TIME TRENDS IN PEPTIC-ULCER DISEASE AND IN GASTRITIS AND DUODENITIS -MORTALITY, UTILIZATION, AND DISABILITY IN THE UNITED-STATES

This study compared the results of two analytic methods testing the ef fects of histamine H-2 receptor antagonists on acid-related conditions . We examined the rates of peptic ulcer disease-related and of gastrit is- and duodenitis-related mortality, hospitalizations, surgery, physi cian visits, work-loss, and disability retirements in the United State s from 1970 to 1986. First, we performed a nonparametric epidemiologic analysis. For mortality, hospitalizations, and surgeries, age-specifi c rates continued their historic decline; there was an additional larg e one-time decline of operations in 1978. Trends were stronger for pep tic ulcer than for gastritis and duodenitis. From pooled annual data, rates of physician visits and physician referral declined for peptic u lcer and for gastritis and duodenitis in the post-1977 period (p = 0.0 001). Work-loss and other restrictions on normal daily activities also declined for persons with peptic ulcer and with gastritis and duodeni tis (p = 0.0001). Second, we fit a parametric model by maximum likelih ood to test specific population effects of H-2 blockers. The model ind icated that people greater-than-or-equal-to 65 years old had increasin g peptic ulcer mortality rates after 1977 (p < 0.001), while people < 65 years old had a deceleration in rates of decline (p < 0.01). Hospit alization rates for peptic ulcer and for gastritis and duodenitis incr eased in the elderly after 1977 (p < 0.01) and decreased among those < 65 years old. Both age groups experienced similar declining trends of operations for peptic ulcer; these were not significantly different w hen pre- and post-1977 periods were compared. The rate of disability r etirement declined sharply for workers greater-than-or-equal-to 50 yea rs old (p < 0.01) and for those < 50 years of age (p < 0.001). The inc onclusive results of the parametric analysis, plus only partial congru ence between parametric and nonparametric analyses, emphasize the diff iculty of relating diverse effects over time to a single, new, more ef fective treatment.