Occupational factors in disability pensions for gastric and duodenal ulcer.

Although a general decline in the prevalence of duodenal ulcer disease during the past 20 to 30 years has been noticed by many authors from different countries, it still lacks a clear explanation. In the present paper a relationship between occupational work load and prevalence of peptic ulcer disease was examined in order to test the hypothesis that ulcer prevalence might be related to occupational work load. The number of disability pensions granted to West German employees between 1979 and 1983 due to gastric and duodenal ulcers served as markers of peptic ulcer morbidity and were used to analyze the relationship between occupation and prevalence of peptic ulcer disease. In men, there was a linear correlation between the energy expenditure of different occupations and the occurrence of duodenal ulcer, but not gastric ulcer. It appears that in gastric ulcer, compared with duodenal ulcer, additional factors related to occupational energy expenditure are relevant for the development of peptic ulceration. The decline of duodenal ulcer in Europe and the United States might be related to the general decline in the work load due to automation during the past 20 to 30 years. The relationship between energy expenditure and duodenal ulcer may also help to explain why the disease affects men two to three times more often than women.