Seasonal Impacts on the Incidence of Esophageal Variceal Hemorrhage: A Nationwide Analysis across a Decade

Abstract

Background/Aims: Seasonal variation has previously been reported in relation to the incidence of non-variceal upper gastrointestinal bleeding; however, the impact of seasonal variation on variceal bleeding is not known. Methods: We conducted a cross-sectional study using the Nationwide Inpatient Sample database from 2005 to 2014. International Classification of Diseases, Clinical Modification-9th Revision codes were used to identify patients hospitalized with a primary or secondary diagnosis of esophageal variceal hemorrhage. The data were analyzed based on the month of hospitalization. Our primary aim was to assess seasonal variations in variceal bleeding-related hospitalizations. The secondary aims were to assess the impact of seasonal variation on outcomes in variceal bleeding including in-hospital mortality and healthcare resource utilization. Results: A total of 348,958 patients hospitalized with esophageal variceal bleeding were included. The highest number of hospitalizations was reported in December (99.3/day) and the lowest was reported in June (90.8/day). In-hospital mortality was highest in January (11.5%) and lowest in June (9.8%). There was no significant difference in hospital length of stay or total hospitalization costs across all months in all years combined. Conclusions: There appears to be a seasonal variation in the incidence and mortality of variceal hemorrhage in the United States. December was the month with the highest number of daily hospitalizations while the nadir occurred in June.

Establishment and Evaluation of a Time Series Model for Predicting the Seasonality of Acute Upper Gastrointestinal Bleeding

“…12 A study that includes 348,958 patients hospitalized with esophagogastric variceal bleeding over the past decade in the USA also has reached a similar conclusion, that is, there are seasonal changes in the incidence and mortality of variceal bleeding. 13 December is the month with the highest number of daily hospitalizations, and June is the lowest one. These studies mostly use correlation analysis and multivariate logistic regression.…”

Seasonal variation in acute variceal upper gastrointestinal tract bleeding: Experience of one decade from Northern India

“…10 Besides these factors, seasonal variation in variceal bleeding has been reported in number of studies with majority of them showing higher frequency of gastrointestinal bleed in winter season. [11][12][13][14] Although some literature has refuted any seasonal variation in gastrointestinal bleed. 15,16 Siddiqui MT et al, 11 reported a higher frequency of variceal bleeding in December (8.8%) and January (8.7%) compared to a nadir in June (7.8%).…”

“…[11][12][13][14] Although some literature has refuted any seasonal variation in gastrointestinal bleed. 15,16 Siddiqui MT et al, 11 reported a higher frequency of variceal bleeding in December (8.8%) and January (8.7%) compared to a nadir in June (7.8%). A retrospective data from Israel 12 found peak incidence during winter season with significant p-values (= 0.02).…”

Are there Seasonal Variations in the Incidence and Mortality of Esophageal Variceal Bleeding?

“…In Siddiqui' s study, 8 the mortality from esophageal variceal bleeding was high in January. However, there are some limita-tions in the mortality analysis of this study.…”

“…6 A Korean study showed that the incidence of esophageal variceal bleeding was high in the spring (March and April) and low in the summer (July and August). 7 In this issue of Clinical Endoscopy, Siddiqui et al 8 showed that most hospitalization because of esophageal variceal bleeding occurred in December (99.3/day) and the least occurred in June (90.8/day) and that mortality was the highest in January (11.5%) and the lowest in June (9.8%). This study analyzed extensive data on seasonal incidence and mortality in 348,958 patients with esophageal variceal bleeding throughout the United States.…”