Researchers in Spain have published results of a population-based observational study, which aimed to determine the mortality associated with hospital admission due to major gastrointestinal (GI) events attributed to NSAID/aspirin use. According to their results, approximately one third of all hospitalisations and deaths related to GI bleeding can be attributed to the use of NSAIDs or aspirin.

This observational study was conducted in the Spanish NHS, and utilised two different large data samples (study 1 and study 2) reporting the frequency of hospital deaths associated with severe and major GI events arising from any part of the GI tract (upper or lower). Study 1 was carried out in 26 general hospitals serving 7,901,198 people. Study 2 used a database from 197 general hospitals, representative of the 269 hospitals in the Spanish National Health System. Private practice in Spain represents less than 20% of all hospitalisations within the country; therefore the data obtained were extrapolated and considered representative of the total population. Events were coded as the primary diagnosis for hospital admission, and any events occurring during, after, or as a consequence of, hospitalisation were not included. Estimates of complications and deaths attributed to NSAID or aspirin use were based on prospective data obtained from a case control study carried out in the majority of hospitals included in study 1.

The following results were reported:

• The incidence of hospital admission due to major GI events was 121.9 events/100,000 persons/year

• Major events related to the upper GI tract were six times more frequent

• Mortality rate was 5.57% (95% CI = 4.9 6.7), and 5.62% (95% CI = 4.8 6.8) in study 1 and study 2, respectively

• The prevalence of NSAID/aspirin use (including OTC use) in the study population was estimated to be approximately 19% (17.7% to 19.8%)

• The estimated rate of GI complications in patients previously exposed to NSAIDs/aspirin was 480/100,000 patients/year

• The proportion of complications and deaths attributed to NSAID/aspirin use was 36.3%

• Death rate attributed to NSAID/aspirin use was between 21.0 and 24.8 cases/million people, respectively, or 15.3 deaths/100,000 NSAID/aspirin users
According to the authors, up to one-third of all NSAID/aspirin deaths can be attributed to low-dose aspirin use.