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Hospital discharge and mortality rates for peptic ulcer disease from 1970-1980 for a large Health Maintenance Organization, the Kaiser-Permanente Medical Care Program of Southern California, are compared with the corresponding rates for the United States. The Kaiser-Permanente Medical Care Program hospitalization and mortality age-adjusted rates for ulcers are well below the national rates. In comparison with the 25%-31% decline in the national ulcer hospitalization rate, the Kaiser-Permanente Medical Care Program rate has been relatively stable. Most of the decline in national ulcer hospitalizations is due to a decrease in hospitalizations for uncomplicated cases. The Kaiser-Permanente Medical Care Program uncomplicated hospitalization rates are less than 25% of the national rate after age-adjustment and have been relatively stable over time. The age-adjusted Kaiser-Permanente Medical Care Program rates for ulcers with hemorrhages and perforations are 77% of the national data. These data suggest that part of the decline in national hospitalization rates for peptic ulcer disease may be due to changes in medical management and hospitalization criteria. In addition, this study supports the results of other studies which show that hospitalization rates are lower in Health Maintenance Organizations than in non-Health Maintenance Organizations with no apparent adverse impact on outcome.

There has been a dramatic decline in reported hospitalization and mortality rates for peptic ulcer disease in the past two decades. Data from the National Center for Health Statistics and from the Commission on Professional and Hospital Activities were examined to determine the cause(s) for this decline. Gastric and duodenal ulcer mortality rates decreased by 58 per cent and 68 per cent, respectively, from 1962 to 1978; changes in criteria for selecting the underlying cause of death might account for some of this apparent decrease. Hospitalization rates for duodenal ulcers decreased nearly 50 per cent from 1970 to 1978, but hospitalizations for gastric ulcers did not decrease. During this same time period, hospitalizations for peptic ulcers as one of the "all listed" causes remained stable, and hospitalizations for a closely related diagnosis, gastritis/duodenitis, increased. Changes in coding practices, hospitalization criteria, and diagnostic procedures appear to have contributed to the decline in reported hospitalization and mortality rates for peptic ulcer disease.