Aims: The aim of the present study was to follow the time trends of mortality from gastric and duodenal ulcer in countries outside Europe and compare them with previous reports of ulcer mortality from Europe and North America.
Methods: Mortality data from eight different countries were analyzed, including Argentina, Australia, Chile, Hong Kong, Japan, Mexico, Singapore, and Taiwan. The age-standardized death rates of individual countries were followed from 1971 to 2004. Japan and Australia had mortality data for more than 50 yr that provided the opportunity to conduct a birth-cohort analysis.
Results: The data from all countries were characterized by a decline in gastric and duodenal ulcer mortality. Except for Hong Kong, mortality from gastric ulcer was higher than mortality from duodenal ulcer. In Japan and Australia, mortality from gastric and duodenal ulcer displayed time trends that were consistent with an underlying birth-cohort phenomenon. The risk of dying from gastric and duodenal ulcer increased in consecutive generations born between the mid- and the end of the nineteenth century and decreased in all subsequent generations. The peak mortality from gastric ulcer occurred among generations born in 1875, whereas peak mortality from duodenal ulcer occurred among generations born 10-20 yr later.
Conclusions: The ubiquitous decline in ulcer mortality in countries from different parts of the world is likely to be associated with a worldwide decline in the occurrence of H. pylori infection. The events accompanying the receding infection in developed countries must have similarly affected populations exposed to increasing standards of hygiene.