Socioeconomic characteristics and comorbidities of diverticular disease in Sweden 1997–2012
Socioeconomic characteristics and comorbidities of diverticular disease in Sweden 1997-2012
Maziar Nikberg 0 1 2 3 4
Abbas Chabok 0 1 2 3 4
Jianguang Ji 0 1 2 3 4
Jerzy Leppert 0 1 2 3 4
Kristina Sundquist 0 1 2 3 4
0 Centre for Clinical Research of Uppsala University, Västmanland's Hospital Västerås , SE-721 89 Västerås , Sweden
1 Department of Surgery, Västmanland's Hospital Västerås , SE-721 89 Västerås , Sweden
2 Maziar Nikberg
3 Department of Medicine, Västmanland's Hospital Västerås , SE-721 89 Västerås , Sweden
4 Center for Primary Health Care Research, Department of Clinical Sciences, Lund University , Lund , Sweden
Purpose This study aimed to evaluate the association of socioeconomic status and comorbidities with uncomplicated and complicated diverticular disease (DD) in Sweden. Methods We identified all individuals aged ≥30 years in Sweden diagnosed with DD between 1997 and 2012 using the Swedish National Population and Housing Census and the Hospital Discharge Register. Data were analyzed by multivariable logistic regression, with individual-level characteristics as covariates. Results A total of 79,481 patients (median age 66 [range 3086] years) were hospitalized for DD, 15,878 (20%) of whom for complicated DD. Admissions for both uncomplicated and complicated DD were more common in women (p < 0.001). A low education level was identified as a risk factor for uncomplicated (unadjusted hazard ratio [HR] 1.79, 95% confidence interval [CI] 1.75-1.82; adjusted HR 1.22, 95% CI 1.19-1.24) and complicated DD (unadjusted HR 1.84, 95% CI 1.77-1.92; adjusted HR 1.26, 95% CI 1.21-1.32). Patients with the lowest income had a lower risk of hospitalization for uncomplicated (adjusted HR 0.94, 95% CI 0.91-0.96) and complicated DD (adjusted HR 0.87, 95% CI 0.83-0.92) than those with the highest income. The correlation coefficient between income and education was 0.25. Diabetes and cardiovascular disease were identified as protective factors against uncomplicated DD (adjusted HR 0.68, 95% CI 0.66-0.69 and HR 0.79, 95% CI 0.74-0.84, respectively). Conclusions Patients with the lowest education level had an increased risk of hospitalization for DD. Further studies are needed to explore the association of diabetes and cardiovascular disease with uncomplicated DD.
Diverticular disease; Socioeconomic status; Education; Income; Comorbidity
Introduction
The clinical burden of colonic diverticular disease (DD) is
impressive. It is responsible for 312,000 hospital admissions
per year in the USA alone, with the incidence of acute
diverticulitis increasing and the average age of the patients
declining. The severity of the disease varies, and DD presents with a
wide spectrum of symptoms ranging from acute
uncomplicated to complicated DD [
1
].
The etiopathogenesis of DD is not well clarified.
Epidemiological studies have analyzed the associations
between DD and obesity, smoking, alcohol intake, and physical
activity [
2, 3
]. In addition, comorbidities and the use of
specific medications can influence the risk of DD. Nonsteroidal
anti-inflammatory drugs and corticosteroids have been shown
to be a risk factor for complicated and uncomplicated DD,
while cardiovascular disease has been found to be a risk factor
for complicated DD [
3–5
]. Socioeconomic variables such as
education, income, and access to healthcare have been shown
to influence the severity of a range of medical conditions
[
6–10
]. Socioeconomic characteristics such as education,
income, and urbanization, together with comorbidities and in
addition to known risk factors such as sex and age, may also
explain the risk of hospitalization for both uncomplicated and
complicated DD.
The relationship of socioeconomic characteristics and
comorbidity with disease is of special interest in Sweden, where
access to healthcare is equal for all residents, and differences
in socioeconomic status (SES) are less apparent compared
with many other countries. The aim of this study was to
evaluate the association of SES and comorbidities with
uncomplicated and complicated DD in Sweden.
Methods
This study was approved by the Ethics Committee of Lund
University, Sweden. All individuals ≥30 years of age
living in Sweden in 1997 were included. The data sources
used included the Swedish National Population and
Housing Census, the Total Population Register, and the
Hospital Discharge Register. Access to these registers
was provided by Statistics Sweden and the National
Board of Health and Welfare. The Swedish Hospital
Discharge Register, which was created by the National
Board of Health and Welfare in 1964, contains hospital
discharge records for all residents of Sweden. From 1987
onwards, the register includes complete nationwide data
with information on dates of admission and discharge,
together with principal causes of hospitalization [11].
Data in these registers were linked using individual
lifetime personal identification numbers assigned to all peopl (...truncated)