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, 22 (6), 508-16

Incidence and Short-Term Mortality From Perforated Peptic Ulcer in Korea: A Population-Based Study

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Incidence and Short-Term Mortality From Perforated Peptic Ulcer in Korea: A Population-Based Study

Seungjin Bae et al. J Epidemiol.

Abstract

Background: Perforated peptic ulcer (PPU) is associated with serious health and economic outcomes. However, few studies have estimated the incidence and health outcomes of PPU using a nationally representative sample in Asia. We estimated age- and sex-specific incidence and short-term mortality from PPU among Koreans and investigated the risk factors for mortality associated with PPU development.

Methods: A retrospective population-based study was conducted from 2006 through 2007 using the Korean National Health Insurance claims database. A diagnostic algorithm was derived and validated to identify PPU patients, and PPU incidence rates and 30-day mortality rates were determined.

Results: From 2006 through 2007, the PPU incidence rate per 100 000 population was 4.4; incidence among men (7.53) was approximately 6 times that among women (1.24). Incidence significantly increased with advanced age, especially among women older than 50 years. Among 4258 PPU patients, 135 (3.15%) died within 30 days of the PPU event. The 30-day mortality rate increased with advanced age and reached almost 20% for patients older than 80 years. The 30-day mortality rate was 10% for women and 2% for men. Older age, being female, and higher comorbidity were independently associated with 30-day mortality rate among PPU patients in Korea.

Conclusions: Special attention should be paid to elderly women with high comorbidity who develop PPU.

Figures

Figure 1.
Figure 1.. Diagnostic algorithm for patients with perforated peptic ulcer. The algorithm was developed to identify PPU patients, using data from the Korean NHI claims database. Q2510, gastrotomy; Q2550, vagotomy; Q2551, truncal vagotomy with gastrojejunostomy or pyloroplasty; Q2552, truncal vagotomy with gastrectomy; Q2571, gastroduodenostomy; Q2572, gastrojejunostomy; Q2573, gastrojejunostomy (Roux-en-Y jejunostomy). UGI, upper gastrointestinal; PPU, perforated peptic ulcer; PPI, proton pump inhibitor; H2RA, H2-receptor antagonist.
Figure 2.
Figure 2.. Annual age- and sex-specific incidence of perforated peptic ulcer per 100 000 Koreans in 2006–2007.
Figure 3.
Figure 3.. Kaplan–Meier plot of early mortality after perforated peptic ulcer development according to age. Early mortality was significantly higher in the oldest group than in the youngest group (log-rank test, P < 0.0001). The unadjusted odds ratios were 6.70 (95% CI 4.31–10.30, P < 0.001) and 22.5 (95% CI 13.92–36.31, P < 0.001) for patients aged 60 to 79 years and 80 years or older, respectively, as compared with patients younger than 60 years. PPU, perforated peptic ulcer.
Figure 4.
Figure 4.. Kaplan–Meier plot of 30-day mortality after perforated peptic ulcer development, by level of comorbidity. Patients with high comorbidity had significantly higher short-term mortality as compared with patients with low comorbidity (log-rank test, P < 0.0001). The unadjusted odds ratios were 7.49 (95% CI 4.99–11.22, P < 0.001) and 16.44 (95% CI 10.26–26.33, P < 0.001), respectively. PPU, perforated peptic ulcer.

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