(A) Association between medication use and serum vitamin B12 concentration among baseline BPHRS participants. (B) Association between medication use and vitamin B12 deficiency among baseline BPHRS participants. Thousand four hundred thirteen participants with the complete outcome and exposure data after adjusting for relevant covariates. Exposure ALA adjusted for age, sex, alcohol frequency, smoking, BMI level, multivitamin, ACE inhibitor, metformin use, and serum creatinine. Exposure PPI adjusted for age, sex, alcohol frequency, smoking, BMI level, multivitamin, ACE inhibitor, H2RA and metformin use, and serum creatinine. Exposure H2RA adjusted for age, sex, alcohol frequency, smoking, BMI level, multivitamin, ACE inhibitor, PPIs and metformin use, and serum creatinine. Exposure ALA and metformin adjusted for age, sex, alcohol frequency, smoking, BMI level, multivitamin, ACE inhibitor use, PPI use, H2RA use, and serum creatinine. ∗P ≤ 0.05. ALA, acid-lowering agent; BPHRS, Boston Puerto Rican Health H2RA, histamine 2 receptor antagonists; PPI, proton pump inhibitor.