Hospitalizations for Peptic Ulcer Disease | CDC EID

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Volume 16, Number 9–September 2010
Research
Trends in Hospitalizations for Peptic Ulcer Disease, United States, 1998–20051
Lydia B. Feinstein,2 Robert C. Holman, Krista L. Yorita Christensen, Claudia A. Steiner, and David L. Swerdlow
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (L.B. Feinstein, R.C. Holman, K.L. Yorita Christensen, D.L. Swerdlow); and Agency for Healthcare Research and Quality, Rockville, Maryland, USA (C.A. Steiner)
in part at the Annual Interscience Conference on Antimicrobial Agents and Chemotherapy and Infectious Diseases Society of America; 2008 Oct 28; Washington, DC (abstract number L-4129).
University of North Carolina, Chapel Hill, North Carolina, USA.

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Abstract
Infection with Helicobacter pylori increases the risk for peptic ulcer disease (PUD) and its complications. To determine whether hospitalization rates for PUD have declined since antimicrobial drugs to eradicate H. pylori became available, we examined 1998–2005 hospitalization records (using the Nationwide Inpatient Sample) in which the primary discharge diagnosis was PUD. Hospitalizations for which the diagnosis was H. pylori infection were also considered. The age-adjusted hospitalization rate for PUD decreased 21% from 71.1/100,000 population (95% confidence interval [CI] 68.9–73.4) in 1998 to 56.5/100,000 in 2005 (95% CI 54.6–58.3). The hospitalization rate for PUD was highest for adults ≥65 years of age and was higher for men than for women. The age-adjusted rate was lowest for whites and declined for all racial/ethnic groups, except Hispanics. The age-adjusted H. pylori hospitalization rate also decreased. The decrease in PUD hospitalization rates suggests that the incidence of complications caused by H. pylori infection has declined.
Peptic ulcer disease (PUD) is a common illness that affects >6 million persons in the United States each year, causing considerable illness and a large economic cost to the healthcare system (1). Infection with Helicobacter pylori substantially increases the risk for PUD and its complications (2). Appropriate antimicrobial drug regimens to eradicate the infection and cure ulcers have been available since Marshall and Warren discovered H. pylori as an etiologic agent of ulcers in the early 1980s (3). Eradicating these infections prevents recurrence and ulcer complications such as bleeding or perforation (4–6). Therefore, a decline in hospitalizations for PUD and its complications could be expected since treatment for H. pylori infection became available.

Although rates of hospitalization for PUD declined in the United States during the 1980s and 1990s, rates remained high (7,8). One reason was the lack of knowledge among the general public and clinicians about the link between H. pylori and PUD (9–11). The Centers for Disease Control and Prevention, in collaboration with partners from other federal agencies, academic institutions, and private industry, initiated an educational campaign in 1997 to increase awareness of the relationship (9). The goals of the campaign were to promote the increased use of appropriate antimicrobial drug treatment to eradicate H. pylori, which would thus lead to a further decline in rates of hospitalization for PUD and its complications. Accordingly, reducing hospitalizations for PUD 35% from the 1998 baseline rate of 71/100,000 population to 46/100,000 population by the year 2010 was included in the Healthy People 2010 objectives that were developed in 1998 by the US Department of Health and Human Services (12).

The prevalence of H. pylori infections and their associated conditions can vary considerably among population groups within the same country. Racial and ethnic differences have been noted, with blacks more affected than whites and Mexican-Americans more affected than non-Hispanic whites and non-Hispanic blacks (12,13). A recent meta-analysis in which researchers adjusted for age and socioeconomic status, showed that H. pylori infection was significantly associated with male sex in 18 adult populations (14). In addition, male patients were hospitalized more often for duodenal ulcers than were female patients (15,16). The prevalence of H. pylori infection and PUD can also vary by geographic location, socioeconomic status, and age (13,17).

Although recent studies have suggested that rates of PUD have declined in European countries and in non-European countries outside the United States (16,18–20), the overall recent national trends of PUD in the United States have not been described. To determine whether rates of hospitalization due to PUD and its complications have decreased and to describe the demographic characteristics of hospitalized persons with PUD, we conducted a retrospective analysis of hospital discharge data for PUD in the United States from 1998 through 2005.

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