Socioeconomic status was measured by the Index of Multiple Depriv

Socioeconomic status was measured by the Index of Multiple Deprivation quintiles obtained from linked Office of National Statistics data. Finally, to assess the effect of using the aggregated and weighted

Charlson Index, the model was re-estimated to assess the effect of the individual component comorbidities from the Charlson Index. There were 16,355 unique cases identified with a first nonvariceal bleed; 13,372 with specific code in Hospital Episodes Statistics, 10,938 with a specific code in GPRD, and 7955 with a specific code in both datasets. There were 16,304 (99.7%) cases matched to 5 controls each and only 8 cases (0.05%) were not matched to any controls. Median observed time before admission for cases was 7.4 years (interquartile range, 3.4–11.5) compared with 7.5 years (interquartile range, 3.5–11.5) for controls. Table 1 shows the proportion of cases and controls with each exposure. As expected, aspirin and NSAIDs were the most BGJ398 clinical trial frequently prescribed risk factor medications, and peptic

ulcer and gastritis/duodenitis/esophagitis were the most frequent risk factor diagnoses. All a priori risk factors were associated with upper GIB. Peptic ulcers were coded as a diagnosis within the linked SCH772984 cell line data in 4,823 patients (29% of cases). The exposures stratified by coding of peptic ulcer are shown in Supplementary Table 1. There was strong evidence for an association between the nongastrointestinal Charlson Index and upper GIB after adjusting for all measured risk factors (single comorbidity adjusted OR = 1.43; 95% CI: 1.35–1.52; multiple or severe comorbidity adjusted OR = 2.26; 95% CI: 2.14–2.38; P < .001 likelihood ratio test). Table 2 shows the adjusted ORs from the final model for each exposure. We found the

largest association with a bleed was with a previous Mallory-Weiss syndrome, which reflects the inherent risk of bleeding in recurrent vomitters. The variables for angiodysplasia and dialysis had the highest variance inflation factors, 1.48 and 2.35, respectively. As both of these were less than the a priori threshold of 5, all exposures were included in the final conditional logistic regression model. Stratifying this model demonstrated similar associations with comorbidity, whether tuclazepam or not peptic ulcer coding was present, and slightly higher associations for a peptic ulcer with exposure to previous peptic ulcers, NSAID, or aspirin use (Table 3). Associations with other risk factors were higher in the nonpeptic ulcer cohort. The proportion of cases attributable in the population to the combined effect of all available measured exposures was 48%, not including the effect of nongastrointestinal comorbidity. The additional proportion of cases attributable to nongastrointestinal comorbidity (or the sequential PAF) was 20%, and this was higher in magnitude than for any other measured exposure (Table 4). The next largest PAFs were 3% for aspirin and NSAID use.

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