Incidence of upper gastrointestinal haemorrhage in <scp>M</scp>aori and <scp>N</scp>ew <scp>Z</scp>ealand <scp>E</scp>uropean ethnic groups, 2001–2010

Irwin, James; Ferguson, Robert; Weilert, Frank; Smith, Anthony C.

doi:10.1111/imj.12489

Cited by 9 publications

(6 citation statements)

References 26 publications

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“…Compared with the present study, the incidence rates of upper GIB in the United States (from 1998 to 2006) were higher at between 1.46 and 1.70 per 1000 person-years and were comparable to those of Spain (from 1996 to 2005), which ranged from 0.47 to 0.87 per 1000 person-years . Furthermore, similar to the present study, these studies showed decreased or stable incidence of upper GIB over the years, a higher incidence in men than in women, and increased incidence with age . Few studies that reported the incidence of lower GIB in the general population showed that the rates in the United States (1998-2006), Spain (1996-2005), and Italy (2001-2010) were about half of the rate reported in our study .…”

Section: Discussionsupporting

confidence: 68%

“…Downloaded From: https://jamanetwork.com/ on 10/31/2020 incidence with age. 2,[11][12][13]25,26 Few studies that reported the incidence of lower GIB in the general population showed that the rates in the United States (1998States ( -2006, Spain (1996Spain ( -2005, and Italy (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) were about half of the rate reported in our study. [10][11][12] Similar to this study, previous studies [10][11][12] reported a slight increasing trend in the incidence of lower GIB or complications.…”

Section: Discussionmentioning

confidence: 75%

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Thirty-Year Incidence and Mortality Trends in Upper and Lower Gastrointestinal Bleeding in Finland

et al. 2020

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IMPORTANCE Epidemiological data on lower gastrointestinal bleeding (GIB) in the general population are sparse. OBJECTIVE To describe the incidence, recurrence, mortality, and case fatality rates of major upper GIB and lower GIB in the general population of Finland between 1987 and 2016. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study used data from the 1987 to the 2012 cycles of the National FINRISK Study, a health examination survey that was conducted every 5 years in Finland. Survey participants were adults aged 25 to 74 years who were recruited from a population register by random sampling; those with a history of hospitalization for GIB were excluded. Participants were followed up from survey enrollment to onset of GIB that led to hospitalization, death from any cause, or study end (December 31, 2016). Follow-up was performed through linkage with national electronic health registers. Data were analyzed from February 1, 2019, to January 31, 2020. MAIN OUTCOMES AND MEASURES Incidence, recurrence, mortality, and case fatality rates for all, upper, lower, and unspecified GIB. Outcome measures were stratified by sex and age group. RESULTS Among the 39 054 participants included in the study, 494 (1.3%) experienced upper GIB (321 men [65.0%]; mean [SD] age, 52.8 [12.1] years) and 645 (1.7%) had lower GIB (371 men [57.5%]; mean [SD] age, 54.0 [11.7] years). The age-standardized incidence rate was 0.94 per 1000 personyears (95% CI, 0.85-1.04) for upper GIB and 1.26 per 1000 person-years (95% CI, 1.15-1.38) for lower GIB; the incidence was higher in men than in women. Between 1987 and 2016 the incidence rate of upper GIB remained mostly stable, ranging from 0.40 to 0.66 per 1000 person-years, whereas constant increases occurred in the incidence of lower GIB until the rate stabilized. The proportion of recurrent GIB events showed an increasing trend from 1987 to 2016. The upper GIB-specific mortality was higher (0.07 per 1000 person-years; 95% CI, 0.04-0.09) than the lower GIB-specific mortality (0.01 per 1000 person-years; 95% CI, 0.001-0.03). Case fatality was high for those with upper GIB (7.0%; 95% CI, 4.7-10.1) compared with those with lower GIB (0.4%; 95% CI, 0.1-1.3). Case fatality remained stable over the years but was higher in men (between 5% and 10%) than women (<2%) with GIB. CONCLUSIONS AND RELEVANCE This study found that the overall incidence rate of upper GIB was lower than the incidence of lower GIB, but the recurrence, mortality, and 28-day case fatality were higher in participants with upper GIB. These data can serve as a reference when putting into context the rates of drug-associated GIB and can inform efforts to improve GIB care and outcome and to prevent rebleeding or death for patients with major GIB.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 75%

Thirty-Year Incidence and Mortality Trends in Upper and Lower Gastrointestinal Bleeding in Finland

et al. 2020

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“…Our ndings are largely consistent with those of other New Zealand (13)(14)(15) and international (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) studies that have also found higher rates of major bleeds (total, gastrointestinal or intracranial) in non-Whites compared with Whites and with increasing socioeconomic deprivation. In these studies, populations were not de ned according to their history of CVD and AF, and there was adjustment for a limited number of variables, if any.…”

Section: Discussionsupporting

confidence: 90%

Risk of Major Bleeding by Ethnicity and Socioeconomic Deprivation among 488,107 People in Primary Care: A Cohort Study

Tse

Grey

Harwood

et al. 2021

Preprint

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Background: Antithrombotic medications (antiplatelets and anticoagulants) reduce the risk of cardiovascular disease (CVD), but with the disadvantage of increasing bleeding risk. Ethnicity and socioeconomic deprivation are independent predictors of major bleeds among patients without CVD, but it is unclear whether they are also predictors of major bleeds among patients with CVD or atrial fibrillation (AF) after adjustment for clinical variables. Methods: Prospective cohort study of 488,107 people in New Zealand Primary Care (including 64,420 Māori, the indigenous people of New Zealand) aged 30-79 years who had their CVD risk assessed between 2007 and 2016. Participants were divided into three mutually exclusive subgroups: (1) AF with or without CVD (n=15,212), (2) CVD and no AF (n=43,790), (3) no CVD or AF (n=429,105). Adjusted hazards ratios (adjHRs) were estimated from Cox proportional hazards models predicting major bleeding risk for each of the three subgroups to determine whether ethnicity and socioeconomic deprivation are independent predictors of major bleeds in different cardiovascular risk groups. Results: In all three subgroups (AF, CVD, no CVD/AF), Māori (adjHR 1.63 [1.39-1.91], 1.24 [1.09-1.42], 1.57 [95% CI 1.45-1.70], respectively), Pacific people (adjHR 1.90 [1.58-2.28], 1.30 [1.12-1.51], 1.62 [95% CI 1.49-1.75], respectively) and Chinese people (adjHR 1.53 [1.08-2.16], 1.15 [0.90-1.47], 1.13 [95% CI 1.01-1.26], respectively) were at increased risk of a major bleed compared to Europeans, although for Chinese people the effect did not reach statistical significance in the CVD subgroup. Compared to Europeans, Māori and Pacific peoples were generally at increased risk of all bleed types (gastrointestinal, intracranial and other bleeds). An increased risk of intracranial bleeds was observed among Chinese and Other Asian people and, in the CVD and no CVD/AF subgroups, among Indian people. Increasing socioeconomic deprivation was also associated with increased risk of a major bleed in all three subgroups (adjHR 1.07 [95% CI 1.02-1.12, 1.07 [1.03-1.10], 1.10 [1.08-1.12], respectively, for each increase in socioeconomic deprivation quintile). Conclusion: Ethnicity and socioeconomic status should be considered in bleeding risk assessments to guide the use of antithrombotic medication for the management of AF and CVD. Primary Funding Source: The Health Research Council of New Zealand

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“…3,24,[36][37][38][39] The variability in incidence rates is mainly caused by the variance of methodology used in diagnosing UGIB. However, despite this limitation, the information corroborates decreasing incidence of UGIB all over the world.…”

Section: Worldwide/regional Incidencementioning

confidence: 99%

Epidemiology and Risk Factors for Upper Gastrointestinal Bleeding

Tielleman

Bujanda

Cryer³

2015

Gastrointestinal Endoscopy Clinics of North America

121

101

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Incidence of upper gastrointestinal haemorrhage in Maori and New Zealand European ethnic groups, 2001–2010

Abstract: AAI of UGIH in the Waikato region was 46.4. This was significantly higher in Maori and in males, and decreased over the study period. These data will provide a comparison for future assessment of trends in UGIH.

Cited by 9 publications

References 26 publications

Thirty-Year Incidence and Mortality Trends in Upper and Lower Gastrointestinal Bleeding in Finland

Thirty-Year Incidence and Mortality Trends in Upper and Lower Gastrointestinal Bleeding in Finland

Risk of Major Bleeding by Ethnicity and Socioeconomic Deprivation among 488,107 People in Primary Care: A Cohort Study

Epidemiology and Risk Factors for Upper Gastrointestinal Bleeding

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