Association Between Gastrointestinal Symptoms and Insomnia among Healthcare Workers: A Cross-Sectional Study

Association Between Gastrointestinal Symptoms and Insomnia among Healthcare Workers: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Association Between Gastrointestinal Symptoms and Insomnia among Healthcare Workers: A Cross-Sectional Study Xiaoqiang Liu, Yisen Huang, Yubin Wang, Chanchan Lin, Boming Xu, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4555208/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Jun, 2025 Read the published version in Scientific Reports → Version 1 posted 14 You are reading this latest preprint version Abstract Background Healthcare workers often suffer from gastrointestinal symptoms and insomnia, which affect their quality of life and job performance. This study explores the link between these conditions in healthcare workers to guide health improvements. Methods This cross-sectional study recruited healthcare workers from various hospitals in Quanzhou via an online survey. The severity of gastrointestinal and insomnia symptoms was assessed using the Gastrointestinal Symptom Rating Scale (GSRS) and Insomnia Severity Index (ISI), respectively. The relationship between gastrointestinal symptoms and insomnia was analyzed using univariate and multivariate logistic regression models. Results A total of 372 healthcare workers participated in the study, and 53.2% of the participants reported having insomnia symptoms. In the unadjusted model, there was a positive correlation between the GSRS total score and the risk of insomnia (OR = 1.21, 95% CI = 1.14–1.28). This positive correlation persisted even after adjusting for confounders such as age, gender, anxiety, depression, somatization, and weekly night shift count (adjusted OR = 1.08, 95% CI = 1.0-1.16). Conclusion Gastrointestinal symptoms and insomnia are significantly positively correlated among healthcare workers. This finding suggests the need to develop interventions that enhance the gastrointestinal and sleep health of healthcare workers, thereby improving their work efficiency and quality of care. Gastrointestinal symptoms Insomnia Healthcare workers Cross-sectional study Figures Figure 1 Figure 2 Introduction Insomnia is a prevalent health issue characterized by difficulty falling asleep, frequent awakenings, early morning awakening, and poor sleep quality, which can severely impact an individual's daily functioning and quality of life. 1 Chronic sleep problems may also increase the risk of cardiovascular disease, metabolic syndrome, and cognitive decline. 2 For healthcare workers under prolonged high-stress conditions, adequate sleep is crucial for maintaining work efficiency and patient care quality. Gastrointestinal symptoms, including but not limited to abdominal pain, indigestion, bloating, constipation, and diarrhea, are common clinical health issues that affect people's quality of life and work efficiency. 3 These symptoms can be caused by multiple factors such as dietary habits, lifestyle, mental stress, and other health conditions. In healthcare workers, due to their unique work environment and high-stress conditions, gastrointestinal symptoms are particularly common, posing significant challenges to their health and job performance. 4 Studies in the general population have shown a significant correlation between gastrointestinal symptoms and insomnia. 5 Gastrointestinal dysfunction may indirectly affect sleep quality by influencing an individual's physiological and psychological states. 6 Conversely, poor sleep patterns may exacerbate gastrointestinal symptoms, creating a vicious cycle. 7 Although research in this field has made some progress, studies focusing specifically on healthcare workers are relatively scarce. Given the prevalence of gastrointestinal symptoms and insomnia among healthcare workers and their known correlation in the general population, this study aims to explore the relationship between gastrointestinal symptoms and insomnia in healthcare workers. Specifically, this study will fill a gap in the current literature and provide scientific evidence for developing targeted interventions to improve healthcare workers' health and thereby enhance their work efficiency and quality of patient care. Materials and Methods This study received formal approval from the Medical Ethics Committee of Quanzhou City First Hospital, approval number: 2023[185]. All methods conformed to relevant guidelines and regulations. All study participants signed informed consent. Study Population This study collected data through a questionnaire survey. As a cross-sectional survey conducted from August 25 to November 30, 2023, we recruited healthcare workers from various hospitals in Quanzhou via an online questionnaire. Inclusion criteria: 1. Healthcare worker; 2. Age between 18 and 65, no gender restrictions. Exclusion criteria: 1. History of gastrointestinal malignancy; 2. History of gastrointestinal surgery (excluding colorectal polypectomy); 3. Evidence of peptic ulcer or erosive esophagitis within the last six months on endoscopy; 4. Chronic pancreatitis, inflammatory bowel disease, or bowel obstruction; 5. Severe organ damage and complications (such as cirrhosis, uremia) and severe cardiovascular, respiratory, or endocrine disease; 6. History of malignancy in other systems or organs; 7. Autoimmune diseases such as systemic lupus erythematosus and ankylosing spondylitis; 8. Long-term use of sleeping pills, anti-anxiety, or antidepressant medication; 9. Pregnant or breastfeeding women. These issues were prepared using "Wenjuanxing ( https://www.wjx.cn/wjx/design/previewmobile.aspx?activity=238985439&s=1) ," an online research tool that converts paper scales to electronic versions. This makes the questionnaire assessment easily accessible and completed using mobile or PC devices. Assessment of Insomnia The Insomnia Severity Index (ISI) is used to assess the severity of insomnia symptoms. This scale consists of seven items, each evaluating the severity and impact of insomnia symptoms on daily life over the past two weeks. Each item is rated from 0 (no problem) to 4 (very severe problem). The total score ranges from 0 to 28, with higher scores indicating more severe insomnia symptoms. According to previous studies, an ISI score of 8–14 and ≥ 15 indicates mild and moderate-to-severe insomnia, respectively. 8 Assessment of gastrointestinal symptoms The Gastrointestinal Symptom Rating Scale (GSRS) is commonly used to evaluate the severity of symptoms in patients with functional gastrointestinal disorders (e.g., functional dyspepsia, irritable bowel syndrome). The GSRS, developed by Svedlund et al. in 1988, assesses multiple aspects of gastrointestinal symptoms, including reflux, abdominal pain, bloating, constipation, and diarrhea. Designed as a self-assessment scale, it allows patients to evaluate the severity of their symptoms based on recent experiences. 9 Covariates Covariates considered in this study included age, gender, Marriage, body mass index (BMI), education, monthly salary, smoking status, drinking status, weekly night shift count, comorbidity, family history of cancer, Profession, department, unhealthy diet, Weekly exercise frequency, anxiety, depression, and somatic symptom disorder. BMI refers to weight divided by height. Smoking was defined as a habit of smoking more than one cigarette daily. Drinking was defined as a habit of drinking alcohol more than once a week. 10 Comorbidity were defined as having hypertension, diabetes, or heart disease. An unhealthy diet was defined as frequently consuming barbecued or fried foods (≥ 1 time/week) or preferring salty flavors; otherwise, it was considered a healthy diet. Anxiety was defined as a total score of ≥ 5 on the Generalized Anxiety Disorder Scale (GAD-7). This scale consists of seven items to assess the frequency of anxiety symptoms over the past two weeks. Each item is rated from 0 (never) to 3 (almost every day), and the total score ranges from 0 to 21, with higher scores indicating more severe functional impairment due to anxiety. Scores of 5–9 and ≥ 10 represent mild and moderate-to-severe anxiety symptoms, respectively. 11 Depression was defined as a total score of ≥ 5 on the Patient Health Questionnaire-9 (PHQ-9). 12 The scale assesses the degree of depressive symptoms experienced over the past two weeks, with each item rated from 0 (never) to 3 (almost every day). The total score ranges from 0 to 27, with higher scores indicating more severe depressive symptoms. Prior literature indicates scores of 5–9 represent mild depressive symptoms, and scores ≥ 10 represent moderate-to-severe depressive symptoms. 13 Somatic symptom disorder (SSD) was defined as a total score of ≥ 30 on the Self-reported Somatic Symptom Scale-China (SSS-CN). 14 In clinical practice, SSD can be divided into mild, moderate, and severe levels based on scale scores: mild (30–39 points), moderate (40–59 points), and severe (over 60 points). Statistical Analysis All analyses were conducted using the R statistical software (The R Foundation) and Free Statistics Software version 1.4. 15 Categorical variables were represented by proportions (%), while continuous variables were described by the mean (standard deviation, SD). We compared outcome variables between the groups with and without insomnia using independent t-tests, chi-square tests, and Fisher's exact tests. The relationship between gastrointestinal symptoms and insomnia was analyzed using univariate and multivariate logistic regression. Interactions between subgroups were examined through likelihood ratio tests. A p -value < 0.05 was considered statistically significant. Results Baseline Characteristics of the Study Population The online survey recruited 380 participants. After excluding three participants who met the exclusion criteria, two with missing data on the Gastrointestinal Symptom Rating Scale, and three with missing data on covariates, 372 participants were included in our analysis (Fig. 1 ). Table 1 presents the clinical characteristics of the study population based on insomnia symptoms. The participants had an average age of 37.8 ± 8.0 years, and 159 (42.7%) were male. At baseline, participants with insomnia symptoms had more weekly night shifts count, higher rates of anxiety, depression, and SSD, and nurses were more prone to insomnia than doctors. Table 1 Baseline characteristics of the study participants Characteristic Total (n = 372) No Insomnia (n = 174) Insomnia (n = 198) p Statistic Gender, n (%) 0.732 0.117 Male 159 (42.7) 76 (43.7) 83 (41.9) Female 213 (57.3) 98 (56.3) 115 (58.1) Age (year) 37.8 ± 8.0 38.5 ± 7.7 37.3 ± 8.1 0.147 2.114 BMI (kg/m 2 ) 23.1 ± 3.3 22.9 ± 2.9 23.2 ± 3.6 0.421 0.648 Marriage, n (%) 0.005 7.804 Single 52 (14.0) 15 (8.6) 37 (18.7) Married 320 (86.0) 159 (91.4) 161 (81.3) Education, n (%) 0.008 Fisher Associate Degree 66 (17.7) 24 (13.8) 42 (21.2) Bachelor’s Degree 202 (54.3) 89 (51.1) 113 (57.1) Master’s Degree 94 (25.3) 53 (30.5) 41 (20.7) Doctorate Degree 10 ( 2.7) 8 (4.6) 2 (1) Profession, n (%) 0.007 7.175 Doctor 259 (69.6) 133 (76.4) 126 (63.6) Nurse 113 (30.4) 41 (23.6) 72 (36.4) Department, n (%) 0.086 9.657 Internal Medicine 190 (51.1) 97 (55.7) 93 (47) Surgery 38 (10.2) 18 (10.3) 20 (10.1) OB/GYN 41 (11.0) 13 (7.5) 28 (14.1) Emergency/ICU 22 ( 5.9) 8 (4.6) 14 (7.1) Medical Technology 41 (11.0) 15 (8.6) 26 (13.1) Others 40 (10.8) 23 (13.2) 17 (8.6) Hospital Grade, n (%) 0.21 3.118 Tertiary Hospital 261 (70.2) 121 (69.5) 140 (70.7) Secondary Hospital 74 (19.9) 31 (17.8) 43 (21.7) Primary Hospital 37 ( 9.9) 22 (12.6) 15 (7.6) Monthly Salary (RMB), n (%) 0.712 1.372 <5000 36 ( 9.7) 14 (8) 22 (11.1) 5000–9999 235 (63.2) 110 (63.2) 125 (63.1) 10000–14999 77 (20.7) 39 (22.4) 38 (19.2) ≥ 150000 24 ( 6.5) 11 (6.3) 13 (6.6) Comorbidity, n (%) 0.055 3.688 No 342 (91.9) 165 (94.8) 177 (89.4) Yes 30 ( 8.1) 9 (5.2) 21 (10.6) Family History of Cancer, n (%) 0.046 3.984 No 312 (83.9) 153 (87.9) 159 (80.3) Yes 60 (16.1) 21 (12.1) 39 (19.7) Smoking Status, n (%) 0.124 2.368 No 342 (91.9) 164 (94.3) 178 (89.9) Yes 30 ( 8.1) 10 (5.7) 20 (10.1) Drinking Status, n (%) 0.632 0.23 No 315 (84.7) 149 (85.6) 166 (83.8) Yes 57 (15.3) 25 (14.4) 32 (16.2) Unhealthy Diet, n (%) 0.396 0.72 No 301 (80.9) 144 (82.8) 157 (79.3) Yes 71 (19.1) 30 (17.2) 41 (20.7) Weekly Night Shift Count 3.9 ± 3.0 3.4 ± 2.8 4.4 ± 3.1 0.002 10.15 Weekly Exercise Frequency, n (%) 0.528 2.218 0 169 (45.4) 72 (41.4) 97 (49) 1 109 (29.3) 54 (31) 55 (27.8) 2–3 65 (17.5) 33 (19) 32 (16.2) ≥ 4 29 ( 7.8) 15 (8.6) 14 (7.1) Anxiety, n (%) < 0.001 62.94 No 173 (46.5) 119 (68.4) 54 (27.3) Yes 199 (53.5) 55 (31.6) 144 (72.7) Depression, n (%) < 0.001 65.834 No 157 (42.2) 112 (64.4) 45 (22.7) Yes 215 (57.8) 62 (35.6) 153 (77.3) SSD, n (%) < 0.001 76.637 No 151 (40.6) 112 (64.4) 39 (19.7) Yes 221 (59.4) 62 (35.6) 159 (80.3) GSRS Total Score 5.0 ± 4.5 3.3 ± 3.2 6.6 ± 5.0 < 0.001 54.678 Data presented are mean ± SD or N (%). Abbreviations: BMI, Body Mass Index; RMB, Renminbi; OB/GYN, Obstetrics and Gynecology; ICU, Intensive Care Unit; SSD, somatic symptom disorder; GSRS, Gastrointestinal Symptom Rating Scale. Effect of Gastrointestinal Symptoms on the Risk of Insomnia in Healthcare Workers Univariate analysis revealed that the weekly night shifts count, education, profession, department, family history of cancer, anxiety, depression, SSD, and GSRS total score were associated with insomnia risk (Table 2). The results of the multivariate logistic regression analysis are shown in Table 3. In the unadjusted model, the GSRS total score was positively correlated with insomnia risk (OR, 1.21; 95% CI, 1.14-1.28). In Model 1, after adjusting for age and gender, the results remained consistent (OR, 1.21; 95% CI, 1.14-1.28). Model 2, which adjusted for variables in Model 1 as well as anxiety, depression, SSD, and weekly night shift count (these confounders were selected based on their association with the outcomes of interest or a change in effect estimate of more than 10%), still showed a positive correlation (OR, 1.11; 95% CI, 1.04-1.18). Model 3, which adjusted for the variables in Model 2 plus marriage, BMI, education, monthly salary, smoking status, drinking status, comorbidity, family history of cancer, profession, department, unhealthy diet, and weekly exercise Frequency, still demonstrated a positive correlation (OR, 1.08; 95% CI, 1.00-1.16). Table 2 Association of covariates and insomnia Variable OR (95%CI) P- value Gender Male 1 (Reference) Female 1.07 (0.71 ~ 1.62) 0.732 Age (year) 0.98 (0.96 ~ 1.01) 0.147 BMI (kg/m 2 ) 1.03 (0.96 ~ 1.09) 0.421 Marriage Single 1 (Reference) Married 0.41 (0.22 ~ 0.78) 0.006 Education Associate Degree 1 (Reference) Bachelor’s Degree 0.73 (0.41 ~ 1.29) 0.273 Master’s Degree 0.44 (0.23 ~ 0.84) 0.013 Doctorate Degree 0.14 (0.03 ~ 0.73) 0.019 Profession Doctor 1 (Reference) Nurse 1.85 (1.18 ~ 2.92) 0.008 Department Internal Medicine 1 (Reference) Surgery 1.16 (0.58 ~ 2.33) 0.679 OB/GYN 2.25 (1.1 ~ 4.6) 0.027 Emergency/ICU 1.83 (0.73 ~ 4.55) 0.197 Medical Technology 1.81 (0.9 ~ 3.63) 0.096 Others 0.77 (0.39 ~ 1.53) 0.459 Hospital Grade , Tertiary Hospital 1 (Reference) Secondary Hospital 1.2 (0.71 ~ 2.02) 0.496 Primary Hospital 0.59 (0.29 ~ 1.19) 0.139 Monthly Salary (RMB) <5000 1 (Reference) 5000–9999 0.72 (0.35 ~ 1.48) 0.376 10000–14999 0.62 (0.28 ~ 1.39) 0.245 ≥ 150000 0.75 (0.26 ~ 2.14) 0.593 Comorbidity No 1 (Reference) Yes 2.18 (0.97 ~ 4.89) 0.06 Family History of Cancer No 1 (Reference) Yes 1.79 (1.01 ~ 3.18) 0.048 Smoking Status No 1 (Reference) Yes 1.84 (0.84 ~ 4.05) 0.129 Drinking Status No 1 (Reference) Yes 1.15 (0.65 ~ 2.03) 0.632 Unhealthy Diet No 1 (Reference) Yes 1.25 (0.74 ~ 2.11) 0.397 Weekly Night Shift Count 1.12 (1.04 ~ 1.2) 0.002 Weekly Exercise Frequency 0 1 0.76 (0.47 ~ 1.23) 0.257 2–3 0.72 (0.41 ~ 1.28) 0.261 ≥ 4 0.69 (0.31 ~ 1.53) 0.362 Anxiety No Yes 5.77 (3.69 ~ 9.02) < 0.001 Depression No Yes 6.14 (3.9 ~ 9.68) < 0.001 SSD No Yes 7.36 (4.61 ~ 11.76) < 0.001 GSRS Total Score 1.21 (1.14 ~ 1.28) < 0.001 Abbreviations: BMI, Body Mass Index; RMB, Renminbi; OB/GYN, Obstetrics and Gynecology; ICU, Intensive Care Unit; SSD, somatic symptom disorder; GSRS, Gastrointestinal Symptom Rating Scale. Table 3 Association between GSRS total score and insomnia Variable Non-adjusted Model 1 Model 2 Model 3 OR (95%CI) P -value OR (95%CI) P -value OR (95%CI) P -value OR (95%CI) P -value GSRS Total Score 1.21(1.14 ~ 1.28) < 0.001 1.21(1.14 ~ 1.28) < 0.001 1.11(1.04 ~ 1.18) 0.002 1.08(1.0 ~ 1.16) 0.04 Abbreviations: GSRS, Gastrointestinal Symptom Rating Scale. Model 1-adjusted for gender, age. Model 2-adjusted for gender, age, weekly night shift count, anxiety, depression, SSD. Model 3-adjusted for gender, age, BMI, marriage, education, profession, department, hospital grade, monthly salary, comorbidity, smoking status, drinking status, unhealth diet, weekly night shift count, weekly exercise frequency, anxiety, depression, SSD. Subgroup Analysis In this study, we performed stratified analyses and interaction tests to determine whether the association between the GSRS total score and insomnia incidence was consistent across several subgroups. When stratified by age, gender, anxiety, depression, and SSD, a consistent positive correlation was observed, and no significant interactions were found in any subgroup (Figure 2). This indicates that the impact of gastrointestinal symptoms on insomnia outcomes is stable and not influenced by changes in covariates Discussion This study examined the association between gastrointestinal symptoms and insomnia among healthcare workers and found a significant positive correlation between the two. That is, an increase in the severity of gastrointestinal symptoms was associated with a higher risk of insomnia. This finding complements existing literature on the relationship between gastrointestinal symptoms and insomnia in both general and specific populations while providing new insights into this relationship in the unique occupational group of healthcare workers. Association Between Gastrointestinal Symptoms and Insomnia Previous studies have identified the correlation between gastrointestinal symptoms and sleep disorders in the general population. For instance, Tu et al. found a positive correlation between gastrointestinal symptoms and sleep disturbances. 16 Clevers et al. explored the predictive relationship between psychological stress, short sleep duration, and gastrointestinal symptoms among office workers. Although this study did not specifically focus on healthcare workers, it presented a work-related stress context similar to the medical environment and emphasized the importance of psychological stress and sleep duration as predictive factors for gastrointestinal symptoms. 17 A study reported similar results, finding that gastrointestinal dysfunctions, such as irritable bowel syndrome (IBS), were significantly related to sleep problems. 18 These studies support our findings that gastrointestinal symptoms may affect sleep quality through mechanisms like pain, discomfort, or anxiety. The Uniqueness of Gastrointestinal Symptoms and Insomnia in Healthcare Workers In contrast, studies focusing on healthcare workers are relatively scarce. Our findings align with a study of South Korean nurses, which found that long working hours and night shifts could lead to poor sleep quality and digestive system problems among nurses. 19 Moreover, due to their high-stress work environment and irregular working hours, healthcare workers are more prone to gastrointestinal symptoms like indigestion and stomach pain, further exacerbating insomnia. 20 This underscores that the relationship between gastrointestinal symptoms and insomnia may differ in healthcare workers compared to the general population, especially given the role of work-related stress and lifestyle factors. Furthermore, the persistent mental stress and emotional burden faced by healthcare workers may also be a key factor. Stress and emotional issues are common triggers of gastrointestinal symptoms and major contributors to insomnia. Our univariate analysis showed that anxiety, depression, and SSD were associated with insomnia risk. Previous research demonstrated that short sleep duration and poor sleep quality significantly affected the mental health of military healthcare workers. 21 Another study revealed that sleep disorders are closely related to the mental health issues of healthcare workers, particularly during the COVID-19 pandemic, where healthcare workers with sleep disorders had 3.74 times the risk of psychological problems compared to those without sleep disorders. 22 When facing gastrointestinal symptoms and insomnia, healthcare workers may need to emphasize stress management and emotional regulation due to the unique nature of their occupational stress. Exploring the Mechanisms of Gastrointestinal Symptoms and Insomnia While this study did not directly investigate the biopsychosocial mechanisms between gastrointestinal symptoms and insomnia, our findings align with existing literature regarding the gut-brain axis and the impact of stress responses on sleep. The possible mechanisms include: 1. Gut-Brain Axis Interaction: Communication between the gut and the brain, known as the gut-brain axis, is crucial for understanding the relationship between gastrointestinal symptoms and sleep disorders. The microbial composition of the gut can affect brain function, including emotional and cognitive processes, thereby influencing sleep regulation. 23 2. Psychosocial Factors: Healthcare workers frequently face high work stress, which significantly affects sleep quality. This stress increases psychological burden and activates the stress response system (autonomic nervous system and Hypothalamic-Pituitary-Adrenal axis), directly affecting gastrointestinal function and sleep. This may exacerbate gastrointestinal symptoms and disrupt normal sleep structure. 24 3. Circadian Rhythm Disruption: Irregular work hours and night shifts can disrupt the circadian rhythm, affecting the normal day-night cycle. This not only directly impacts sleep quality but also indirectly causes gastrointestinal problems by influencing the regularity of gastrointestinal activity. 25 Limitations and Future Research Directions This study has several limitations. First, because it is a cross-sectional design, it cannot establish a causal relationship. Second, the study data relied primarily on self-reported questionnaires, which may introduce reporting bias. Future studies should employ longitudinal designs to explore causal relationships and further validate the biopsychosocial mechanisms between gastrointestinal symptoms and insomnia, particularly in high-stress work environments. Conclusion This study found a significant positive correlation between gastrointestinal symptoms and insomnia among healthcare workers. This finding highlights the health challenges healthcare workers face, particularly the close link between gastrointestinal health and sleep quality in high-stress work environments. Declarations Author contributions : X.L., Y.H. and X.L. participated in the design of research schemes, extracted, and analyzed the data, and wrote the main manuscript text. C.L. and Y.H. collected the data. Y.Z., P.C. and B.X. participated in the design of research schemes. Y.W. reviewed the manuscript. All authors contributed to the article and approved the submitted version. All authors read and approved the final manuscript. Competing interests The authors declare that there are no conflicts of interest regarding the publication of this paper. Funding This study was supported by China Scholarship Council（grant No. 201906070289）, Startup Fund for Scientific Research, Fujian Medical University (grant No. 2022QH1268). The funders had no role in the study design, analysis, decision to publish, nor preparation of the manuscript. Data availability Datasets can be obtained from the corresponding author upon reasonable request. Acknowledgement Firstly, we thank the Free Statistics team for providing technical assistance and valuable tools for data analysis and visualization. We also extend our gratitude to the Zotero team. Their reference management tool greatly simplified the collection and organization of my literature, making the management of references more efficient and standardized. Lastly, we thank the Obsidian team. Their note-taking software provided an efficient platform for my research notes, idea recording, and material organization, significantly improving my work efficiency. References Perlis, M. L. et al. Insomnia. The Lancet 400, 1047–1060 (2022). Lechat, B. et al. The association of co‐morbid insomnia and sleep apnea with prevalent cardiovascular disease and incident cardiovascular events. Journal of Sleep Research 31, e13563 (2022). Mühlbacher, A. C. & Kaczynski, A. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4555208","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":318752184,"identity":"16b6ce75-8803-41f5-911d-1f95326f2d8b","order_by":0,"name":"Xiaoqiang Liu","email":"","orcid":"","institution":"First Hospital of Quanzhou Affiliated to Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoqiang","middleName":"","lastName":"Liu","suffix":""},{"id":318752185,"identity":"211379b5-faa0-44a2-bdb8-5db8a8eff609","order_by":1,"name":"Yisen Huang","email":"","orcid":"","institution":"First Hospital of Quanzhou Affiliated to Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yisen","middleName":"","lastName":"Huang","suffix":""},{"id":318752186,"identity":"1da81f2b-60d6-43cf-8bed-8ea4decf86f1","order_by":2,"name":"Yubin Wang","email":"","orcid":"","institution":"First Hospital of Quanzhou Affiliated to Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yubin","middleName":"","lastName":"Wang","suffix":""},{"id":318752187,"identity":"978c9e02-4ddb-49b7-bb77-603a03610961","order_by":3,"name":"Chanchan Lin","email":"","orcid":"","institution":"First Hospital of Quanzhou Affiliated to Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chanchan","middleName":"","lastName":"Lin","suffix":""},{"id":318752188,"identity":"2df0fbd6-ae4f-428d-a11e-3ee747f3055b","order_by":4,"name":"Boming Xu","email":"","orcid":"","institution":"First Hospital of Quanzhou Affiliated to Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Boming","middleName":"","lastName":"Xu","suffix":""},{"id":318752189,"identity":"80b51797-ee42-48b3-9a3b-9092c40cebd8","order_by":5,"name":"Yilin Zeng","email":"","orcid":"","institution":"First Hospital of Quanzhou Affiliated to Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yilin","middleName":"","lastName":"Zeng","suffix":""},{"id":318752190,"identity":"d665ad5a-0892-4e02-8647-49ac254b80c8","order_by":6,"name":"Peizhong Chen","email":"","orcid":"","institution":"First Hospital of Quanzhou Affiliated to Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Peizhong","middleName":"","lastName":"Chen","suffix":""},{"id":318752191,"identity":"6eb96268-6d64-4ef9-9c20-7146f1c08a2d","order_by":7,"name":"Yingxuan Huang","email":"","orcid":"","institution":"First Hospital of Quanzhou Affiliated to Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yingxuan","middleName":"","lastName":"Huang","suffix":""},{"id":318752192,"identity":"0a2af9d2-92f4-4bb8-80bf-892cf230435b","order_by":8,"name":"Xiaobo Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYDACZjBikGFjYD7AwGBgARY88KCAsBYeNga2BKAWCYiWBAOCFjHwABFIGUQLAz4tBseZHz4uqGDg4ZPI+brhR4EEg2778YsgW+T5G7BrkWxmMzaecQboMIncbTd7gA4zO5NTANJiOOMAdi38zAxm0rxtEC03eEBabvAkgLQkMODQwsbM/g2qJefZzT/IWuRx2sIDsyWH7TbEFvYDYC0GOLRINvMUA/0iwcPG88zstoyBBA/QL6BAljDciEOLwfnjG4EhZiMn35787OabPzZyZsePP/7wocJGXg6HFiiQgLPQIohIwP6AJOWjYBSMglEw7AEAFzpPMipPlekAAAAASUVORK5CYII=","orcid":"","institution":"First Hospital of Quanzhou Affiliated to Fujian Medical University","correspondingAuthor":true,"prefix":"","firstName":"Xiaobo","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2024-06-09 23:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4555208/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4555208/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-05079-w","type":"published","date":"2025-06-04T15:57:23+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":59606739,"identity":"90a2ecae-382a-4bb8-b1e3-8bb5c7891a64","added_by":"auto","created_at":"2024-07-03 18:54:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":84971,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart of the participant selection process.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4555208/v1/cf6deb93e072679a7988d39f.png"},{"id":59606740,"identity":"3cc4d0d6-0379-4a27-bfe5-a2a823381814","added_by":"auto","created_at":"2024-07-03 18:54:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":208788,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSubgroup analyses for the association of GSRS total score and insomnia.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbbreviations: GSRS, Gastrointestinal Symptom Rating Scale; SSD, somatic symptom disorder.\u003c/p\u003e\n\u003cp\u003eAdjusted for weekly night shift count, anxiety, depression, SSD.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4555208/v1/d3b25de4d53ee493671703f6.png"},{"id":84242692,"identity":"8b208e89-f51f-4ebe-aed8-031b66ab0755","added_by":"auto","created_at":"2025-06-09 16:11:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1738793,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4555208/v1/c13d60ce-51c2-4170-99e4-932e936e83fe.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association Between Gastrointestinal Symptoms and Insomnia among Healthcare Workers: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInsomnia is a prevalent health issue characterized by difficulty falling asleep, frequent awakenings, early morning awakening, and poor sleep quality, which can severely impact an individual's daily functioning and quality of life.\u003csup\u003e1\u003c/sup\u003e Chronic sleep problems may also increase the risk of cardiovascular disease, metabolic syndrome, and cognitive decline.\u003csup\u003e2\u003c/sup\u003e For healthcare workers under prolonged high-stress conditions, adequate sleep is crucial for maintaining work efficiency and patient care quality.\u003c/p\u003e \u003cp\u003eGastrointestinal symptoms, including but not limited to abdominal pain, indigestion, bloating, constipation, and diarrhea, are common clinical health issues that affect people's quality of life and work efficiency. \u003csup\u003e3\u003c/sup\u003e These symptoms can be caused by multiple factors such as dietary habits, lifestyle, mental stress, and other health conditions. In healthcare workers, due to their unique work environment and high-stress conditions, gastrointestinal symptoms are particularly common, posing significant challenges to their health and job performance. \u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eStudies in the general population have shown a significant correlation between gastrointestinal symptoms and insomnia.\u003csup\u003e5\u003c/sup\u003e Gastrointestinal dysfunction may indirectly affect sleep quality by influencing an individual's physiological and psychological states.\u003csup\u003e6\u003c/sup\u003e Conversely, poor sleep patterns may exacerbate gastrointestinal symptoms, creating a vicious cycle.\u003csup\u003e7\u003c/sup\u003e Although research in this field has made some progress, studies focusing specifically on healthcare workers are relatively scarce.\u003c/p\u003e \u003cp\u003eGiven the prevalence of gastrointestinal symptoms and insomnia among healthcare workers and their known correlation in the general population, this study aims to explore the relationship between gastrointestinal symptoms and insomnia in healthcare workers. Specifically, this study will fill a gap in the current literature and provide scientific evidence for developing targeted interventions to improve healthcare workers' health and thereby enhance their work efficiency and quality of patient care.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e This study received formal approval from the Medical Ethics Committee of Quanzhou City First Hospital, approval number: 2023[185]. All methods conformed to relevant guidelines and regulations. All study participants signed informed consent.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Population\u003c/h2\u003e \u003cp\u003eThis study collected data through a questionnaire survey. As a cross-sectional survey conducted from August 25 to November 30, 2023, we recruited healthcare workers from various hospitals in Quanzhou via an online questionnaire. Inclusion criteria: 1. Healthcare worker; 2. Age between 18 and 65, no gender restrictions. Exclusion criteria: 1. History of gastrointestinal malignancy; 2. History of gastrointestinal surgery (excluding colorectal polypectomy); 3. Evidence of peptic ulcer or erosive esophagitis within the last six months on endoscopy; 4. Chronic pancreatitis, inflammatory bowel disease, or bowel obstruction; 5. Severe organ damage and complications (such as cirrhosis, uremia) and severe cardiovascular, respiratory, or endocrine disease; 6. History of malignancy in other systems or organs; 7. Autoimmune diseases such as systemic lupus erythematosus and ankylosing spondylitis; 8. Long-term use of sleeping pills, anti-anxiety, or antidepressant medication; 9. Pregnant or breastfeeding women. These issues were prepared using \"Wenjuanxing (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.wjx.cn/wjx/design/previewmobile.aspx?activity=238985439\u0026amp;s=1)\u003c/span\u003e\u003cspan address=\"https://www.wjx.cn/wjx/design/previewmobile.aspx?activity=238985439\u0026amp;s=1)\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e,\" an online research tool that converts paper scales to electronic versions. This makes the questionnaire assessment easily accessible and completed using mobile or PC devices.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eAssessment of Insomnia\u003c/h2\u003e \u003cp\u003eThe Insomnia Severity Index (ISI) is used to assess the severity of insomnia symptoms. This scale consists of seven items, each evaluating the severity and impact of insomnia symptoms on daily life over the past two weeks. Each item is rated from 0 (no problem) to 4 (very severe problem). The total score ranges from 0 to 28, with higher scores indicating more severe insomnia symptoms. According to previous studies, an ISI score of 8\u0026ndash;14 and \u0026ge;\u0026thinsp;15 indicates mild and moderate-to-severe insomnia, respectively.\u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eAssessment of gastrointestinal symptoms\u003c/h2\u003e \u003cp\u003eThe Gastrointestinal Symptom Rating Scale (GSRS) is commonly used to evaluate the severity of symptoms in patients with functional gastrointestinal disorders (e.g., functional dyspepsia, irritable bowel syndrome). The GSRS, developed by Svedlund et al. in 1988, assesses multiple aspects of gastrointestinal symptoms, including reflux, abdominal pain, bloating, constipation, and diarrhea. Designed as a self-assessment scale, it allows patients to evaluate the severity of their symptoms based on recent experiences.\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eCovariates\u003c/h2\u003e \u003cp\u003eCovariates considered in this study included age, gender, Marriage, body mass index (BMI), education, monthly salary, smoking status, drinking status, weekly night shift count, comorbidity, family history of cancer, Profession, department, unhealthy diet, Weekly exercise frequency, anxiety, depression, and somatic symptom disorder. BMI refers to weight divided by height. Smoking was defined as a habit of smoking more than one cigarette daily. Drinking was defined as a habit of drinking alcohol more than once a week. \u003csup\u003e10\u003c/sup\u003e Comorbidity were defined as having hypertension, diabetes, or heart disease. An unhealthy diet was defined as frequently consuming barbecued or fried foods (\u0026ge;\u0026thinsp;1 time/week) or preferring salty flavors; otherwise, it was considered a healthy diet. Anxiety was defined as a total score of \u0026ge;\u0026thinsp;5 on the Generalized Anxiety Disorder Scale (GAD-7). This scale consists of seven items to assess the frequency of anxiety symptoms over the past two weeks. Each item is rated from 0 (never) to 3 (almost every day), and the total score ranges from 0 to 21, with higher scores indicating more severe functional impairment due to anxiety. Scores of 5\u0026ndash;9 and \u0026ge;\u0026thinsp;10 represent mild and moderate-to-severe anxiety symptoms, respectively. \u003csup\u003e11\u003c/sup\u003e Depression was defined as a total score of \u0026ge;\u0026thinsp;5 on the Patient Health Questionnaire-9 (PHQ-9).\u003csup\u003e12\u003c/sup\u003e The scale assesses the degree of depressive symptoms experienced over the past two weeks, with each item rated from 0 (never) to 3 (almost every day). The total score ranges from 0 to 27, with higher scores indicating more severe depressive symptoms. Prior literature indicates scores of 5\u0026ndash;9 represent mild depressive symptoms, and scores\u0026thinsp;\u0026ge;\u0026thinsp;10 represent moderate-to-severe depressive symptoms.\u003csup\u003e13\u003c/sup\u003e Somatic symptom disorder (SSD) was defined as a total score of \u0026ge;\u0026thinsp;30 on the Self-reported Somatic Symptom Scale-China (SSS-CN). \u003csup\u003e14\u003c/sup\u003e In clinical practice, SSD can be divided into mild, moderate, and severe levels based on scale scores: mild (30\u0026ndash;39 points), moderate (40\u0026ndash;59 points), and severe (over 60 points).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll analyses were conducted using the R statistical software (The R Foundation) and Free Statistics Software version 1.4.\u003csup\u003e15\u003c/sup\u003e Categorical variables were represented by proportions (%), while continuous variables were described by the mean (standard deviation, SD). We compared outcome variables between the groups with and without insomnia using independent t-tests, chi-square tests, and Fisher's exact tests. The relationship between gastrointestinal symptoms and insomnia was analyzed using univariate and multivariate logistic regression. Interactions between subgroups were examined through likelihood ratio tests. A \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\"\u003e\n \u003ch2\u003eBaseline Characteristics of the Study Population\u003c/h2\u003e\n \u003cp\u003eThe online survey recruited 380 participants. After excluding three participants who met the exclusion criteria, two with missing data on the Gastrointestinal Symptom Rating Scale, and three with missing data on covariates, 372 participants were included in our analysis (Fig. \u003cspan\u003e1\u003c/span\u003e). Table \u003cspan\u003e1\u003c/span\u003e presents the clinical characteristics of the study population based on insomnia symptoms. The participants had an average age of 37.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.0 years, and 159 (42.7%) were male. At baseline, participants with insomnia symptoms had more weekly night shifts count, higher rates of anxiety, depression, and SSD, and nurses were more prone to insomnia than doctors.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eBaseline characteristics of the study participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;372)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo Insomnia\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;174)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eInsomnia\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;198)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.732\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e159 (42.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76 (43.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83 (41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e213 (57.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98 (56.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e115 (58.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (year)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.114\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (kg/m\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.648\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarriage, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.804\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52 (14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (18.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e320 (86.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e159 (91.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e161 (81.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFisher\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAssociate Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66 (17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (13.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e202 (54.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89 (51.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e113 (57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster\u0026rsquo;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e94 (25.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53 (30.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41 (20.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoctorate Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10 ( 2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfession, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.175\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e259 (69.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e133 (76.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e126 (63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e113 (30.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41 (23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepartment, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.657\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInternal Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e190 (51.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97 (55.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93 (47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38 (10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOB/GYN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41 (11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency/ICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22 ( 5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical Technology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41 (11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (13.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital Grade, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.118\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTertiary Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e261 (70.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e121 (69.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e140 (70.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e74 (19.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31 (17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43 (21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37 ( 9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (12.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonthly Salary (RMB), n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.712\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.372\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36 ( 9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5000\u0026ndash;9999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e235 (63.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e110 (63.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e125 (63.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10000\u0026ndash;14999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e77 (20.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;150000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24 ( 6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidity, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.688\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e342 (91.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e165 (94.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e177 (89.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30 ( 8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily History of Cancer, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.984\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e312 (83.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e153 (87.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e159 (80.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (19.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking Status, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.368\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e342 (91.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e164 (94.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e178 (89.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30 ( 8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDrinking Status, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.632\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e315 (84.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e149 (85.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e166 (83.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57 (15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnhealthy Diet, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e301 (80.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e144 (82.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e157 (79.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e71 (19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41 (20.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeekly Night Shift Count\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeekly Exercise Frequency, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.528\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.218\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e169 (45.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72 (41.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97 (49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e109 (29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54 (31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u0026ndash;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65 (17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29 ( 7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e173 (46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e119 (68.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54 (27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e199 (53.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e144 (72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.834\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e157 (42.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e112 (64.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45 (22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e215 (57.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62 (35.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e153 (77.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSSD, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.637\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e151 (40.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e112 (64.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (19.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e221 (59.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62 (35.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e159 (80.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGSRS Total Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54.678\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eData presented are mean \u0026plusmn; SD or N (%).\u003c/p\u003e\n \u003cp\u003eAbbreviations: BMI, Body Mass Index; RMB, Renminbi; OB/GYN, Obstetrics and Gynecology; ICU, Intensive Care Unit; SSD, somatic symptom disorder; GSRS, Gastrointestinal Symptom Rating Scale.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEffect of Gastrointestinal Symptoms on the Risk of Insomnia in Healthcare Workers\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eUnivariate analysis revealed that the weekly night shifts count, education, profession, department, family history of cancer, anxiety, depression, SSD, and GSRS total score were associated with insomnia risk (Table 2). The results of the multivariate logistic regression analysis are shown in Table 3. In the unadjusted model, the GSRS total score was positively correlated with insomnia risk (OR, 1.21; 95% CI, 1.14-1.28). In Model 1, after adjusting for age and gender, the results remained consistent (OR, 1.21; 95% CI, 1.14-1.28). Model 2, which adjusted for variables in Model 1 as well as anxiety, depression, SSD, and weekly night shift count (these confounders were selected based on their association with the outcomes of interest or a change in effect estimate of more than 10%), still showed a positive correlation (OR, 1.11; 95% CI, 1.04-1.18). Model 3, which adjusted for the variables in Model 2 plus marriage, BMI, education, monthly salary, smoking status, drinking status, comorbidity, family history of cancer, profession, department, unhealthy diet, and weekly exercise Frequency, still demonstrated a positive correlation (OR, 1.08; 95% CI, 1.00-1.16).\u003c/p\u003e\n \u003cdiv\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eAssociation of covariates and insomnia\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (Reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.07 (0.71\u0026thinsp;~\u0026thinsp;1.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.732\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (year)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.98 (0.96\u0026thinsp;~\u0026thinsp;1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (kg/m\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.03 (0.96\u0026thinsp;~\u0026thinsp;1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.421\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarriage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (Reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.41 (0.22\u0026thinsp;~\u0026thinsp;0.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAssociate Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (Reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.73 (0.41\u0026thinsp;~\u0026thinsp;1.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.273\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster\u0026rsquo;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.44 (0.23\u0026thinsp;~\u0026thinsp;0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoctorate Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.14 (0.03\u0026thinsp;~\u0026thinsp;0.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfession\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (Reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.85 (1.18\u0026thinsp;~\u0026thinsp;2.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepartment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInternal Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (Reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.16 (0.58\u0026thinsp;~\u0026thinsp;2.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.679\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOB/GYN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.25 (1.1\u0026thinsp;~\u0026thinsp;4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency/ICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.83 (0.73\u0026thinsp;~\u0026thinsp;4.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical Technology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.81 (0.9\u0026thinsp;~\u0026thinsp;3.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.77 (0.39\u0026thinsp;~\u0026thinsp;1.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.459\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital Grade\u003c/strong\u003e,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTertiary Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (Reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.2 (0.71\u0026thinsp;~\u0026thinsp;2.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.496\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.59 (0.29\u0026thinsp;~\u0026thinsp;1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.139\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonthly Salary (RMB)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (Reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5000\u0026ndash;9999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.72 (0.35\u0026thinsp;~\u0026thinsp;1.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.376\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10000\u0026ndash;14999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.62 (0.28\u0026thinsp;~\u0026thinsp;1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.245\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;150000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.75 (0.26\u0026thinsp;~\u0026thinsp;2.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.593\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (Reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.18 (0.97\u0026thinsp;~\u0026thinsp;4.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily History of Cancer\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (Reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.79 (1.01\u0026thinsp;~\u0026thinsp;3.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (Reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.84 (0.84\u0026thinsp;~\u0026thinsp;4.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDrinking Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (Reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.15 (0.65\u0026thinsp;~\u0026thinsp;2.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.632\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnhealthy Diet\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (Reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.25 (0.74\u0026thinsp;~\u0026thinsp;2.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.397\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeekly Night Shift Count\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.12 (1.04\u0026thinsp;~\u0026thinsp;1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeekly Exercise Frequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.76 (0.47\u0026thinsp;~\u0026thinsp;1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.257\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u0026ndash;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.72 (0.41\u0026thinsp;~\u0026thinsp;1.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.261\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.69 (0.31\u0026thinsp;~\u0026thinsp;1.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.362\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.77 (3.69\u0026thinsp;~\u0026thinsp;9.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.14 (3.9\u0026thinsp;~\u0026thinsp;9.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.36 (4.61\u0026thinsp;~\u0026thinsp;11.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGSRS Total Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.21 (1.14\u0026thinsp;~\u0026thinsp;1.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003eAbbreviations: BMI, Body Mass Index; RMB, Renminbi; OB/GYN, Obstetrics and Gynecology; ICU, Intensive Care Unit; SSD, somatic symptom disorder; GSRS, Gastrointestinal Symptom Rating Scale.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eAssociation between GSRS total score and insomnia\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNon-adjusted\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eModel 1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eModel 2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eModel 3\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGSRS Total Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.21(1.14\u0026thinsp;~\u0026thinsp;1.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.21(1.14\u0026thinsp;~\u0026thinsp;1.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.11(1.04\u0026thinsp;~\u0026thinsp;1.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.08(1.0\u0026thinsp;~\u0026thinsp;1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\"\u003eAbbreviations: GSRS, Gastrointestinal Symptom Rating Scale.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\"\u003eModel 1-adjusted for gender, age.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\"\u003eModel 2-adjusted for gender, age, weekly night shift count, anxiety, depression, SSD.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\"\u003eModel 3-adjusted for gender, age, BMI, marriage, education, profession, department, hospital grade, monthly salary, comorbidity, smoking status, drinking status, unhealth diet, weekly night shift count, weekly exercise frequency, anxiety, depression, SSD.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eSubgroup Analysis\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eIn this study, we performed stratified analyses and interaction tests to determine whether the association between the GSRS total score and insomnia incidence was consistent across several subgroups. When stratified by age, gender, anxiety, depression, and SSD, a consistent positive correlation was observed, and no significant interactions were found in any subgroup (Figure 2). This indicates that the impact of gastrointestinal symptoms on insomnia outcomes is stable and not influenced by changes in covariates\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined the association between gastrointestinal symptoms and insomnia among healthcare workers and found a significant positive correlation between the two. That is, an increase in the severity of gastrointestinal symptoms was associated with a higher risk of insomnia. This finding complements existing literature on the relationship between gastrointestinal symptoms and insomnia in both general and specific populations while providing new insights into this relationship in the unique occupational group of healthcare workers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociation Between Gastrointestinal Symptoms and Insomnia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrevious studies have identified the correlation between gastrointestinal symptoms and sleep disorders in the general population. For instance, Tu et al. found a positive correlation between gastrointestinal symptoms and sleep disturbances.\u003csup\u003e16\u003c/sup\u003e Clevers et al. explored the predictive relationship between psychological stress, short sleep duration, and gastrointestinal symptoms among office workers. Although this study did not specifically focus on healthcare workers, it presented a work-related stress context similar to the medical environment and emphasized the importance of psychological stress and sleep duration as predictive factors for gastrointestinal symptoms.\u003csup\u003e17\u003c/sup\u003e A study reported similar results, finding that gastrointestinal dysfunctions, such as irritable bowel syndrome (IBS), were significantly related to sleep problems.\u003csup\u003e18\u003c/sup\u003e These studies support our findings that gastrointestinal symptoms may affect sleep quality through mechanisms like pain, discomfort, or anxiety.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Uniqueness of Gastrointestinal Symptoms and Insomnia in Healthcare Workers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn contrast, studies focusing on healthcare workers are relatively scarce. Our findings align with a study of South Korean nurses, which found that long working hours and night shifts could lead to poor sleep quality and digestive system problems among nurses.\u0026nbsp;\u003csup\u003e19\u003c/sup\u003e Moreover, due to their high-stress work environment and irregular working hours, healthcare workers are more prone to gastrointestinal symptoms like indigestion and stomach pain, further exacerbating insomnia.\u0026nbsp;\u003csup\u003e20\u003c/sup\u003e\u0026nbsp; This underscores that the relationship between gastrointestinal symptoms and insomnia may differ in healthcare workers compared to the general population, especially given the role of work-related stress and lifestyle factors.\u003c/p\u003e\n\u003cp\u003eFurthermore, the persistent mental stress and emotional burden faced by healthcare workers may also be a key factor. Stress and emotional issues are common triggers of gastrointestinal symptoms and major contributors to insomnia. Our univariate analysis showed that anxiety, depression, and SSD were associated with insomnia risk. Previous research demonstrated that short sleep duration and poor sleep quality significantly affected the mental health of military healthcare workers.\u003csup\u003e21\u003c/sup\u003e Another study revealed that sleep disorders are closely related to the mental health issues of healthcare workers, particularly during the COVID-19 pandemic, where healthcare workers with sleep disorders had 3.74 times the risk of psychological problems compared to those without sleep disorders.\u003csup\u003e22\u003c/sup\u003e\u0026nbsp; When facing gastrointestinal symptoms and insomnia, healthcare workers may need to emphasize stress management and emotional regulation due to the unique nature of their occupational stress.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExploring the Mechanisms of Gastrointestinal Symptoms and Insomnia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile this study did not directly investigate the biopsychosocial mechanisms between gastrointestinal symptoms and insomnia, our findings align with existing literature regarding the gut-brain axis and the impact of stress responses on sleep. The possible mechanisms include: 1. Gut-Brain Axis Interaction: Communication between the gut and the brain, known as the gut-brain axis, is crucial for understanding the relationship between gastrointestinal symptoms and sleep disorders. The microbial composition of the gut can affect brain function, including emotional and cognitive processes, thereby influencing sleep regulation.\u003csup\u003e23\u003c/sup\u003e 2. Psychosocial Factors: Healthcare workers frequently face high work stress, which significantly affects sleep quality. This stress increases psychological burden and activates the stress response system (autonomic nervous system and Hypothalamic-Pituitary-Adrenal axis), directly affecting gastrointestinal function and sleep. This may exacerbate gastrointestinal symptoms and disrupt normal sleep structure.\u003csup\u003e24\u003c/sup\u003e 3. Circadian Rhythm Disruption: Irregular work hours and night shifts can disrupt the circadian rhythm, affecting the normal day-night cycle. This not only directly impacts sleep quality but also indirectly causes gastrointestinal problems by influencing the regularity of gastrointestinal activity. \u003csup\u003e25\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations and Future Research Directions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. First, because it is a cross-sectional design, it cannot establish a causal relationship. Second, the study data relied primarily on self-reported questionnaires, which may introduce reporting bias. Future studies should employ longitudinal designs to explore causal relationships and further validate the biopsychosocial mechanisms between gastrointestinal symptoms and insomnia, particularly in high-stress work environments.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study found a significant positive correlation between gastrointestinal symptoms and insomnia among healthcare workers. This finding highlights the health challenges healthcare workers face, particularly the close link between gastrointestinal health and sleep quality in high-stress work environments.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eX.L., Y.H. and X.L. participated in the design of research schemes, extracted, and analyzed the data, and wrote the main manuscript text. C.L. and Y.H. collected the data. Y.Z., P.C. and B.X. participated in the design of research schemes. Y.W. reviewed the manuscript. All authors contributed to the article and approved the submitted version. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflicts of interest regarding the publication of this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by China Scholarship Council（grant No. 201906070289）,\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eStartup Fund for Scientific Research, Fujian Medical University (grant No. 2022QH1268). The funders had no role in the study design, analysis, decision to publish, nor preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDatasets can be obtained from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirstly, we thank the Free Statistics team for providing technical assistance and valuable tools for data analysis and visualization. We also extend our gratitude to the Zotero team. Their reference management tool greatly simplified the collection and organization of my literature, making the management of references more efficient and standardized. Lastly, we thank the Obsidian team. Their note-taking software provided an efficient platform for my research notes, idea recording, and material organization, significantly improving my work efficiency.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePerlis, M. L. \u003cem\u003eet al.\u003c/em\u003e Insomnia. \u003cem\u003eThe Lancet\u003c/em\u003e 400, 1047\u0026ndash;1060 (2022).\u003c/li\u003e\n\u003cli\u003eLechat, B. \u003cem\u003eet al.\u003c/em\u003e The association of co‐morbid insomnia and sleep apnea with prevalent cardiovascular disease and incident cardiovascular events. \u003cem\u003eJournal of Sleep Research\u003c/em\u003e 31, e13563 (2022).\u003c/li\u003e\n\u003cli\u003eM\u0026uuml;hlbacher, A. C. \u0026amp; Kaczynski, A. 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GSRS--a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. \u003cem\u003eDig Dis Sci\u003c/em\u003e 33, 129\u0026ndash;134 (1988).\u003c/li\u003e\n\u003cli\u003eTakeoka, A. \u003cem\u003eet al.\u003c/em\u003e Psychological effects of\u003cem\u003eHelicobacter pylori\u003c/em\u003e-associated atrophic gastritis in patients under 50 years: A cross-sectional study. \u003cem\u003eHelicobacter\u003c/em\u003e 22, e12445 (2017).\u003c/li\u003e\n\u003cli\u003ePlummer, F., Manea, L., Trepel, D. \u0026amp; McMillan, D. Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. \u003cem\u003eGeneral Hospital Psychiatry\u003c/em\u003e 39, 24\u0026ndash;31 (2016).\u003c/li\u003e\n\u003cli\u003eKroenke, K., Spitzer, R. L. \u0026amp; Williams, J. B. W. 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Factors Associated with Gastrointestinal Symptoms among Rotating Shift Nurses in South Korea: A Cross-Sectional Study. \u003cem\u003eIJERPH\u003c/em\u003e 19, 9795 (2022).\u003c/li\u003e\n\u003cli\u003eRoman, P. \u003cem\u003eet al.\u003c/em\u003e Influence of Shift Work on The Health of Nursing Professionals. \u003cem\u003eJPM\u003c/em\u003e 13, 627 (2023).\u003c/li\u003e\n\u003cli\u003ePan, X. \u003cem\u003eet al.\u003c/em\u003e Prevalence of mental health problems and associated risk factors among military healthcare workers in specialized COVID ‐19 hospitals in Wuhan, China: A cross‐sectional survey. \u003cem\u003eAsia-Pacific Psychiatry\u003c/em\u003e 14, (2022).\u003c/li\u003e\n\u003cli\u003eLiu, Y. \u003cem\u003eet al.\u003c/em\u003e Association between sleep disturbance and mental health of healthcare workers: A systematic review and meta-analysis. \u003cem\u003eFront. Psychiatry\u003c/em\u003e 13, 919176 (2022).\u003c/li\u003e\n\u003cli\u003eMayer, E. A., Nance, K. \u0026amp; Chen, S. The Gut\u0026ndash;Brain Axis. \u003cem\u003eAnnu. Rev. Med.\u003c/em\u003e 73, 439\u0026ndash;453 (2022).\u003c/li\u003e\n\u003cli\u003eMiyama, H. \u003cem\u003eet al.\u003c/em\u003e Association of Chronotypes and Sleep Disturbance with Perceived Job Stressors and Stress Response: A Covariance Structure Analysis\u0026amp;lt;/p\u0026amp;gt; \u003cem\u003eNDT\u003c/em\u003e Volume 16, 1997\u0026ndash;2005 (2020).\u003c/li\u003e\n\u003cli\u003eAlbrecht, U. \u0026amp; Ripperger, J. A. Circadian Clocks and Sleep: Impact of Rhythmic Metabolism and Waste Clearance on the Brain. \u003cem\u003eTrends in Neurosciences\u003c/em\u003e 41, 677\u0026ndash;688 (2018).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Gastrointestinal symptoms, Insomnia, Healthcare workers, Cross-sectional study","lastPublishedDoi":"10.21203/rs.3.rs-4555208/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4555208/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHealthcare workers often suffer from gastrointestinal symptoms and insomnia, which affect their quality of life and job performance. This study explores the link between these conditions in healthcare workers to guide health improvements.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study recruited healthcare workers from various hospitals in Quanzhou via an online survey. The severity of gastrointestinal and insomnia symptoms was assessed using the Gastrointestinal Symptom Rating Scale (GSRS) and Insomnia Severity Index (ISI), respectively. The relationship between gastrointestinal symptoms and insomnia was analyzed using univariate and multivariate logistic regression models.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 372 healthcare workers participated in the study, and 53.2% of the participants reported having insomnia symptoms. In the unadjusted model, there was a positive correlation between the GSRS total score and the risk of insomnia (OR\u0026thinsp;=\u0026thinsp;1.21, 95% CI\u0026thinsp;=\u0026thinsp;1.14\u0026ndash;1.28). This positive correlation persisted even after adjusting for confounders such as age, gender, anxiety, depression, somatization, and weekly night shift count (adjusted OR\u0026thinsp;=\u0026thinsp;1.08, 95% CI\u0026thinsp;=\u0026thinsp;1.0-1.16).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eGastrointestinal symptoms and insomnia are significantly positively correlated among healthcare workers. This finding suggests the need to develop interventions that enhance the gastrointestinal and sleep health of healthcare workers, thereby improving their work efficiency and quality of care.\u003c/p\u003e","manuscriptTitle":"Association Between Gastrointestinal Symptoms and Insomnia among Healthcare Workers: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-03 18:54:21","doi":"10.21203/rs.3.rs-4555208/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-17T14:04:45+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-16T15:35:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"144901361454030994814802005666571201659","date":"2024-12-14T09:26:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"265433355940583971575176236456818674382","date":"2024-12-14T05:56:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"12217443434937540072285105539182359157","date":"2024-12-11T14:35:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-01T03:14:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"199097481357838271721891981851896318136","date":"2024-10-27T09:36:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-21T15:47:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"301311192278882977747433876206853135474","date":"2024-09-11T03:43:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-08T05:39:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-08T05:35:29+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-12T07:27:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-12T04:06:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-06-09T23:46:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5c02f275-05f0-4a2a-840d-a58b380e5d44","owner":[],"postedDate":"July 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-09T16:06:27+00:00","versionOfRecord":{"articleIdentity":"rs-4555208","link":"https://doi.org/10.1038/s41598-025-05079-w","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-06-04 15:57:23","publishedOnDateReadable":"June 4th, 2025"},"versionCreatedAt":"2024-07-03 18:54:21","video":"","vorDoi":"10.1038/s41598-025-05079-w","vorDoiUrl":"https://doi.org/10.1038/s41598-025-05079-w","workflowStages":[]},"version":"v1","identity":"rs-4555208","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4555208","identity":"rs-4555208","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}