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A Longitudinal Study of US Adults

Robert F. Anda, MD, MS; David F. Williamson, MS, PhD; Luis G. Escobedo, MD, MPH; Patrick L. Remington, MD, MPH; Eric E. Mast, MD, MPH; Jennifer H. Madans, PhD

Arch Intern Med. 1992;152(4):829-833.

Abstract
Background.—
Although many physicians and laypersons believe that stress plays a role in the occurrence of peptic ulcer disease, the importance of stress in the pathogenesis of peptic ulcers remains controversial.

Methods.—
To investigate the relationship between perceived stress and peptic ulcer disease we used data from the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study—a nationally representative cohort study of US adults. This analysis included 4511 persons who had not previously been diagnosed with peptic ulcer disease.

Results.—
At baseline, 68% of the cohort perceived themselves as stressed. During 13 years of follow-up, 208 persons developed ulcers; the cumulative incidence of ulcers was 7.2% for persons who were stressed and 4.0% for persons who were not. After we adjusted for age, sex, education, smoking status, and regular aspirin use, persons who perceived themselves as stressed were 1.8 times more likely to develop ulcers than those who did not (95% confidence interval, 1.3 to 2.5). We also found a graded relationship between the perceived amount of stress and the incidence of peptic ulcers; relative to nonstressed persons, the relative risk of developing an ulcer was 1.4,1.9,2.3,2.4, and 2.9 at five increasing levels of stress.

Conclusions.—
These findings suggest that persons who perceive their lives as stressful may be at increased risk for the development of peptic ulcer disease.

(Arch Intern Med. 1992;152:829-833)

Author Affiliations
From the Office of Surveillance and Analysis (Drs Anda, Escobedo, and Mast) and the Division of Nutrition (Dr Williamson), Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control, Atlanta, Ga; the Bureau of Community Health and Prevention, Wisconsin Division of Health, Madison (Dr Remington); and the Division of Analysis, National Center for Health Statistics, Centers for Disease Control, Hyattsville, Md (Dr Madans).

Footnotes
Accepted for publication October 16, 1991.

Reprint requests to the Division of Chronic Disease Control and Community Intervention, Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control, Mailstop K-47, 1600 Clifton Road NE, Atlanta, GA 30333 (Dr Anda).

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