title: Reductions in 28-day mortality following hospital admission for upper gastrointestinal hemorrhage.
abstract: OBJECTIVE
  It is unclear whether mortality from upper gastrointestinal hemorrhage is changing: any differences observed might result from changes in age or comorbidity of patient populations. We estimated trends in 28-day mortality in England following hospital admission for gastrointestinal hemorrhage.
  
  
  METHODS
  We used a case-control study design to analyze data from all adults administered to a National Health Service hospital, for upper gastrointestinal hemorrhage, from 1999 to 2007 (n=516,153). Cases were deaths within 28 days of admission (n=74,992), and controls were survivors to 28 days. The 28-day mortality was derived from the linked national death register. A logistic regression model was used to adjust trends in nonvariceal and variceal hemorrhage mortality for age, sex, and comorbidities and to investigate potential interactions.
  
  
  RESULTS
  During the study period, the unadjusted, overall, 28-day mortality following nonvariceal hemorrhage was reduced from 14.7% to 13.1% (unadjusted odds ratio, 0.87; 95% confidence interval: 0.84-0.90). The mortality following variceal hemorrhage was reduced from 24.6% to 20.9% (unadjusted odds ratio, 0.8; 95% confidence interval: 0.69-0.95). Adjustments for age and comorbidity partly accounted for the observed trends in mortality. Different mortality trends were identified for different age groups following nonvariceal hemorrhage.
  
  
  CONCLUSIONS
  The 28-day mortality in England following both nonvariceal and variceal upper gastrointestinal hemorrhage decreased from 1999 to 2007, and the reduction had been partly obscured by changes in patient age and comorbidities. Our findings indicate that the overall management of bleeding has improved within the first 4 weeks of admission.
authors: Division of Epidemiology and Public Health, The University of Nottingham, Nottingham City Hospital, Nottingham, United Kingdom. colincrooks@doctors.org.uk
authors: Colin
authors: C
authors: Crooks
authors: Tim
authors: T
authors: Card
authors: Joe
authors: J
authors: West
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015897:Comorbidity; D004739:England / Q000453:epidemiology; D004932:Esophageal and Gastric Varices / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013222:State Medicine; D013997:Time Factors; D016896:Treatment Outcome