还用于计算IDA组中有或没有出血病变的风险差异.
结果：IDA组总共分析了1210例病例-409例，对照组为801。发现IDA表现与长期暴露于PPI（OR3.29，95％CI：2.47至4.41，p<0.001）和OAC（OR2.04，95％CI：1.29至3.24，p=0.002）之间存在显着关联。IDA与长期暴露于其他三种药物中的任何一种无关。与PPI的关系相反，与OAC的关联主要发生在有出血性病变的IDA亚组.
结论：长期暴露于PPI和OAC与发生IDA的风险独立相关。有理由认为这些关联可能是因果关系，尽管潜在的机制可能有所不同。
方法：一项病例对照研究，涉及IDA患者中社区重复处方的分析，和无与伦比的对照被称为胃肠病学其他适应症的快速通道。使用多变量逻辑回归模型来计算IDA表现与每个药物类别之间的关联的OR。根据年龄调整，性和共同处方。对于那些显示意义的课程，它还用于计算IDA组中有或没有出血病变的风险差异.
结果：IDA组总共分析了1210例病例-409例，对照组为801。发现IDA表现与长期暴露于PPI（OR3.29，95％CI：2.47至4.41，p<0.001）和OAC（OR2.04，95％CI：1.29至3.24，p=0.002）之间存在显着关联。IDA与长期暴露于其他三种药物中的任何一种无关。与PPI的关系相反，与OAC的关联主要发生在有出血性病变的IDA亚组.
结论：长期暴露于PPI和OAC与发生IDA的风险独立相关。有理由认为这些关联可能是因果关系，尽管潜在的机制可能有所不同。
