Seasonal pattern of peptic ulcer hospitalizations: analysis of the hospital discharge data of the Emilia-Romagna region of Italy

Abstract

BackgroundPrevious studies have reported seasonal variation in peptic ulcer disease (PUD), but few large-scale, population-based studies have been conducted.MethodsTo verify whether a seasonal variation in cases of PUD (either compicated or not complicated) requiring acute hospitalization exists, we assessed the database of hospital admissions of the region Emilia Romagna (RER), Italy, obtained from the Center for Health Statistics, between January 1998 and December 2005. Admissions were categorized by sex, age (<65, 65-74, ≥ 75 yrs), site of PUD lesion (stomach or duodenum), main complication (hemorrhage or perforation), and final outcome (intended as fatal outcome: in-hospital death; nonfatal outcome: patient discharged alive). Temporal patterns in PUD admissions were assessed in two ways, considering a) total counts per single month and season, and b) prevalence proportion, such as the monthly prevalence of PUD admissions divided by the monthly prevalence of total hospital admissions, to assess if the temporal patterns in the raw data might be the consequence of seasonal and annual variations in hospital admissions per se in the region. For statistical analysis, the χ2 test for goodness of fit and inferential chronobiologic method (Cosinor and partial Fourier series) were used.ResultsOf the total sample of PUD patients (26,848 [16,795 males, age 65 ± 16 yrs; 10,053 females, age 72 ± 15 yrs, p < 0.001)], 7,151 were <65 yrs of age, 8,849 between 65 and 74 yrs of age, and 10,848 ≥ 75 yrs of age. There were more cases of duodenal (DU). (89.8%) than gastric ulcer (GU) (3.6%), and there were 1,290 (4.8%) fatal events. Data by season showed a statistically difference with the lowest proportion of PUD hospital admissions in summer (23.3%) (p < 0.001), for total cases and rather all subgroups. Chronobiological analysis identified three major peaks of PUD hospitalizations (September-October, January-February, and April-May) for the whole sample (p = 0.035), and several subgroups, with nadir in July. Finally, analysis of the monthly prevalence proportions yielded a significant (p = 0.025) biphasic pattern with a main peak in August-September-October, and a secondary one in January-February.ConclusionsA seasonal variation in PUD hospitalization, characterized by three peaks of higher incidence (Autumn, Winter, and Spring) is observed. When data corrected by monthly admission proportions are analyzed, late summer-autumn and winter are confirmed as higher risk periods. The underlying pathophysiologic mechanisms are unknown, and need further studies. In subjects at higher risk, certain periods of the year could deserve an appropriate pharmacological protection to reduce the risk of PUD hospitalization.

Seasonal Variations and Trends in Hospitalization for Peptic Ulcer Disease in the United States: A 12-Year Analysis of the Nationwide Inpatient Sample

“…Similar inferences were drawn in other studies [9, 25-26] wherein, the highest number of gastric and duodenal ulcers and related complications were diagnosed between October to March, i.e end of fall and early spring.…”

“…Some studies showed two peaks in spring and autumn [8]; whereas a large scale study in Italy by Roberto Manfredini, et al [9] described three peaks in spring, autumn and winter. Various other disease processes like myocardial infarction, cerebrovascular accident and congestive heart failure have shown seasonal variation in their hospitalization rates [10-11].…”

Occurrence and fate of pharmaceuticals in WWTPs in India and comparison with a similar study in the United States

“…3). The concentration of ranitidine was expected to be highest in winter as several studies have established that peptic ulcer cases show spike during winter months (Manfredini et al, 2010). The concentration of ranitidine in European WWTPs has been reported in the ranges from 0.04 mg/L (Loos et al, 2013) to 1.5 mg/L (Rosal et al, 2010) while it has been reported at 90e160 mg/L in CETP effluent in Hyderabad, India (Larsson et al, 2007).…”

Weekly pattern of emergency room admissions for peptic ulcers: A population-based study

“…This seasonal fluctuation of PU may be affected by several factors, including climatic factors [30] , increased intake of NSAIDs in winter [31] , significantly increased number of H. pylori infections in winter [32] , and variations in alcohol consumption [33] . The importance of the diurnal and weekly rhythms in weekends.…”