Baik SH, Fung KW, McDonald CJ., et al. - Researchers analyzed the impacts of proton pump inhibitors (PPIs) on survival in an incident drug user cohort of 1,930,728 elderly Medicare fee-for-service beneficiaries. PPI-associated death risk was evaluated with Cox regression analysis with time-varying covariates and propensity score adjustments. There were 80,972 (4.2%) people in the study group who died during a median follow-up of 3.8 years, resulting in an overall unadjusted death rate/1000 person-years of 9.85; 14.31 for PPI users and 7.93 for non- users. The association of PPIs with an increased risk of death documented in observational studies may be due to protopathic bias, given the use patterns of PPIs in patients with conditions that may predict death.  With no lag-time, PPI use (vs no use) was correlated with 10% greater mortality risk, but with a lag-time of 90 days, mortality risk correlated with PPI use was close to zero.