Changing patterns in the epidemiology and hospital care of peptic ulcer

Our aim was to study trends in hospital admission rates for peptic ulcer in a geographically defined population, and to distinguish the effects of period, age and birth cohort on the rates.

Analysis of linked, routinely collected abstracts of hospital inpatient care held by the Oxford record linkage study for the period 1970-1986. Age- and sex-specific and age-standardized hospitalization, readmission and operation rates were calculated for patients with peptic ulcer. Age, cohort and period effects were examined using log-linear models.

Records for a total of 5462 people with gastric ulcer and 10,186 with duodenal ulcer were identified. Overall, the age-standardized admission rates for both gastric and duodenal ulcer declined over the study period. The decrease was confined to people < 65 years of age. Among elderly patients admission rates for peptic ulcer increased over time, more so in females than in males. Admission rates were higher in the elderly than in young people for both gastric and duodenal ulcer. The apparent age effect was, in fact, mainly attributable to a birth cohort effect: age-specific admission rates were lower in people born after 1925 than in people born at the beginning of the century. This was more marked for males than females. There was a considerable decline in major operations undertaken on peptic ulcer; admission rates for endoscopy increased; and readmission rates did not show significant changes.

The overall decline found for hospital care of peptic ulcer during the study period is consistent with that found in England for mortality rates ascribed to peptic ulcer. The cohort effect found in the data for hospitalized morbidity supports that reported by others for mortality. The cohort effect indicates that the decline was related more to changes in risk factors in the cohorts born in different periods than to the introduction of new pharmacological treatments since the 1970s.