Objective: Despite its frequent occurrence, the etiology of constipation has remained pearl-understood, The influence of widely accepted risk Factors such as inadequate dietary fiber intake, immobility, insufficient fluid intake, and poor muscle tone is unclear, This study examined the geographic distribution of constipation among Medicare beneficiaries to identify potential environmental risk Factors. Methods: All Medicare beneficiaries with a diagnosis of constipation were extracted from the total Health Care Financing Administration data file of 1987 said stratified by sex, race, and state of residence, The population of each state by sex race, and age >65 yr served as the denominator to calculate sex-and race-specific morbidity rates, Results: A distinct geographic distribution was observed. When stratified by individual states, hospital discharges for constipation were more common in rural as compared with urban states, Constipation also appeared tea be more common in northern and in poorer states, Conclusion: The distinct geographic pattern of constipation suggests thr influence of three global environmental Factors: rural living, colder temperature, and lowcr socioeconomic status, (C) 1998 by Am, Coil, of Gastroenterology).