title: Chronic obstructive pulmonary disease: an independent risk factor for peptic ulcer bleeding: a nationwide population-based study.
abstract: BACKGROUND
  Peptic ulcer bleeding remains a major healthcare problem despite decreasing prevalence of peptic ulcer disease. The role of chronic obstructive pulmonary disease (COPD) in the risk of peptic ulcer bleeding has not yet been established.
  
  
  OBJECTIVE
  To determine if COPD patients have a higher risk of peptic ulcer bleeding than the general population and to identify the risk factors of peptic ulcer bleeding in COPD patients.
  
  
  METHODS
  From Taiwan's National Health Insurance research database, 62,876 patients, including 32,682 COPD and 30,194 age-gender-matched non-COPD controls, were recruited. Cox proportional hazard regression was performed to evaluate independent risk factors for ulcer bleeding in all patients and to identify risk factors in COPD patients.
  
  
  RESULTS
  During the 8-year follow-up, COPD patients had a significant higher rate of peptic ulcer bleeding than the control group (P < 0.001, by log-rank test). By Cox proportional hazard regression analysis, COPD [hazard ratio (HR) 1.93, 95% CI 1.73-2.17] was an independent risk factor after adjusting for age, gender, underlying comorbidities and ulcerogenic medication. Age > 65 years, male, comorbidities of hypertension, diabetes, heart failure, history of peptic ulcer disease, and chronic renal disease and use of nonsteroidal anti-inflammatory drugs were risk factors of ulcer bleeding in COPD patients.
  
  
  CONCLUSIONS
  Patients with chronic obstructive pulmonary disease have a higher risk of peptic ulcer bleeding after adjustments for possible confounding factors like underlying comorbidities and ulcerogenic medication.
authors.affiliation: Department of Medicine, National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: K-W
authors.initials: KW
authors.lastname: Huang
authors.forename: J-C
authors.initials: JC
authors.lastname: Luo
authors.forename: H-B
authors.initials: HB
authors.lastname: Leu
authors.forename: H-C
authors.initials: HC
authors.lastname: Lin
authors.forename: F-Y
authors.initials: FY
authors.lastname: Lee
authors.forename: W-L
authors.initials: WL
authors.lastname: Chan
authors.forename: S-J
authors.initials: SJ
authors.lastname: Lin
authors.forename: J-W
authors.initials: JW
authors.lastname: Chen
authors.forename: F-Y
authors.initials: FY
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology