{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T16:20:46Z","timestamp":1784564446203,"version":"3.55.0"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,2,10]],"date-time":"2016-02-10T00:00:00Z","timestamp":1455062400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100004334","name":"Merck","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004334","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Differential diagnostic evaluation associated with a drug may bias effect estimates because of an increased detection of preclinical outcomes. Persistent cough is a common side effect with angiotensin\u2010converting enzyme inhibitors (ACEI), and we hypothesized that ACEI initiators would undergo more diagnostic evaluations, potentially leading to diagnosis of preclinical lung cancer. We compared the incidence of cough\u2010related diagnostic evaluations and lung cancer among ACEI versus angiotensin receptor blockers (ARB) initiators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using a 20% sample of Medicare claims 2007\u20132012, we identified initiators of ACEI or ARB, age 66\u201399 years. Incidence of diagnostic evaluation and lung cancer were compared using adjusted Cox models. Monthly probabilities of workup were compared using proportion differences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 342\u2009611 and 108\u2009116 ACEI and ARB initiators, respectively. Monthly probability of chest X\u2010rays ranged from minimum 4.7% to maximum 21.2% in the 6 months pre and post\u2010initiation. Differences in incidence of diagnostic procedures in the 6 months after initiation were only minimal (chest X\u2010rays hazard ratio (HR)\u2009=\u20091.12; 95% CI: 1.10\u20131.14), chest\u2010MRI (0.86, 95% CI: 0.74\u20130.99), CT\u2010scans (1.09, 95% CI: 0.99\u20131.18) or bronchoscopies (1.03, 95% CI: 0.83\u20131.29). Proportion differences for chest X\u2010rays peaked in the month pre\u2010initiation (8.4%, 95% CI: 8.1\u20138.6) but negligible thereafter. There was no difference in the incidence of lung cancer among ACEI versus ARB initiators (HR\u2009=\u20090.99, 95% CI: 0.84\u20131.16).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Results indicate minimal differential chest workup after ACEI versus ARB initiation and no difference in lung cancer incidence, but suggest differential workup in the month before the first recorded prescription. The latter may reflect drug use before the first observed pharmacy claim or increased workup before initiation of ACEI therapy. 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