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Role of Meteorological Factors in Duodenal Ulcer Seasonality

A Nation-wide, Population-Based Study

Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND

Understanding disease seasonality can provide guidance for future biomedical research.

OBJECTIVE

To examine whether meteorological factors and calendar months impact duodenal ulcer (DU) exacerbations.

DESIGN

We conducted a retrospective time series analysis of population-based claims data.

PARTICIPANTS

DU inpatients (1997–2003; all endoscopy confirmed) from Taiwan, a small island nation, n = 160,510. Inpatient admission was used as a proxy for exacerbation because 98.5% of cases had hemorrhage or perforation or both.

MEASUREMENTS

We used multivariate autoregressive integrated moving average (ARIMA) modeling to examine if DU admissions/100,000 was associated with calendar month, ambient temperature, relative humidity, rainfall, atmospheric pressure, and sunshine hours, controlling for available DU-relevant comorbidities.

RESULTS

DU admissions increased with age. ARIMA modeling showed a February (Chinese New Year-related) trough in all age groups (all p < 0.001; adjusted for meteorological variables and comorbidities), consistent with a February dip in all-cause admissions. Among 35–49 and 50+ age groups, DU admissions were negatively associated with temperature (both p < 0.05; model R 2 = 0.875 and 0.920, respectively), representing a winter peak and summer trough. Among the ≤19 age group, sunshine hours and rainfall are positively associated with DU admissions (both p < 0.001; R 2 = 0.565), representing a summer peak.

CONCLUSION

Meteorological variables are associated with DU exacerbations, although the potential role of nonsteroidal anti-inflammatory drug (NSAID) use because of seasonal acute respiratory illness cannot be ruled out. We recommend in-depth studies using chart reviews of DU patients admitted during peak and trough (incidence) months to clarify whether meteorological factors or the associated seasonal peaks of respiratory and other illnesses involving NSAID use are responsible for the observed seasonality.

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Acknowledgment

This study is based on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health, Taiwan and managed by the National Health Research Institutes. The interpretations and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health or the National Health Research Institutes.

Conflict of interest

This study used publicly available, de-identified data published by the National Health Insurance Research Database for research purpose. Authors declare that there was no conflict of interest involved in conducting this research or publishing the work.

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Authors and Affiliations

  1. Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Sudha Xirasagar MBBS, PhD

  2. School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing St., Taipei, 110, Taiwan

    Herng-Ching Lin PhD

  3. Department of Economics, National Taipei University, Taipei, Taiwan

    Chin-Shyan Chen PhD

Authors
  1. Sudha Xirasagar MBBS, PhD
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  2. Herng-Ching Lin PhD
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  3. Chin-Shyan Chen PhD
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Corresponding author

Correspondence to Herng-Ching Lin PhD.

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Xirasagar, S., Lin, HC. & Chen, CS. Role of Meteorological Factors in Duodenal Ulcer Seasonality. J GEN INTERN MED 22, 1439–1446 (2007). https://doi.org/10.1007/s11606-007-0288-z

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  • DOI: https://doi.org/10.1007/s11606-007-0288-z

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