Increased Statin Prescribing Does Not Lower Pneumonia Risk

Linnea A. Polgreen; Elizabeth A. Cook; John M. Brooks; Yuexin Tang; Philip M. Polgreen

doi:10.1093/cid/civ190

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Increased Statin Prescribing Does Not Lower Pneumonia Risk

Journal article

Open access

Peer reviewed

Increased Statin Prescribing Does Not Lower Pneumonia Risk

Linnea A. Polgreen, Elizabeth A. Cook, John M. Brooks, Yuexin Tang and Philip M. Polgreen

Clinical infectious diseases, Vol.60(12), pp.1760-1766

06/15/2015

DOI: 10.1093/cid/civ190

PMID: 25759433

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Abstract

Background. Investigators have attributed protective effects of statins against pneumonia and other infections. However, these reports are based on observational data where treatments are not assigned randomly. We aimed to determine if the protective effects of statins against pneumonia are due to nonrandom treatment assignment. Methods. We built a cohort consisting of 124 695 Medicare beneficiaries diagnosed with an acute myocardial infarction (AMI) for which we had complete claims data. We considered patients who survived at least 30 days post-AMI (full sample), or who survived for 1 year post-AMI (survivors). First, we used ordinary least squares (OLS) and logit models to determine if receiving a statin was protective against pneumonia. Second, to control for nonrandom treatment assignment, we performed an instrumental variables analysis using geographic treatment rates as an instrument. All models included patient demographics, medications, diagnoses, length of hospital stay, and out-of-pocket drug costs as covariates. Our outcome measure was a pneumonia diagnosis during the 1 year following AMI. Results. A total of 76 994 patients (61.9%) filled a statin prescription, and 19 078 (15.3%) were diagnosed with pneumonia. Using OLS, the statin coefficient was -0.016 (P < .001), indicating that statins are associated with a reduction in pneumonia. Using instrumental variables, we find that statin prescriptions are not associated with a reduction in pneumonia. For the full sample, statin coefficients ranged from -0.001 to -0.01 (P > .6). Conclusions. For patients with AMI, the protective effect of statins against pneumonia is most likely the result of nonrandom treatment assignment (ie, a healthy-user bias).

Immunology

Infectious Diseases

Life Sciences & Biomedicine

Microbiology

Science & Technology

Details

Title: Subtitle: Increased Statin Prescribing Does Not Lower Pneumonia Risk
Creators: Linnea A. Polgreen - Department of Pharmacy Practice and Science
Elizabeth A. Cook - University of Iowa
John M. Brooks - University of South Carolina
Yuexin Tang - Department of Pharmacy Practice and Science
Philip M. Polgreen - University of Iowa
Resource Type: Journal article
Publication Details: Clinical infectious diseases, Vol.60(12), pp.1760-1766
DOI: 10.1093/cid/civ190
PMID: 25759433
NLM abbreviation: Clin Infect Dis
ISSN: 1058-4838
eISSN: 1537-6591
Publisher: Oxford Univ Press
Number of pages: 7
Grant note: R21HS019574 / AGENCY FOR HEALTHCARE RESEARCH AND QUALITY; United States Department of Health & Human Services; Agency for Healthcare Research & Quality R01 HSO18381-01A1 / Agency for Healthcare Research and Quality; United States Department of Health & Human Services; Agency for Healthcare Research & Quality
Language: English
Date published: 06/15/2015
Academic Unit: Infectious Diseases; Epidemiology; Economics; Pharmacy Practice and Science; Injury Prevention Research Center; Internal Medicine
Record Identifier: 9984360044002771

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