title: Perceived stress as a risk factor for peptic ulcers: a register-based cohort study.
abstract: BACKGROUND
  The association between stress and peptic ulcers has been questioned since the discovery of helicobacter pylori. This study examined whether high perceived everyday life stress was associated with an increased risk of either receiving a triple treatment or being diagnosed with a peptic ulcer.
  
  
  METHODS
  Cohen's perceived stress scale measured the level of stress in a general health survey in 2010 of 17,525 residents of northern Jutland, Denmark, and was linked with National Danish registers on prescription drugs and hospital diagnoses. Cox proportional hazard regression was used to estimate the risk of either receiving a triple treatment or being diagnosed in a hospital with a peptic ulcer, in relation to quintiles of stress levels.
  
  
  RESULTS
  A total of 121 peptic ulcer incidents were recorded within 33 months of follow-up. The lowest stress group had a cumulative incidence proportion of either receiving triple treatment or being diagnosed with peptic ulcer of approximately 0.4%, whereas the highest stress group had a cumulative incidence proportion of approximately 1.2%. Compared with that of the lowest stress group, those in the highest stress group had a 2.2-fold increase in risk of either receiving triple treatment or being diagnosed with peptic ulcer (HR 2.24; CI 95% 1.16:4.35) after adjustment for age, gender, socioeconomic status, non-steroid anti-inflammatory drug use, former ulcer and health behaviours. There was no difference in risk between the four least stressed quintiles. Subgroup analysis of diagnosed peptic ulcer patients revealed the same pattern as the main analysis, although the results were not significant.
  
  
  CONCLUSIONS
  The highest level of perceived everyday life stress raised the risk of either receiving triple treatment or being diagnosed with peptic ulcer during the following 33 months more than twice compared with that of the lowest level of perceived stress.
authors.affiliation: Department of Health Science and Technology, Public Health and Epidemiology Group, Aalborg University, Niels Jernes Vej 14, Aalborg, Øst, 9220, Denmark. ulrikdeding@hotmail.com.
authors.forename: Ulrik
authors.identifier: http://orcid.org/0000-0002-8263-2989
authors.initials: U
authors.lastname: Deding
authors.affiliation: Department of Health Science and Technology, Public Health and Epidemiology Group, Aalborg University, Niels Jernes Vej 14, Aalborg, Øst, 9220, Denmark.
authors.forename: Linda
authors.initials: L
authors.lastname: Ejlskov
authors.affiliation: Department of Health Science and Technology, Public Health and Epidemiology Group, Aalborg University, Niels Jernes Vej 14, Aalborg, Øst, 9220, Denmark.
authors.forename: Mads Phillip Kofoed
authors.initials: MP
authors.lastname: Grabas
authors.affiliation: Department of Clinical Epidemiology, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg, DK-9000, Denmark.
authors.forename: Berit Jamie
authors.initials: BJ
authors.lastname: Nielsen
authors.affiliation: Department of Health Science and Technology, Public Health and Epidemiology Group, Aalborg University, Niels Jernes Vej 14, Aalborg, Øst, 9220, Denmark.|Department of Clinical Epidemiology, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg, DK-9000, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.affiliation: Department of Health Science and Technology, Public Health and Epidemiology Group, Aalborg University, Niels Jernes Vej 14, Aalborg, Øst, 9220, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Bøggild
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D003718:Denmark / Q000453:epidemiology; D059026:Diagnostic Self Evaluation; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013315:Stress, Psychological / Q000523:psychology*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents
keywords: Cohen’s perceived stress scale; Eradication therapy; NSAID; PSS-10; Peptic ulcer; Psychological stress; Smoking