(70) Temporal Trends and Correlates of Early Life Exposure to Acid-Suppressant Therapy

Publication Number: 401

Background: Studies have shown no efficacy for acid-suppressants therapy (AST) in infants suspected with gastro-esophageal reflux disease and potential safety concerns including fractures, infections, and allergies. However, acid-suppressants usage in children has increased in the United States, United Kingdom, Belgium, New Zealand, Ireland and France.

Objectives: To examine temporal trends in acid-suppressants initiation within the first year of life in a large unselected cohort and to detect socio-demographic and medical characterizations associated with treatment initiation.

Methods: A retrospective population-based cohort in a large state-mandated health fund in Israel, including all members born between 2005-2020. AST initiation was defined as at least one purchase of H2 receptor antagonists or proton pump inhibitors within the first year of life. The association between AST initiation and socio-demographic and medical characteristics was assessed via multivariable logistic regression including calendar year, birth order, multiple vs. singleton birth, gestational age at birth, infant weight and sex.

Results: Among 595,860 children born during the study period, 22,412 (37.6 per 1,000) initiated AST. The incidence rate of AST initiation increased by 2.8 fold from 18.2 per 1,000 in the year 2005 to 51.0 per 1,000 in 2020, while the median age at initiation decreased steadily over time from a median of 3.0 (IQR: 1.6-5.0) to 2.4 (IQR: 1.5-3.8) months. Preterm birth was strongly (p < 0.001) associated with AST usage with OR of 4.23, 3.05 and 1.65 for extreme, early and moderate preterm vs. term birth, respectively. Birth order was negatively associated with AST initiation, with third and fourth born onwards less likely to initiate treatment vs. firstborns (OR of 0.62, 95% CI: 0.59-0.65 and 0.57, 95% CI: 0.54-0.60, respectively). High socioeconomic status was associated with increased usage rates, with OR=1.12 per 1-point increase on a socioeconomic scale ranging between 1-10.

Conclusions: Our analysis indicates a substantial temporal trend of increase in early life exposure to AST. Birth order and preterm birth are the strongest correlates for AST use after controlling for the temporal trend. The impact of this change in treatment patterns on children’s health should be explored in future studies.