Risk factors for hospitalized gastrointestinal bleeding among older persons

OBJECTIVES: We sought to estimate the incidence of hospitalization for uppe r and lower gastrointestinal bleeding among older persons and to identify i ndependent 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 throu gh 2998 were identified using hospital discharge diagnosis codes and confir med by medical records review. Risk-factor information was collected in a s tandardized fashion at study baseline and annually during follow-up. RESULTS: Among CHS participants (mean baseline age 73.3 years, 42% male), t he 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 m edications, and use of oral anticoagulants were independent risk factors. C ompared with nonsmokers, subjects who smoked more than half a pack per day had a multivariate-adjusted hazard ratio (HR) of 2.14 (95% confidence inter val [CI] = 1.22-3.75) for upper gastrointestinal bleeding and a multivariar e-adjusted HR of 0.21 (95% CI = 0.03-1.54) for lower gastrointestinal bleed ing. 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 a nti-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 gastroint estinal bleeding among subjects with clinical cardiovascular disease but no t among those without clinical cardiovascular disease. CONCLUSION: This study identifies risk factors for gastrointestinal bleedin g, such as disability, that may be amenable to modification. The findings w ill help clinicians to identify older persons who are at high risk for gast rointestinal bleeding.