title: Irritable bowel syndrome in middle-aged and elderly Palestinians: its prevalence and effect of location of residence.
abstract: OBJECTIVE
  The prevalence of irritable bowel syndrome (IBS) around the world is variable, ranging from as little as 1.1 to 45%. Limited studies have been carried out in Arab populations. The aim of this study was to determine the prevalence of IBS and its subtypes in the West Bank, Palestine, and to assess variation by locality of residence.
  
  
  METHODS
  We conducted a population-based, cross-sectional study. Participants were randomly selected from all districts of the West Bank, including cities, villages, and refugee camps, and they were at least 50 years of age. Participants completed the Rome III IBS questionnaire along with demographic data. The primary outcome was the effect of location of residence on the prevalence of IBS. A multivariable logistic regression model was used to assess the difference in IBS prevalence based on locality of residence.
  
  
  RESULTS
  A total of 1,601 people were approached for interview, of which 1,352 agreed to participate (response rate 84%). Most participants (53%; n=637) lived in urban centers. The overall prevalence of IBS was 30% (28-33%). IBS was more common in refugee camps (34%) and in villages (34%) compared with urban centers (27%) (P<0.05). Mixed IBS (IBS-M) was the most common of IBS subtypes (55%, n=244). In a multivariable logistic regression analysis, living in refugee camps (odds ratio (OR) 1.68 (95% confidence interval (CI) 1.14-2.40), P=0.005) and in villages (OR 1.33 (1.02-1.72), P=0.033) was associated with increased odds of having IBS when compared with residents of urban centers. IBS, IBS with constipation, and IBS-M were more common in women than in men (P<0.05).
  
  
  CONCLUSIONS
  The prevalence of IBS among middle-aged and elderly residents of Palestine is high. Residents in refugee camps and rural areas have a higher incidence of IBS than those in urban areas.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Bashar J
authors.initials: BJ
authors.lastname: Qumseya
authors.affiliation: Al-Quds University Medical School, Abu-Dis, Palestine.
authors.forename: Yasin
authors.initials: Y
authors.lastname: Tayem
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Cristina
authors.initials: C
authors.lastname: Almansa
authors.affiliation: Al-Quds University Medical School, Abu-Dis, Palestine.
authors.forename: Osama Y
authors.initials: OY
authors.lastname: Dasa
authors.affiliation: Al-Quds University Medical School, Abu-Dis, Palestine.
authors.forename: Murad K
authors.initials: MK
authors.lastname: Hamadneh
authors.affiliation: Al-Quds University Medical School, Abu-Dis, Palestine.
authors.forename: Ahmed F
authors.initials: AF
authors.lastname: Al-sharif
authors.affiliation: Al-Quds University Medical School, Abu-Dis, Palestine.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Hmidat
authors.affiliation: Al-Quds University Medical School, Abu-Dis, Palestine.
authors.forename: Ismael M
authors.initials: IM
authors.lastname: Abu-limon
authors.affiliation: Al-Quds University Medical School, Abu-Dis, Palestine.
authors.forename: Khaled W
authors.initials: KW
authors.lastname: Nahhal
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Khadija
authors.initials: K
authors.lastname: Alassas
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: DeVault
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Houghton
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018912:Arabs; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000208:ethnology* / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008877:Middle East; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D012036:Refugees; D012111:Residence Characteristics; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014504:Urban Health / Q000706:statistics & numerical data