Adverse or disruptive early-life experiences and incident peptic ulcer disease in middle-aged and older Europeans: a prospective cohort study from SHARE

Abstract Background Peptic ulcer disease (PUD), a common disorder of the gastrointestinal tract, can be responsible for serious complications such as bleeding within that system. Previous studies have linked adverse or disruptive early-life experiences to PUD, but most evidence comes from single-country or region-specific studies. Using SHARE data, we examined the association between adverse or disruptive early-life experiences and adult peptic ulcer disease. Methods This prospective cohort study used SHARE Waves 4–9 and included an embedded secondary cross-sectional analysis. The exposure was a 0–4 cumulative early-life adversity score based on four self-reported adverse or disruptive experiences before age 16 and was primarily categorized as 0–1 versus ≥2 experiences. PUD was defined by self-report of a physician diagnosis of gastric, duodenal, or peptic ulcer. Multivariable logistic regression was used for the cross-sectional analysis, whereas Kaplan–Meier methods and Cox proportional hazards models were used for the longitudinal analysis. Models adjusted for age, sex, educational level, marital status, smoking, alcohol consumption, and BMI. Results The cross-sectional analysis included 32,099 participants. After excluding 2,389 participants with PUD at baseline and a further 20,152 participants with missing PUD outcome data at any follow-up wave from Waves 5 to 9, 9,558 participants were included in the longitudinal analysis. The median follow-up was 128 months (IQR, 126–131 months), during which 678 incident PUD cases were reported. After full adjustment, reporting ≥ 2 experiences rather than 0–1 was associated with higher odds of a lifetime physician diagnosis of PUD at baseline (OR = 1.44, 95% CI: 1.11–1.87, P = 0.01) and a higher hazard of incident PUD (HR = 1.61, 95% CI: 1.04–2.48, P = 0.03). Kaplan–Meier curves showed lower PUD-free survival among participants reporting ≥ 2 experiences (log-rank P = 0.02). Conclusion Reporting ≥2 adverse or disruptive early-life experiences rather than 0–1 was associated with lifetime physician-diagnosed PUD at baseline and incident PUD during follow-up.