title: Decreasing trend of upper gastrointestinal bleeding mortality risk over three decades.
abstract: BACKGROUND
  Upper gastrointestinal bleeding (UGIB) causes over $1 billion in medical expenses annually.
  
  
  OBJECTIVE
  The purpose of this study was to examine changes of UGIB mortality risks and trends over the last three decades.
  
  
  METHODS
  We analyzed the National Hospital Discharge Sample from 1979 to 2009. Patients with primary ICD-9 code representing a diagnosis of UGIB were included. The UGIB mortality risks and trends in each decade by anatomical sites, bleeding causes, comorbidities, and other important variables were analyzed.
  
  
  RESULTS
  UGIB mortality risk decreased by 35.4 % from 4.8 % in the first decade to 3.1 % in the third decade (P < 0.001). Age and number of hospitalization days were significant risk factors in all decades. Most significant decreases were observed in patients over 65 years and during the first day of admission. Gastric (P < 0.001) and esophageal (P = 0.018) bleedings showed significant decreasing mortality risk trends. Duodenal bleeding mortality risk was stable in three decades. Mortality risk declined significantly among patients with renal failure (from 50.0 to 4.0 %) and heart failure (from 17.9 to 5.2 %; both P < 0.001) while changes in cases with ischemic heart disease, cancer, and liver failure were less significant.
  
  
  CONCLUSIONS
  UGIB morality risks, especially of the first hospital day and geriatric patients, significantly decreased over the last three decades, presumably from recent advances in emergency medical care. Mortality risk of gastric, but not duodenal, bleeding had the most significant reduction. Critical care improvements in patients with various comorbidities may explain significant UGIB mortality risk reductions. This study provides invaluable insight into the causes and trends of UGIB mortality risks for future studies.
authors.affiliation: Department of Medicine, MedStar Washington Hospital Center, 110 Irving St, NW Suite 3A3-A7, Washington, DC, 20010-2975, USA.
authors.forename: Amir
authors.initials: A
authors.lastname: Taefi
authors.forename: Won Kyoo
authors.initials: WK
authors.lastname: Cho
authors.forename: Mehdi
authors.initials: M
authors.lastname: Nouraie
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D041742:Upper Gastrointestinal Tract / Q000503:physiopathology*