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Despite reported associations with undesirable effects, their long\u2010term use is on the rise, while appropriate indications, dose, and treatment duration may deviate from guideline recommendations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Primary to examine the annual patterns of PPI use. Secondary\u2010 to assess indications for initiating PPI treatment, long\u2010term use, and factors associated with long\u2010term use in a large Israeli health maintenance organization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A historical cohort study of 528\u2009420 eligible PPI users during 2000\u20132015, analyzed PPI use using defined daily doses and the proportion of patients covered method. Data on indications for treatment initiation, clinical and socio\u2010demographic parameters were captured as well. A multivariable logistic\u2010regression model was used to identify factors associated with long\u2010term use of PPI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The annual incidence rates of patients initiating PPI treatment were relatively constant, ranging between 2.4% and 3.1% of the adult population, with a monotonic increase in annual consumption and prevalence (reaching 12.7% in 2015). Reflux, functional symptoms, and <jats:italic>Helicobacter pylori<\/jats:italic> eradication were the most common indications for initiating PPI therapy. However, 27% of patients had no recorded indication for treatment. Fifteen percent of patients used PPI for over 6\u2009months, especially in older age groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Utilization of PPI increases steadily, mainly due to chronic use. Prolonged consumption is associated with specific clinical indications and older age. Health organizations should encourage awareness of appropriate use among physicians, specifically in the elderly, patients with reflux, and those with functional disorders.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.5352","type":"journal-article","created":{"date-parts":[[2021,8,28]],"date-time":"2021-08-28T11:36:57Z","timestamp":1630150617000},"page":"1576-1587","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Proton pump inhibitors long term use\u2010trends and patterns over 15\u2009years of a large health maintenance organization"],"prefix":"10.1002","volume":"30","author":[{"given":"Vered","family":"Rosenberg","sequence":"first","affiliation":[{"name":"Kahn\u2010Sagol\u2010Maccabi Research and Innovation Institute Maccabi Healthcare Services  Tel Aviv 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