A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal antiinflammatory drug use.
BACKGROUND
The worst outcome of gastrointestinal complications is death. Data regarding those associated with nonsteroidal antiinflammatory drug (NSAID) or aspirin use are scarce.


OBJECTIVE
To determine mortality associated with hospital admission due to major gastrointestinal (GI) events and NSAID/aspirin use.


METHODS
The study was based on actual count of deaths from two different data sets from 2001. Study 1 was carried out in 26 general hospitals serving 7,901,198 people. Study 2 used a database from 197 general hospitals, representative of the 269 hospitals in the Spanish National Health System. Information regarding gastrointestinal complications and deaths was obtained throughout the Minimum Basic Data Set (CIE-9-MC) provided by participating hospitals. Deaths attributed to NSAID/aspirin use were estimated on the basis of prospectively collected data from hospitals of study 1.


RESULTS
The incidence of hospital admission due to major GI events of the entire (upper and lower) gastrointestinal tract was 121.9 events/100,000 persons/year, but those related to the upper GI tract were six times more frequent. Mortality rate was 5.57% (95% CI = 4.9-6.7), and 5.62% (95% CI = 4.8-6.8) in study 1 and study 2, respectively. Death rate attributed to NSAID/aspirin use was between 21.0 and 24.8 cases/million people, respectively, or 15.3 deaths/100,000 NSAID/aspirin users. Up to one-third of all NSAID/aspirin deaths can be attributed to low-dose aspirin use.


CONCLUSIONS
Mortality rates associated with either major upper or lower GI events are similar but upper GI events were more frequent. Deaths attributed to NSAID/ASA use were high but previous reports may have provided an overestimate and one-third of them can be due to low-dose aspirin use.
Lanas
Angel
A
Servicio de Aparato Digestivo, Hospital Clínico Zaragoza, Zaragoza, Spain.
Perez-Aisa
Maria Angeles
MA
Feu
Faust
F
Ponce
Julio
J
Saperas
Esteban
E
Santolaria
Santos
S
Rodrigo
Luis
L
Balanzo
Joaquim
J
Bajador
Eduardo
E
Almela
Pedro
P
Navarro
Jose M
JM
Carballo
Fernando
F
Castro
Manuel
M
Quintero
Enrique
E
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality*; D006471:Gastrointestinal Hemorrhage / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D013030:Spain / Q000453:epidemiology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin