Enduring association between irritable bowel syndrome and war trauma during the Nicaragua civil war period: A population-based study

Table 1 Demographic, irritable bowel syndrome and war exposure summary

Variable	Total	Gender		P value1	Age group			P value1
	N (%)	Men, n (%)	Women, n (%)		29-39, n (%)	40-49, n (%)	50-65, n (%)
Poverty				0.175				0.0102
Non-poor	657 (64.9)	229 (62.2)	428 (66.5)		227 (59.6)	224 (65.9)	206 (70.8)
Poor/extremely poor	355 (35.1)	139 (37.8)	216 (33.5)		154 (40.4)	116 (34.1)	85 (29.1)
Educational level				0.933				< 0.0012
Primary school	489 (48.3)	175	314 (48.8)		117 (30.7)	163 (47.8)	209 (71.8)
High school	372 (36.8)	(47.6) 137	235 (36.5)		183 (48.0)	124 (36.5)	65 (22.3)
Professional	151 (14.9)	(37.2) 56 (15.2)	95 (14.7)		81 (21.2)	53 (15.6)	17 (5.8)
IBS				0.0292				0.593
No	858 (84.8)	324 (88.0)	534 (82.9)		320 (84.0)	286 (84.1)	252 (86.6)
Yes	154 (15.2)	44 (12.0)	110 (17.1)		61 (16.0)	54 (15.9)	39 (13.4)
PTSD				0.180				0.537
No	955 (94.4)	352 (95.7)	603 (93.6)		362 (95.0)	317 (93.2)	276 (94.8)
Yes	57 (5.6)	16 (4.3)	41 (6.4)		19 (5.0)	23 (6.8)	15 (5.2)
War				< 0.0012				0.0222
No	817 (80.7)	233 (63.3)	584 (90.7)		321 (84.3)	259 (76.2)	237 (81.4)
Yes	195 (19.3)	135 (36.7)	60 (9.3)		60 (15.7)	81 (23.8)	54 (18.6)
PTSD + War				0.422				0.095
No	987 (97.0)	357 (97.0)	630 (97.8)		376 (98.7)	327 (96.2)	284 (97.6)
Yes	25 (3.0)	11 (3.0)	14 (2.2)		5 (1.3)	13 (3.8)	7 (2.4)
Dose Effect				< 0.0012				0.199
0-2 exposures	945 (93.4)	308 (83.7)	637 (98.9)		358 (94.0)	311 (91.5)	276 (94.8)
≥ 3 exposures	67 (6.6)	60 (16.3)	7 (1.1)		23 (6.0)	29 (8.5)	15 (5.2)
Total	1012 (100.0)	368 (100.0)	644 (100.0)		381 (100.0)	340 (100.0)	291 (100.0)

¹Mantel-Haenszel chi square test.

²P value < 0.05.

IBS: Irritable bowel syndrome; PTSD: Post-traumatic stress disorder.

Table 2 Irritable bowel syndrome prevalence by Rome II criteria among 1012 study participants

Variables	IBS		P value1
	N (%)	95%CI
Gender			0.0292
Male	44 (12.0)	9.0–15.7
Female	110 (17.1)	14.4–20.2
Age group			0.593
29-39	61 (16.0)	12.7-20.0
40-49	54 (15.9)	12.4-20.1
≥ 50	39 (13.4)	9.9-17.8
Socioeconomic status3			0.298
Non-poor	97 (14.8)	12.3-17.7
Poor/Extremely poor	57 (16.1)	12.6-20.24
Educational level			0.701
Primary school/Lower	70 (14.3)	11.5-17.7
High school	61 (16.4)	13.0-20.5
University/Professional	23 (15.2)	10.4-21.8
War			0.237
No	119 (14.6)	12.3-17.1
Yes	35 (17.9)	13.2-23.9

¹Mantel-Haenszel chi square test.

²P value < 0.05.

³Based on United Nations Poverty Index, adapted to Nicaraguan population.

95%CI: 95% confidence interval; IBS: Irritable bowel syndrome.

Table 3 Association between Irritable bowel syndrome and specific war exposures

Condition	IBS, n (%)	Non-IBS, n (%)	Unadjusted1, OR (95%CI)	Adjusted2, OR (95%CI)
Direct Exposures
War experience	35 (22.7)	160 (18.6)	1.28 (0.84-1.94)	1.30 (0.81-2.09)
Direct combat involvement	13 (8.4)	77 (9.0)	0.93 (0.50-1.72)	0.61 (0.27-1.38)
Abuse, physical or psychological3	17 (11.0)	47 (5.5)	2.19 (1.19-3.83)	2.25 (1.12-4.49)
Witnessed execution3	17 (11.0)	51 (5.9)	1.96 (1.10-3.50)	2.41 (1.11-5.23)
Physical injury or disability	3 (1.9)	8 (0.9)	2.11 (0.55-8.04)	1.29 (0.27-6.02)
Indirect Exposures
Death of a family member3	20 (13.0)	68 (7.9)	1.73 (1.01-2.94)	2.21 (1.17-4.17)
Family member wounded	9 (5.8)	42 (4.9)	1.20 (0.57-2.53)	0.80 (0.33-1.93)
Post-war effects
Loss of personal property	3 (1.9)	19 (2.2)	0.87 (0.25-3.00)	0.86 (0.24-3.08)
Rejection by family	5 (3.2)	16 (1.9)	2.58 (0.88-7.54)	2.57 (0.82-8.07)
Unemployment	9 (5.8)	36 (4.2)	1.41 (0.66-3.00)	1.58 (0.69-3.65)
Dose effect
≥ 3 exposures3	16 (10.4)	67 (7.8)	1.83 (1.01-3.30)	2.67 (1.39-5.13)
PTSD
PTSD3	24 (15.6)	33 (3.8)	4.61 (2.64-8.05)	2.63 (1.21-5.73)
PTSD, war associated3	14 (9.1)	11 (1.3)	7.70 (3.42-17.3)	3.31 (1.09-10.0)

¹Crude odds ratio.

²Multiple logistic regression analysis adjusted by gender, age, poverty and educational level.

³Significant association with IBS.

95%CI: 95% confidence interval; IBS: Irritable bowel syndrome; PTSD: Post-traumatic stress disorder.