Risk of hospitalization resulting from upper gastrointestinal bleeding among patients taking corticosteroids: a register-based cohort study.

PURPOSE: We assessed the risk of hospitalization for upper gastrointestinal bleeding among patients using systemic corticosteroids, accounting for the use of other drugs that may increase the risk of bleeding. SUBJECTS AND METHODS: We conducted a population-based cohort study in North Jutland County, Denmark. Data on the use of corticosteroids, nonsteroidal anti-inflammatory drugs, aspirin, and anticoagulants during 1991 to 1995 were obtained from a countywide prescription database. All hospitalizations because of upper gastrointestinal bleeding were identified through the Hospital Discharge Registry. The observed numbers of patients with gastrointestinal bleeding in various exposure categories among corticosteroid users were compared with the expected number based on the North Jutland population who did not receive prescriptions for any of the drugs under study. RESULTS: A total of 45,980 patients accrued 18,379 person-years of corticosteroid use. There were 109 hospital admissions for gastrointestinal bleeding among corticosteroid users, compared with 26 expected, yielding a relative risk of 4.2 [95% confidence interval (CI): 3.4 to 5.0]. Among corticosteroid users who did not use other drugs associated with gastrointestinal bleeding, the relative risk was 2.9 (95% CI: 2.2 to 3.7). The relative risk decreased further to 1.9 (95% CI: 1.4 to 2.5) when current corticosteroid usage was compared with former usage. CONCLUSION: We observed an increased risk of hospitalization because of upper gastrointestinal bleeding among patients prescribed corticosteroids, especially among those who use other medications. Confounding from the underlying disease may also have contributed to the observed increase in risk.

Hospitalisation for upper gastrointestinal bleeding associated with use of oral anticoagulants.

The incidence of hospitalisation for upper GI bleeding with use of oral anticoagulants (OA) alone or in combination with other drugs was examined in a cohort of 4,204 users of OA, identified through record linkage between a population-based prescription database and a hospital discharge registry in Denmark, and compared with the incidence in the general population not exposed to OA. The standardised incidence ratio (SIR) was 2.8 (95% CI = 1.6-4.5) for use of OA alone. SIRs tended to be higher for use of OA combined with acetaminophen alone (4.4, 95% CI = 1.2-11.4), non-aspirin NSAIDs alone (8.0, 95% CI = 2.1 to 20.4) or aspirin/corticosteroids alone (3.8, 95% CI = 0.8-11.0), respectively. These results indicate that use of OA is associated with a significantly increased risk of upper GI bleeding, with still higher risks associated with the concomitant use of other medications including acetaminophen. Further research is needed to clarify the extent to which drugs interacting with oral anticoagulants may cause GI bleeding and the mechanisms through which these associations operate.

Mortality and causes of death in patients with monoclonal gammopathy of undetermined significance.

To evaluate the mortality and causes of death in monoclonal gammopathy of undetermined significance (MGUS), we identified 1324 cases of MGUS in the period 1978-93 in North Jutland County, Denmark. Data on mortality were obtained by record linkage to the Danish Death Registry. There were 868 deaths in the MGUS cohort during 7785 years of follow-up vs. 409.6 expected, giving a standardized mortality ratio (SMR) of 2.1 (95% confidence interval 2.0-2.3). Malignant transformation was the cause of death in 97 patients vs. 4.9 expected, yielding a SMR of 20.0 (16.2-24.4), which explained about 20% of the excess mortality in the cohort. The mortality was increased for several other malignant and non-malignant causes of death during the first 4 years of follow-up. For late follow-up, 5-18 years after detection of the M-component, the overall SMR was 1.7 (1.5-1.9), and malignant transformation was the only cause of death with a substantial increase of SMR. Although malignant transformation is an important cause of death in MGUS patients, it did not entirely explain the increased mortality. MGUS patients often suffer from coexisting clinical conditions that increase the mortality, especially during the first years after detection of the M-component.

The Danish National Hospital Register. A valuable source of data for modern health sciences.

The Danish National Hospital Register (LPR) has collected nationwide data on all somatic hospital admissions since 1977, and since 1995 data on outpatients and emergency patients have been included as well. Numerous research projects have been undertaken in the national Danish context as well as in collaboration with international teams, and the LPR is truly a valuable source of data for health sciences, especially in epidemiology, health services research and clinical research. Nearly complete registration of somatic hospital events in Denmark is combined with ideal conditions for longterm follow-up due to the existence of a national system of unique person identification in a population of relative demographic stability. Examples of studies are provided for illustration within three main areas: I: Using LPR for surveillance of the occurrence of diseases and of surgical procedures, II: Using the Register as a sampling frame for longitudinal population based and clinical research, and III: Using the Register as a data source for monitoring outcomes. Data available from the Register as well as studies of the validity of the data are mentioned, and it is described how researchers may get access to the Register. The Danish National Hospital Register is well suited to contribute to international comparative studies with relevance for evidence-based medicine.

[Pernicious anemia and risk of cancer in Denmark]. / Perniciøs anaemi og cancerrisiko i Danmark.

The cancer pattern was investigated among 5072 patients with a discharge diagnosis of pernicious anaemia during 1977-1989, using data from the Danish Hospital Discharge, Central Population and Cancer registries. During 1-15 years of follow-up we found, in line with earlier reports, two to three-fold increases in the risk of cancer of the stomach, buccal cavity and pharynx, which were unchanged when the analysis was stratified according to sex and duration of follow-up. A previously reported positive association with haematological cancers could only be found for short term follow-up to indicate that no real association exists. Our cohort of patients with pernicious anaemia experienced significantly reduced risks of cervix and non-melanoma skin cancer.

[Incidence and mortality of breast cancer among women in Denmark 1943-1992]. / Incidens og mortalitet af brystkraeft hos kvinder i Danmark 1943-1992.

Nationwide incidence and mortality rates are presented for female breast cancer in Denmark from 1943 to 1992. The annual incidence rate of breast cancer has increased among Danish women from 61 in 1943-1947 to 105 per 100,000 women in 1988-1992. Mortality rates have increased to a smaller extent, from 36 to 43 per 100,000 women. We found that only a small part of the observed increase in incidence of breast cancer can be explained by the known risk factors, based on calculation of population attributable-risk per cent.

Cancer risk after splenectomy.

BACKGROUND: Splenectomy may have an impact on immunologic function. To the authors' knowledge, the only previous epidemiologic study investigating cancer risk among patients splenectomized because of trauma reported no increased cancer risk. In contrast, several investigations have suggested that splenectomy in patients with Hodgkin's disease increases the risk for secondary leukemia independent of treatment. METHODS: To evaluate the cancer risk of patients who underwent splenectomy after traumatic rupture of the spleen, 1103 patients were identified between 1977 and 1989 through Danish hospital discharge records. Another 5212 splenectomized patients also were identified to perform additional analyses for assessing cancer risk subsequent to splenectomy for nontraumatic indications including benign and malignant conditions. Cancer occurrence was determined by performing a linkage to the Danish Cancer Registry. For comparison, expected numbers of cases of cancer were calculated from national cancer incidence rates. RESULTS: The number of cancer cases observed among posttraumatic splenectomized patients matched the expected number (relative risk = 1.0; n = 20; 95% confidence interval = 0.6-1.6) in an average follow-up of 6.8 years. Additional analyses identified possible excesses of a number of site-specific neoplasms among certain subgroups of patients undergoing splenectomy for nontraumatic reasons, but the numbers in the subgroup analyses were small. CONCLUSIONS: No increased risk for cancer was observed among patients who underwent splenectomy because of trauma. However, an increased risk for some specific cancer sites was found in patients who underwent splenectomy for nontraumatic reasons, although the effect of treatments for underlying disease and lifestyle habits such as cigarette smoking could not be ruled out in explaining these excess risks.