Some factors associated with mortality in perforated peptic ulcer: a case-control study.

This study examined the associations of individual coexisting illnesses, septicaemia, intra-abdominal abscess, marital status, smoking and alcohol use, with mortality following perforation of peptic ulcer without pre-operative evidence of haemorrhage. Patients who died in hospital following ulcer perforation (cases; n = 300) were compared with patients who survived following ulcer perforation (controls; n = 276). The controls were frequency-matched to the cases on age, sex and perforation site. Data were analysed by logistic regression. Cardiac, respiratory, cerebrovascular, renal, liver and malignant diseases, and septicaemia and intra-abdominal abscess were associated with mortality and the coexisting illnesses were significantly increased in cases compared to controls both on admission and at the end of hospital stay. During hospitalization, the odds of pneumonia decreased in cases, otherwise there was little change in strengths of associations over this period. Being widowed or never married was positively associated with mortality, and moderate alcohol use was negatively associated. In conclusion, this study identifies several coexisting illnesses, septicaemia and intra-abdominal abscess as risk factors for mortality following ulcer perforation. The results suggest that, with little exception, the same level of mortality risk is associated with coexisting illnesses whether the beginning or end of hospital stay is used as the index time point.

Trends in peptic ulcer mortality in Sydney from 1971 to 1987.

Gastric and duodenal ulcer (GU,DU) mortality in Western countries has varied over time by age and sex. Temporal variation raises the question of whether these ulcers have an environmental etiology. Using death certificate data, we investigated peptic ulcer mortality time trends from 1971 to 1987 in Sydney, Australia, and whether ulcer mortality and overall mortality in Sydney were similar with regard to time trends and associations with demographic and environmental factors. In men in all age groups and in women age < 65, GU and DU mortality decreased. In women age > or = 70, GU mortality remained constant and DU mortality increased. Average age at ulcer death increased: from 1971 to 1987, ulcer deaths at age > or = 70 rose from 52 to 80% of all ulcer deaths. In men who died at age 30-54, GU and DU mortality decreased relative to overall mortality. In women who died at age > or = 55, DU mortality increased relative to overall mortality. Compared with overall mortality, the ulcer mortality rate was affected more adversely by lower social class and lack of the marriage tie, and smoking rates tended to correlate more strongly with GU mortality. The greater-than-expected decrease in GU and DU mortality in younger men and the increase in DU mortality in elderly women suggest important changes in as yet unidentified environmental risk factors for ulcer mortality within the young adult male and elderly female general populations.