Abstract
BackgroundMortality after perforated and bleeding peptic ulcer increases with age. Limited data exist on how the higher burden of comorbidity among elderly patients affects this association. We aimed to examine the association of age with short-term mortality after perforated and bleeding peptic ulcer and to determine the impact of comorbidity on this association.MethodsIn this population-based cohort study in three Danish counties between 1991 and 2003 we identified two cohorts of patients: those hospitalized with a first-time discharge diagnosis of perforated peptic ulcer and those with bleeding peptic ulcer. The diagnoses were ascertained from hospital discharge registries and mortality through the Danish Civil Registration System. Information on comorbidity and use of ulcer-related drugs was obtained through administrative medical databases. We computed age-, gender- and comorbidity-standardized 30-day mortality rates and used Cox's regression to estimate adjusted 30-day mortality rate ratios (MRR) for elderly compared with younger patients.ResultsAmong 2,061 patients with perforated peptic ulcer, 743 (36%) were 65–79 years old and 513 patients (25%) were aged 80+ years. Standardized 30-day mortality was 8.9% among patients younger than 65 years rising to 44.6% among patients aged 80+ years, corresponding to an adjusted MRR of 5.3 (95% CI: 4.0–7.0). Among 7,232 patients with bleeding peptic ulcer 2,372 (33%) were aged 80+ years. Standardized 30-day mortality among patients younger than 65 was 4.3% compared with 16.9% among patients aged 80+ years, corresponding to an adjusted MRR of 3.7 (95% CI: 2.9–4.7). Analyses stratified by comorbidity consistently showed high MRRs among elderly patients, regardless of comorbidity level.ConclusionAgeing is a strong predictor for a poor outcome after perforated and bleeding peptic ulcer independently of comorbidity.
Highlights
Mortality after perforated and bleeding peptic ulcer increases with age
The adjusted 30-day mortality rate ratios (MRR) were 2.8 among patients aged 65–79 years and 5.3 among patients aged 80+ years, each compared with patients younger than 65 years
Including comorbidity diagnoses made during the index hospitalisation with perforated peptic ulcer did not change any of the MRRs
Summary
This population-based cohort study used data from medical registries in the Danish counties of North Jutland, Viborg and Aarhus, covering a population of 1.4 million, which is approximately 25% of the entire Danish population. Other covariates Information on use of drugs potentially associated with both advanced age and a poor outcome of bleeding and perforated peptic ulcer was obtained through the prescription databases of Viborg, North Jutland, and Aarhus counties. Statistical analysis Based on the date of first admission with perforated or bleeding peptic ulcer we constructed Kaplan-Meier survival curves and life-table estimates of 30-day mortality for the main study variables: age group (15–64, 65–79, 80+ years), level of comorbidity (according to the Charlson score categories), gender, use of ulcer-related drugs, and previous hospitalisation with uncomplicated peptic ulcer disease. We used Cox's regression analysis to estimate 30-day mortality rate ratios (MRRs), while adjusting for comorbidity level, gender, use of ulcerrelated drugs, and previous hospitalisation with uncomplicated peptic ulcer disease.
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