title: The excess long-term mortality in peptic ulcer bleeding is explained by nonspecific comorbidity.
abstract: OBJECTIVE
  Previous studies have concluded that peptic ulcer bleeding (PUB) is associated with increased long-term mortality. The underlying mechanism of this excess mortality is poorly understood. The aim of the present study was to examine if PUB patients have an increased long-term mortality compared to a matched control group when adjusting for comorbidity and socioeconomic status. Additionally, we identified predictive factors for mortality and examined causes of death.
  
  
  METHODS
  We performed an observational study, comparing consecutive patients admitted with PUB with a matched control cohort from the source population. Predictors of mortality were identified using proportional hazards models. Causes of death were retrieved from death certificates. Long-term mortality was analyzed with adjustment for Charlson comorbidity index (CCI) and average income in residence municipality using proportional hazards models.
  
  
  RESULTS
  We included 455 PUB cases and 2224 control subjects. Median follow up was 9.7 years, and median survival for the PUB and control cohorts was 7 and 12 years, respectively (p < 0.001). PUB patients had a higher level of comorbidity (mean CCI: 0.92 vs. 0.49; p < 0.0001). After adjustments, PUB patients had an excess mortality lasting at least 10 years after presentation. Age, comorbidity, male sex, anemia, and smoking were predictors for long-term mortality. The distribution of causes of death was similar in the two cohorts.
  
  
  CONCLUSIONS
  PUB patients have an increased long-term mortality that is explained by nonspecific comorbidity.
authors.affiliation: Department of Medical Gastroenterology, Odense University Hospital , Odense C , Denmark.
authors.forename: Stig Borbjerg
authors.initials: SB
authors.lastname: Laursen
authors.forename: Jane Møller
authors.initials: JM
authors.lastname: Hansen
authors.forename: Jesper
authors.initials: J
authors.lastname: Hallas
authors.forename: Ove B
authors.initials: OB
authors.lastname: Schaffalitzky de Muckadell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010437:Peptic Ulcer / Q000453:epidemiology*; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality*; D016016:Proportional Hazards Models; D012959:Socioeconomic Factors; D065227:Transfusion Reaction
keywords: mortality; peptic ulcer hemorrhage