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Nonsteroidal Anti-Inflammatory Drug Use and Death from Peptic Ulcer in Elderly Persons

Marie R. Griffin, MD, MPH; Wayne A. Ray, PhD; and William Schaffner, MD
[+] Article, Author, and Disclosure Information

Grant Support: Partial support by grant FD-U-000073 from the Food and Drug Administration; and grants HHS HS05179 and BRSG RR-05424from the National Center for Health Services Research. Drs. Griffin and Ray are Burroughs Wellcome Scholars in Pharmacoepidemiology.

Requests for Reprints: Marie R. Griffin, MD, Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232.

Current Author Addresses: Drs. Griffin, Ray, and Schaffner: Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232.

© 1988 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1988;109(5):359-363. doi:10.7326/0003-4819-109-5-359
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Study Objective: To determine the association between current non-aspirin nonsteroidal anti-inflammatory drug (NSAID) use and fatal peptic ulcers or upper gastrointestinal hemorrhage.

Design: Nested case control study using a linked Medicaid-death certificate database.

Setting: Tennessee Medicaid enrollees aged 60 and greater from 1976 to 1984.

Patients: One hundred twenty-two patients, "the cases," had a terminal hospitalization and a peptic ulcer or upper gastrointestinal hemorrhage confirmed by hospital chart review. Population controls (n = 3897) were matched to potential cases by age, sex, race, calendar year, and nursing home status.

Measurements and Main Results: "Cases" more frequently filled a prescription for an NSAID within 30 days before onset of illness than controls (34% compared with 11%; adjusted odds ratio, 4. 7; 95% CI, 3.1 to 7.2). This association between fatal ulcer disease and current NSAID use was consistent in three age groups, women and men, whites and nonwhites, and community and nursing home dwellers. There was no significant association between case status and previous NSAID use (adjusted odds ratio, 1.9; 95% CI, 0.7 to 4.7).

Conclusions: The findings of this study add to the growing evidence that NSAIDs can increase the risk for clinically serious peptic ulcer disease in the elderly.





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