121 Historic Time Trends of Hospitalization for Gastric Cancer and Peptic Ulcer in Scotland

Abstract

Aims: Gastric cancer, gastric ulcer and duodenal ulcer are linked to upper gastrointestinal infection with H. pylori. The infection is found ubiquitously in human populations from all continents. H. pylori is thought to have emerged out of Africa and followed similar migration routes as taken by the first humans thousands of years ago. However, the risk of dying from gastric cancer or peptic ulcer increased only among generations born during the 19th century. After reaching a peak shortly before the turn of the century, the risk started to fall again among people born during the 20th century. Whereas the recent fall is explained by a declining infection of the general population with H. pylori, the initial rise has remained mysterious. The present study followed the time trends of gastric cancer, gastric and duodenal ulcer in Scotland during the 19th century to test whether the initial rise observed in mortality data can also be observed in other morbidity statistics. Methods: The inpatient records of the last two centuries from the Scottish Royal Infirmaries of Aberdeen, Dundee, Edinburgh, and Glasgow were analyzed. Rates were calculated for consecutive 5-year periods and expressed per million residents of each city living at the time of hospitalization. Individual rates were treated as Poisson variables, with two rates being considered statistically significant if their 95% confidence intervals did not overlap. Results: The data from all four cities revealed strikingly similar patterns. No hospital admissions for gastric cancer or peptic ulcer were recorded prior to 1800. From 1820-24 until 1910-14 the average hospitalization rate of all four cities for gastric cancer increased from 8.2 to 148.3 per million. The rise in gastric ulcer started about 20-25 years later than gastric cancer and increased from 2.5 to 131.7 hospitalizations per million. The rise in duodenal ulcer hospitalization only began in 189094 and increased until 1910-14 from 1.0 to 39.2 per million. The increase in hospitalization for all three diagnoses was statistically significant with p<0.001 even when analyzed in each city individually. Conclusion: The risk of developing gastric cancer, gastric ulcer, and duodenal ulcer increased among consecutive generations born throughout the 19th century. Hospital statistics support the time trends revealed initially by the birth-cohort analysis of mortality data. As long as the mechanisms underlying the surging epidemics of gastric cancer und peptic ulcer during 19th century remain poorly understood, a risk persists that such epidemics may re-occur, especially in countries where large fractions of the population still harbour H. pylori.