Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2016; 22(48): 10643-10652
Published online Dec 28, 2016. doi: 10.3748/wjg.v22.i48.10643
Prevalence of upper gastrointestinal bleeding risk factors among the general population and osteoarthritis patients
Sang Hyuck Kim, Jae Moon Yun, Chong Bum Chang, Heng Piao, Su Jong Yu, Dong Wook Shin
Sang Hyuck Kim, Jae Moon Yun, Dong Wook Shin, Department of Family Medicine, Seoul National University Hospital, Seoul 03080, South Korea
Chong Bum Chang, Department of Orthopedic Surgery, Seoul Municipal Government-Seoul National University Boramae Medical Center, Seoul 03080, South Korea
Heng Piao, Department of Family Medicine, Graduate School, Seoul National University, Seoul 03080, South Korea
Su Jong Yu, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
Author contributions: All authors contributed to this work; Kim SH had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of data analysis; Kim SH, Yun JM, Shin DW concepted and designed this study; Kim SH, Yun JM, Shin DW, Piao PH acquisited data; all authors analysis data, or interpretation; all authors preparated and approved this manuscript.
Supported by Pfizer Pharmaceutical Korea Ltd, No. A3191378.
Institutional review board statement: This study was approved by the institutional review board of Seoul National University Hospital, No. E-1508-002-689.
Informed consent statement: As this study was an observational study and we used data from the public repository (National Health Insurance Service Sharing Service, https://nhiss.nhis.or.kr/bd/ay/bdaya001iv.do;jsessionid=3xOUDsw6a2QK3ySYMpQ89I3lkGUasr6famrJXqsPHnXUv5ZSQHwSrTY3jZiuZLPh.primrose2_servlet_engine1), informed consent was exempted (IRB No. E-1508-002-689).
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author from email of DW Shin (dwshin.snuh@gmail.com). The presented data are anonymized and risk of identification is low. As the data is owned to the National Health Insurance, institutional approval must precede before providing the dataset.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dong Wook Shin, MD, DrPH, MBA, Department of Family Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea. dwshin.snuh@gmail.com
Telephone: +82-2-20720847 Fax: +82-2-7663276
Received: August 4, 2016
Peer-review started: August 5, 2016
First decision: September 12, 2016
Revised: October 13, 2016
Accepted: October 30, 2016
Article in press: October 31, 2016
Published online: December 28, 2016
Processing time: 144 Days and 8.4 Hours
Abstract
AIM

To assess the prevalence of possible risk factors of upper gastrointestinal bleeding (UGIB) and their age-group specific trend among the general population and osteoarthritis patients.

METHODS

We utilized data from the National Health Insurance Service that included claims data and results of the national health check-up program. Comorbid conditions (peptic ulcer, diabetes, liver disease, chronic renal failure, and gastroesophageal reflux disease), concomitant drugs (aspirin, clopidogrel, cilostazol, non-steroidal anti-inflammatory drugs, steroid, anticoagulants, and SSRI), personal habits (smoking, and alcohol consumption) were considered as possible UGIB risk factors. We randomly imputed the prevalence of infection in the data considering the age-specific prevalence of Helicobacter pylori (H. pylori) infection in Korea. The prevalence of various UGIB risk factors and the age-group specific trend of the prevalence were identified. Prevalence was compared between osteoarthritis patients and others.

RESULTS

A total of 801926 subjects (93855 osteoarthritis patients) aged 20 and above were included. The prevalence of individual and concurrent multiple risk factors became higher as the age increased. The prevalence of each comorbid condition and concomitant drug were higher in osteoarthritis patients. Thirty-five point zero two percent of the overall population and 68.50% of osteoarthritis patients had at least one or more risk factors of UGIB. The prevalence of individual and concurrent multiple risk factors in younger age groups were also substantial. Furthermore, when personal habits (smoking, and alcohol consumption) and H. pylori infection were included, the prevalence of concurrent multiple risk factors increased greatly even in younger age groups.

CONCLUSION

Prevalence of UGIB risk factors was high in elderly population, but was also considerable in younger population. Patient with osteoarthritis was at higher UGIB risk than those without osteoarthritis. Physicians should consider individualized risk assessment regardless of age when prescribing drugs or performing procedures that may increase the risk of UGIB, and take necessary measures to reduce modifiable risk factors such as H. pylori eradication or lifestyle counseling.

Keywords: Upper gastrointestinal bleeding; Prevalence; Risk factor; General population; Osteoarthritis

Core tip: This study identified the prevalence of various upper gastrointestinal bleeding (UGIB) risk factors and the age-group specific trend of the prevalence in general population and osteoarthritis patients using large population representative data. Considering the age-group specific trend of the prevalence of UGIB risk factors, physicians should consider individualized risk assessment regardless of age when prescribing drugs or performing procedures that predispose to UGIB. Additionally, subjects with high risk should control modifiable UGIB risk factors.