Peptic Ulcer Disease in Healthcare Workers: A Nationwide Population-Based Cohort Study.

Hong-Yue Lin,Shih-Bin Su,Chien-Cheng Huang,Chien-Chin Hsu,Hung-Jung Lin,How-Ran Guo,Jhi-Joung Wang,Shih-Feng Weng,John Green

doi:10.1371/journal.pone.0135456

Abstract

Health care workers (HCWs) in Taiwan have heavy, stressful workloads, are on-call, and have rotating nightshifts, all of which might contribute to peptic ulcer disease (PUD). We wanted to evaluate the PUD risk in HCWs, which is not clear. Using Taiwan’s National Health Insurance Research Database, we identified 50,226 physicians, 122,357 nurses, 20,677 pharmacists, and 25,059 other HCWs (dieticians, technicians, rehabilitation therapists, and social workers) as the study cohort, and randomly selected an identical number of non-HCW patients (i.e., general population) as the comparison cohort. Conditional logistical regression analysis was used to compare the PUD risk between them. Subgroup analysis for physician specialties was also done. Nurses and other HCWs had a significantly higher PUD risk than did the general population (odds ratio [OR]: 1.477; 95% confidence interval [CI]: 1.433–1.521 and OR: 1.328; 95% CI: 1.245–1.418, respectively); pharmacists had a lower risk (OR: 0.884; 95% CI: 0.828–0.945); physicians had a nonsignificantly different risk (OR: 1.029; 95% CI: 0.987–1.072). In the physician specialty subgroup analysis, internal medicine, surgery, Ob/Gyn, and family medicine specialists had a higher PUD risk than other physicians (OR: 1.579; 95% CI: 1.441–1.731, OR: 1.734; 95% CI: 1.565–1.922, OR: 1.336; 95% CI: 1.151–1.550, and OR: 1.615; 95% CI: 1.425–1.831, respectively). In contrast, emergency physicians had a lower risk (OR: 0.544; 95% CI: 0.359–0.822). Heavy workloads, long working hours, workplace stress, rotating nightshifts, and coping skills may explain our epidemiological findings of higher risks for PUD in some HCWs, which might help us improve our health policies for HCWs.

Highlights

Peptic ulcer disease (PUD) is caused by a disruption of the balance between hostile factors such as Helicobacter pylori, gastric acid, nonsteroidal anti-inflammatory drugs (NSAIDs), and pepsin, and protective factors such as mucus, prostaglandins, bicarbonate, and blood flow to the mucosa [1]
Using Taiwan’s National Health Insurance Research Database, we identified 50,226 physicians, 122,357 nurses, 20,677 pharmacists, and 25,059 other healthcare workers (HCWs) as the study cohort, and randomly selected an identical number of non-HCW patients as the comparison cohort
Physicians specialized in internal medicine, surgery, Ob/Gyn, and family medicine had a significantly higher risk for PUD than did physicians in other specialties (Table 4)

Summary

Introduction

Peptic ulcer disease (PUD) (gastric and duodenal ulcers) is caused by a disruption of the balance between hostile factors such as Helicobacter pylori, gastric acid, nonsteroidal anti-inflammatory drugs (NSAIDs), and pepsin, and protective factors such as mucus, prostaglandins, bicarbonate, and blood flow to the mucosa [1]. The annual number of outpatient visits per physician in Taiwan increased from 6,621 in 1992 to 8,600 in 2012 (+30%). Stress and shift work were risk factors for PUD [2,7]; there is no study on PUD in HCWs in the literature. We conceived this nationwide population-based retrospective cohort study to investigate PUD in HCWs versus the general population. We hypothesized that Taiwan’s HCWs, especially those with more shift work and physicians specialized in emergency and critical care medicine, have a higher risk for PUD than does the general population

Methods

Results

Discussion

Conclusion