Abstract
PurposeThis study aimed to evaluate the association of socioeconomic status and comorbidities with uncomplicated and complicated diverticular disease (DD) in Sweden.MethodsWe 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.ResultsA total of 79,481 patients (median age 66 [range 30–86] 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).ConclusionsPatients 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.
Highlights
The clinical burden of colonic diverticular disease (DD) is impressive
The socioeconomic status (SES) variables, individual disposable income and years of Of 79,481 patients admitted to hospital with a diagnosis of education in 1997, were identified from the Total Population DD, 15,878 (20%) were admitted for complicated DD
In an additional multivariable logistic analysis stratified according to the general Swedish retirement age of 65 years, the identified risk factors including income did not differ from the results of the main analysis (Table S1). This population-based study based on the Swedish national inpatient register showed that patients with the lowest level of education had an increased risk of being hospitalized for DD
Summary
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. 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 [3,4,5].
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