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. 2001 Jul;49(1):66–72. doi: 10.1136/gut.49.1.66

Low socioeconomic class is a risk factor for upper and lower gastrointestinal symptoms: a population based study in 15 000 Australian adults

P Bytzer 1, S Howell 1, M Leemon 1, L Young 1, M Jones 1, N Talley 1
PMCID: PMC1728377  PMID: 11413112

Abstract

BACKGROUND—The association of social class with health has been extensively studied, yet relationships between social class and gastrointestinal symptoms remain almost unexplored.
AIMS—To examine relationships between social class and gastrointestinal symptoms in a population sample.
METHODS—The prevalence of 16 troublesome gastrointestinal symptoms was determined by a postal questionnaire sent to 15 000 subjects (response rate 60%) and compared with a validated composite measure of socioeconomic status (index of relative socioeconomic disadvantage). Comparisons across social class were explored for five symptom categories (oesophageal symptoms; upper dysmotility symptoms; bowel symptoms; diarrhoea; and constipation). Results are reported as age standardised rate ratios with the most advantaged social class as the reference category.
RESULTS—There were clear trends for the prevalence rates of all gastrointestinal symptoms to increase with decreasing social class. These trends were particularly strong for the five symptom categories. Lower social class was associated with a significantly (p<0.0001) higher number of symptoms reported overall and with a higher proportion of individuals reporting 1-2 symptoms and more than five symptoms. In both sexes, the most pronounced effects for subjects in the lowest social class were found for constipation (males: rate ratio 1.83 (95% confidence intervals (CI) 1.16-2.51); females: rate ratio 1.68 (95% CI 1.31-2.04)) and upper dysmotility symptoms (males: rate ratio 1.45 (95% CI 1.02-1.88); females: rate ratio 1.35 (95% CI 1.07-1.63)). Oesophageal symptoms and diarrhoea were not associated with social class.
CONCLUSIONS—Troublesome gastrointestinal symptoms are linked to socioeconomic status with more symptoms reported by subjects in low socioeconomic classes. Low socioeconomic class should be considered a risk factor for both upper and lower gastrointestinal symptoms.


Keywords: social class; population sample; functional gastrointestinal disorders; symptoms

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Selected References

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  1. Agréus L., Svärdsudd K., Nyrén O., Tibblin G. The epidemiology of abdominal symptoms: prevalence and demographic characteristics in a Swedish adult population. A report from the Abdominal Symptom Study. Scand J Gastroenterol. 1994 Feb;29(2):102–109. doi: 10.3109/00365529409090447. [DOI] [PubMed] [Google Scholar]
  2. Blaxter M. Evidence on inequality in health from a national survey. Lancet. 1987 Jul 4;2(8549):30–33. doi: 10.1016/s0140-6736(87)93062-5. [DOI] [PubMed] [Google Scholar]
  3. Buckley M. J., O'Shea J., Grace A., English L., Keane C., Hourihan D., O'Morain C. A. A community-based study of the epidemiology of Helicobacter pylori infection and associated asymptomatic gastroduodenal pathology. Eur J Gastroenterol Hepatol. 1998 May;10(5):375–379. doi: 10.1097/00042737-199805000-00004. [DOI] [PubMed] [Google Scholar]
  4. Danesh J., Gault S., Semmence J., Appleby P., Peto R. Postcodes as useful markers of social class: population based study in 26 000 British households. BMJ. 1999 Mar 27;318(7187):843–844. doi: 10.1136/bmj.318.7187.843. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Drossman D. A., Li Z., Andruzzi E., Temple R. D., Talley N. J., Thompson W. G., Whitehead W. E., Janssens J., Funch-Jensen P., Corazziari E. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci. 1993 Sep;38(9):1569–1580. doi: 10.1007/BF01303162. [DOI] [PubMed] [Google Scholar]
  6. Goodman K. J., Correa P. Transmission of Helicobacter pylori among siblings. Lancet. 2000 Jan 29;355(9201):358–362. doi: 10.1016/S0140-6736(99)05273-3. [DOI] [PubMed] [Google Scholar]
  7. Graham D. Y., Malaty H. M., Evans D. G., Evans D. J., Jr, Klein P. D., Adam E. Epidemiology of Helicobacter pylori in an asymptomatic population in the United States. Effect of age, race, and socioeconomic status. Gastroenterology. 1991 Jun;100(6):1495–1501. doi: 10.1016/0016-5085(91)90644-z. [DOI] [PubMed] [Google Scholar]
  8. Gwee K. A., Leong Y. L., Graham C., McKendrick M. W., Collins S. M., Walters S. J., Underwood J. E., Read N. W. The role of psychological and biological factors in postinfective gut dysfunction. Gut. 1999 Mar;44(3):400–406. doi: 10.1136/gut.44.3.400. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Johanson J. F. Geographic distribution of constipation in the United States. Am J Gastroenterol. 1998 Feb;93(2):188–191. doi: 10.1111/j.1572-0241.1998.00188.x. [DOI] [PubMed] [Google Scholar]
  10. Johnsen R., Førde O. H., Straume B., Burhol P. G. Aetiology of peptic ulcer: a prospective population study in Norway. J Epidemiol Community Health. 1994 Apr;48(2):156–160. doi: 10.1136/jech.48.2.156. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Johnsen R., Straume B., Førde O. H. Peptic ulcer and non-ulcer dyspepsia--a disease and a disorder. Scand J Prim Health Care. 1988 Nov;6(4):239–243. doi: 10.3109/02813438809009324. [DOI] [PubMed] [Google Scholar]
  12. Jones R. H., Lydeard S. E., Hobbs F. D., Kenkre J. E., Williams E. I., Jones S. J., Repper J. A., Caldow J. L., Dunwoodie W. M., Bottomley J. M. Dyspepsia in England and Scotland. Gut. 1990 Apr;31(4):401–405. doi: 10.1136/gut.31.4.401. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kalantar J. S., Talley N. J. The effects of lottery incentive and length of questionnaire on health survey response rates: a randomized study. J Clin Epidemiol. 1999 Nov;52(11):1117–1122. doi: 10.1016/s0895-4356(99)00051-7. [DOI] [PubMed] [Google Scholar]
  14. Kay L., Jørgensen T. Epidemiology of upper dyspepsia in a random population. Prevalence, incidence, natural history, and risk factors. Scand J Gastroenterol. 1994 Jan;29(1):2–6. [PubMed] [Google Scholar]
  15. Landis J. R., Koch G. G. The measurement of observer agreement for categorical data. Biometrics. 1977 Mar;33(1):159–174. [PubMed] [Google Scholar]
  16. Lawson J. S., Black D. Socioeconomic status: the prime indicator of premature death in Australia. J Biosoc Sci. 1993 Oct;25(4):539–552. doi: 10.1017/s002193200002191x. [DOI] [PubMed] [Google Scholar]
  17. Levenstein S., Kaplan G. A., Smith M. Sociodemographic characteristics, life stressors, and peptic ulcer. A prospective study. J Clin Gastroenterol. 1995 Oct;21(3):185–192. doi: 10.1097/00004836-199510000-00004. [DOI] [PubMed] [Google Scholar]
  18. Levenstein S., Kaplan G. A. Socioeconomic status and ulcer. A prospective study of contributory risk factors. J Clin Gastroenterol. 1998 Jan;26(1):14–17. doi: 10.1097/00004836-199801000-00005. [DOI] [PubMed] [Google Scholar]
  19. Locke G. R., 3rd, Zinsmeister A. R., Talley N. J., Fett S. L., Melton L. J. Risk factors for irritable bowel syndrome: role of analgesics and food sensitivities. Am J Gastroenterol. 2000 Jan;95(1):157–165. doi: 10.1111/j.1572-0241.2000.01678.x. [DOI] [PubMed] [Google Scholar]
  20. McLoone P., Ellaway A. Postcodes don't indicate individuals' social class. BMJ. 1999 Oct 9;319(7215):1003–1004. [PMC free article] [PubMed] [Google Scholar]
  21. McMichael A. J. Social class (as estimated by occupational prestige) and mortality in Australian males in the 1970s. Community Health Stud. 1985;9(3):220–230. doi: 10.1111/j.1753-6405.1985.tb00489.x. [DOI] [PubMed] [Google Scholar]
  22. Murphy J. M., Olivier D. C., Monson R. R., Sobol A. M., Federman E. B., Leighton A. H. Depression and anxiety in relation to social status. A prospective epidemiologic study. Arch Gen Psychiatry. 1991 Mar;48(3):223–229. doi: 10.1001/archpsyc.1991.01810270035004. [DOI] [PubMed] [Google Scholar]
  23. Nasiry R., Piper D. W. Social aspects of chronic duodenal ulcer. A case control study. Digestion. 1983;27(4):196–202. doi: 10.1159/000198953. [DOI] [PubMed] [Google Scholar]
  24. Pearce N. E., Davis P. B., Smith A. H., Foster F. H. Social class, ethnic group, and male mortality in New Zealand, 1974-8. J Epidemiol Community Health. 1985 Mar;39(1):9–14. doi: 10.1136/jech.39.1.9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Pell J. P., Pell A. C., Norrie J., Ford I., Cobbe S. M. Effect of socioeconomic deprivation on waiting time for cardiac surgery: retrospective cohort study. BMJ. 2000 Jan 1;320(7226):15–18. doi: 10.1136/bmj.320.7226.15. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Rodríguez L. A., Ruigómez A. Increased risk of irritable bowel syndrome after bacterial gastroenteritis: cohort study. BMJ. 1999 Feb 27;318(7183):565–566. doi: 10.1136/bmj.318.7183.565. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Saul C., Payne N. How does the prevalence of specific morbidities compare with measures of socio-economic status at small area level? J Public Health Med. 1999 Sep;21(3):340–347. doi: 10.1093/pubmed/21.3.340. [DOI] [PubMed] [Google Scholar]
  28. Siskind V., Najman J. M., Veitch C. Socioeconomic status and mortality revisited: an extension of the Brisbane area analysis. Aust J Public Health. 1992 Sep;16(3):315–320. doi: 10.1111/j.1753-6405.1992.tb00072.x. [DOI] [PubMed] [Google Scholar]
  29. Smith G. D., Neaton J. D., Wentworth D., Stamler R., Stamler J. Socioeconomic differentials in mortality risk among men screened for the Multiple Risk Factor Intervention Trial: I. White men. Am J Public Health. 1996 Apr;86(4):486–496. doi: 10.2105/ajph.86.4.486. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Stanghellini V. Three-month prevalence rates of gastrointestinal symptoms and the influence of demographic factors: results from the Domestic/International Gastroenterology Surveillance Study (DIGEST). Scand J Gastroenterol Suppl. 1999;231:20–28. doi: 10.1080/003655299750025237. [DOI] [PubMed] [Google Scholar]
  31. Stewart W. F., Liberman J. N., Sandler R. S., Woods M. S., Stemhagen A., Chee E., Lipton R. B., Farup C. E. Epidemiology of constipation (EPOC) study in the United States: relation of clinical subtypes to sociodemographic features. Am J Gastroenterol. 1999 Dec;94(12):3530–3540. doi: 10.1111/j.1572-0241.1999.01642.x. [DOI] [PubMed] [Google Scholar]
  32. Talley N. J., Boyce P., Jones M. Identification of distinct upper and lower gastrointestinal symptom groupings in an urban population. Gut. 1998 May;42(5):690–695. doi: 10.1136/gut.42.5.690. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Talley N. J., Weaver A. L., Zinsmeister A. R., Melton L. J., 3rd Functional constipation and outlet delay: a population-based study. Gastroenterology. 1993 Sep;105(3):781–790. doi: 10.1016/0016-5085(93)90896-k. [DOI] [PubMed] [Google Scholar]
  34. Talley N. J., Zinsmeister A. R., Melton L. J., 3rd Irritable bowel syndrome in a community: symptom subgroups, risk factors, and health care utilization. Am J Epidemiol. 1995 Jul 1;142(1):76–83. doi: 10.1093/oxfordjournals.aje.a117548. [DOI] [PubMed] [Google Scholar]
  35. Talley N. J., Zinsmeister A. R., Schleck C. D., Melton L. J., 3rd Smoking, alcohol, and analgesics in dyspepsia and among dyspepsia subgroups: lack of an association in a community. Gut. 1994 May;35(5):619–624. doi: 10.1136/gut.35.5.619. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Talley N. J., Zinsmeister A. R., Van Dyke C., Melton L. J., 3rd Epidemiology of colonic symptoms and the irritable bowel syndrome. Gastroenterology. 1991 Oct;101(4):927–934. doi: 10.1016/0016-5085(91)90717-y. [DOI] [PubMed] [Google Scholar]
  37. Taylor R., Quine S., Lyle D., Bilton A. Socioeconomic correlates of mortality and hospital morbidity differentials by Local Government Area in Sydney 1985-1988. Aust J Public Health. 1992 Sep;16(3):305–314. doi: 10.1111/j.1753-6405.1992.tb00071.x. [DOI] [PubMed] [Google Scholar]
  38. Tougas G., Chen Y., Hwang P., Liu M. M., Eggleston A. Prevalence and impact of upper gastrointestinal symptoms in the Canadian population: findings from the DIGEST study. Domestic/International Gastroenterology Surveillance Study. Am J Gastroenterol. 1999 Oct;94(10):2845–2854. doi: 10.1111/j.1572-0241.1999.01427.x. [DOI] [PubMed] [Google Scholar]
  39. Woodward M., Morrison C. E., McColl K. E. The prevalence of dyspepsia and use of antisecretory medication in North Glasgow: role of Helicobacter pylori vs. lifestyle factors. Aliment Pharmacol Ther. 1999 Nov;13(11):1505–1509. doi: 10.1046/j.1365-2036.1999.00632.x. [DOI] [PubMed] [Google Scholar]

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