Acid Suppressing Medication Use in Infants in the United States, 2002-2018

Introduction: I attempted to determine rates of use and associations with use of acid-suppressing medications in infants under 2 years old given these are not well studied. Methods: The 2002-2018 Medical Expenditure Panel Survey (MEPS) was used for the analysis. The survey is sponsored by the Agency of Healthcare Research and Quality and is conducted on households to be nationally representative of the non-institutionalized population of the United States. The survey is comprised of two overlapping panels that are each included in the survey for two years. Newborns and infants under 2 years old on December 31 of a survey year were included in the study. Additionally, adult men and women living in the same household between 18-45 years old were considered fathers and mothers of infants. Histamine2-receptor antagonists (H2RA) and proton pump inhibitors (PPI) were identified for infants. H2RA, PPIs, and anti-depressant (selective serotonin re-uptake inhibitors and serotonin-norepinephrine re-uptake inhibitors) were identified for parents. Sex, age (by month for child), race/ethnicity (White non-Hispanic, Black non-Hispanic, Hispanic, or other), region (Northeast, Midwest, South, and West), and poverty category were identified. Chi-squared and adjusted Wald tests were used to determine statistical significance with acid-suppressing medication use between 2010-2018. A multivariable logistic regression predicted any acid suppressing medication use with month of age and month of age2 as independent variables of use for the population between 2009-2018. The study was considered exempt by the OhioHealth Institutional Review Board. Survey weighting was included in all analyses. Results: The study included a total of 16,604 infants between 2002-2018. The rate of any acid suppressing medication increased between 2002-2004. H2RA use was more common than PPI use, especially after 2012. H2RA use appeared to increase after 2015. PPI use initially increased, but then remained relatively stable before appearing to decrease in 2015-2018. Ranitidine clearly had the most users of the H2RA, which was maintained throughout the study period. Lansoprazole had the most users among users of PPIs, but this decreased notably after 2010. Of the infants with a reported PPI, 34.0% (95%CI:23.6-46.3) also had an H2RA reported during the year. In total, 40.8% (95%CI:35.0-46.8) had only 1 reported fill of an acid suppresser. There were 8,075 infants under 2 years of age between 2010-2018. The rate of use was highest in infants between 4-11 months of age at the end of the survey year at 8.6% (95%CI:6.9-10.6). Acid-suppressing medication use was more common among infants in higher income families, White (non-Hispanic) race/ethnicity, infants with private health insurance, parents who reported acid-suppressing medication, maternal anti-depressant use, and certain regions of the country. Discussion: Between 6.9-10.6% of infants used an acid suppressing medication before their second birthday between 2010-2018, of which around 60% had multiple medication fills. It appears that there has been a small increases in use over the last few decades, of which ranitidine appears to be the medication driving the increase. Numerous socio-economic and demographic characteristics were associated with acid suppressing medication use. This study has numerous limitations, including potential under-reporting of acid-suppressing medications, an imperfect identification of parent, unreliable diagnoses (not included in the analysis), and a relatively small sample size. We opted not to run a multivariable logistic regression of socio-economic and demographic characteristics given concern for table 2 fallacy and relatively small sample size. Acid suppressing medication use was common in infants before their second birthday. Additional research should be conducted on efficacy and safety of these medications given the level of use and very low quality of available evidence.