Birth-cohort analysis of peptic ulcer mortality in Europe.

The age- and sex-specific death rates of gastric and duodenal ulcer are followed in eight European countries over a period ranging from 30 to 60 yr. A cohort analysis demonstrates that the temporal changes of peptic ulcer mortality in the European countries seem to occur in a fashion characteristic of those due to changes in birth-cohort risks. Generations born at the end of the 19th century manifested a high risk of dying from gastric and duodenal ulcer. The birth-cohorts with a high risk for duodenal ulcer lagged 10-30 yr behind those with a high risk for gastric ulcer. Male and female cohorts with the highest risk were born at the same time. The birth-cohort phenomenon is most obvious in male death rates of gastric and duodenal ulcer. A birth-cohort phenomenon would imply that important determinants for the development of gastric and duodenal ulcer occur early in the life of a cohort and that it is these early determinants that are changing with time. The determinants could be environmental factors which interact with the pathophysiology of peptic ulcer from the outside.