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Peptic ulcer epidemiology and demographics

Introduction

Overview

Overview

Global age-standardized incidence, prevalence, and mortality of peptic ulcer disease (PUD) fell by 40.3%, 41.1%, and 61.5%, respectively, between 1990 and 2021.[1] Absolute case numbers continued to rise because of population growth and aging.[2] Men carry a higher burden than women across most age groups.[1] In the United States, PUD-related mortality fell sharply from 2001 to 2012, plateaued, and then rose from 2018 to 2020.[3] US racial and ethnic disparities largely track Helicobacter pylori exposure, which is highest in non-Hispanic Black and Hispanic individuals and in immigrants from endemic regions.[4][5]

Epidemiology and Demographics

Epidemiology and Demographics

Incidence and Prevalence

  • In the United States, the estimated prevalence of PUD is 103 per 100,000 and the annual incidence is 44 per 100,000.[6] Worldwide incidence and prevalence vary, partly because H. pylori infection rates and NSAID use differ by region.[6]
  • Approximately 5–10% of people develop a peptic ulcer during their lifetime.
  • Etiologic distribution of ulcers:[6]
    • H. pylori infection: ~41.8%
    • Aspirin or NSAID use: ~36.1%
    • Idiopathic: ~22.1%
  • Reported complication rates are 19.5–57.0 per 100,000 person-years for bleeding and 3.8–14.0 per 100,000 person-years for perforation.[7]
Global age-standardized PUD burden, 1990 vs 2021 (GBD 2021)
Measure (per 100,000) 1990 2021 Relative change
Incidence 57.1 34.1 −40.3%
Prevalence 133.0 78.3 −41.1%
Mortality 7.14 2.75 −61.5%

Sources: [1][8]

  • In the earlier GBD 2019 analysis, global age-standardized prevalence fell from 143.37 per 100,000 in 1990 to 99.40 per 100,000 in 2019.[2] Over the same period, the absolute number of prevalent cases rose by 25.8% to about 8.09 million.[2]
  • Global age-standardized DALY rates fell by 63.1% between 1990 and 2021.[1]

Hospitalization and Mortality

  • PUD-related hospitalizations in the United States fell by 25.8% between 2005 and 2014 (National Inpatient Sample). The rate of decline slowed after 2008, and in-hospital mortality was 2.4%.[9]
  • PUD causes approximately 10,000 deaths per year in the United States.[6]
  • US age-adjusted mortality rate (AAMR) trends, 1999–2020 (37,471 PUD deaths in total):[3]
    • 1999–2001: stable (annual percent change [APC] +0.59%)
    • 2001–2012: sharp decline (APC −11.79%)
    • 2012–2018: stable (APC +1.53%)
    • 2018–2020: increase (APC +8.45%)
  • US PUD-related mortality is higher in the following groups:[3]
    • Adults aged ≥85 years (crude mortality rate 7.63 per 100,000)
    • Men (AAMR 0.84 vs 0.71 per 100,000 in women)
    • Rural residents (AAMR 0.86 vs 0.76 per 100,000 in urban residents)
    • Residents of the Western United States (AAMR 0.87 per 100,000, the highest of any region)

Age

  • Incidence and prevalence rise with age in both sexes. They peak at ages 55–59 years in men and 65–69 years in women.[1]
  • Mortality peaks later, at ages 70–74 years in men and 75–79 years in women.[1]

Sex

  • Men had higher numbers and age-standardized rates of incidence, prevalence, deaths, and DALYs than women across most age groups in 2021.[1][8]
  • The difference has been attributed partly to estrogen’s protective effect on gastric acid secretion and gastrin release. Higher rates of smoking and alcohol use among men also contribute.[1]

Race, Ethnicity, and Immigration

  • Global H. pylori prevalence fell from 58.2% (1980–1990) to 43.1% (2011–2020).[4]
  • In North America, H. pylori prevalence is estimated at 30–40%.[4] Infection is more common in the following groups:[4]
    • Non-White racial and ethnic groups
    • People living in crowded or poor sanitary conditions
    • Early-generation immigrants from endemic regions
  • In the Veterans Health Administration (VHA), overall H. pylori positivity was 25.8%, with marked racial and ethnic disparities that persisted despite declines in every group over time:[5]
H. pylori positivity by race/ethnicity, US VHA (1999–2018)
Group All ages Age <60 years
Non-Hispanic White 20.1% 17.2%
Hispanic 36.7% 34.4%
Non-Hispanic Black 40.2% 40.7%
  • Geographic variation is substantial. For example, positivity exceeds 50% among Black veterans in Alabama and Mississippi.[5]
  • In a Houston endoscopy cohort with 51.5% H. pylori prevalence, first-generation immigrant status and Black or Hispanic race/ethnicity were the strongest individual predictors of infection.[10]
  • In asymptomatic adults served by a Houston safety-net health system, overall seroprevalence was 63.9%:[11]
    • Highest in people born in Central America (75.1%)
    • Higher in Hispanic (65.9%) than non-Hispanic White (45.0%) individuals
    • No difference in risk between second- and third-generation immigrants

Geography and Socioeconomic Status

  • Low and low-middle sociodemographic index (SDI) regions, particularly South Asia and Sub-Saharan Africa, carry the highest prevalence and mortality burden.[1][2]
  • Oceania has been reported to have the highest age-standardized incidence and prevalence.[1]
  • Studies conflict on whether socioeconomic status, household crowding, and psychosocial stress contribute to PUD risk independently of H. pylori and NSAID use.[12]
References

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 Hao W, Zheng C, Wang Z, Ma H (2025). “Global burden and risk factors of peptic ulcer disease between 1990 and 2021: an analysis from the global burden of disease study 2021”. PLoS One. 20 (7): e0325821. doi:10.1371/journal.pone.0325821. PMC 12250541 Check |pmc= value (help).
  2. ↑ 2.0 2.1 2.2 2.3 Xie X, Ren K, Zhou Z, Dang C, Zhang H (2022). “The global, regional and national burden of peptic ulcer disease from 1990 to 2019: a population-based study”. BMC Gastroenterol. 22 (1): 58. doi:10.1186/s12876-022-02130-2. PMC 8832644 Check |pmc= value (help).
  3. ↑ 3.0 3.1 3.2 Babar M, Raza M, Nadir MA; et al. (2025). “Trends and disparities in peptic ulcer disease-related mortality in the United States from 1999 to 2020: a cross-sectional study”. Medicine (Baltimore). 104 (40): e42129. doi:10.1097/MD.0000000000042129. PMC 12499665 Check |pmc= value (help).
  4. ↑ 4.0 4.1 4.2 4.3 Chey WD, Howden CW, Moss SF; et al. (2024). “ACG clinical guideline: treatment of Helicobacter pylori infection”. Am J Gastroenterol. 119 (9): 1730–1753. doi:10.14309/ajg.0000000000002968. PMID 39626064 Check |pmid= value (help).
  5. ↑ 5.0 5.1 5.2 Shah SC, Halvorson AE, Lee D; et al. (2024). “Helicobacter pylori burden in the United States according to individual demographics and geography: a nationwide analysis of the Veterans Healthcare System”. Clin Gastroenterol Hepatol. 22 (1): 42–50.e26. doi:10.1016/j.cgh.2023.05.016. PMC 11552088 Check |pmc= value (help). PMID 37245717 Check |pmid= value (help).
  6. ↑ 6.0 6.1 6.2 6.3 Vakil N (2024). “Peptic ulcer disease: a review”. JAMA. 332 (21): 1832–1842. doi:10.1001/jama.2024.19094.
  7. ↑ Almadi MA, Lu Y, Alali AA, Barkun AN (2024). “Peptic ulcer disease”. Lancet. 404 (10447): 68–81. doi:10.1016/S0140-6736(24)00155-7. PMID 38885678 Check |pmid= value (help).
  8. ↑ 8.0 8.1 Tan R, Zhao D, Zhang X, Liu T, Han C, Li Z, Qi C, Wang Z (2025). “Gender and age differences in the global burden of peptic ulcers: an analysis based on GBD data from 1990 to 2021”. Front Med (Lausanne). 12: 1586270. doi:10.3389/fmed.2025.1586270. PMC 12066501 Check |pmc= value (help).
  9. ↑ Guo H, Ma C; et al. (2021). “Urban-rural disparities and temporal trends in peptic ulcer disease epidemiology, treatment, and outcomes in the United States”. Am J Gastroenterol. 116 (2): 296–305.
  10. ↑ Nguyen Wenker T, Peng FB, Emelogu I; et al. (2023). “The predictive performance of contemporary guideline recommendations for Helicobacter pylori testing in a United States population”. Clin Gastroenterol Hepatol. 21 (7): 1771–1780. doi:10.1016/j.cgh.2022.10.009. PMC 10110767 Check |pmc= value (help). PMID 36270616 Check |pmid= value (help).
  11. ↑ Thrift AP, Dinarvand P, Juarez L; et al. (2026). “Seroprevalence of Helicobacter pylori infection among asymptomatic patients served by a safety-net healthcare system”. Clin Gastroenterol Hepatol. 24 (5): 1289–1297. doi:10.1016/j.cgh.2025.10.005. PMC 12857391 Check |pmc= value (help). PMID 41101428 Check |pmid= value (help).
  12. ↑ Yim MH, Kim KH, Lee BJ (2021). “The number of household members as a risk factor for peptic ulcer disease”. Sci Rep. 11 (1): 5274. doi:10.1038/s41598-021-84892-5.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Fahad Hasan, M.D.[2] Manpreet Kaur, MD [3]