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Sci Rep ; 11(1): 20987, 2021 10 25.
Article in English | MEDLINE | ID: covidwho-1483149


Acid suppressants are widely-used classes of medications linked to increased risks of aerodigestive infections. Prior studies of these medications as potentially reversible risk factors for COVID-19 have been conflicting. We aimed to determine the impact of chronic acid suppression use on COVID-19 infection risk while simultaneously evaluating the influence of social determinants of health to validate known and discover novel risk factors. We assessed the association of chronic acid suppression with incident COVID-19 in a 1:1 case-control study of 900 patients tested across three academic medical centers in California, USA. Medical comorbidities and history of chronic acid suppression use were manually extracted from health records by physicians following a pre-specified protocol. Socio-behavioral factors by geomapping publicly-available data to patient zip codes were incorporated. We identified no evidence to support an association between chronic acid suppression and COVID-19 (adjusted odds ratio 1.04, 95% CI 0.92-1.17, P = 0.515). However, several medical and social features were positive (Latinx ethnicity, BMI ≥ 30, dementia, public transportation use, month of the pandemic) and negative (female sex, concurrent solid tumor, alcohol use disorder) predictors of new infection. These findings demonstrate the value of integrating publicly-available databases with medical data to identify critical features of communicable diseases.

COVID-19/epidemiology , COVID-19/therapy , Gastroesophageal Reflux/complications , Social Determinants of Health , Aged , Behavior , COVID-19/psychology , California , Case-Control Studies , Computational Biology/methods , Databases, Factual , Female , Gastroenterology , Gastroesophageal Reflux/drug therapy , Geography , Histamine H2 Antagonists/pharmacology , Humans , Incidence , Male , Middle Aged , Odds Ratio , Proton Pump Inhibitors/pharmacology , Risk Factors , Social Class
Am J Gastroenterol ; 115(10): 1707-1715, 2020 10.
Article in English | MEDLINE | ID: covidwho-732653


INTRODUCTION: Proton pump inhibitors (PPIs) increase the risk for enteric infections that is likely related to PPI-induced hypochlorhydria. Although the impact of acid suppression on severe acute respiratory syndrome coronavirus 2 is unknown thus far, previous data revealed that pH ≤3 impairs the infectivity of the similar severe acute respiratory syndrome coronavirus 1. Thus, we aimed to determine whether use of PPIs increases the odds for acquiring coronavirus disease 2019 (COVID-19) among community-dwelling Americans. METHODS: From May 3 to June 24, 2020, we performed an online survey described to participating adults as a "national health survey." A multivariable logistic regression was performed on reporting a positive COVID-19 test to adjust for a wide range of confounding factors and to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS: Of 53,130 participants, 3,386 (6.4%) reported a positive COVID-19 test. In regression analysis, individuals using PPIs up to once daily (aOR 2.15; 95% CI, 1.90-2.44) or twice daily (aOR 3.67; 95% CI, 2.93-4.60) had significantly increased odds for reporting a positive COVID-19 test when compared with those not taking PPIs. Individuals taking histamine-2 receptor antagonists were not at elevated risk. DISCUSSION: We found evidence of an independent, dose-response relationship between the use of antisecretory medications and COVID-19 positivity; individuals taking PPIs twice daily have higher odds for reporting a positive test when compared with those using lower-dose PPIs up to once daily, and those taking the less potent histamine-2 receptor antagonists are not at increased risk. These findings emphasize good clinical practice that PPIs should only be used when indicated at the lowest effective dose, such as the approved once-daily label dosage of over-the-counter and prescription PPIs. Further studies examining the association between PPIs and COVID-19 are needed.

Betacoronavirus/pathogenicity , Coronavirus Infections/epidemiology , Gastric Acid/metabolism , Health Surveys/statistics & numerical data , Pneumonia, Viral/epidemiology , Proton Pump Inhibitors/adverse effects , Adolescent , Adult , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/statistics & numerical data , Confounding Factors, Epidemiologic , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/virology , Drug Prescriptions/statistics & numerical data , Female , Gastric Mucosa/drug effects , Gastric Mucosa/metabolism , Gastroesophageal Reflux/drug therapy , Gastrointestinal Microbiome/drug effects , Gastrointestinal Microbiome/physiology , Heartburn/drug therapy , Humans , Hydrogen-Ion Concentration/drug effects , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pneumonia, Viral/virology , SARS-CoV-2 , Young Adult