Risk factors for inguinal hernia in middle-aged and elderly men: Results from the Rotterdam Study

Background. Prospective data on risk factors and the incidence of inguinal hernia are sparse, especially in an elderly population. The aim of this study was to determine the incidence of and risk factors for inguinal hernia. Methods. We analyzed data from the Rotterdam Study, a prospective cohort study that observed the general population aged >= 45 years of Ommoord, a district in Rotterdam, from baseline (1990) over a period of >20 years. Diagnoses of inguinal hernia were obtained from hospital discharge records and records from general practitioners. Multivariate regression analysis was performed to determine risk factors for inguinal hernia development. Results. Among 5,780 men, with a total of 50,802 person-years, who did not have a hernia at baseline, 416 cases of inguinal hernia (7.2%) occurred. The 20-year cumulative incidence was 14%. Age-adjusted hazard ratio (HR) for inguinal hernia for men relative to women was 12.4 (95% CI, 9.5-16.3; P < .001). On multivariate analysis, the risk of inguinal hernia increased with advancing age (HR per 1-year increase in age, 1.03; 95% CI, 1.02-1.04; P < .001). Participants with a body mass index (BMI) of 25-30 kg/m(2) had an HR of 0.72 (95% CI, 0.58-0.89; P = .003) compared with a BMI of <25; a BMI of >30 had an associated HR of 0.63 (95% CI, 0.42-0.94; P = .025). Conclusion. Inguinal hernia is common in the middle-aged and elderly male population and its incidence increases with advancing age. Overweight or obese patients have a lesser risk of developing an inguinal hernia.