Causes of death in patients with peptic ulcer perforation: A long-term follow-up study

Background: Survival is lower in ulcer perforation patients than in the gen eral population. This study assesses the causes of death in patients treate d for peptic ulcer perforation. Methods: Cause-specific mortality in a popu lation-based cohort of 817 patients treated for ulcer perforation in wester n Norway during the period 1962-1990 was compared with cause-specific popul ation death rates. Analyses were based on observed and expected mortality c urves for major causes of death and on standardized mortality rates (SMRs). Cox regression models were used to analyse possible differences on the bas is of sex, birth cohort, surgical procedure, and ulcer location. Results: U lcer perforation patients experienced increased mortality from neoplasms (S MR = 1.8; 95 % confidence interval (CI) = 1.4-2.1), lung cancer (SMR = 3.6; 95 % CI=2.3-4.9), circulatory diseases (SMR =1.3; 95 % CI = 1.1-1.6), isch aemic heart disease (SMR = 1.3; 95 % CI = 1.03-1.6), and respiratory diseas es (SMR = 1.9; 95% CI = 1.3-2.6). Postoperative deaths accounted for 38 % o f all excess deaths. Death from recurrent peptic ulcer was increased also i n subjects who survived the 1st year after the perforation (SMR = 5.8; 95% CI = 1.2-10.4) but accounted for only a few deaths. The increase in mortali ty from lung cancer was higher in subjects born after 1910 than in patients of older generations. Excess mortality from lung cancer and from circulato ry diseases was higher in male than in female patients. Conclusions: Increa sed mortality in ulcer perforation patients could mainly be attributed to s moking-related diseases. This is indirect evidence that smoking may be an i mportant aetiologic factor for ulcer perforation.