Potential risk factors for constipation in the community

Table 1 Age and constipation

Ref.	Location	Sample size	Definition of constipation	Age range (yr)	Prevalence (%)	Odds ratio (95%CI)	P value
Harari et al[62], 1989	United States	42375	Self-report (12 mo)	< 40; 40-49; 50-59; 60-69; 70-79; > 80	2.6; 2.6; 2.9; 4.1; 5.5; 10.0	1.00; 1.00 (0.84, 1.18); 1.11 (0.92, 1.33); 1.60 (1.36, 1.86); 2.11 (1.80, 2.46); 3.80 (3.22, 4.49)	NR
Drossman et al[44], 1993	United States	5430	Rome I	15-34; 35-49; > 45	3.8; 3.6; 3.5	NR	NR
Talley et al[49], 1993	United States	690	Rome I	30-39; 60-64	25; 15	NR	< 0.05
Pare et al[45], 2001	Canada	1149	Self-report (3 mo)	18-34; 35-49; 50-64; > 65	26.4; 28.4; 26.3; 27.4	NR	NR
Pare et al[45], 2001	Canada	1149	Rome I	18-34; 35-49; 50-64; > 65	20.3; 14.5; 15.1; 15.4	NR	NR
Pare et al[45], 2001	Canada	1149	Rome II	18-34; 35-49; 50-64; > 65	16.1; 12.9; 14.8; 16.7	NR	NR
Choung et al[63], 2006	United States	3022	Self-report (12 mo)	< 50; > 50	1.321; 7.871	NR	NR
Wald et al[61], 2008	United States	2000	Self-report (12 mo)	< 29; 30-44; 45-59; > 60	13.41; 19.11 17.51; 19.91	NR	NR
Chang et al[46], 2007	United States	523	Rome III	< 50; > 50	18.2; 17.3	1.0; 0.94 (0.60, 1.48)	NR
Meinds et al[47], 2017	Netherlands	1259	Rome III	18-34; 35-46; 47-55; 56-64; 65-85	36.3; 26.6; 19.0; 19.2; 19.8	NR	< 0.001
Garrigues et al[60], 2004	Spain	349	Self-report (12 mo)	18-30; 31-50; 51-65	29.2; 29.2; 30.7	NR	NS
Fosnes et al[54], 2011	Norway	4622	Rome II	NR	NR	1.01 (1.003, 1.02)	0.005
Rey et al[55], 2014	Spain	1500	Rome III	18-40; 41-65; > 65	19; 19; 20	NR
Ebling et al[50], 2014	Croatia	658	Rome III	20-34; 35-49; 50-69	16.2; 22.7; 26.2	NR	0.035; 0.182
Papatheodoridis et al[51], 2010	Greece	1000	Rome III or self-report (12 mo)	15-29; 30-44; 45-59; 60-64	12; 16; 18; 25	0.422 (0.226, 0.788); 0.721 (0.397, 1.310); 0.670 (0.362, 1.241); 1.0	0.007; 0.283; 0.203; 0.010
Wald et al[61], 2008	United Kingdom	2000	Self-report (12 mo)	< 29; 30-44; 45-59; > 60	5.91; 7.71; 8.11; 9.11	NR	NR
Wald et al[61], 2008	France	2000	Self-report (12 mo)	< 29; 30-44; 45-59; > 60	12.21; 12.41; 9.41; 22.01	NR	NR
Wald et al[61], 2008	Germany	2000	Self-report (12 mo)	< 29; 30-44; 45-59; > 60	1.51; 4.31; 5.51; 8.71	NR	NR
Wald et al[61], 2008	Italy	2000	Self-report (12 mo)	< 29; 30-44; 45-59; > 60	5.81; 6.91; 8.91 10.61	NR	NR
Wald et al[59], 2010	China	2100	Self-report (12 mo)	< 29; 30-44; 45-59	12.71; 16.01; 18.61	NR	NR
Wald et al[59], 2010	Indonesia	2000	Self-report (12 mo)	< 29; 30-44; 45-59; > 60;	11.61; 13.51; 15.31; 9.61	NR	NR
Wald et al[59], 2010	South Korea	2000	Self-report (12 mo)	< 29; 30-44; 45-59; > 60;	18.11; 15.61; 16.91; 14.11	NR	NR
Jun et al[58], 2006	South Korea	1029	Self-report (3 mo)	15-19; 20-29; 30-39; 40-49; 50-59; > 60	22; 22; 15; 15; 14; 12	NR	0.003
Cheng et al[57], 2003	Hong Kong	3282	Rome II	< 30; 30-39; 40-49; 50-59; > 59	14.5; 13.6; 11.8; 13.7; 14.9	NR	NR
Lu et al[56], 2006	Taiwan	2018	Rome II	20-29; 30-39; 40-49; 50-59; 60-69; 70-79	12.2; 7.9; 7.4; 7.1; 10.4; 11.9	NR	0.04
Sorouri et al[53], 2010	Iran	18180	Rome III	< 40; 40-60; > 60	1.4; 4.7; 4.9	1.01 (1, 1.01)	< 0.05
Moezi et al[52], 2018	Iran	9264	Rome IV	40-59; > 60	6.91; 11.91	1.55 (1.31, 1.83)	< 0.001
Wald et al[59], 2010	Argentina	2000	Self-report (12 mo)	< 29; 30-44; 45-59; > 60	11.61; 12.31; 17.11; 17.31	NR	NR
Wald et al[59], 2010	Colombia	2000	Self-report; (12 mo)	< 29; 30-44; 45-59; > 60	19.61; 25.61; 25.31; 25.51	NR	NR
Wald et al[59], 2010	Brazil	2000	Self-report (12 mo)	< 29; 30-44; 45-59; > 60	13.91; 17.31; 19.41; 19.01	NR	NR
Howell et al[48], 2006	Sydney	1673	Rome II	25-34; 35-44; 45-54; 55-64	37.8; 27.7; 27.4; 27.6	NR	0.03

¹Calculated from data published. NR: Not reported; NS: Not significant.

Table 2 Gender and constipation

Ref.	Location	Sample size	Age range (yr)	Definition of constipation	Prev. males (%)	Prev. females (%)	F/M ratio	Odds ratio (95%CI)	P value
Everhart et al[67], 1989	United States	11204	25-74	Self-report (NTP)	3.6	11.4	3.171	3.8 (2.6, 5.6)	NR
Talley et al[64], 1991	United States	835	30-64	Rome I	13.9	20.8	1.501	1.6 (1.1, 2.3)	NR
Talley et al[49], 1993	United States	690	30-64	Self-reportRome I	2.7; 18.3	7.3; 20.1	2.701; 1.011	NR	NR
Drossman et al[44], 1993	United States	5430	> 15	Rome I	2.4	4.8	2.001	1.99 (1.5, 2.7)	NR
Stewart et al[68], 1999	United States	10018	> 18	Rome II	12.0	16.0	1.331	NR	NR
Pare et al[45], 2001	Canada	1149	> 18	Self-report (3 mo)	18.4	35.4	1.921	NR	NR
Pare et al[45], 2001	Canada	1149	> 18	Rome I	12.0	21.0	1.751	NR	NR
Pare et al[45], 2001	Canada	1149	> 18	Rome II	8.3	21.1	2.541	NR	NR
Choung et al[63], 2006	United States	2718	20-95	Self-report (12 mo)	2.761	6.441	2.331	NR	NR
Chang et al[46], 2007	United States	523	30-64	Rome III	17.8	17.8	1.00	1.0 (0.64, 1.57)	NR
Wald et al[61], 2008	United States	2000	> 15	Self-report (12 mo)	13.6	21.4	1.57	NR	NR
Choung et al[65], 2012	United States	2853	> 20	Rome II	20.11	27.71	1.381	1.6 (1.3, 1.9)	< 0.01
Choung et al[69], 2016	United States	2327	> 25	Rome III (mod)	5.1	8.7	1.711	NR	NR
Meinds et al[47], 2017	Netherlands	1259	> 18	Rome III	18.8	29.3	1.561	1.8 (1.4, 2.3)	< 0.001
Van Kerkhoven et al[70], 2008	Netherlands	1616	> 18	Self-report (4 wk)	7	18	2.571	NR	< 0.01
Garrigues et al[60], 2004	Spain	349	18-65	Self-report (12 mo)	18.0	40.1	2.231	2.9 (1.68, 4.98)	0.0001
Garrigues et al[60], 2004	Spain	349	18-65	Rome II	5.5	22.0	4.01	4.58 (1.98, 10.60)	0.0004
Walter et al[22], 2002	Sweden	1610	31-76	Self-report (NTP)	8.3	19.8	2.391	NR	< 0.0001
Haug et al[71], 2002	Norway	62651	> 20	Self-report (12 mo)	1.5	5.7	3.81	NR	< 0.05
Fosnes et al[54], 2011	Norway	4622	31-76	Rome II	6.71	19.31	2.881	3.24 (2.61, 4.02)	< 0.001
Gaburri et al[72], 1989	Italy	519	NR	Self-report (3 yr)	1.21	8.11	6.751	NR	NR
Heaton et al[73], 1993	United Kingdom	1892	26-69	Self-report (NTP)	14.7	31.1	2.121	NR	< 0.001
Wald et al[61], 2008	United Kingdom	2000	> 15	Self-report (12 mo)	4.2	10.9	2.60	NR	NR
Wald et al[61], 2008	Germany	2000	> 15	Self-report (12 mo)	3.0	7.5	2.5	NR	NR
Wald et al[61], 2008	Italy	2000	> 15	Self-report (12 mo)	4.9	10.8	2.2	NR	NR
Wald et al[61], 2008	France	2000	> 15	Self-report (12 mo)	8.6	18.9	2.2	NR	NR
Rey et al[55], 2014	Spain	1500	> 18	Rome III	10.6	27.6	2.7	NR	NR
Esteban y Peña et al[74], 2014	Spain	7341	> 16	Self-report (NTP)	1.9	5.9	3.11	NR	< 0.001
Enck et al[75], 2016	Germany	15002	> 18	Self-report (12 mo)	NR	NR	2.3	NR	NR
Ebling et al[50], 2014	Croatia	658	20-70	Rome III	24.3	20.3	0.841	NR	0.2260.126
Papatheodoridis et al[51], 2010	Greece	1000	15-64	Rome III or self-report (12 mo)	11	21	1.911	2.10 (1.41, 3.12)	< 0.001
Wald et al[61], 2008	Brazil	2000	> 15	Self-report	8.5	24.2	2.85	NR	NR
Wald et al[59], 2010	Argentina	2000	> 15	Self-report	7.9	20.2	2.56	NR	NR
Wald et al[59], 2010	Colombia	2000	> 15	Self-report	14.7	28.3	1.93	NR	NR
Schmidt et al[66], 2016	Brazil	2162	> 18	Rome III	5.3	21.9	4.131	4.3 (3.1, 6.1)	NR
Ho et al[76], 1998	Singapore	706	21-95	Rome II	2.8	5.6	2.01	NR	NR
Chen et al[77], 2000	Singapore	271	> 16	Rome II	3.6	11.3	3.141	NR	< 0.05
Cheng et al[57], 2003	Hong Kong	3282	18-80	Rome II	13.9	14.5	1.041	NR	NR
Lu et al[56], 2006	Taiwan	2018	> 20	Rome II	7.01	10.61	1.511	NR	< 0.001
Chang et al[78], 2012	Taiwan	4275	> 19	Rome III	2.8	6.2	2.211	NR	0.001
Jun et al[58], 2006	South Korea	1029	> 15	Self-report (3 mo)	10.4	22.8	2.191	NR	< 0.001
Jeong et al[79], 2008	South Korea	1417	18-69	Rome II	0.5	5.0	10.01	NR	< 0.05
Wald et al[61], 2008	South Korea	2000	> 15	Self-report (12 mo)	10.7	22.7	2.12	NR	NR
Tamura et al[23], 2016	Japan	5155	20-79	Self-report (NTP)	19.1	37.5	1.961	NR	< 0.001
Wald et al[59], 2010	Indonesia	2000	> 15	Self-report (12 mo)	10.7	15.1	1.41	NR	NR
Wald et al[59], 2010	China	2100	15-60	Self-report (12 mo)	10.8	19.7	1.82	NR	NR
Sorouri et al[53], 2010	Iran	18180	NR	Rome III	1.2	3.7	3.081	1.83 (1.44, 2.32)	< 0.01
Moezi et al[52], 2018	Iran	9264	40-75	Rome IV	6.7	9.3	1.44	NR	< 0.001
Talley et al[80], 1998	Australia	730	> 18	BSQ	6.3	21.1	3.35	NR	NR
Howell et al[48], 2006	Australia	1673	25-64	Rome II	25.1	36.0	1.43	NR	NR
Koloski et al[81], 2015	Australia	3260	> 18	Rome III	3.251	8.951	2.751	NR	NR

¹Calculated from published data. Prev.: Prevalence; F/M: Female/Male; Mod: Modified; NR: Not reported; NS: Not significant; NTP: No time period specified; BSQ: Bowel symptom questionnaire (similar to Rome criteria).

Table 3 Income level and constipation

Ref.	Location	Sample size	Age range (yr)	Definition of constipation	Income/year or week	Prevalence (%)	Odds ratio (95%CI)	P value
Stewart et al[68], 1999	United States	10018	> 18	Rome II	< $20000; $20-29900; $30-49900; > $50000	NR	1; 0.90; 1.10; 1.02	NR
Pare et al[45], 2001	Canada	1149	> 18	Self-report (3 mo)	< $20000; $20-39900; $40-59900; $60-79900; > $80000	33.8; 23.7; 24.3; 28.0; 21.8	1.55; 1.01; 1.11; 1.28; 1	NR
Pare et al[45], 2001	Canada	1149	> 18	Rome I	< $20000; $20-39900; $40-59900; $60-79900; > $80000	18.5; 16.3; 17.6; 13.1; 12.1	1.53; 1.35; 1.45; 1.08; 1	NR
Pare et al[45], 2001	Canada	1149	> 18	Rome II	< $20000; $20-39900; $40-59900; $60-79900; > $80000	15.3; 14.3; 13.9; 14.5; 8.3	1.84; 1.72; 1.67; 1.75; 1	NR
Wald et al[61], 2008	United States	2000	> 15	Self-report (12 mo)	Low; Middle; High	20.9; 16.1; 16.8	NR	NR
Wald et al[61], 2008	United Kingdom	2000	> 15	Self-report (12 mo)	Low; Middle;High	8.8; 7.27.1	NR	NR
Wald et al[61], 2008	France	2000	> 15	Self-report (12 mo)	Low; Middle; High	14.9; 11.3; 15.8	NR	NR
Wald et al[61], 2008	Germany	2000	> 15	Self-report (12 mo)	Low; Middle; High	7.2; 3.6; 5.3	NR	NR
Enck et al[75], 2016	Germany	15002	> 18	Self-report (12 mo)	< 1000; 1000-1500; 1500-2000; 2000-2500; 2500-3000; 3000-4000; > 4000	19.01; 18.81; 14.61; 13.61; 13.31; 11.31; 11.51	NR	< 0.001
Wald et al[61], 2008	Italy	2000	> 15	Self-report (12 mo)	Low; Middle; High	7.8; 7.0; 8.4	NR	NR
Wald et al[61], 2008	Brazil	2000	> 15	Self-report (12 mo)	Low; Middle; High	17.9; 15.8; 14.2	NR	NR
Schmidt et al[66], 2016	Brazil	2162	> 18	Rome III	2-15; 1.5-2; 1-1.5; 0.5-1; 0-0.5	11.1; 9.7; 13.8; 15.4; 21.8	1.0; 0.8 (0.5, 1.4); 1.3 (0.8, 2.1); 1.4 (0.9, 2.2); 1.9 (1.2, 3.0)	NR
Wald et al[61], 2008	South Korea	2000	> 15	Self-report (12 mo)	Low; Middle; High	17.1; 15.7; 17.1	NR	NR
Wald et al[59], 2010	Colombia	2000	> 15	Self-report (12 mo)	Low; Middle; High	23.9; 20.3; 14.8	NR	NR
Wald et al[59], 2010	China	2100	15-60	Self-report (12 mo)	Low; Middle; High	16.2; 15.5; 13.2	NR	NR
Wald et al[59], 2010	Indonesia	2000	> 15	Self-report (12 mo)	Low; Middle; High	13.1; 12.2; 14.0	NR	NR
Moezi et al[52], 2018	Iran	9264	40-75	Rome IV	Low; High	9.1; 6.5	NR	0.024
Cheng et al[57], 2003	Hong Kong	3282	18-80	Rome II	Nil; < 10000; 10000-19999; 20000-29999; 30000-39999; 40000-49999; > 50000	13.6; 14.8; 12.5; 12.6; 12.5; 12.5; 13.1	NR	NR
Jun et al[58], 2006	South Korea	1029	> 15	Rome II	< 1000; 1010-2000; 2010-3000; 3010-4000; > 4010	16; 15; 20; 26; 24	NR	0.044
Bytzer et al[82], 2001	Australia	8185	> 18	Rome II	5th quintile (lowest); 4th quintile; 3rd quintile; 2nd quintile; 1st quintile (highest)	10.2; 10.3; 9.6; 8.7; 6.3	NR	NR

¹Calculated from data published.

Note: Income is stated in various currencies. NR: Not reported; NS: Not significant.

Table 4 Educational level and constipation

Ref.	Location	Sample size	Age range (yr)	Definition of constipation	Educational level	Prevalence (%)	Odds ratio (95%CI)	P value
Everhart et al[67], 1989	United States	11204	25-74	Self-report (NTP)	> 8 yr; 9-11 yr; > 12 yr	NR	2.78; 1.35; 1	NR
Talley et al[49], 1993	United States	690	30-64	Rome I	< HS; HS; > HS	23.3; 18.4; 18.0	NR	NR
Stewart et al[68], 1999	United States	10018	> 18	Rome II	< 12 yr; 12 yr; 13-15.9 yr; > 16 yr	NR	1; 1.49; 1.41; 1.39	NR
Pare et al[45], 2001	Canada	1149	> 18	Self-report (3 mo)	Grade school; Some HS; HS; Diploma; Tech school; Some college; College; Grad school	28.8; 35.1; 24.6; 29.4; 20.5; 25.4; 31.5; 19.6	NR	NR
Pare et al[45], 2001	Canada	1149	> 18	Rome I	Grade school; Some HS; HS; Diploma; Tech school; Some college; College; Grad school	14.3; 23.8; 18.8; 22.1; 15.0; 9.9; 17.2; 11.3	NR	NR
Pare et al[45], 2001	Canada	1149	> 18	Rome II	Grade school; Some HS; HS; Diploma; Tech school; Some college; College; Grad school	4.3; 21.7; 18.6; 18.4; 12.0; 8.6; 6.5; 10.0	NR	NR
Wald et al[61], 2008	United States	2000	> 15	Self-report (12 mo)	< Secondary; Secondary; Tertiary	24.7; 18.9; 15.4	1.82 (1.16, 2.86)	< 0.01
Choung et al[83], 2007	United States	3022	20-95	BDQ	< HS; HS/College; > College	NR	1.3 (0.5, 3.1); 1.0; 0.8 (0.5, 3.1)	NS
Chang et al[46], 2007	United States	523	30-64	Rome III	< HS; HS/College; > College	16.7; 19.8; 14.8	0.81 (0.27, 2.46);1.00; 0.70 (0.43, 1.14)	NR
Choung et al[65], 2012	United States	2853	> 20	Rome II	< HS; HS/College; > College	7.0; 26.5; 20.3	NR	0.002
Wald et al[61], 2008	United Kingdom	2000	> 15	Self-report (12 mo)	< Secondary; Secondary; Tertiary	9.4; 7.0; 7.3	NR	NR
Wald et al[61], 2008	France	2000	> 15	Self-report (12 mo)	< Secondary; Secondary; Tertiary	17.6; 13.0; 12.7	1.48 (1.01, 2.15)	< 0.05
Wald et al[61], 2008	Germany	2000	> 15	Self-report (12 mo)	< Secondary; Secondary; Tertiary	5.6; 5.5; 4.5	NR	NR
Enck et al[75], 2016	Germany		> 18	Self-report (12 mo)	< Secondary; Secondary; Tertiary	19.6; 15.3; 15.6	NR	< 0.001
Ebling et al[50], 2014	Croatia	658	20-69	Rome III	< Elementary; Elementary; High school; Bachelor; University	50.0; 25.6; 20.2; 23.0; 23.4	0.278; 0.229; 0.248; 0.383	0.065; 0.028; 0.060; 0.178
Wald et al[61], 2008	Italy	2000	> 15	Self-report (12 mo)	< Secondary; Secondary; Tertiary	8.0; 8.1; 6.0	NR	NR
Papatheodoridis et al[51], 2010	Greece	1000	15-64	Rome III or self-report (12 mo)	Primary or less; Secondary; Higher	18; 14; 17	NR	0.31
Rey et al[55], 2014	Spain	1500	> 18	Rome III	Primary Secondary; University	19; 18; 20	NR	NR
Garrigues et al[60], 2004	Spain	349	18-65	Self-report (12 mo)	Basic; Primary Secondary or more	31.4; 26.4; 30.3	NR	NS
Wald et al[59], 2010	Argentina	2000	> 15	Self-report (12 mo)	< Secondary; Secondary; Tertiary	15.1; 13.4; 14.8	NR	NR
Wald et al[59], 2010	Colombia	2000	> 15	Self-report (12 mo)	< Secondary; Secondary; Tertiary	25.2; 21.0; 24.5	NR	NR
Wald et al[59], 2010	Brazil	2000	> 15	Self-report (12 mo)	< Secondary; Secondary; Tertiary	17.0; 15.2; 26.5	0.58 (0.36, 0.92)	< 0.03
Wald et al[59], 2010	China	2100	15-60	Self-report (12 mo)	< Secondary; Secondary; Tertiary	10.2; 16.5; 14.4	NR	NR
Wald et al[59], 2010	Indonesia	2000	> 15	Self-report (12 mo)	< Secondary; Secondary; Tertiary	10.6; 13.2; 19.0	NR	NR
Wald et al[59], 2010	Korea	2000	> 15	Self-report (12 mo)	< Secondary; Secondary; Tertiary	18.1; 16.7; 16.0	NR	NR
Cheng et al[57], 2003	Hong Kong	3282	18-80	Rome II	Nil; Primary; Junior HS; HS; Matriculation; University	14.5; 12.2; 14.8; 12.6; 14.0; 14.1	NR	NR
Sorouri et al[53], 2010	Iran	18180	NR	Rome III	Illiterate; < Diploma; HS diploma; University; > Masters	2.9; 2.1; 2.5; 2.1; 1.6	NR	NR
Moezi et al[52], 2018	Iran	9264	40-75	Rome IV	Illiterate; Other	9.0; 7.2	NR	0.002
Howell et al[48], 2006	Australia	1673	25-64	Rome II	Low; Low-mid; Mid-upper; High	30.6; 31.6; 38.9; 25.1	1.50 (0.97, 2.31); 1.49 (1.02, 2.18); 1.91 (1.33, 2.73)1	0.07; 0.04; 0.001

¹Calculated from published data.

HS: High school; BDQ: Bowel disease questionnaire (similar to Rome criteria); NR: Not reported; NS: Not significant.

Table 5 Residential region and constipation

Ref.	Location	Sample size	Age range (yr)	Definition of constipation	Region of residence	Prevalence (%)	Odds ratio (95%CI)	P value
Pare et al[45], 2000	Canada	1149	> 18	Self-report (3 mo)	Atlantic; Quebec; Ontario; Prairies; British Columbia	26.7; 25.8; 26.7; 25.6; 32.3	NR	NR
Pare et al[45], 2000	Canada	1149	> 18	Rome I	Atlantic; Quebec; Ontario; Prairies; British Columbia	18.2; 22.1; 13.5; 16.4; 14.5	NR	NR
Pare et al[45], 2000	Canada	1149	> 18	Rome II	Atlantic; Quebec; Ontario; Prairies; British Columbia	15.9; 18.6; 13.7; 14.0; 11.9	NR	NR
Papatheodoridis et al[51], 2010	Greece	1000	15-64	Rome III or self-report (12 mo)	Athens; Thessaloniki; Other cities	13; 18; 19	0.581 (0.399, 0.844); 0.928 (0.539, 1.598);1.0	0.004; 0.787; 0.017
Rey et al[55], 2014	Spain	1500	> 18	Rome III	Mediterranean; Centre; Atlantic	21; 17; 15	NR	NR
Rey et al[55], 2014	Spain	1500	> 18	Rome III	Urban; Rural	20; 18	NR	NR
Ebling et al[50], 2014	Croatia	658	20-69	Rome III	Urban; Rural	22.2; 17.5	1.947	0.003
Chu et al[41], 2014	China		> 18	Rome II	Hong Kong; Mainland	14.0; 6.4	NR	< 0.001
Chu et al[41], 2014	China		> 18	Rome II	North; South	15.5; 3.3	NR	< 0.001
Chu et al[41], 2014	China		> 18	Rome II	East; Midwest	4.0; 11.0	NR	< 0.001
Chu et al[41], 2014	China		> 18	Rome II	Urban; Rural	6.7; 7.2	NR	< 0.001

¹Calculated from data published. NR: Not reported.

Table 6 Other demographic/socioeconomic factors and constipation

Ref.	Location	Sample size	Age range (yr)	Definition of constipation	Factor	Variable	Prevalence (%)	Odds ratio (95%CI)	P value
Talley et al[49], 1993	United States	690	30-64	Self-report; Rome I	Marital status	Married; Not married	17.8; 22.1	NR	NR
Chang et al[46], 2007	United States	523	30-64	Rome III	Marital status	Married; Single; Other	17.2; 23.1; 19.1	1.0; 1.27 (0.46, 3.48); 1.07 (0.53, 2.16)	NS
Choung et al[83], 2007	United States	3022	20-95	BDQ	Marital status	Married; Not married	16; 22	0.8 (0.5, 1.2); 1.0	NS
Rey et al[55], 2014	Spain	1500	> 18	Rome III	Marital status	Married; Single; Other	20; 16; 22	NR	NR
Ebling et al[50], 2014	Croatia	658	20-69	Rome III	Marital status; House; hold size	Divorced; Large size	35.7; NR	2.91; 1.19	0.039; 0.01
Sorouri et al[53], 2010	Iran	18180	NR	Rome III	Marital status	Married; Single; Widowed; Divorced	3.5; 0.7; 8.8; 12.5	NR	NR
Moezi et al[52], 2018	Iran	9264	40-75	Rome IV	Marital status	Divorced or Widowed	12.9	NR	< 0.001
Pare et al[45], 2000	Canada	1149	> 18	Self-report (3 mo)	Work status	Employed; Unemployed; Retired	27.2; 23.4; 25.5	NR	NR
Pare et al[45], 2000	Canada	1149	> 18	Rome I	Work status	Employed; Unemployed; Retired	16.3; 9.2; 15.0	NR	NR
Pare et al[45], 2000	Canada	1149	> 18	Rome II	Work status	Employed; Unemployed; Retired	14.1; 5.7; 16.2	NR	NR
Talley et al[49], 1993	United States	690	30-64	Rome I	Work status	Employed; Unemployed	20.1; 12.0	NR	NR
Enck et al[75], 2016	Germany	15002	> 18	Self-report (12 mo)	Work status	Full-time; Part-time; Unemployed	10.81; 13.31; 18.31	NR	< 0.001
Drossman et al[44], 1993	United States	5430	> 15	Rome I	Ethnicity	White; Other	NR	0.54 (0.3, 0.9)	NR

¹Calculated from data published.

NR: Not reported; NS: Not significant; BDQ: Bowel disease questionnaire (similar to Rome criteria).

Table 7 Physical activity and constipation

Ref.	Location	Sample size	Age range (yr)	Definition of constipation	Physical activity status	Prevalence (%)	Odds ratio (95%CI)	P value
Garrigues et al[60], 2004	Spain	349	18-65	Self-report (12 mo)	Never; Sometimes; Habitually	23.2; 10.9; 7.4	1.00; 0.43 (0.20, 0.89); 0.31 (0.11, 0.87)	0.02; 0.03
Rey et al[55], 2014	Spain	1500	> 18	Rome III	Regular sport; Long walks; Short walks; No regular walk	14; 16; 24; 30	1.00; 0.97 (0.66, 1.43); 1.52 (1.06, 2.19); 2.04 (1.23, 3.39)	< 0.01
Wald et al[61], 2008	United States, United Kingdom, France, Germany, Italy, Brazil and South Korea	14000	> 15	Self-report (12 mo)	Active; Reduced activity	NR	1.00; 1.23 (1.07, 1.40)	< 0.05
Moezi et al[52], 2018	Iran	9264	40-75	Rome IV	Low; Medium; High	10.91; 7.81; 5.61	1.00; 0.74 (0.62, 0.89); 0.56 (0.46, 0.68)	< 0.001

¹Calculated from data published. NR: Not reported.

Table 8 Smoking and constipation

Ref.	Location	Sample size	Age range (yr)	Definition of constipation	Smoking status	Prevalence (%)	Odds ratio (95%CI)	P value
Choung et al[65], 2012	United States	2853	> 20	Rome II	Current smoker	26.3	NR	NS
Choung et al[83], 2007	United States	7805	20-95	BDQ	Non-smoker; Smoker	16; 20	1.00; 1.40 (0.7, 2.7)	NS
Talley et al[49], 1993	United States	690	30-64	Rome I	No cigarettes; > 15/d	20.9; 12.3	4.7 (1.6, 13.7)	< 0.05
Chang et al[46], 2007	United States	523	30-64	Rome III	Never; Current; Past; Ever	18.9; 17.3; 17.0; 17.1	1.0; 0.90 (0.47, 1.73); 0.88 (0.53, 1.45); 0.89 (0.57, 1.39)	NS
Haug et al[71], 2002	Norway	62651	> 20	Self-report (12 mo)	Non-smoker; Smoker	NR; NR	1.00; 0.83	NR
Papatheodoridis et al[51], 2010	Greece	1000	15-64	Rome III or self-report (12 mo)	Active; Inactive	16; 16	NR	0.98
Lu et al[56], 2006	Taiwan	2018	> 20	Rome II	Non-smoker; Smoker	8.81; 6.51	NR	NS

¹Calculated from data published.

NR: Not reported; NS: Not significant; BDQ: Bowel disease questionnaire (similar to Rome criteria).

Table 9 Fibre and constipation

Ref.	Location	Sample size	Age range (yr)	Definition of constipation	Dietary intake of fibre	Prevalence (%)	Odds ratio (95%CI)	P value
Garrigues et al[60], 2004	Spain	349	18-65	Self-report (12 mo)	Low fibre; Medium fibre; High fibre	19.2; 10.9; 20.9	1.00; 0.38 (0.15, 0.96); 1.05 (0.35, 3.17)	0.04; 0.93
Rey et al[55], 2014	Spain	1500	> 18	Rome III	1st quintile; 2nd quintile; 3rd quintile; 4th quintile; 5th quintile	23; 18; 17; 18; 20	NR	NS

NR: Not reported; NS: Not significant.

Table 10 Fluid and constipation

Ref.	Location	Sample size	Age range (yr)	Definition of constipation	Fluid intake per day	Prevalence (%)	Odds ratio (95%CI)	P value
Rey et al[55], 2014	Spain	1500	> 18	Rome III	7 glasses or less; 8-9 glasses; 10-11 glasses; 12-14 glasses; 15 glasses or more	21; 20; 19; 18; 16	NR	< 0.01
Chang et al[46], 2007	United States	523	30-64	Rome III	No coffee; Coffee	18.7; 17.8	1.00; 0.94 (0.5, 1.77)	NS

NR: Not reported; NS: Not significant.

Table 11 Alcohol and constipation

Ref.	Location	Sample size	Age range (yr)	Definition of constipation	Weekly alcohol consumption	Prevalence (%)	Odds ratio (95%CI)	P value
Choung et al[83], 2007	United States	7805	20-95	BDQ	No alcohol; Alcohol	16; 17	1; 1.1 (0.7, 1.7)	NS
Talley et al[49], 1993	United States	690	30-64	Rome I	No alcohol; > 7 drinks	19.7; 9.41	3.6 (1.2, 10.4)	< 0.05
Chang et al[46], 2007	United States	523	30-64	Rome III	0 drinks; 1-2; 3-6; > 7; Any alcohol	19.3; 19.2; 14.1; 14.9; 16.3	1.0; 0.99 (0.55, 1.79); 0.69 (0.34, 1.39); 0.73 (0.35, 1.53); 0.82 (0.52, 1.29)	NS
Fosnes et al[54], 2011	Norway	4622	31-76	Rome II	> Once; < Once	10.61; 14.21	0.94 (0.89, 0.99)	0.024
Choung et al[65], 2012	United States	2853	> 20	Rome II	1-6 drinks; 7+ drinks	25.31; 23.11	NR	NS
Moezi et al[52], 2018	Iran	9264	40-75	Rome IV	No alcohol; Alcohol	7.91; 9.71	NR	NS
Lu et al[56], 2006	Taiwan	2018	> 20	Rome II	No alcohol; Alcohol	8.91; 7.41	NR	NS

¹Calculated from data published.

NR: Not reported; NS: Not significant; BDQ: Bowel disease questionnaire (similar to Rome criteria).

Table 12 Self-rated health and constipation

Ref.	Location	Sample size	Age range (yr)	Definition of constipation	Self-rated health	Prevalence (%)	Odds ratio (95%CI)	P value
Ebling et al[50], 2014	Croatia	658	20-69	Rome III	Lower	NR	0.628	< 0.001
Enck et al[75], 2016	Germany	15002	> 18	Self-report (12 mo)	Very good; Good; Satisfactory; Less good; Bad	9.11; 12.21; 18.41; 22.11; 28.21	NR	< 0.001

¹Calculated from data published. NR: Not reported.

Table 13 Medical conditions and constipation

Ref.	Location	Sample size	Age range (yr)	Definition of constipation	Condition	Prevalence (%)	Odds ratio (95%CI)	P value
Schmidt et al[66], 2016	Brazil	2162	> 18	Rome III	Fistula; Haemorrhoids; Anal fissures; Nervous disease; Stroke	54.5; 29.3; 35.8; 24.5; 48.3	3.8 (1.5, 9.7); 1.9 (1.3, 2.7); 2.2 (1.3, 3.6); 1.6 (1.1, 2.1); 5.3 (2.3, 12.1)	NR
Cheng et al[57], 2003	Hong Kong	3282	18-80	Rome II	Anxiety; Depression	NR	NR	< 0.0001; < 0.0001
Koloski et al[84], 2002	Australia	2910	> 18	Rome I	Anxiety; Depression	5.6; 4.2	NR	< 0.05; < 0.05
Bytzer et al[86], 1989	Australia	8185	> 18	BDQ	Control; Diabetes mellitus	9.2; 11.4	1.00; 1.54	NR
Choung et al[69], 2016	United States	2327	> 25	Rome III	Rectal cancer; Neurological dis; Parkinson’s dis; Multiple sclerosis; Metabolic dis; Cardiovascular dis; Angina; Psychiatric disorder	NR	4.7 (1.0, 22.2); 1.5 (1.1, 1.9); 6.5 (2.9, 14.4); 5.5 (1.9, 15.8); 1.4 (1.1, 1.9); 1.5 (1.1, 1.9); 1.4 (1.1, 1.9); 1.3 (1.0, 1.7)	NR
Choung et al[65], 2012	United States	2853	> 20	Rome II	Dyspepsia; GORD	46.9; 34.3	NR; NR	< 0.01; < 0.01
Enck et al[75], 2016	Germany	15002	> 18	Self-report (12 mo)	Back pain; Circulation problem; Gynecological; Urological; Gastrointestinal	19.01; 25.21; 35.11; 34.31; 31.61	NR	< 0.001 < 0.001; < 0.001 < 0.001; < 0.001
Ebling et al[50], 2014	Croatia	658	20-69	Rome III	BMI; Anemia	NR; 40.0	1.051; NR	0.777; < 0.01
Chang et al[46], 2007	United States	523	30-64	Rome III	BMI 1st Q; BMI 2nd Q; BMI 3rd Q; BMI 4th Q	19.4; 13.6; 18.0; 20.7	1.0; 0.65 (0.32, 1.32); 0.92 (0.46, 1.82); 1.07 (0.55, 2.10)	NS
Rey et al[55], 2014	Spain	1500	> 18	Rome III	Normal; Overweight; Obese	22; 15; 20	NR	NR
Papatheodoridis et al[51], 2010	Greece	1000	15-64	Rome III or self-report (12 mo)	Underweight; Normal weight; Overweight; Obese	18; 14; 17; 20	NR	0.21
Pourhoseingholi et al[85], 2008	Iran	2547	NR	Self-report (NTP)	BMI < 25; BMI 25-30; BMI > 30	40.4; 38.9; 40.7	NR	NS
Haug et al[71], 2002	Norway	60998	> 20	Self-report (12 mo)	Anxiety; Depression	NR; NR	1.86 (1.67, 2.07); 1.46 (1.30, 1.65)	NR
Fosnes et al[54], 2011	Norway	4622	31-76	Rome II	BMI; M/S complaints; Angina; MS	NR	0.95 (0.93, 0.97); 1.04 (1.002, 1.09); 1.86 (1.21, 2.85); 2.14 (1.03, 5.66)	< 0.001; 0.042; 0.004; 0.043
Lu et al[56], 2006	Taiwan	2018	> 20	Rome II	Diabetes; Hypertension	14.11;11.11	NR	NS; NS
Moezi et al[52], 2018	Iran	9264	40-75	Rome IV	Insomnia; Anxiety; Depression; Back or joint pain; GORD	13.51; 11.71; 12.41; 9.41; 11.71	1.62 (1.36, 1.93); 1.38 (1.15, 1.65); 1.22 (1.01, 1.48); 1.38 (1.14, 1.67); 1.51 (1.28, 1.78)	< 0.001; < 0.001; < 0.001; < 0.001; < 0.001

¹Calculated from data published.

NR: Not reported; NS: Not significant; BDQ: Bowel disease questionnaire (similar to Rome criteria); BMI: Body mass index; M/S: Musculoskeletal; MS: multiple sclerosis; GORD: Gastroesophageal reflux disease.

Table 14 Surgery and constipation

Ref.	Location	Sample size	Age range (yr)	Definition of constipation	Surgery	Odds ratio (95%CI)	P value
Choung et al[83], 2007	United States	7805	20-95	BDQ	Abdominal	1.2 (0.7, 2.0)	NS
Choung et al[69], 2016	United States	2327	> 25	Rome III	Anorectal surgery; Hysterectomy	3.3 (1.2, 9.1); 1.5 (1.0, 2.2)	0.02; 0.033
Schmidt et al[66], 2016	Brazil	2162	> 18	Rome III	Anorectal surgery	5.3 (2.3, 12.1)	NR
Lu et al[56], 2006	Taiwan	2018	> 20	Rome II	Appendectomy; Cholecystectomy; Hysterectomy	NR	NS; NS; NS
Sorouri et al[53], 2010	Iran	18180	NR	Rome III	Abdominal surgery	0.66 (0.52, 0.83)	< 0.01

NR: Not reported; NS: Not significant; BDQ: Bowel disease questionnaire (similar to Rome criteria).

Table 15 Number of medications and constipation

Ref.	Location	Sample size	Age	Definition of constipation	Number of drugs taken	Odds ratio (95%CI)	P value
Fosnes et al[54], 2011	Norway	4622	31-76	Rome II	0; 1; 2-3; 4 or more	1; 1.34 (1.07, 1.69); 1.26 (0.99, 1.61); 1.21 (0.85, 1.71)	0.012; 0.062; 0.288

Table 16 Medications and constipation

Ref.	Location	Sample size	Age range (yr)	Definition of constipation	Medications	Prevalence (%)	Odds ratio (95%CI)	P value
Fosnes et al[54], 2011	Norway	4622	31-76	Rome II	Digoxin; GTN; Furosemide; Atorvastatin; Tibolone; Levothyroxine; Ibuprofen	NR	NR	0.025; 0.015; 0.001; 0.037; 0.038; < 0.001; 0.001
Talley et al[49], 1993	United States	690	30-64	Rome I	Aspirin > 7 tabs/wk	31.1	2.6 (1.2, 5.7)	< 0.05
Chang et al[46], 2007	United States	523	30-64	Rome III	Paracetamol; Aspirin; NSAIDs	25.3; 23.0; 26.6	1.50 (0.91, 2.47) 1.67 (1.04, 2.70) 1.80 (1.09, 2.98)	NS; < 0.05; < 0.05

GTN: Glyceryl trinitrate; NSAIDs: Non-steroidal anti-inflammatory drugs; NR: Not reported; NS: Not significant.

Table 17 Summary of evidence from population-based studies for factors potentially associated with constipation

Category	Factor	Association with constipation
Demographic	Age	Conflicting data, probably only > 70 yr
	Female gender	Associated
	Income level	Conflicting data, probably country specific
	Educational level	Conflicting data, probably country specific
	Residential location	Associated
	Work status	Conflicting data
	Marital status	Conflicting data
	Ethnicity	Possible association
Lifestyle	Physical activity	Associated
	Fibre	No evidence for low fibre
	Fluid	Possible association
	Smoking	Conflicting data
	Alcohol	No clear evidence
	Coffee	No association
Health-related	Self-rated health	Associated
	Obesity	Conflicting data
	Depression	Associated
	Anorectal	Associated – haemorrhoids and other conditions
	Gastrointestinal	Associated
	Neurological	Associated – MS, Parkinson’s disease
	Endocrine	Associated - diabetes
	Cardiovascular	Associated
	Musculoskeletal	Associated
	Surgery	Associated – gynaecological, anorectal, abdominal
	No. of medications	Possible association
	NSAIDs	Associated
	Aspirin	Associated
	Other drugs	Possible association

NSAIDs: Non-steroidal anti-inflammatory drugs; MS: Multiple sclerosis.