THE IMPACT OF THERAPEUTIC IMPROVEMENTS IN REDUCING PEPTIC-ULCER MORTALITY IN EUROPE

Trends in death certification rates from peptic ulcer between 1955 and 1989 have been analysed for 24 European countries on the basis of age-specific and age-standardized rates, and a log-linear model to estimate the effects of age, cohort of birth and period of death. For males, in all Western countries there were substantial declines in mortality. In the late 1950s, the range of variation of the world standardized rates was between 4/100 000 in France and 17.8 in Portugal. In the late 1980s, only Ireland had a rate over 5/100 000, and values for most Western countries ranged between 2 and 4/100 000. The average fall in rates over the last three decades was 56%. Of this, a high proportion (45%) was registered between 1975 and 1984. In Eastern Europe, no systematic change was observed until the early 1970s, but over the last 15 years peptic ulcer mortality declined by an average of 20%. In 1985-1989 the lowest rate was 4.5/100 000 in Bulgaria, and for all other countries peptic ulcer mortality ranged between 5 and 7.2/100 000. Peptic ulcer mortality was substantially lower in females, and showed no appreciable modification in Western Europe, and several increases in Eastern Europe until the mid 1970s. Thereafter, mortality declined by an overall 25% in the West and 15% in the East. Earlier declines for males in Western Europe were chiefly related to a cohort effect, reflecting more favourable risk factor exposure (such as diet, Helicobacter pylori or smoking) of subsequent generations. The recent falls, in contrast, were mainly on a period of death basis indicating therapeutic advancements (including the introduction of H-2-receptor-antagonists in the mid-1970s) as the major determinant. These falls correspond to about 20 000 deaths from peptic ulcer avoided every year in the whole of Europe.