title: Predictive factors for the diagnosis of irritable bowel syndrome in a large cohort of 440,822 young adults.
abstract: BACKGROUND
  The prevalence of irritable bowel syndrome (IBS) in the community has been reported in numerous cross-sectional surveys. However, little is known about the incidence and predictive factors for the clinical diagnosis of IBS.
  
  
  METHODS
  We examined the association of socioeconomic, anthropometric, and occupational factors with the incidence of IBS in a cohort of 440,822 young Israeli adults aged 18 to 39 who served in active military service during the years 2005 to 2011.
  
  
  RESULTS
  During the follow-up of 1,925,003 person-years, IBS was diagnosed de novo in 976 patients, giving an incidence rate of 221:100,000 (0.2%) person-years for the diagnosis of IBS. On multivariable Cox analysis, higher socioeconomic status [hazard ratio (HR) 1.629; 95% confidence interval (CI), 1.328-1.999; P<0.0001], Israeli birth (HR 1.362; 95% CI, 1.084-1.712; P=0.008), Jewish ethnicity (HR 2.089; 95% CI, 1.344-3.248; P=0.001), education ≥than 11 years (HR 1.674; 95% CI, 1.019-2.751; P=0.042), and a noncombat military position (HR 1.196; 95% CI, 1.024-1.397; P=0.024) were found to be risk factors for the diagnosis or for the worsening of IBS. Overweight (HR 0.744; 95% CI, 0.589-0.941; P=0.014), obesity (HR 0.698; 95% CI, 0.510-0.95; P=0.025), living in a rural settlement (HR 0.705; 95% CI, 0.561-0.886; P=0.003), and Middle Eastern (HR 0.739; 95% CI, 0.617-0.884; P=0.001,) or North African and Ethiopian origin (HR 0.702; 95% CI, 0.585-0.842; P<0.001) were found to be protective for the diagnosis or the worsening of IBS.
  
  
  CONCLUSIONS
  This study provides novel data on the socioeconomic, anthropometric, and occupational factors predictive for IBS development. The predictive factors for IBS diagnosis may point to the fact that stress had a lower impact on IBS incidence in our study cohort.
authors.affiliation: *Israel Defense Force, Medical Corps, Headquarters Tel Hashomer †Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer ‡Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Carter
authors.forename: Marc
authors.initials: M
authors.lastname: Beer-Gabel
authors.forename: Dorit
authors.initials: D
authors.lastname: Tzur
authors.forename: Gad
authors.initials: G
authors.lastname: Levy
authors.forename: Estela
authors.initials: E
authors.lastname: Derazne
authors.forename: Ben
authors.initials: B
authors.lastname: Novis
authors.forename: Arnon
authors.initials: A
authors.lastname: Afek
mesh_terms: D000293:Adolescent; D000328:Adult; D000352:Africa, Northern / Q000208:ethnology; D015992:Body Mass Index; D015331:Cohort Studies; D004522:Educational Status; D005002:Ethiopia / Q000208:ethnology; D005260:Female; D006801:Humans; D015994:Incidence; D043183:Irritable Bowel Syndrome / Q000453:epidemiology*; D007557:Israel / Q000453:epidemiology; D007585:Jews / Q000208:ethnology; D008297:Male; D008877:Middle East / Q000208:ethnology; D008889:Military Personnel / Q000706:statistics & numerical data; D009790:Occupations / Q000706:statistics & numerical data*; D050177:Overweight / Q000453:epidemiology; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D055815:Young Adult