Risk of hospitalization resulting from upper gastrointestinal bleeding among patients taking corticosteroids: A register-based cohort study

PURPOSE: We assessed the risk of hospitalization for upper gastrointestinal bleeding among patients using systemic corticosteroids, accounting for the use of other drugs that may increase the risk of bleeding. SUBJECTS AND METHODS: We conducted a population-based cohort study in North Jutland County, Denmark. Data on the use of corticosteroids, nonsteroidal anti-inflammatory drugs, aspirin, and anticoagulants during 1991 to 1995 we re obtained from a countywide prescription database. All hospitalizations b ecause of upper gastrointestinal bleeding were identified through the Hospi tal Discharge Registry. The observed numbers of patients with gastrointesti nal bleeding in various exposure categories among corticosteroid users were compared with the expected number based on the North Jutland population wh o did not receive prescriptions for any of the drugs under study. RESULTS: A total of 45,980 patients accrued 18,379 person-years of corticos teroid use. There were 109 hospital admissions for gastrointestinal bleedin g among corticosteroid users, compared with 26 expected, yielding a relativ e risk of 4.2 [95% confidence interval (Cl): 3.4 to 5.0]. Among corticoster oid users who did not use other drugs associated with gastrointestinal blee ding, the relative risk was 2.9 (95% Ch 2.2 to 3.7). The relative risk decr eased further to 1.9 (95% Cl: 1.4 to 2.5) when current corticosteroid usage was compared with former usage. CONCLUSION: We observed an increased risk of hospitalization because of upp er gastrointestinal bleeding among patients prescribed corticosteroids, esp ecially among those who use other medications. Confounding from the underly ing disease may also have contributed to the observed increase in risk. (C) 2001 by Excerpta Medica, Inc.