The influence of socioeconomic status on the prevalence of upper gastrointestinal symptoms: a 13-Nation Population Survey

Abstract

Background: Previous studies suggest geographic variability in the prevalence of upper gastrointestinal (uGI) symptoms. This might be related to socioeconomic factors but has not been studied so far. Thus the aim of this study was to determine the prevalence of uGI symptoms in 13 European countries and to determine associations of sociodemographic status and uGI symptoms. Methods: Overall, 23.000 population based subjects (aged 18- 69 years) were enrolled in this survey. Nations included were Austria, Belgium, Denmark, Finland, France, Germany, Hungary, Italy, Netherlands, Poland, Portugal, Spain and Switzer- land. Results: The overall prevalence of uGI symptoms is high in all thirteen countries (37.8%, 95% CI 37.2-38.4), with a broad range from 23.6% in the Netherlands up to 45.3% in Hungary. Females have a higher symptom prevalence (39%, 95%CI 38.4-39.6) vs. males (37%, 95%CI 36.4-37.6). Heartburn (24%, 95%CI 23.4-24.6) and acidic reflux (14%, 95%CI 13.6-14.4) were the predominant symptoms. BMI, smoking or alcohol consumption, the highest achieved level of education, income per month, the number of phones (main lines and cell), and internet use as indirect markers of a high socioeconomic status were univariately associated with the prevalence of uGI symptoms. Socioeconomic status as measured by gross domestic product was inversely associated with symptoms and in total, socioeconomic factors, gender, body mass index, smoking habits and alcohol consumption explained 83.4% of the variance of UGI symptoms. However, after adjusting for total population size and weighting for age, gender and body mass index, smoking and alcohol consumption were no longer significantly associated with either uGI symptoms or dyspepsia. The gross domestic product per capita was negatively correlated with uGI symptoms and dyspepsia. Subjects with a monthly purchase parity adjusted income of <1499€/month reported higher rates of uGI symptoms or dyspepsia compared to those with a monthly income >1500€/month. The numbers of phones (main lines in use) as well as internet use were negatively correlated with uGI symptoms, while both mentioned variables and the electricity consumption were negatively correlated with dyspepsia. Summary: There are marked differences in the country specific prevalence of uGI complaints. In all countries, acidic reflux and heartburn are the most prevalent symptoms. A high socioeconomic status is negatively associated with the prevalence of uGI symptoms.