{"title":"Exception reporting reforms protect us from being treated as expendable volunteers.","authors":"Haseena Wazir","doi":"10.1136/bmj.s118","DOIUrl":"https://doi.org/10.1136/bmj.s118","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"2 1","pages":"s118"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Lucy Letby: Former nurse to face no further charges.","authors":"Clare Dyer","doi":"10.1136/bmj.s132","DOIUrl":"https://doi.org/10.1136/bmj.s132","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"101 1","pages":"s132"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVETo test the hypothesis that women assigned to a natural ovulation regimen before frozen embryo transfer compared with a programmed regimen would have an increased chance of a healthy live birth and a reduced risk of pre-eclampsia or eclampsia.DESIGNMulticentre, randomised, parallel group, assessor blinded clinical trial.SETTING24 academic fertility centres in China.PARTICIPANTS4376 ovulatory women (aged 20-40 years) planning to undergo a frozen single blastocyst transfer.INTERVENTIONSEligible participants were randomised (1:1) to receive a natural ovulation regimen or a programmed regimen of hormone replacement for endometrial preparation. Endometrial preparation and frozen embryo transfer timing were determined in the natural ovulation regimen group by monitoring natural follicle development and measuring serum levels of luteinising hormone, oestradiol, and progesterone. In the programmed regimen group, endometrial preparation was achieved by sequential administration of oestrogen and progesterone.MAIN OUTCOMES AND MEASURESPrimary outcomes were a healthy live birth and pre-eclampsia or eclampsia after a frozen embryo transfer. Secondary outcomes were cycle cancellation, biochemical pregnancy, clinical pregnancy, ongoing pregnancy, pregnancy loss, ectopic pregnancy, live birth, birth weight, and maternal, fetal, and neonatal complications.RESULTSIn the intention-to-treat analyses, 910 (41.6%) of 2185 patients in the natural ovulation regimen group and 890 (40.6%) of 2191 in the programmed regimen group achieved a healthy live birth (relative ratio 1.03 (95% confidence interval (CI) 0.96 to 1.10); P=0.49). The risk of pre-eclampsia was lower in the natural ovulation regimen group among patients who achieved clinical pregnancy than in the programmed regimen group (2.9% (38 of 1302) v 4.6% (61 of 1326); 0.63 (0.43 to 0.94); P=0.02). The incidences of early pregnancy loss (12.1% (158 of 1302) v 15.2% (201 of 1326); 0.80 (0.66 to 0.97)), placental accreta spectrum (1.8% (24 of 1302) v 3.6% (48 of 1326); 0.51 (0.31 to 0.83)), caesarean section (69.5% (776 of 1117) v 75.6% (831 of 1100); 0.92 (0.87 to 0.97)), and postpartum haemorrhage (2.0% (22 of 1117) v 6.1% (67 of 1100); 0.32 (0.20 to 0.52)) were lower in the natural ovulation regimen group. No differences between groups were observed for birth weight or neonatal complications. The rate of cycle cancellation was higher in the natural ovulation regimen (16.2% (354 of 2185) v 11.5% (251 of 2191), P<0.001). The prespecified per protocol and subgroup analyses yielded results consistent with the intention-to-treat analyses.CONCLUSIONSIn ovulatory women, a natural ovulation regimen for endometrial preparation was as effective as programmed regimen in terms of achieving a healthy live birth after frozen embryo transfer, but with a lower risk of maternal complications during pregnancy.TRIAL REGISTRATIONChinese Clinical Trial Registry ChiCTR2200057990.
{"title":"Natural ovulation versus programmed regimens before frozen embryo transfer in ovulatory women: multicentre, randomised clinical trial.","authors":"Daimin Wei,Yingying Qin,Yun Sun,Junhao Yan,Han Zhao,Yichun Guan,Jichun Tan,Ting Guo,Ze Wang,Fei Gong,Cuifang Hao,Xiang Ma,Cuilian Zhang,Aijun Zhang,Ling Geng,Mei Sun,Xiufang Li,Xiufeng Ling,Qun Lu,Hongchu Bao,Lan Chao,Wei Huang,Qinghua Shi,Junli Zhao,Yao Lu,Sheling Wu,Shunji Zhang,Jing Wang,Meiling Guo,Xiaoxi Sun,Yanlin Ma,Qiongfang Wu,Yanping Li,Xianghong Ou,Zhou Fang,Jiao Chen,Guimin Hao,Heping Zhang,Richard S Legro,Zi-Jiang Chen, ","doi":"10.1136/bmj-2025-087045","DOIUrl":"https://doi.org/10.1136/bmj-2025-087045","url":null,"abstract":"OBJECTIVETo test the hypothesis that women assigned to a natural ovulation regimen before frozen embryo transfer compared with a programmed regimen would have an increased chance of a healthy live birth and a reduced risk of pre-eclampsia or eclampsia.DESIGNMulticentre, randomised, parallel group, assessor blinded clinical trial.SETTING24 academic fertility centres in China.PARTICIPANTS4376 ovulatory women (aged 20-40 years) planning to undergo a frozen single blastocyst transfer.INTERVENTIONSEligible participants were randomised (1:1) to receive a natural ovulation regimen or a programmed regimen of hormone replacement for endometrial preparation. Endometrial preparation and frozen embryo transfer timing were determined in the natural ovulation regimen group by monitoring natural follicle development and measuring serum levels of luteinising hormone, oestradiol, and progesterone. In the programmed regimen group, endometrial preparation was achieved by sequential administration of oestrogen and progesterone.MAIN OUTCOMES AND MEASURESPrimary outcomes were a healthy live birth and pre-eclampsia or eclampsia after a frozen embryo transfer. Secondary outcomes were cycle cancellation, biochemical pregnancy, clinical pregnancy, ongoing pregnancy, pregnancy loss, ectopic pregnancy, live birth, birth weight, and maternal, fetal, and neonatal complications.RESULTSIn the intention-to-treat analyses, 910 (41.6%) of 2185 patients in the natural ovulation regimen group and 890 (40.6%) of 2191 in the programmed regimen group achieved a healthy live birth (relative ratio 1.03 (95% confidence interval (CI) 0.96 to 1.10); P=0.49). The risk of pre-eclampsia was lower in the natural ovulation regimen group among patients who achieved clinical pregnancy than in the programmed regimen group (2.9% (38 of 1302) v 4.6% (61 of 1326); 0.63 (0.43 to 0.94); P=0.02). The incidences of early pregnancy loss (12.1% (158 of 1302) v 15.2% (201 of 1326); 0.80 (0.66 to 0.97)), placental accreta spectrum (1.8% (24 of 1302) v 3.6% (48 of 1326); 0.51 (0.31 to 0.83)), caesarean section (69.5% (776 of 1117) v 75.6% (831 of 1100); 0.92 (0.87 to 0.97)), and postpartum haemorrhage (2.0% (22 of 1117) v 6.1% (67 of 1100); 0.32 (0.20 to 0.52)) were lower in the natural ovulation regimen group. No differences between groups were observed for birth weight or neonatal complications. The rate of cycle cancellation was higher in the natural ovulation regimen (16.2% (354 of 2185) v 11.5% (251 of 2191), P<0.001). The prespecified per protocol and subgroup analyses yielded results consistent with the intention-to-treat analyses.CONCLUSIONSIn ovulatory women, a natural ovulation regimen for endometrial preparation was as effective as programmed regimen in terms of achieving a healthy live birth after frozen embryo transfer, but with a lower risk of maternal complications during pregnancy.TRIAL REGISTRATIONChinese Clinical Trial Registry ChiCTR2200057990.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"52 1","pages":"e087045"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Help me piece my story together.","authors":"Jen Higgs","doi":"10.1136/bmj.r2624","DOIUrl":"https://doi.org/10.1136/bmj.r2624","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"39 1","pages":"r2624"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVETo evaluate the impact of a new blood donation incentive policy-an honour model promoting blood donation quality and quantity to inform future policy changes in China and worldwide.DESIGNStaggered difference-in-differences analysis in China.SETTINGBlood donation policies (from provincial government official websites), annual blood donation data (from China's reports on blood safety and annual reports on development of China's blood collection and supply industry), and demographic and socioeconomic indicators (from China city statistical yearbooks and provincial statistical yearbooks) from 2012 to 2018.POPULATIONBlood stations from 30 provinces of China; four regions excluded because data not available.INTERVENTIONThe honour model (social recognition through an honour card granting frequent blood donors honorary incentives such as free access to public bus services and outpatient consultations in hospitals) was piloted to stimulate blood donations in intervention provinces.MAIN OUTCOME MEASUREAnnual total count of blood donations and total count of whole blood donations to measure the quantity of blood donations, and annual donor eligibility rate to measure the quality of blood donations.RESULTSThe honour model increased blood donation counts by 3.55% (95% confidence interval 1.30% to 5.80%, P=0.003) by the end of the second year of implementation. By the end of the fifth year, this effect had doubled to 7.70% (2.42% to 12.98%, P=0.006). Most of these increases were driven by absolute increases in whole blood donation of 3.34% (1.11% to 5.56%, P=0.005) and 7.23% (1.90% to 12.56%, P=0.01) by the end of the second and fifth years, respectively. The honour model did not significantly affect the donor eligibility rate. The Borusyak-Jaravel-Spiess difference-in-differences analysis, synthetic difference-in-differences analysis, and placebo test all suggested the results were robust.CONCLUSIONSThe honour model of blood donation increased the quantity of blood donation in China, while donation quality remained unchanged. This impact was sustained after the introduction of the honour model within the study period.
{"title":"Impact of shifting blood donation policy from gift to honour model: staggered difference-in-differences analysis in China.","authors":"Yuhao Liu,Yiming Pan,Zhoutao Zheng,Bo Pan,Shiyu Zhang,Ling Li,Jinghan Zhao,Wen-Hua Wei,Pascal Geldsetzer,Till Bärnighausen,Simiao Chen,Zhong Liu","doi":"10.1136/bmj-2025-084999","DOIUrl":"https://doi.org/10.1136/bmj-2025-084999","url":null,"abstract":"OBJECTIVETo evaluate the impact of a new blood donation incentive policy-an honour model promoting blood donation quality and quantity to inform future policy changes in China and worldwide.DESIGNStaggered difference-in-differences analysis in China.SETTINGBlood donation policies (from provincial government official websites), annual blood donation data (from China's reports on blood safety and annual reports on development of China's blood collection and supply industry), and demographic and socioeconomic indicators (from China city statistical yearbooks and provincial statistical yearbooks) from 2012 to 2018.POPULATIONBlood stations from 30 provinces of China; four regions excluded because data not available.INTERVENTIONThe honour model (social recognition through an honour card granting frequent blood donors honorary incentives such as free access to public bus services and outpatient consultations in hospitals) was piloted to stimulate blood donations in intervention provinces.MAIN OUTCOME MEASUREAnnual total count of blood donations and total count of whole blood donations to measure the quantity of blood donations, and annual donor eligibility rate to measure the quality of blood donations.RESULTSThe honour model increased blood donation counts by 3.55% (95% confidence interval 1.30% to 5.80%, P=0.003) by the end of the second year of implementation. By the end of the fifth year, this effect had doubled to 7.70% (2.42% to 12.98%, P=0.006). Most of these increases were driven by absolute increases in whole blood donation of 3.34% (1.11% to 5.56%, P=0.005) and 7.23% (1.90% to 12.56%, P=0.01) by the end of the second and fifth years, respectively. The honour model did not significantly affect the donor eligibility rate. The Borusyak-Jaravel-Spiess difference-in-differences analysis, synthetic difference-in-differences analysis, and placebo test all suggested the results were robust.CONCLUSIONSThe honour model of blood donation increased the quantity of blood donation in China, while donation quality remained unchanged. This impact was sustained after the introduction of the honour model within the study period.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"66 1","pages":"e084999"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mark D Russell,Andrea Schaffer,Katie Bechman,Mark Gibson,Jon Massey,Rose Higgins,Brian MacKenna,Peter Inglesby,Seb Bacon,Amir Mehrkar,Ben Goldacre,Edward Alveyn,Victoria Allen,Zijing Yang,Samir Patel,Maryam A Adas,Gurjinder Sandhu,Elizabeth Price,Rouvick M Gama,Kate Bramham,Matthew Hotopf,Sam Norton,Andrew P Cope,James B Galloway
OBJECTIVETo evaluate temporal changes in rates of newly recorded diagnoses for 19 long term conditions in England in relation to the covid-19 pandemic by disease, age group, sex, socioeconomic status, and ethnicity.DESIGNPopulation based cohort study.SETTINGPrimary care and hospital admission data, with the approval of NHS England.PARTICIPANTS29 995 025 individuals registered with general practices in England contributing data to the OpenSAFELY-TPP platform.MAIN OUTCOME MEASURESTemporal trends in age and sex standardised incident and prevalent diagnosis rates for 19 long term conditions between 1 April 2016 and 30 November 2024. Differences between expected and observed diagnosis rates after the onset of the covid-19 pandemic were compared using seasonal autoregressive integrated moving-average models, based on modelled projections of expected rates from pre-pandemic patterns.RESULTSAll 19 conditions showed a sharp decline in newly recorded diagnoses during the first year of the pandemic, followed by variable recovery. As of November 2024, cumulative reductions in diagnoses remained evident for conditions such as depression (734 800 (27.7%) fewer diagnoses than expected; 95% prediction interval (PI) 703 100 to 766 400), asthma (152 900 (16.4%) fewer diagnoses; 95% PI 137 500 to 168 300), chronic obstructive pulmonary disease (COPD) (90 100 (15.8%) fewer diagnoses; 95% PI 81 400 to 98 900), psoriasis (54 700 (17.1%) fewer diagnoses; 95% PI 50 100 to 59 200), and osteoporosis (54 100 (11.5%) fewer diagnoses; 95% PI 47 100 to 61 100). Conversely, diagnoses of chronic kidney disease have increased by 34.8% above expected levels during the pandemic recovery period, corresponding to 359 000 additional diagnoses (95% PI 333 500 to 384 500). Unadjusted subgroup analyses stratified by ethnicity and socioeconomic status indicated that, after an initial decrease, dementia diagnosis rates have risen above pre-pandemic levels for people of white ethnicity and in less deprived socioeconomic areas, but not for those from other ethnicities and more deprived areas.CONCLUSIONSSince the covid-19 pandemic, there have been fewer diagnoses than expected for conditions such as depression, asthma, COPD, and osteoporosis, in contrast with a rapid increase in diagnoses of chronic kidney disease since 2022. Unadjusted analyses stratified by ethnicity and socioeconomic status suggest differential patterns of recovery, particularly for individuals with dementia. This study highlights the potential for near real time monitoring of disease epidemiology using routinely collected health data, informing strategies to enhance case detection and investigate inequities in healthcare.
{"title":"Time trends in newly recorded diagnoses of 19 long term conditions before, during, and after the covid-19 pandemic: population based cohort study in England using OpenSAFELY.","authors":"Mark D Russell,Andrea Schaffer,Katie Bechman,Mark Gibson,Jon Massey,Rose Higgins,Brian MacKenna,Peter Inglesby,Seb Bacon,Amir Mehrkar,Ben Goldacre,Edward Alveyn,Victoria Allen,Zijing Yang,Samir Patel,Maryam A Adas,Gurjinder Sandhu,Elizabeth Price,Rouvick M Gama,Kate Bramham,Matthew Hotopf,Sam Norton,Andrew P Cope,James B Galloway","doi":"10.1136/bmj-2025-086393","DOIUrl":"https://doi.org/10.1136/bmj-2025-086393","url":null,"abstract":"OBJECTIVETo evaluate temporal changes in rates of newly recorded diagnoses for 19 long term conditions in England in relation to the covid-19 pandemic by disease, age group, sex, socioeconomic status, and ethnicity.DESIGNPopulation based cohort study.SETTINGPrimary care and hospital admission data, with the approval of NHS England.PARTICIPANTS29 995 025 individuals registered with general practices in England contributing data to the OpenSAFELY-TPP platform.MAIN OUTCOME MEASURESTemporal trends in age and sex standardised incident and prevalent diagnosis rates for 19 long term conditions between 1 April 2016 and 30 November 2024. Differences between expected and observed diagnosis rates after the onset of the covid-19 pandemic were compared using seasonal autoregressive integrated moving-average models, based on modelled projections of expected rates from pre-pandemic patterns.RESULTSAll 19 conditions showed a sharp decline in newly recorded diagnoses during the first year of the pandemic, followed by variable recovery. As of November 2024, cumulative reductions in diagnoses remained evident for conditions such as depression (734 800 (27.7%) fewer diagnoses than expected; 95% prediction interval (PI) 703 100 to 766 400), asthma (152 900 (16.4%) fewer diagnoses; 95% PI 137 500 to 168 300), chronic obstructive pulmonary disease (COPD) (90 100 (15.8%) fewer diagnoses; 95% PI 81 400 to 98 900), psoriasis (54 700 (17.1%) fewer diagnoses; 95% PI 50 100 to 59 200), and osteoporosis (54 100 (11.5%) fewer diagnoses; 95% PI 47 100 to 61 100). Conversely, diagnoses of chronic kidney disease have increased by 34.8% above expected levels during the pandemic recovery period, corresponding to 359 000 additional diagnoses (95% PI 333 500 to 384 500). Unadjusted subgroup analyses stratified by ethnicity and socioeconomic status indicated that, after an initial decrease, dementia diagnosis rates have risen above pre-pandemic levels for people of white ethnicity and in less deprived socioeconomic areas, but not for those from other ethnicities and more deprived areas.CONCLUSIONSSince the covid-19 pandemic, there have been fewer diagnoses than expected for conditions such as depression, asthma, COPD, and osteoporosis, in contrast with a rapid increase in diagnoses of chronic kidney disease since 2022. Unadjusted analyses stratified by ethnicity and socioeconomic status suggest differential patterns of recovery, particularly for individuals with dementia. This study highlights the potential for near real time monitoring of disease epidemiology using routinely collected health data, informing strategies to enhance case detection and investigate inequities in healthcare.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"64 1","pages":"e086393"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"UK is better protected than US against vaccine politicisation-but is not immune, top adviser warns.","authors":"Elisabeth Mahase","doi":"10.1136/bmj.s60","DOIUrl":"https://doi.org/10.1136/bmj.s60","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"16 1","pages":"s60"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"John Launer: A bellyful of the NHS-why can't we treat our doctors like our patients?","authors":"John Launer","doi":"10.1136/bmj.s73","DOIUrl":"https://doi.org/10.1136/bmj.s73","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"222 1","pages":"s73"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Onyinyechi Duru,Giola Santoni,Dag Holmberg,Helgi Birgisson,Joonas H Kauppila,My von Euler-Chelpin,Eivind Ness-Jensen,Jesper Lagergren
OBJECTIVETo help to clarify whether long term use of proton pump inhibitors is associated with an increased risk of gastric adenocarcinoma by designing a study that considered the existing literature's methodological weaknesses.DESIGNPopulation based case-control study using prospectively collected data from multiple complete nationwide registries in five Nordic nations.SETTINGAll healthcare in five Nordic countries-Denmark, Finland, Iceland, Norway, and Sweden-between 1994 and 2000.PARTICIPANTSCase patients with gastric adenocarcinoma, each matched for age, sex, calendar year, and country with 10 control participants randomly identified from each country's entire population.EXPOSUREThe exposure was long term (>1 year) proton pump inhibitor use, excluding the 12 months before the diagnosis date (cases) or inclusion date (controls). Long term (>1 year) use of histamine-2-receptor antagonists was analysed to assess the validity and specificity of the findings for proton pump inhibitor use MAIN OUTCOMES MEASURES: The outcome was gastric non-cardia adenocarcinoma. Gastric cardia adenocarcinoma was excluded to avoid confounding by indication (that is, gastro-oesophageal reflux). As well as controlling for the matching variables, multivariable logistic regression provided odds ratios with 95% confidence intervals, adjusted for country, Helicobacter pylori treatment, peptic ulcer disease, smoking related diseases, alcohol related diseases, obesity or type 2 diabetes, and drug treatment with metformin, non-steroidal anti-inflammatory drugs, and statins.RESULTSThe study included 17 232 cases of gastric (non-cardia) adenocarcinoma and 172 297 controls. Long term proton pump inhibitor use occurred in 1766 (10.2%) cases and 16 312 (9.5%) controls. No association was found between long term proton pump inhibitor use and gastric adenocarcinoma (adjusted odds 1.01, 95% confidence interval 0.96 to 1.07). The risk was similar for histamine-2-receptor antagonist use (adjusted odds ratio 1.03, 0.86 to 1.23). Multiple sources of error that led to a false positive association were identified-inclusion of proton pump inhibitor use shortly before the gastric adenocarcinoma diagnosis, short term use of proton pump inhibitors, cardia adenocarcinoma, and lack of adjustment for Helicobacter pylori related variables.CONCLUSIONSLong term proton pump inhibitor use may not be associated with an increased risk of gastric adenocarcinoma.
{"title":"Long term use of proton pump inhibitors and risk of stomach cancer: population based case-control study in five Nordic countries.","authors":"Onyinyechi Duru,Giola Santoni,Dag Holmberg,Helgi Birgisson,Joonas H Kauppila,My von Euler-Chelpin,Eivind Ness-Jensen,Jesper Lagergren","doi":"10.1136/bmj-2025-086384","DOIUrl":"https://doi.org/10.1136/bmj-2025-086384","url":null,"abstract":"OBJECTIVETo help to clarify whether long term use of proton pump inhibitors is associated with an increased risk of gastric adenocarcinoma by designing a study that considered the existing literature's methodological weaknesses.DESIGNPopulation based case-control study using prospectively collected data from multiple complete nationwide registries in five Nordic nations.SETTINGAll healthcare in five Nordic countries-Denmark, Finland, Iceland, Norway, and Sweden-between 1994 and 2000.PARTICIPANTSCase patients with gastric adenocarcinoma, each matched for age, sex, calendar year, and country with 10 control participants randomly identified from each country's entire population.EXPOSUREThe exposure was long term (>1 year) proton pump inhibitor use, excluding the 12 months before the diagnosis date (cases) or inclusion date (controls). Long term (>1 year) use of histamine-2-receptor antagonists was analysed to assess the validity and specificity of the findings for proton pump inhibitor use MAIN OUTCOMES MEASURES: The outcome was gastric non-cardia adenocarcinoma. Gastric cardia adenocarcinoma was excluded to avoid confounding by indication (that is, gastro-oesophageal reflux). As well as controlling for the matching variables, multivariable logistic regression provided odds ratios with 95% confidence intervals, adjusted for country, Helicobacter pylori treatment, peptic ulcer disease, smoking related diseases, alcohol related diseases, obesity or type 2 diabetes, and drug treatment with metformin, non-steroidal anti-inflammatory drugs, and statins.RESULTSThe study included 17 232 cases of gastric (non-cardia) adenocarcinoma and 172 297 controls. Long term proton pump inhibitor use occurred in 1766 (10.2%) cases and 16 312 (9.5%) controls. No association was found between long term proton pump inhibitor use and gastric adenocarcinoma (adjusted odds 1.01, 95% confidence interval 0.96 to 1.07). The risk was similar for histamine-2-receptor antagonist use (adjusted odds ratio 1.03, 0.86 to 1.23). Multiple sources of error that led to a false positive association were identified-inclusion of proton pump inhibitor use shortly before the gastric adenocarcinoma diagnosis, short term use of proton pump inhibitors, cardia adenocarcinoma, and lack of adjustment for Helicobacter pylori related variables.CONCLUSIONSLong term proton pump inhibitor use may not be associated with an increased risk of gastric adenocarcinoma.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"66 1","pages":"e086384"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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