Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2022; 28(18): 2008-2020
Published online May 14, 2022. doi: 10.3748/wjg.v28.i18.2008
Risk factors for major gastrointestinal bleeding in the general population in Finland
Pareen Vora, Ronald Herrera, Arto Pietila, Ulrich Mansmann, Gunnar Brobert, Markku Peltonen, Veikko Salomaa
Pareen Vora, Ronald Herrera, Integrated Evidence Generation, Bayer AG, Berlin 13353, Germany
Pareen Vora, Ulrich Mansmann, Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilians Universität, Munich 81337, Germany
Pareen Vora, Ulrich Mansmann, Pettenkofer School of Public Health, Ludwig Maximilians Universität, Munich 81337, Germany
Arto Pietila, Markku Peltonen, Veikko Salomaa, Department of Public Health and Welfare, National Institute for Health and Welfare (THL), Helsinki FI-00271, Finland
Gunnar Brobert, Medical Affairs, Bayer AB, Solna 171 65, Sweden
Author contributions: Vora P, Brobert G and Salomaa V proposed the concept and design; Salomaa V and Pietila A supported in acquisition of the collected data; Vora P, Herrera R, Pietila A and Mansmann U performed the statistical analysis; Vora P drafted the manuscript; Vora P, Brobert G and Salomaa V obtained funding; Pietila A and Salomaa V provided the administrative, technical, and material support; Salomaa V, Mansmann U and Brobert G were responsible for supervision; All authors were involved in the interpretation of the results, critical revision of the manuscript and approved the final version of the article for publication.
Supported by Bayer AG.
Institutional review board statement: The National FINRISK Study surveys started in 1972 were approved by the ethics committee of the Finnish Institute of Health and Welfare and the Coordinating Ethical Committee of Helsinki and Uusimaa Hospital District in Finland (THL/66/0.05.00/2015). Data from the participants were pseudonymized for this study, and the secondary use of the survey data was approved by the Finnish Institute of Health and Welfare in 2017.
Informed consent statement: All participants provided their informed consents at enrollment in to the FINRISK surveys and it was conducted following the principles of the World Medical Association’s Declaration of Helsinki.
Conflict-of-interest statement: Vora P and Herrera R are employees at Integrated Evidence Generation, Bayer AG, Berlin Germany. Vora P is affiliated to Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, Ludwig Maximilians Universität Munich, Munich, Germany, and Pettenkofer School of Public Health, Munich, Germany. Brobert G was an employee at Medical Affairs, Bayer AB, Solna Sweden. Salomaa V reported being an employee of the Finnish Institute for Health and Welfare, which received a funding from Bayer AG during the conduct of the study, as well as receiving honorarium for consultation from Sanofi and grants from Finnish foundation for Cardiovascular research outside the submitted work. Pietila A reported being an employee of the Finnish Institute for Health and Welfare, which received a funding from Bayer AG during the conduct of the study. Peltonen M works for the Department of Public Health and Welfare, National Institute for Health and Welfare (THL), Helsinki, Finland. Mansmann U is the director of IBE - Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilians Universität Munich, Munich, Germany.
Data sharing statement: Salomaa V and Pietila A had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pareen Vora, MSc, Director, Integrated Evidence Generation, Bayer AG, Muellerstrasse 178, Berlin 13353, Germany. pareen.vora@bayer.com
Received: November 14, 2021
Peer-review started: November 14, 2021
First decision: January 9, 2022
Revised: January 22, 2022
Accepted: March 26, 2022
Article in press: March 26, 2022
Published online: May 14, 2022
Processing time: 178 Days and 15.3 Hours
Abstract
BACKGROUND

Data on non-drug related risk-factors for gastrointestinal bleeding (GIB) in the general population are limited, especially for life-style factors, clinical measurements and laboratory parameters.

AIM

To identify and investigate non-drug risk factors for major GIB in the general population of Finland.

METHODS

We performed a retrospective cohort study using data from the FINRISK health examination surveys, which have been conducted every 5 years across Finland from 1987 to 2007. Participants were adults aged 25 years to 74 years, excluding those with a previous hospitalization for GIB. Follow-up from enrollment was performed through linkage to national electronic health registers and ended at an event of GIB that led to hospitalization/death, death due to any other cause, or after 10 years. Covariates included demographics, socioeconomic and lifestyle factors, clinical measurements, laboratory parameters and comorbidities. Variable selection was undertaken using Least Absolute Shrinkage and Selection Operator (LASSO) and factors associated with GIB were identified using Cox regression.

RESULTS

Among 33,508 participants, 403 (1.2%) experienced GIB [256 men (63.5%); mean age, 56.0 years (standard deviation (SD) ± 12.1)] and 33105 who did not experience GIB [15768 men (47.6%); mean age, 46.8 (SD ± 13) years], within 10 years of follow-up. Factors associated with a significantly increased risk of GIB were baseline age [per 10-year increase; hazard ratio (HR) 1.62, 95% confidence interval (CI): 1.42-1.86], unemployment (HR: 1.70, 95%CI: 1.11-2.59), body mass index (BMI) (HR: 1.15, 95%CI: 1.01-1.32), gamma-glutamyl transferase (GGT) (HR: 1.05, 95%CI: 1.02-1.09), precursors of GIB (HR: 1.90, 95%CI: 1.37-2.63), cancer (HR: 1.47, 95%CI: 1.10-1.97), psychiatric disorders (HR: 1.32, 95%CI: 1.01-1.71), heart failure (HR: 1.46, 95%CI: 1.04-2.05), and liver disorders (HR: 3.20, 95%CI: 2.06-4.97). Factors associated with a significantly decreased risk of GIB were systolic blood pressure (SBP) (HR: 0.78, 95%CI: 0.64-0.96), 6-10 cups of coffee a day (HR: 0.67, 95%CI: 0.46-0.99), or > 10 cups (HR: 0.43, 95%CI: 0.23-0.81).

CONCLUSION

Our study confirms established risk-factors for GIB and identifies potential risk-factors not previously reported such as unemployment, BMI, GGT, SBP and coffee consumption.

Keywords: Risk factors; Gastrointestinal hemorrhage; General population; Finland; Life style; Population health

Core Tip: This retrospective study of 33508 Finnish survey participants aimed to identify and investigate non-drug factors associated with the risk of major gastrointestinal bleeding (GIB) in the general population in Finland. Aside from established risk factors, our study identified unemployment, body mass index and gamma-glutamyl transferase enzyme were all associated with increased risk of major GIB. Systolic blood pressure and coffee consumption were associated with a decreased risk of major GIB.