Gastroenterology

Gastroenterology

Volume 132, Issue 7, June 2007, Pages 2320-2327
Gastroenterology

Clinical–alimentary tract
Time Trends of Ulcer Mortality in Europe

https://doi.org/10.1053/j.gastro.2007.03.108Get rights and content

Background & Aims: The aim of the present study was to follow the time trends of ulcer disease in a representative sample of European countries and assess whether the most recent behavior of peptic ulcer still fits the overall pattern governed by an underlying birth-cohort phenomenon. Methods: Mortality data from 6 countries between 1921 and 2004 were analyzed, including Denmark, France, Germany, The Netherlands, Spain, and Switzerland. The age-specific death rates of gastric and duodenal ulcers from each individual country were plotted as period-age and cohort-age contours. Results: The data from the past 50–80 years show striking similarities among the 6 European countries. In all countries alike, the risk of dying from gastric and duodenal ulcer increased among consecutive generations born during the second half of the 19th century until shortly before the turn of the century, and then decreased in all subsequent generations. The time trends of gastric ulcer preceded those of duodenal ulcer by 10–30 years. The increase in nonsteroidal anti-inflammatory drug consumption or introduction of potent antisecretory medications have not affected the long-term downward trends of ulcer mortality. The birth-cohort pattern has continued to influence the temporal variations of peptic ulcer until most recently. Conclusions: The unique shape of the birth-cohort patterns of gastric and duodenal ulcers and their identical appearance in countries with different health care systems and varying political and socioeconomic histories reflect the overriding influence of Helicobacter pylori infection.

Section snippets

Data Sources

Initially, mortality data from 16 different European countries were analyzed. The present analysis was restricted to 6 exemplary countries listed in Table 1. Three countries were chosen because their vital statistics regarding peptic ulcer covered a time period of more than 70 years (Denmark, The Netherlands, and Switzerland). Three other countries (France, Germany, and Spain) were chosen because of their large population size and large number of ulcer cases. Data from other European countries

Results

Figure 1 shows the period-age contours of mortality from gastric ulcer among the 6 countries. In general, mortality is much higher among the older than among the younger age groups. With the exception of Switzerland, the same line patterns in different countries refer to the same age groups. To present the time trends of all age groups in a single graph, a logarithmic y-axis is chosen. In all countries alike, the period-age contours of gastric ulcer mortality appear to be arranged in a fan-like

Discussion

The present study analyzed the birth-cohort patterns of mortality from gastric and duodenal ulcers in 6 exemplary European countries. The first aim of the study was to assess the ubiquity and similarity of the birth-cohort patterns among different countries. The second aim was to determine the latest trends of ulcer disease and assess the influence of the most recent data on the overall pattern. The analysis reveals that a birth-cohort pattern has continued to influence the temporal variations

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