Role of Sex and Socioeconomic Status in the Peptic Ulcer Bleeding Hospitalization: A Nationwide Cohort Study Between 2006 and 2015 in Korea

Abstract

Background: Gastrointestinal peptic ulcer disease has been decreased during the last decades; however, the recent trend of peptic ulcer bleeding (PUB) incidence has not been reported. Besides traditional risk factors such as H. pylori and NSAIDs, sex has gained attention as a potential risk factor, and socioeconomic status (SES) was suggested as a critical factor in PUB. We investigated the effect of sex and SES as well as other risk factors on PUB in Korea using nationwide cohort data. Method: The records of patients hospitalized with PUB from 2006-2015 were retrieved from the Korean National Health Insurance Service-Database. SES was categorized into four classes by health insurance premiums, and clinical characteristics such as H. pylori infection, drug exposure, comorbidities, and mortality were compared according to sex and SES. Findings: In total, 151,507 hospitalizations with PUB were identified. The overall annual hospitalization rate was 34.98 per 100,000 population. The incidence of PUB from 2008 to 2015 decreased by an annual change of -2.7% (p < 0.05), but this was only significant in males. Although the incidence of PUB was increased with age, it was higher in males than in women aged between 40–70 years old and higher in women than in males aged over 80 years old. The lowest economic class had a 2.6-fold higher hospitalization rate than the other economic classes. Furthermore, compared to the upper economic classes, the lowest economic class was older and showed higher exposure to risk drugs, a higher transfusion rate and 30-day mortality, and lower H. pylori eradication. This discrepancy associated with SES has not improved in the last decade. Interpretation: The incidence of PUB is different according to sex and age. Economic deprivation also appears to be an important determinant for the development of PUB. Funding Statement: This research was supported by Support Program for Women in Science, Engineering and Technology through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT. (No. 2019H1C3A1032224). Declaration of Interests: The authors stated: None declared. Ethics Approval Statement: Ethical approval of this study protocol was obtained through the Wonkwang University Sanbon Hospital IRB. (No. 7302-201649).