TRENDS IN PEPTIC-ULCER MORTALITY IN ITALY, 1955-1985

Study objective-The aim was to analyse trends in mortality from peptic ulcer in Italy between 1955 and 1985, disentangling the role of age, cohort of birth, and period of death. Design-This was a descriptive epidemiological survey. Death certification numbers from peptic ulcer and estimates of the resident population were obtained from official sources. From these data, age specific and age standardised mortality rates from peptic ulcer were computed. A log-linear age, period, and cohort model with arbitrary constraints on the parameters was applied to the matrices of age specific rates between 25 and 74 years of age. Setting-This was a national survey. Main results-For males, overall peptic ulcer mortality was constant or moderately upwards (from 9.0 to 9.4/100 000, on the basis of World Standard Population) from 1955 to the mid-1970s, but declined considerably afterwards to 3.7/100 000 in 1985. Truncated (35-64 years) rates were slightly more favourable, even in earlier calendar periods, but a substantial drop was observed only from the late 1970s onwards. In 1985 the standardised rate was 3.3/100 000 compared to 18.3 in 1955-1959. For females, the time pattern was similar, although the extent of the decline was smaller in absolute terms (from 1.6 to 1.2/100 000, all ages; from 2.3 to 0.7, truncated). Age specific rates showed an earlier decline in the young, while the fall started only after the mid-1970s in older age groups. On the basis of a log-linear age, period, and cohort model, the Italian generations born in the first decade of this century had the highest risk of dying from peptic ulcer, with a substantial decline for each subsequent cohort. Period trends were stable between 1955 and the mid-1970s, but declined appreciably afterwards. Conclusions-In Italy the peak rate of peptic ulcer mortality was observed in the early 1970s, with a delay of around two decades in comparison with northern Europe and the USA. This can be related to the later process of industrialisation in Italy, with the consequent changes in lifestyle habits, and to a later pattern of rise and decline of cigarette smoking. A likely explanation of the falls in mortality on a period of death basis over the last decade is the introduction of new drugs (histamine-2 receptor antagonists) for the treatment of peptic ulcer, with a reduction of complications of the disease and related mortality. This decline in mortality from peptic ulcer corresponds to the avoidance of over 1500 deaths per year in the whole of Italy.