Volume 49, Issue 2 p. 126-133

Risk Factors for Hospitalized Gastrointestinal Bleeding Among Older Persons

Robert C. Kaplan PhD

Robert C. Kaplan PhD

Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine;

Cardiovascular Health Research Unit,

Departments of Epidemiology,

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Susan R. Heckbert MD, PhD

Susan R. Heckbert MD, PhD

Cardiovascular Health Research Unit,

Departments of Epidemiology,

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Thomas D. Koepsell MD, MPH

Thomas D. Koepsell MD, MPH

Cardiovascular Health Research Unit,

Departments of Epidemiology,

Medicine, and

Health Services, University of Washington;

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Curt D. Furberg MD, PhD

Curt D. Furberg MD, PhD

Department of Public Health Sciences, Wake Forest University School of Medicine;

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Joseph F. Polak MD, MPH

Joseph F. Polak MD, MPH

Department of Radiology, Brigham and Women's Hospital, Harvard University; and

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Robert E. Schoen MD, MPH

Robert E. Schoen MD, MPH

Division of Gastroenterology and Hepatology and Department of Epidemiology, University of Pittsburgh.

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Bruce M. Psaty MD, PhD

Bruce M. Psaty MD, PhD

Cardiovascular Health Research Unit,

Departments of Epidemiology,

Medicine, and

Health Services, University of Washington;

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For The Cardiovascular Health Study Investigators

For The Cardiovascular Health Study Investigators

A complete list of investigators is included at the end of this manuscript.

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First published: 21 December 2001
Citations: 75
Address correspondence to Robert C. Kaplan, PhD, Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Belfer Building, Room 1308C, Bronx, NY 10461.

Abstract

OBJECTIVES: We sought to estimate the incidence of hospitalization for upper and lower gastrointestinal bleeding among older persons and to identify independent risk factors.

DESIGN: Prospective cohort study.

SETTING: The Cardiovascular Health Study (CHS).

PARTICIPANTS: 5888 noninstitutionalized men and women age 65 years or older in four U.S. communities enrolled in the CHS.

MEASUREMENTS: Gastrointestinal bleeding events during the period 1989 through 1998 were identified using hospital discharge diagnosis codes and confirmed by medical records review. Risk-factor information was collected in a standardized fashion at study baseline and annually during follow-up.

RESULTS: Among CHS participants (mean baseline age 73.3 years, 42% male), the incidence of hospitalized gastrointestinal bleeding was 6.8/1000 person-years. In multivariate analyses, advanced age, male sex, unmarried status, cardiovascular disease, difficulty with daily activities, use of multiple medications, and use of oral anticoagulants were independent risk factors. Compared with nonsmokers, subjects who smoked more than half a pack per day had a multivariate-adjusted hazard ratio (HR) of 2.14 (95% confidence interval [CI] = 1.22–3.75) for upper gastrointestinal bleeding and a multivariate-adjusted HR of 0.21 (95% CI = 0.03–1.54) for lower gastrointestinal bleeding. Aspirin users did not have an elevated risk of upper gastrointestinal bleeding (HR = 0.76, 95% CI = 0.52–1.11), and users of other nonsteroidal anti-inflammatory drugs had a HR of 1.54 (95 % CI = 0.99–2.36). Low ankle-arm systolic blood pressure index was associated with higher risk of gastrointestinal bleeding among subjects with clinical cardiovascular disease but not among those without clinical cardiovascular disease.

CONCLUSION: This study identifies risk factors for gastrointestinal bleeding, such as disability, that may be amenable to modification. The findings will help clinicians to identify older persons who are at high risk for gastrointestinal bleeding.