(92) Risk of Drug-Related Upper Gastrointestinal Bleeding in The Total Population of the Netherlands: A Time-Trend Analysis

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1137

Presenting Author(s)

Ajda Bedene, MPharm
– Leiden University Medical Center, Leiden University Medical Center, Leiden, Netherlands

Co-Author(s)

Eveline L.A. van Dorp, MD PhD
– Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands
Frits R. Rosendaal, MD PhD
– Head of the Department, Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
Albert Dahan, MD PhD
– Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands
Willem M. Lijfering, MD PhD
– Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands

Background: Many prescribed and over-the-counter medications, e.g., nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with upper gastrointestinal bleeding (UGIB).

Objectives: Recently, a decrease in prescribing of NSAIDs was observed in the Netherlands, but whether a similar decreasing trend could be observed in the incidence of severe UGIB (either fatal or requiring hospitalization), contingent on medication prescription, is unknown.

Methods: We conducted a cohort study using Dutch national statistics on pharmacy claims, hospitalization and mortality between 2013 and 2018. We explored the annual and biannual incidence of sex- and age-specific severe UGIB in four (sub)populations: A) total population, B) without filled NSAIDs prescriptions, C) without filled NSAIDs and antithrombotic agents, D) without any risk factors for UGIB. Next we compared the incidences by means of logistic regression where the calendar year of 2013 was considered a reference. Finally, we compared the risk of severe UGIB between women and men in different age groups and the proposed (sub)populations.

Results: The cumulative incidence of severe UGIB did not decrease throughout the study period, regardless of the subgroup analysis. In the total population, it was 199 per 100,000 inhabitants [95% confidence interval (CI), 197-201] in 2013-2014 and 260 [95% CI, 258-263] in 2017-2018. The absolute risk of severe UGIB was 50% lower in the subgroup B than in the full cohort. It decreased further by 50% in the subgroup D when compared to subgroup B. The risk of severe UGIB was 1.5-1.9-fold higher in young women than in young men; an indication of over-the-counter NSAIDs use being more prevalent in women than men in this age group.

Conclusions: We found no evidence to support the relationship between the prescribing of NSAIDs and the incidence of severe UGIB in the Netherlands since 2013. The relationship was not observed when we removed the effect of risk factors.