Trends in hospitalizations for gastrointestinal bleeding among patients with rheumatoid arthritis in Rochester, Minnesota, 1950-1991

Objective. Estimates of the incidence of significant gastrointestinal (GI) bleeding among patients with rheumatoid arthritis (RA) vary and population based estimates of this event have been unavailable. We examine the incidence of this event in a well defined cohort of patients with RA. Methods. The study cohort consisted of patients with RA incident in Rochester, MN, between 1950 and 1974 and reported by Linos, et al (Am J Epidemiol 1980;111:87-98). These patients were followed for up to 40.5 yrs, and retrospective analysis of hospitalization for GI bleeding was performed. Results. A total of 58 patients with RA were hospitalized for GI bleeding, including 46 patients who had a first episode of bleeding after the diagnosis of RA was made, for a first episode incidence rate of 0.52% per person-year of followup. These 46 patients experienced 72 hospitalizations for GI bleeding. Patients diagnosed with RA after 1963 and patients older than 53 yrs of age at the time of diagnosis of RA had a higher incidence of hospitalization for GI bleeding. Overall survival among all patients with RA was slightly less than expected in the general population, while survival in patients hospitalized for GI bleeding was significantly lower than that of nonhospitalized patients. In a nested case-control study, nonsteroidal antiinflammatory drug use was found to be a significant risk factor for hospitalization for GI bleeding (odds ratio 3.25:1 compared with nonusers). Conclusion. Estimates of the overall incidence of hospitalization for GI bleeding in this population based cohort of patients with RA may be somewhat lower than some reported for referral populations, but an upward trend in recent years is noted.