Although it has the potential to be a more appropriate measure for our study than the Charlson index, it has not been previously validated within HES, so it was not used for our primary analysis. The recorded age was grouped into

age bands of 15–29 years, 30–59 years, 60–79 years, and older than 80 years. A further analysis assessed whether using a higher minimum age limit of 18 years altered the results. We calculated the length of inpatient stay as the number of days between admission and discharge APO866 datasheet dates. We defined admissions as either having a higher probability of being an acute bleed on admission (if an upper gastrointestinal hemorrhage was coded on the first episode in a nonelective admission) or as lower probability of being an acute bleed on admission with a higher probability of being an inpatient bleed (if the coding occurred after the first episode within a nonelective admission, or during an elective [nonemergency] admission). Hereafter, these are referred to, respectively, as acute admissions and inpatient bleeds. To assess trends in diagnoses that were associated with a gastrointestinal hemorrhage code, we extracted additional diagnoses for gastritis/duodenitis, Mallory–Weiss syndrome, any peptic ulcer, gastric ulcer, duodenal ulcer, and malignancy. We analyzed variceal and nonvariceal hemorrhage admissions

learn more separately. After the exclusions described above, 28-day case fatalities were calculated by age group, sex, year, grouped Charlson index, and acute or inpatient hemorrhage. A case-control study analysis was carried Clomifene out with cases defined as patients who had died by 28 days and controls as patients who were alive at 28 days. The primary exposure of interest was defined as year of upper gastrointestinal hemorrhage. A logistic regression model was constructed to adjust for the change in mortality over the study period by sex, age group, and Charlson index. Variables that changed the odds of mortality were judged to be confounders. We assessed whether there was a trend in mortality over time and whether this could be modelled as a linear trend using likelihood

ratio tests. We also performed a secondary analysis comparing trends in mortality that occurred before discharge and trends in mortality that occurred after discharge. The calculation of postdischarge mortality excluded patients who had died as inpatients. In addition, to determine whether the changes in mortality varied for different ages, sex, and comorbidities, the model was also tested for interactions between each of the variables and year of bleed with likelihood ratio testing. If there was evidence against the null hypothesis of no interaction, stratified results were presented. The use of the a priori age groups was assessed against alternative groupings of 5-year age bands or age as a linear variable. All analysis was performed using Stata version 10 (StataCorp LP, College Station, TX).