Psychosocial factors and their association with reflux oesophagitis, Barrett’s oesophagus and oesophageal adenocarcinoma

Table 1 Characteristics of participants

Variables	Controls	RO		BO		OAC
	n (%)	n (%)	P value	n (%)	P value	n (%)	P value
Gender			0.47		0.55		0.99
Male	220 (84.6)	189 (82.2)		185 (82.6)		192 (84.6)
Female	40 (15.4)	41 (17.8)		39 (17.4)		35 (15.4)
Age (yr)	63.0	61.7	0.22	62.4	0.57	64.2	0.28
Education (yr)	12.0	10.8	< 0.001	11.3	0.01	10.7	< 0.001
Job type			0.71		0.02		0.01
Manua	119 (48.0)	107 (48.2)		130 (59.1)		128 (59.5)
Non-manual	129 (52.0)	115 (51.8)		90 (40.9)		87 (40.5)
GOR symptoms			< 0.001		< 0.001		< 0.001
Neve	211 (81.2)	140 (60.9)		60 (26.8)		117 (51.5)
Ever	49 (18.8)	90 (39.1)		164 (73.2)		110 (48.5)
Smoking status			0.03		0.40		< 0.001
Never	102 (40.2)	109 (48.4)		87 (39.2)		45 (20.4)
Ex-smoker	107 (42.1)	68 (30.2)		85 (38.3)		99 (44.8)
Current	45 (17.7)	48 (21.3)		50 (22.5)		77 (34.8)
Alcohol (g/d)	26.1	22.0	0.15	22.3	0.21	19.2	0.01
Body mass index (kg/m2)	27.0	27.8	0.05	27.0	0.90	28.7	< 0.001
Reed stress inventory, mean ± SD			0.014		0.187		< 0.001
Mean score (range 2-8)	4.50 ± 2.08	4.11 ± 1.88		4.28 ± 2.08		3.80 ± 2.09
Stress teenage years			0.146		0.539		0.655
Mean score (range 1-5	1.80 ± 1.05	1.67 ± 0.95		1.86 ± 1.18		1.85 ± 1.17
Stress young adulthood			0.301		0.328		0.486
Mean score (range 1-5	2.45 ± 1.23	2.67 ± 1.11		2.34 ± 1.25		2.37 ± 1.24
Stress midlife			< 0.001		0.038		0.928
Mean score (range 1-5)	2.49 ± 1.26	3.33 ± 1.20		2.75 ± 1.34		2.50 ± 1.33
Stress senior years			< 0.001		0.08		0.088
Mean score (range 1-5)	2.07 ± 1.17	2.80 ± 1.42		2.34 ± 1.35		2.33 ± 1.37
Depression			0.107		0.147		0.109
Mean score (range 2-8)	4.11 ± 1.74	4.42 ± 2.37		4.38 ± 2.25		3.82 ± 2.31
Self efficacy			< 0.001		0.794		< 0.001
Mean score (range 10-40)	32.0 ± 4.76	33.8 ± 4.32		31.8 ± 5.52		34.3 ± 4.89
Self esteem			0.828		0.022		0.034
Mean score (range 1-4)	2.95 ± 0.81	2.93 ± 1.10		2.76 ± 1.04		3.13 ± 0.97
Repression			0.097		0.501		0.554
Mean score	2.80 ± 0.89	2.64 ± 1.17		2.86 ± 1.05		2.86 ± 1.17
Social support			< 0.001		0.40		< 0.001
Mean score (range 1-4)	3.57 ± 0.60	3.82 ± 0.50		3.62 ± 0.63		3.76 ± 0.48

RO: Reflux oesophagitis; BO: Barrett’s oesophagus; OAC: Oesophageal adenocarcinoma; GOR: Gastroesophageal reflux.

Table 2 Self-reported stress levels during lifetime

	Controls	RO		BO		OAC
Stress levels	n (%)	n (%)	AOR (95%CI)	n (%)	AOR (95%CI)	n (%)	AOR (95%CI)
Reed stress inventory levels
Low	45 (17.6)	63 (27.9)	1.00	60 (27.2)	1.00	81 (36.3)	1.00
Medium	154 (60.2)	122 (54.0)	0.92 (0.51-1.63)	102 (46.2)	0.51 (0.31-0.86)	91 (40.8)	0.37 (0.23-0.61)
High	57 (22.3)	41 (18.1)	1.43 (0.64-3.22)	59 (26.7)	0.60 (0.33-1.09)	51 (22.9)	0.51 (0.29-0.90)
			P for trend 0.48		P for trend 0.10		P for trend 0.010
Teenage years
1	135 (52.7)	132 (58.7)	1.00	122 (55.5)	1.00	127 (57.5)	1.00
2	67 (26.1)	53 (23.6)	1.05 (0.64-1.71)	42 (19.1)	0.73 (0.43-1.23)	32 (14.5)	0.63 (0.37-1.06)
3	31 (14.1)	26 (11.6)	0.77 (0.40-1.49)	31 (14.1)	1.06 (0.57-1.96)	42 (19.0)	1.50 (0.84-2.67)
4	16 (6.3)	11 (4.9)	0.67 (0.26-1.70)	14 (6.4)	0.75 (0.31-1.79)	9 (4.1)	0.58 (0.23-1.48)
5	7 (2.7)	3 (1.3)	0.28 (0.06-1.26)	11 (5.0)	0.76 (0.25-2.29)	11 (5.0)	1.18 (0.40-3.48)
			P for trend 0.10		P for trend 0.55		P for trend 0.85
Young adulthood
1	64 (25.0)	38 (16.9)	1.00	76 (34.7)	1.00	70 (32.3)	1.00
2	67 (26.2)	61 (27.1)	2.04 (1.11-3.76)	47 (21.5)	0.59 (0.34-1.04)	52 (24.0)	0.80 (0.47-1.38)
3	82 (32.0)	75 (33.3)	1.92 (1.06-3.49)	57 (26.0)	0.47 (0.27-0.81)	55 (25.4)	0.67 (0.39-1.14)
4	32 (12.5)	39 (17.3)	2.65 (1.27-5.55)	23 (10.5)	0.46 (0.22-0.96)	24 (11.1)	0.71 (0.35-1.44)
5	11 (4.3)	12 (5.3)	3.20 (1.07-9.55)	16 (7.3)	0.86 (0.33-2.28)	16 (7.4)	1.22 (0.47-3.18)
			P for trend 0.01		P for trend 0.05		P for trend 0.49
Midlife
1	68 (28.7)	20 (9.1)	1.00	52 (25.0)	1.00	58 (27.9)	1.00
2	57 (24.1)	38 (17.2)	2.56 (1.22-5.37)	39 (18.8)	0.87 (0.48-1.59)	62 (29.8)	1.25 (0.73-2.16)
3	55 (23.2)	50 (22.6)	4.04 (1.97-8.25)	48 (23.1)	1.07 (0.59-1.94)	38 (18.3)	0.95 (0.53-1.71)
4	41 (17.3)	76 (34.4)	8.50 (4.14-17.46)	47 (22.6)	1.23 (0.65-2.30)	25 (12.0)	0.70 (0.36-1.36)
5	16 (6.8)	37 (16.7)	9.82 (4.11-23.45)	22 (10.6)	1.27 (0.55-2.89)	25 (12.0)	1.60 (0.72-3.53)
			P for trend 0.001		P for trend 0.33		P for trend 0.97
Senior years
1	64 (42.4)	30 (24.4)	1.00	47 (39.2)	1.00	47 (37.3)	1.00
2	38 (25.1)	28 (22.8)	1.76 (0.86-3.61)	23 (19.2)	0.71 (0.35-1.45)	32 (25.4)	1.08 (0.56-2.09)
3	30 (19.9)	22 (17.9)	1.77 (0.82-3.83)	22 (18.3)	0.93 (0.44-1.96)	19 (15.1)	0.84 (0.40-1.78)
4	12 (8.0)	23 (18.7)	4.28 (1.72-10.67)	18 (15.0)	2.15 (0.85-5.43)	14 (11.1)	1.71 (0.67-4.35)
5	7 (4.6)	20 (16.3)	5.92 (1.72-16.77)	10 (8.3)	1.48 (0.48-4.54)	14 (11.1)	2.35 (0.82-6.70)
			P for trend 0.001		P for trend 0.20		P for trend 0.14

RO: Reflux oesophagitis; BO: Barrett’s oesophagus; OAC: Oesophageal adenocarcinoma; 1: Low; 2-4: Medium; 5: High; AOR: Adjusted odds ratio.

Table 3 Psychosocial factors by group status

	Controls	RO		BO		OAC
	n (%)	n (%)	AOR (95%CI)	n (%)	AOR (95%CI)	n (%)	AOR (95%CI)
Depression
No	163 (63.7)	131 (58.0)	1.00	118 (52.2)	1.00	147 (65.9)	1.00
Yes	93 (36.3)	95 (42.0)	0.92 (0.61-1.40)	104 (46.9)	1.12 (0.74-1.70)	76 (34.1)	0.64 (0.42-0.98)
Self-efficacy
Low	84	35	1.00	79	1.00	43	1.00
Medium	74	55	1.65 (0.92-2.98)	54	0.61 (0.36-1.05)	49	1.06 (0.60 -1.87)
High	97	135	3.14 (1.86-5.31)	86	0.78 (0.48-1.27)	128	2.17 (1.32- 3.57)
Self-esteem
Low	67 (26.2)	63 (27.9)	1.00	77 (35.0)	1.00	46 (20.6)	1.00
High	189 (73.4)	163 (72.1)	0.93 (0.59 - 1.47)	143 (65.0)	0.76 (0.48 -1.18)	177 (79.4)	1.58 (0.99 - 2.52)
Repression
Low	83 (32.4)	100 (44.4)	1.00	71 (32.0)	1.00	72 (32.3)	1.00
High	173 (67.6)	125 (55.6)	0.63 (0.41-0.95)	151 (68.0)	1.20 (0.78 -1.86)	151 (67.7)	1.10 (0.72-1.67)
Social support
Hardly any	89	78	1.00	77	1.00	60	1.00
Some	89	53	0.72 (0.43-1.21)	61	1.12 (0.67-1.86)	58	1.28 (0.77-2.14)
Moderate	37	30	0.93 (0.49-1.77)	30	1.26 (0.66-2.39)	38	1.89 (1.02-3.48)
Substantial	41	64	1.97 (1.13-3.44)	54	1.83 (1.03-3.24)	67	2.84 (1.63-4.97)

RO: Reflux oesophagitis; BO: Barrett’s oesophagus; OAC: Oesophageal adenocarcinoma; AOR: Adjusted odds ratio.