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. 2020 Oct 1;3(10):e2020172.
doi: 10.1001/jamanetworkopen.2020.20172.

Thirty-Year Incidence and Mortality Trends in Upper and Lower Gastrointestinal Bleeding in Finland

Pareen Vora  1   2   3 , Arto Pietila  4 , Markku Peltonen  4 , Gunnar Brobert  5 , Veikko Salomaa  4
Affiliations

Thirty-Year Incidence and Mortality Trends in Upper and Lower Gastrointestinal Bleeding in Finland

Pareen Vora et al. JAMA Netw Open. .

Abstract

Importance: Epidemiological data on lower gastrointestinal bleeding (GIB) in the general population are sparse.

Objective: To describe the incidence, recurrence, mortality, and case fatality rates of major upper GIB and lower GIB in the general population of Finland between 1987 and 2016.

Design, setting, and participants: This prospective cohort study used data from the 1987 to the 2012 cycles of the National FINRISK Study, a health examination survey that was conducted every 5 years in Finland. Survey participants were adults aged 25 to 74 years who were recruited from a population register by random sampling; those with a history of hospitalization for GIB were excluded. Participants were followed up from survey enrollment to onset of GIB that led to hospitalization, death from any cause, or study end (December 31, 2016). Follow-up was performed through linkage with national electronic health registers. Data were analyzed from February 1, 2019, to January 31, 2020.

Main outcomes and measures: Incidence, recurrence, mortality, and case fatality rates for all, upper, lower, and unspecified GIB. Outcome measures were stratified by sex and age group.

Results: Among the 39 054 participants included in the study, 494 (1.3%) experienced upper GIB (321 men [65.0%]; mean [SD] age, 52.8 [12.1] years) and 645 (1.7%) had lower GIB (371 men [57.5%]; mean [SD] age, 54.0 [11.7] years). The age-standardized incidence rate was 0.94 per 1000 person-years (95% CI, 0.85-1.04) for upper GIB and 1.26 per 1000 person-years (95% CI, 1.15-1.38) for lower GIB; the incidence was higher in men than in women. Between 1987 and 2016 the incidence rate of upper GIB remained mostly stable, ranging from 0.40 to 0.66 per 1000 person-years, whereas constant increases occurred in the incidence of lower GIB until the rate stabilized. The proportion of recurrent GIB events showed an increasing trend from 1987 to 2016. The upper GIB-specific mortality was higher (0.07 per 1000 person-years; 95% CI, 0.04-0.09) than the lower GIB-specific mortality (0.01 per 1000 person-years; 95% CI, 0.001-0.03). Case fatality was high for those with upper GIB (7.0%; 95% CI, 4.7-10.1) compared with those with lower GIB (0.4%; 95% CI, 0.1-1.3). Case fatality remained stable over the years but was higher in men (between 5% and 10%) than women (<2%) with GIB.

Conclusions and relevance: This study found that the overall incidence rate of upper GIB was lower than the incidence of lower GIB, but the recurrence, mortality, and 28-day case fatality were higher in participants with upper GIB. These data can serve as a reference when putting into context the rates of drug-associated GIB and can inform efforts to improve GIB care and outcome and to prevent rebleeding or death for patients with major GIB.

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Conflict of interest statement

Conflict of Interest Disclosures: Mr Vora reported being an employee of Bayer AG. Mr Pietila reported being an employee of the Finnish Institute for Health and Welfare, which received a grant from Bayer AG during the conduct of the study. Dr Peltonen reported being an employee of the Finnish Institute for Health and Welfare. Dr Brobert reported being an employee of Bayer AB. Dr Salomaa reported being an employee of the Finnish Institute for Health and Welfare, which received a grant from Bayer AG during the conduct of the study, as well as receiving personal fees from Novo Nordisk and honorarium for consultation from Sanofi outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Incidence Rate Trends in Major Upper and Lower Gastrointestinal Bleeding (GIB) for 5-Year Cohorts
Error bars indicate 95% CIs.
Figure 2.
Figure 2.. Recurrent Major Upper and Lower Gastrointestinal Bleeding (GIB) for 5-Year Cohorts
Error bars indicate 95% CIs.
Figure 3.
Figure 3.. Twenty-Eight-Day Case Fatality Trends in Major Gastrointestinal Bleeding for 5-Year Cohorts
Error bars indicate 95% CIs.
See this image and copyright information in PMC

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