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


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.


CONCLUSIONS
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.
Nielsen
G L
GL
Department of Clinical Epidemiology at Aarhus University Hospitals, Aarhus, Denmark.
Sørensen
H T
HT
Mellemkjoer
L
L
Blot
W J
WJ
McLaughlin
J K
JK
Tage-Jensen
U
U
Olsen
J H
JH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced*; D005938:Glucocorticoids / Q000009:adverse effects*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000009:adverse effects; D011241:Prednisone / Q000009:adverse effects; D012306:Risk
D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D011239:Prednisolone; D011241:Prednisone