Relation between gastroesophageal reflux symptoms and socioeconomic factors: A population-based study (the HUNT study)

Background & Aims: Gastroesophageal. reflux constitutes a major public health problem in the Western world. Few population-based studies have addressed socioeconomic factors in relation to reflux. Methods: We conducted a case-control study based on 2 health surveys performed in the Norwegian county of Nord-Trondelag in 1984-1986 and 1995-1997, respectively. Reflux was assessed in the second survey, comprising 65,333 participants representing 70% of the county's adult population. Among 58,596 persons responding to questions regarding reflux symptoms, 3153 persons reporting severe symptoms represented the cases, and 40,210 persons without symptoms represented the controls. Data collected in questionnaires included socioeconomic status (SES) based on occupation, education, and material deprivation; family situation; and potential confounders. Odds ratios (ORs) with 95% confidence intervals (Cls) were estimated from unconditional logistic regression in crude models and models adjusted for age, sex, smoking, and body mass. Results: The risk of reflux increased with decreasing levels of SES based on occupation, education, and material deprivation. Increased risks of reflux were seen among unskilled laborers (OR, 1.6; 95% CI, 1.3-2.0), skilled laborers (OR, 1.4; 95% CI, 1.1-1.7), and self-employed and farmers (OR, 1.3; 95% CI, 1.1-1.6). A 1.9-fold (95% CI, 1.7-2.2) increased risk of reflux was observed among persons with low education, compared with highly educated persons. Reflux was more common among materially deprived persons (OR, 3.4; 95% CI, 2.9-4.1). The results were similar in crude and adjusted models. Conclusions: This large population-based study reveals a link between low SES and reflux symptoms that is not explained by the known risk factors of smoking or obesity. This finding deserves further research.