Long Term Population Study of Prevalence and Risk Factors for Rebleeding in Patients with Peptic Ulcer Disease (PUD)

Abstract

Background: Most data on rebleeding are reported from tertiary care centers over a short follow up period and may not reflect community trends. We sought to determine the prevalence and risk factors for being hospitalized with rebleeding over a 5 year period for patients in California. Methods: California Health Data and Advisory Council Consolidation Act mandates that all hospitals licensed in California report details of all hospitalizations to the California Office of Statewide Health Planning and Development. We used these data to identify all patients hospitalized in California with gastric or duodenal ulcer bleeding in 1995. 1,070 of total 15,503 such patients had prior admissions for PUD bleeding between 1991-4. Therefore 14,473 patients were admitted with an initial PUD bleed in 1995. We compared 367 (2.5%) patients who were readmitted with rebleeding during 1995-2000 to 14,106 patients who did not rebleed using multivariate analysis which adjusted for age, gender, length of stay, level of care, disposition, disease severity, and time to endoscopic therapy. We extrapolated income from the ZIP code of admission using data from the 2000 US Census. We used chi-square and student t-tests for univariate analysis and logistic regression for multivariate analysis with alpha of 0.05 considered significant. This study was approved by the Statewide and the University IRB. Results: Patients readmitted with rebleeding had significantly shorter (3.8 ± 2.7d vs. 4.8 ± 6.6d, p<0.0001) and less expensive ($10,615 ± 10,625 vs. $13,758 ± 25,455, p<0.0001) initial hospital stay, lower annual household income ($44,593 ± 15,726 vs. $48,163 ± 18,657, p<0.0001) compared to non rebleeders. The rebleed rates also differed significantly according to the funding source, p = 0.0024. Multivariate analysis showed Native American/Eskimo race (OR = 4.0, 95% CI: 1.7-9.4, p = 0.0015) and black race (OR = 1.5, 95% CI: 1.2-2.0, p = 0.0005) to have significantly higher risk of rebleeding compared to Caucasians. The same analysis showed HMO funding (OR = 0.76, 95% CI: 0.62-0.95, p = 0.014) and higher income (OR = 0.94, 95% CI: 0.90-0.98, p = 0.0078) to be associated with lower risk of rebleeding. Conclusion: Only 2.5% of patients admitted with PUD bleeding were readmitted for recurrent PUD bleeding during the 5 year follow up. Risk factors for rebleeding were being black, Native American or Eskimo race, while HMO funding and higher income were associated with lower risk of rebleeding. Background: Most data on rebleeding are reported from tertiary care centers over a short follow up period and may not reflect community trends. We sought to determine the prevalence and risk factors for being hospitalized with rebleeding over a 5 year period for patients in California. Methods: California Health Data and Advisory Council Consolidation Act mandates that all hospitals licensed in California report details of all hospitalizations to the California Office of Statewide Health Planning and Development. We used these data to identify all patients hospitalized in California with gastric or duodenal ulcer bleeding in 1995. 1,070 of total 15,503 such patients had prior admissions for PUD bleeding between 1991-4. Therefore 14,473 patients were admitted with an initial PUD bleed in 1995. We compared 367 (2.5%) patients who were readmitted with rebleeding during 1995-2000 to 14,106 patients who did not rebleed using multivariate analysis which adjusted for age, gender, length of stay, level of care, disposition, disease severity, and time to endoscopic therapy. We extrapolated income from the ZIP code of admission using data from the 2000 US Census. We used chi-square and student t-tests for univariate analysis and logistic regression for multivariate analysis with alpha of 0.05 considered significant. This study was approved by the Statewide and the University IRB. Results: Patients readmitted with rebleeding had significantly shorter (3.8 ± 2.7d vs. 4.8 ± 6.6d, p<0.0001) and less expensive ($10,615 ± 10,625 vs. $13,758 ± 25,455, p<0.0001) initial hospital stay, lower annual household income ($44,593 ± 15,726 vs. $48,163 ± 18,657, p<0.0001) compared to non rebleeders. The rebleed rates also differed significantly according to the funding source, p = 0.0024. Multivariate analysis showed Native American/Eskimo race (OR = 4.0, 95% CI: 1.7-9.4, p = 0.0015) and black race (OR = 1.5, 95% CI: 1.2-2.0, p = 0.0005) to have significantly higher risk of rebleeding compared to Caucasians. The same analysis showed HMO funding (OR = 0.76, 95% CI: 0.62-0.95, p = 0.014) and higher income (OR = 0.94, 95% CI: 0.90-0.98, p = 0.0078) to be associated with lower risk of rebleeding. Conclusion: Only 2.5% of patients admitted with PUD bleeding were readmitted for recurrent PUD bleeding during the 5 year follow up. Risk factors for rebleeding were being black, Native American or Eskimo race, while HMO funding and higher income were associated with lower risk of rebleeding.