Historic changes of occupational work load and mortality from peptic ulcer in Germany.

The occurrence of peptic ulcer disease appears to be associated with the amount of occupational work load. Worldwide the number of hospital admissions, surgical operations, and death rates from gastric and duodenal ulcer have declined during recent decades. This communication examines the probability of a correlation between the time trends of gastric and duodenal ulcer mortality in Germany and changes in the occupational work load between 1870 and 1984. Lifetime cumulative hours of work declined for all consecutive cohorts of the population born between 1840 and 1955. The fall occurred similarly in all age groups. However, lifetime cumulative energy expenditure originating from industrial blue collar work showed a peak for the cohorts born during the last quarter of the 19th century. A marked decline occurred in all cohorts born after 1905. A similar birth-cohort pattern was found for mortality from peptic ulcer disease, with those born at the turn of the century showing a higher risk of dying from peptic ulcer disease than any previous or subsequent generation. The coincidence of the birth-cohort patterns of both mortality from peptic ulcer and occupational energy expenditure suggests that birth-cohort pattern of peptic ulcer may be related to the trends of occupational work load that occurred during the industrial revolution. The amount of work hours appears to be a less sensitive measure for the occupational work load. The superimposition of two counteracting historic changes, namely the increased industrial work force and the decreased occupational work load due to legislative regulations, industrial automation, and mechanization may have shaped the rise and fall in the occurrence of peptic ulcer disease.