Although 776 responded to the survey, the sample had 734 subjects as some replied had invalid responses or left essential questions unanswered with 94.6% response rate. The sample comprised of 24.5% being male and 75.5% being female. The mean age was 23.97 ± 6.589 years. Age group of (18-30) constituted 88.3% of the subjects. Characteristics of the subjects are demonstrated in Table 1. Also, 31.9% of subjects had a possible LPR using RSI questionnaire. Other characteristics of the war, current medical conditions and medication, and reflux symptoms index for the subjects are demonstrated in Table 2. LPR prevalence was 31.9% (CI 95%: 28.2-35.4). In patients with LPR, males comprised of 20.5% (CI 95%: 15.4-26.1), females comprised of 79.5% (CI 95%: 73.9-84.6), cigarette smoking comprised of 21.4% (CI 95%: 16.2-26.9) shisha smoking comprised of 33.3% (CI 95%: 27.4-39.7), subjects with asthma comprised of 4.3% (CI 95%: 2.1-7.3), and subjects with allergic reactions comprised of 8.1% (CI 95%: 4.7-12).
Comparisons between subjects of negative and positive RSI are demonstrated in Table 3. Females had LPR more frequently than males, but with no statistical significance P=0.084 (OR, 1.390; 95% CI 0.956-2.021). However, age group younger than 30 years had lower rates of LPR P=0.012 (OR, 0.534; 95% CI 0.325-0.877) than subjects in the age group of older than 30 years. Subjects who reported they were distressed from war noises had LPR more frequently P=0.009 (OR, 1.562; 95% CI 1.117-2.183). Subjects who reported having LPR also reported having other medical conditions more frequently P=0.003 (OR, 1.843; 95% CI 1.223-2.780), such as asthma P>0.0001 (OR, 13.750; 95% CI 2.969-63.690), allergic reactions P=0.001 (OR, 3.074; 95% CI 1.545-6.115) and pulmonary medical conditions P=0.029 (OR, 5.500; 95% CI 0.994-30.428). Furthermore, regularly smoking cigarettes was correlated with having LPR P=0.002 (OR, 1.920; 95% CI 1.273-2.894). This was the case with shisha smoking but the result was insignificant P=0.126 (OR, 1.299; 95% CI 0.929-1.815). However, regularly smoking shisha and cigarette together was correlated with LPR more frequently when compared to all other subjects P=0.001 (OR, 2.323; 95% CI 1.395-3.869). Furthermore, a statistically significant difference was found when comparing RSI score and smoking cigarettes P<0.0001, smoking shisha P=0.035, and smoking them both P<0.0001 as smoking had higher RSI scores suggesting more symptoms of LPR. Nevertheless, no statistically significant difference was found when comparing having LPR or not with current place of living, consanguinity, marital status, education level, SES, being employed, type of work, losing someone close, or changing place of living due to war P>0.05. There was a weak negative correlation found when comparing RSI score and SES (r = - 0.075). However, no correlation was found when comparing RSI score with age and number of times changing living due to war P>0.05 and when one-way ANOVA test was used, SES classification did not correlate with RSI scores P>0.05.
Comparing the subjects, aging (18- 30) years with having LPR or not is demonstrated in Table 4. In this age group, females had more LPR (P=0.044) than males. Subjects who were involved in the medical field had LPR less frequently (P=0.033). In addition, being distressed from war noises was correlated with LPR more frequently (P=0.007). Smoking was correlated with having LPR for either cigarette smoking P<0.0001 (OR, 2.410; 95% CI 1.545-3.759), shisha smoking P=0.022 (OR, 1.504; 95% CI 1.058-2.137) or smoking both P=0.0001 (OR, 2.803; 95% CI 1.632-4.815). In addition, higher RSI scores were associated with smoking cigarettes P<0.0001, smoking shisha P=0.007, and smoking both P<0.0001. However, in this age group of (18-30) years, education level, marital status, SES, being employed, type of work, losing someone close and changing place of living due to war were not correlated with LPR.
The mean score of RSI of all subjects was 10.50 ± 9.022 (CI 95%: 8.467-9.584). The mean score of reflux symptoms index of subjects aging (18-30) years was 10.21 ± 8.114 (CI 95%: 9.55-10.86). The mean score of reflux symptoms index in subjects with positive LPR was 21.34 ± 7.533 (CI 95%: 20.38-22.34). The mean score of each question of the index in subjects with positive LPR is demonstrated in Table 5. The mean score of RSI in shisha smoking subjects was 11.43 ± 9.666 (CI 95%: 10.14-12.74), and the mean score of RSI of shisha smoking subjects aging (18-30) years was 11.36 ± 9.364 (CI 95%: 10.04-12.83). The mean RSI score in each province with gender prevalence is shown in Figure 1.
When using forward linear regression on RSI score with smoking cigarettes or not, smoking shisha or not, being distressed from war noises, gender, age, having asthma and\or allergic reaction or not, (P<0.001) for asthma and allergic reaction (R2=3.4%), for cigarette smoking (R2==3.1%), and for being distressed from war noises (R2=2.2%). When applying the same model but with using any chronic condition instead of asthma, (P<0.001) for chronic medical condition (R2=3.3%), for cigarette smoking (R2=3.1%) and for being distressed from war noises (R2=2.1%). When excluding age variable and applying the same regression on subjects aged (18-30) years, (P<0.001) for cigarette smoking (R2=4.9%), for being distressed from war noises (R2=2.6%), and for having asthma and/or allergic reaction (R2=2%).
When applying the same model (forward linear regression on RSI score with smoking cigarettes or not, smoking shisha or not, being distressed from war noises, gender, age, having asthma and\or allergic reaction or not) but with one variable for smoking (smoking shisha, cigarette, both and none), (P<0.001) and (R2=2%) for smoking, and when excluding age variable and applying the previous model on subjects aging (18-30) years, (P<0.001) for smoking shisha, cigarette, both, or none (R2=3%), for being distressed from war noises (R2=2.4%), and for having asthma and/or allergic reactions (R2=2%).