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Cross-National Changes in the Effects of Peptic Ulcer Disease

Bernard S. Bloom, PhD
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Requests for Reprints: Bernard S. Bloom, PhD, University of Pennsylvania, 2L, Nursing Education Building, Philadelphia, PA 19104-6020.

Current Author Address: Dr. Bloom: University of Pennsylvania, 2L, Nursing Education Building, Philadelphia, PA 19104-6020.

©1991 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1991;114(7):558-562. doi:10.7326/0003-4819-114-7-558
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Objective: To describe and to analyze the changing effects of peptic ulcer disease over time.

Design: Variables relating to peptic ulcer disease from 1970-1986 were compared. The variables included rates of mortality, hospitalizations, operations, physician visits, and endoscopies, and the amount of disability-related loss of work and early retirement in six countries (Belgium, England and Wales, the Federal Republic of Germany, The Netherlands, Sweden, and the United States).

Measurements: Nonparametric epidemiologic time-trend analysis. Main Results: The historic, slow, declining trend in mortality and hospitalization rates continued. The rate of operations for peptic ulcer disease exhibited a large, one-time reduction, then returned to a parallel declining trend, but at a lower level. The rate of physician visits declined by 50%. The greatest changes were found in the rate of endoscopy use and in disability-related loss of work and early retirement, where increasing trends were quickly followed by decreasing trends. The elderly, especially women, generally did not share many of these benefits.

Conclusions: The effects of new interventions can be understood more fully by examining several variables in many countries over a long time. Contrary to expectations, the effects of the widespread use of histamine H2 antagonists have been more indirect (affecting work loss and disability retirement more) than direct (affecting high-cost medical service use and mortality less).


peptic ulcer





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