How Much Has PPI Use Increased Among US Adults?
Prescription proton pump inhibitor use among US adults roughly doubled between 1999 and 2018, rising from 4.1% of adults in 1999-2000 to 8.6% in 2017-2018. That figure comes from a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES), a nationally representative survey of non-institutionalized US civilians, in which PPI use was defined as any use during the month before the survey. The growth was not steady across the two decades: prescription use climbed by 4.6% from 1999 to 2008, then fell by 0.5% from 2009 to 2018.
Dr. Kumar’s Take
A doubling of prescription PPI use in a single generation is a large shift in how a class of acid-suppressing drugs gets used, and the shape of the curve matters as much as the size. The authors went in expecting an inverted U, a rise followed by a decline as safety concerns accumulated. They found a rise and then a flat line instead. In my reading, that means the prescribing habits formed in the early 2000s largely stuck, even as the literature on long-term risks grew. The other finding I keep coming back to is the age split: almost all of the increase came from adults 55 and older, the same group that tends to accumulate other medications and the fewest opportunities for anyone to stop and ask whether the PPI is still needed. This is a survey of use, not of appropriateness, so it cannot tell me which of those prescriptions were justified. It does tell me the population taking these drugs is larger and older than it was in 1999, which is reason enough to make deprescribing conversations routine.
What the Research Shows
Investigators at Columbia University used NHANES data covering 1999 through 2018 to track prescription PPI use among US adults. Because NHANES is a repeated cross-sectional survey, each cycle captures a fresh nationally representative sample rather than following the same people over time. Use was counted if a respondent reported taking a prescription PPI at any point in the month preceding the survey.
Trends were examined overall and stratified by sex, age, race, body mass index, and poverty level. The stated purpose was to test whether use followed an inverted U-shaped curve, with a decline in recent years driven by published safety concerns.
Results in Real Numbers
- Overall usage: prescription PPI use rose from 4.1% of US adults in 1999-2000 to 8.6% in 2017-2018 (p for trend <0.01)
- First half of the period: a 4.6% increase from 1999 to 2008
- Second half of the period: a 0.5% decrease from 2009 to 2018
- Adults aged 55 and older: an 8.6% increase across the study period
- Adults under 55: a 1.2% increase across the study period
- Age interaction: p for interaction based on age <0.01
Safety, Limits, and Caveats
This is a survey of medication use, not a study of outcomes. It cannot say whether any given prescription was appropriate, how long individual patients stayed on therapy, or what happened to them clinically.
The measure was prescription PPI use reported for the month before the survey, so it reflects prescribed therapy rather than the full picture of acid suppression in the population. And because NHANES samples a different group of people each cycle, the trend describes the population, not the course of treatment in any one person.
Practical Takeaways
- Prescription PPI use among US adults is about twice what it was in 1999, and it has held steady rather than fallen since 2008
- The growth is concentrated in adults aged 55 and older, so that is where periodic review pays off most
- Revisit whether a PPI still has an active indication rather than letting a prescription renew by default
- Weigh the accumulating literature on long-term PPI risks when starting therapy, not only when stopping it
- Use the lowest effective dose for the shortest duration that controls symptoms
- Talk with patients about both the benefits and the open questions around years-long acid suppression
Related Studies and Research
- ACG Clinical Guideline: Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease
- Pharmacology of Proton Pump Inhibitors
- Proton Pump Inhibitors and Risk of Fractures: Meta-Analysis of 11 International Studies
- Use of Proton Pump Inhibitors and Risk of Iron Deficiency: Population-Based Study
- Episode 25: The Great GERD Mistake - How Medicine Made Heartburn Worse and How to Fix It
FAQs
How much did PPI use actually increase?
Prescription PPI use went from 4.1% of US adults in 1999-2000 to 8.6% in 2017-2018, roughly a doubling over two decades.
Is PPI use still rising?
No. The entire increase occurred between 1999 and 2008. From 2009 to 2018 use decreased by 0.5%, which the authors describe as a plateau.
Which age group drove the increase?
Adults aged 55 and older. Their use rose by 8.6% over the study period, compared with 1.2% among adults under 55.
Did the study find the decline the authors expected?
No. The researchers hypothesized an inverted U-shaped curve with a recent decline driven by safety concerns. Use rose and then leveled off instead.
Does this study show that PPIs are being overprescribed?
It does not address that question. The survey measured whether adults reported taking a prescription PPI in the previous month, not why it was prescribed or whether it was still needed.
Bottom Line
Prescription PPI use among US adults roughly doubled from 1999 to 2018, from 4.1% to 8.6%, with all of that growth occurring before 2008 and a plateau since. Almost all of the increase came from adults aged 55 and older, which is where periodic reassessment of continued acid suppression matters most.
