Epidemiology, Bayer AG, Berlin, Germany.
Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilians Universität Munich, Munich, Germany.
JAMA Netw Open. 2020 Oct 1;3(10):e2020172. doi: 10.1001/jamanetworkopen.2020.20172.
Epidemiological data on lower gastrointestinal bleeding (GIB) in the general population are sparse.
To describe the incidence, recurrence, mortality, and case fatality rates of major upper GIB and lower GIB in the general population of Finland between 1987 and 2016.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study used data from the 1987 to the 2012 cycles of the National FINRISK Study, a health examination survey that was conducted every 5 years in Finland. Survey participants were adults aged 25 to 74 years who were recruited from a population register by random sampling; those with a history of hospitalization for GIB were excluded. Participants were followed up from survey enrollment to onset of GIB that led to hospitalization, death from any cause, or study end (December 31, 2016). Follow-up was performed through linkage with national electronic health registers. Data were analyzed from February 1, 2019, to January 31, 2020.
Incidence, recurrence, mortality, and case fatality rates for all, upper, lower, and unspecified GIB. Outcome measures were stratified by sex and age group.
Among the 39 054 participants included in the study, 494 (1.3%) experienced upper GIB (321 men [65.0%]; mean [SD] age, 52.8 [12.1] years) and 645 (1.7%) had lower GIB (371 men [57.5%]; mean [SD] age, 54.0 [11.7] years). The age-standardized incidence rate was 0.94 per 1000 person-years (95% CI, 0.85-1.04) for upper GIB and 1.26 per 1000 person-years (95% CI, 1.15-1.38) for lower GIB; the incidence was higher in men than in women. Between 1987 and 2016 the incidence rate of upper GIB remained mostly stable, ranging from 0.40 to 0.66 per 1000 person-years, whereas constant increases occurred in the incidence of lower GIB until the rate stabilized. The proportion of recurrent GIB events showed an increasing trend from 1987 to 2016. The upper GIB-specific mortality was higher (0.07 per 1000 person-years; 95% CI, 0.04-0.09) than the lower GIB-specific mortality (0.01 per 1000 person-years; 95% CI, 0.001-0.03). Case fatality was high for those with upper GIB (7.0%; 95% CI, 4.7-10.1) compared with those with lower GIB (0.4%; 95% CI, 0.1-1.3). Case fatality remained stable over the years but was higher in men (between 5% and 10%) than women (<2%) with GIB.
This study found that the overall incidence rate of upper GIB was lower than the incidence of lower GIB, but the recurrence, mortality, and 28-day case fatality were higher in participants with upper GIB. These data can serve as a reference when putting into context the rates of drug-associated GIB and can inform efforts to improve GIB care and outcome and to prevent rebleeding or death for patients with major GIB.
关于普通人群中下部胃肠道出血（GIB）的流行病学数据很少。
描述芬兰普通人群中 1987 年至 2016 年间主要上 GIB 和下 GIB 的发病率、复发率、死亡率和病死率。
设计、设置和参与者：本前瞻性队列研究使用了来自芬兰 1987 年至 2012 年全国 FINRISK 研究的连续数据，这是一项每 5 年在芬兰进行的健康检查调查。调查参与者为年龄在 25 至 74 岁之间的成年人，通过随机抽样从人口登记册中招募；排除了因 GIB 住院治疗的患者。参与者从调查登记开始，到导致住院的 GIB 发作、任何原因导致的死亡或研究结束（2016 年 12 月 31 日）为止进行随访。通过与国家电子健康记录的链接进行随访。数据分析于 2019 年 2 月 1 日至 2020 年 1 月 31 日进行。
所有、上、下和未特指 GIB 的发病率、复发率、死亡率和病死率。根据性别和年龄组分层了结局。
在纳入研究的 39054 名参与者中，494 名（1.3%）经历了上 GIB（321 名男性[65.0%]；平均[SD]年龄为 52.8[12.1]岁），645 名（1.7%）患有下 GIB（371 名男性[57.5%]；平均[SD]年龄为 54.0[11.7]岁）。上 GIB 的年龄标准化发病率为 0.94/1000 人年（95%CI，0.85-1.04），下 GIB 的发病率为 1.26/1000 人年（95%CI，1.15-1.38）；男性的发病率高于女性。1987 年至 2016 年间，上 GIB 的发病率基本保持稳定，范围在 0.40 至 0.66/1000 人年之间，而下 GIB 的发病率则持续上升，直到稳定。复发性 GIB 事件的比例从 1987 年到 2016 年呈上升趋势。上 GIB 的特异性死亡率（0.07/1000 人年；95%CI，0.04-0.09）高于下 GIB 的特异性死亡率（0.01/1000 人年；95%CI，0.001-0.03）。上 GIB 的病死率较高（7.0%；95%CI，4.7-10.1），而与下 GIB（0.4%；95%CI，0.1-1.3）相比，病死率较低。病死率多年来保持稳定，但男性（5%至 10%）的病死率高于女性（<2%）。
本研究发现，上 GIB 的总体发病率低于下 GIB，但上 GIB 患者的复发率、死亡率和 28 天病死率较高。这些数据可以作为药物相关 GIB 发生率的参考，并有助于改善 GIB 的治疗和预后，预防主要 GIB 患者再次出血或死亡。
