American Journal of Epidemiology Vol. 136, No. 10: 1280-1287
Copyright © 1992 by The Johns Hopkins University School of Hygiene and Public Health
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The Importance of Biopsychosocial Factors in the Development of Duodenal Ulcer in a Cohort of Middle-aged Men
1Department of Family Medicine, Case Western Reserve University Cleveland, OH
2Neufeld Cardiac Research Institute and Department of Epidemiology and Preventive Medicine, Tel Avrv University Israel
3Department of Epidemiology and Biostatistics; Department of Sociology, Case Western Reserve University Cleveland, OH
Reprint requests to Dr. Jack H. Medalie, Department of Family Medicine, Case Western Reserve University, U.C.R.C. Building no. 2, Suite 306, 11001 Cedar Avenue, Cleveland, OH 44106–7136.
This study prospectively evaluated psychosocial as well as biologic, behavioral, and demographic factors in the development of duodenal ulcer. Baseline data were collected in 1963 on 8, 458 Israeli men over age 40 years who had no history of duodenal ulcer. The subjects were followed for 5 years, and 254 reported the development of radio-graphically proven duodenal ulcer. The average annual incidence was six per 1,000 subjects. Multivariable logistic regression analysis confirmed several previously reported risk factors: smoking (odds ratio (OR) = 1.64, 95% confidence interval (Cl) 1.25–2.16), greater age (60 years and over) (OR = 1.85, 95% Cl 1.25–2.74), lower salary (OR = 1.50, 95% Cl 1.14–1.96), and lower systolic blood pressure (less than 140 mmHg) (OR = 1.58, 95% Cl 1.16–2.15). In addition, logistic regression analysis revealed a significant association of duodenal ulcer incidence with preceding measures of family stress, emotional support, and coping style. These were: increased family problems (OR = 1.60, 95% Cl 1.19–2.16), low level of perceived love and support from subject‘s wife (OR = 2.06, 95% Cl 1.05–4.05), and restraining retaliation when hurt by coworkers (OR = 1.89, 95% Cl 1.19–3.00). This study confirms several previously reported risk factors and underlines the importance of stress, lack of social support, and coping style In the development of duodenal ulcer. Am J Epidemiol 1992; 136: 1280–7
cohort studies; duodenal ulcer; risk factors; stress, psychological
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