Nonsteroidal Anti-Inflammatory Drug Use and Death from Peptic Ulcer in Elderly Persons

Abstract

STUDY OBJECTIVE: To determine the association between current non-aspirin nonsteroidal anti-inflammatory drug (NSAID) use and fatal peptic ulcers or upper gastrointestinal hemorrhage. DESIGN: Nested case control study using a linked Medicaid-death certificate database. SETTING: Tennessee Medicaid enrollees aged 60 and greater from 1976 to 1984. PATIENTS: One hundred twenty-two patients, "the cases," had a terminal hospitalization and a peptic ulcer or upper gastrointestinal hemorrhage confirmed by hospital chart review. Population controls (n = 3897) were matched to potential cases by age, sex, race, calendar year, and nursing home status. MEASUREMENTS AND MAIN RESULTS: "Cases" more frequently filled a prescription for an NSAID within 30 days before onset of illness than controls (34% compared with 11%; adjusted odds ratio, 4.7; 95% CI, 3.1 to 7.2). This association between fatal ulcer disease and current NSAID use was consistent in three age groups, women and men, whites and nonwhites, and community and nursing home dwellers. There was no significant association between case status and previous NSAID use (adjusted odds ratio, 1.9; 95% CI, 0.7 to 4.7). CONCLUSIONS: The findings of this study add to the growing evidence that NSAIDs can increase the risk for clinically serious peptic ulcer disease in the elderly.