A Nationwide PopulationBased Cohort Study Shows Reduced Hospitalization

健保資料庫研究設計與統計分析論壇 第一回合 A Nationwide Population-Based Cohort Study Shows Reduced Hospitalization for Peptic Ulcer Disease Associated With H pylori Eradication and Proton Pump Inhibitor Use

• The results were based on a 1, 000 NHID representative database covering all drugs prescribed by nationwide hospitals and clinics between 1997 and 2006.

• From this database, we selected hospitalized patients admitted for the first time between January 1, 1997, and December 31, 2006 with a primary diagnosis of peptic ulcer (International Classification of Diseases, ninth revision codes 531, 532, and 533 for gastric ulcer, duodenal ulcer, and nonspecific peptic ulcer, respectively).

• Patients younger than 20 years of age and those with previous gastric cancer or a diagnosis of gastric cancer registered within 90 days of admission were excluded.

• For each cohort year, the incidence was calculated as the number of patients with peptic ulcer diseases divided by the total population of that cohort year. • Standardized incidences were calculated by age in 10 -year gradients and by gender according to the 2001 population census of Taiwan. • The percentage change indicated the percentage change from 1997 to 2006.

• Because threshold of admission might vary significantly according to hospital level, we also analyzed the incidences of admissions for medical centers (minimum of 500 beds), regional hospitals (minimum 250 beds), and district hospitals (minimum 20 beds). 需加買 醫院醫療服務量檔(Health 12, H_OST_UTIMF)

• The items analyzed included ulcer-healing agents (anti–H pylori, PPIs, and H 2 receptor antagonists) and ulcer-inducing agents (lowdose and high-dose aspirin, NSAIDs, and cyclooxygenase-2 [COX-2] specific inhibitors).

定義殺幽門螺旋桿菌 • H pylori eradication triple or quadruple therapy was defined as PPI or H 2 receptor blocker plus clarithromycin or metronidazole plus amoxicillin or tetracycline, with or without bismuth.

• These drug combinations were prescribed within the same prescription order, and the duration of therapy was 7– 14 days.

胃潰瘍INDEX DAY 當時之狀況 • For patients with peptic ulcer diseases, we further investigated the use of NSAIDs and the status of H pylori. • NSAID use (including low-dose and high-dose aspirin, NSAIDs, and COX-2 specific inhibitors) during the last 3 months before the index hospitalization was defined as NSAID users. • H pylori eradication during the last 3 months before the index hospitalization or after the hospitalization was defined as H pylori–infected subjects.

• For patients with peptic ulcer diseases, we further investigated • the use of NSAIDs and the status of H pylori. NSAID use • (including low-dose and high-dose aspirin, NSAIDs, and COX -2 • specific inhibitors) during the last 3 months before the index • hospitalization was defined as NSAID users. H pylori eradication • during the last 3 months before the index hospitalization • or after the hospitalization was defined as H pylori–infected • subjects.