Cumulative Incidence of Chronic Constipation: A Population-Based Study
Cumulative Incidence of Chronic Constipation: A Population-Based Study
Aim: To estimate the cumulative incidence of chronic constipation and evaluate potential risk factors.
Methods: In previous cross-sectional studies in 1988, random samples of Olmsted County, MN residents were mailed valid gastrointestinal symptoms surveys. A similar survey was mailed in 2003 to all the remaining eligible subjects who had been mailed to previously. An incident case of chronic constipation was defined as no reported constipation or irritable bowel syndrome on their initial survey but reported constipation on the second survey.
Results: In all, 5507 (79%) subjects responded to the initial survey and 2298 (55%) subjects responded to the second survey in which chronic constipation could be defined. Over 12 years, the cumulative incidence of chronic constipation was 17.4% (14.5, 20.5). Among those less than age 50 years at baseline, the incidence of chronic constipation differed by gender (9.2% in men vs. 18.3% in women). In those over 70 years, the incidence of chronic constipation was more similar for men and women (20.6% vs. 25.0%). The other risk factor associated with new onset chronic constipation was the presence of abdominal pain at baseline [OR = 2.0 (1.3, 3.0)].
Conclusion: The cumulative incidence of chronic constipation over more than a decade was almost one in six, and more pronounced in women and the elderly.
Chronic constipation (CC) is a common and heterogeneous disorder, which is often characterized by difficult, infrequent stool passage, or incomplete evacuation. Population-based studies have estimated that the prevalence of CC in North America varies between 2% and 27%, representing 4-56 million adults in the United States alone. This variation may be explained by different diagnostic criteria and different study designs. However, by any definition, CC is one of the most common reasons for patients visiting clinics in North America. Constipation leads to 2.5 million physician visits per year in the United States. Several studies have suggested that constipation has a clinically significant deleterious effect on health-related quality of life and represents an economic burden on the patient and health care provider. For example, a tertiary care evaluation for constipation was reported to cost an average of $2752 per patient in 1997. Therefore, knowledge of the epidemiology of constipation is highly relevant to primary care providers, gastroenterologists, and health care policy makers.
There are no representative North American population based studies that address the incidence of constipation. Just two articles reported the onset rates of constipation after a previous survey. However, in these two studies, the periods were very short and without reference to whether the subject had ever had constipation in the past. Population-based data on the true incidence of CC in the USA are lacking.
When evaluating risk factors for CC, incident cases are preferable to prevalent cases, because cross-sectional studies cannot distinguish cause and effect relationships. There are no true incidence studies assessing potential risk factors. Several prevalence studies have reported that increasing age or female gender was associated with CC. Other risk factors for CC identified in population studies have included race, socioeconomic status, educational status, medications, and diverticulosis.
The aim of the present study was to estimate the cumulative incidence of CC and evaluate the potential risk factors for the incidence of CC in a community.
Aim: To estimate the cumulative incidence of chronic constipation and evaluate potential risk factors.
Methods: In previous cross-sectional studies in 1988, random samples of Olmsted County, MN residents were mailed valid gastrointestinal symptoms surveys. A similar survey was mailed in 2003 to all the remaining eligible subjects who had been mailed to previously. An incident case of chronic constipation was defined as no reported constipation or irritable bowel syndrome on their initial survey but reported constipation on the second survey.
Results: In all, 5507 (79%) subjects responded to the initial survey and 2298 (55%) subjects responded to the second survey in which chronic constipation could be defined. Over 12 years, the cumulative incidence of chronic constipation was 17.4% (14.5, 20.5). Among those less than age 50 years at baseline, the incidence of chronic constipation differed by gender (9.2% in men vs. 18.3% in women). In those over 70 years, the incidence of chronic constipation was more similar for men and women (20.6% vs. 25.0%). The other risk factor associated with new onset chronic constipation was the presence of abdominal pain at baseline [OR = 2.0 (1.3, 3.0)].
Conclusion: The cumulative incidence of chronic constipation over more than a decade was almost one in six, and more pronounced in women and the elderly.
Chronic constipation (CC) is a common and heterogeneous disorder, which is often characterized by difficult, infrequent stool passage, or incomplete evacuation. Population-based studies have estimated that the prevalence of CC in North America varies between 2% and 27%, representing 4-56 million adults in the United States alone. This variation may be explained by different diagnostic criteria and different study designs. However, by any definition, CC is one of the most common reasons for patients visiting clinics in North America. Constipation leads to 2.5 million physician visits per year in the United States. Several studies have suggested that constipation has a clinically significant deleterious effect on health-related quality of life and represents an economic burden on the patient and health care provider. For example, a tertiary care evaluation for constipation was reported to cost an average of $2752 per patient in 1997. Therefore, knowledge of the epidemiology of constipation is highly relevant to primary care providers, gastroenterologists, and health care policy makers.
There are no representative North American population based studies that address the incidence of constipation. Just two articles reported the onset rates of constipation after a previous survey. However, in these two studies, the periods were very short and without reference to whether the subject had ever had constipation in the past. Population-based data on the true incidence of CC in the USA are lacking.
When evaluating risk factors for CC, incident cases are preferable to prevalent cases, because cross-sectional studies cannot distinguish cause and effect relationships. There are no true incidence studies assessing potential risk factors. Several prevalence studies have reported that increasing age or female gender was associated with CC. Other risk factors for CC identified in population studies have included race, socioeconomic status, educational status, medications, and diverticulosis.
The aim of the present study was to estimate the cumulative incidence of CC and evaluate the potential risk factors for the incidence of CC in a community.
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