Incidence, Morbidity, and Mortality of Achalasia: A Nationwide, Population-Based Cohort Study in South Korea
- Author:
Ga Hee KIM
1
;
Hyungchul PARK
;
Kee Wook JUNG
;
Min-Ju KIM
;
Ye-Jee KIM
;
Ji Min LEE
;
Bong Eun LEE
;
Yang Won MIN
;
Jeong Hwan KIM
;
Hee Kyong NA
;
Ji Yong AHN
;
Jeong Hoon LEE
;
Do Hoon KIM
;
Kee Don CHOI
;
Ho June SONG
;
Gin Hyug LEE
;
Hwoon-Yong JUNG
;
Hyun Jin KIM
;
Author Information
- Publication Type:Original Article
- From:Gut and Liver 2023;17(6):894-904
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background/Aims:Although an association between achalasia and esophageal cancer has been reported, whether achalasia confers a substantial increase in mortality is unknown. Moreover, the causes of death related to achalasia have not been investigated. We performed this nationwide, population-based cohort study on achalasia because no such study has been performed since the introduction of high-resolution manometry in 2008.
Methods:This study was performed using data extracted from the Korean National Health Insurance Service database, covering a 9-year period from 2009 to 2017. Control participants without a diagnostic code for achalasia were randomly selected and matched by sex and birth year at a case-to-control ratio of 1:4. Data on the cause of death from Statistics Korea were also analyzed.
Results:The overall incidence of achalasia was 0.68 per 100,000 person-years, and the prevalence was 6.46 per 100,000 population. Patients with achalasia (n=3,063) had significantly higher adjusted hazard ratio (aHR) for esophageal cancer (aHR, 3.40; 95% confidence interval [CI], 1.25 to 9.22; p=0.017), pneumonia (aHR, 2.30; 95% CI, 1.89 to 2.81; p<0.001), aspiration pneumonia (aHR, 3.92; 95% CI, 2.38 to 6.48; p<0.001), and mortality (aHR, 1.68; 95% CI, 1.44 to 1.94; p<0.001). Esophageal cancer carried the highest mortality risk (aHR, 8.82; 95% CI, 2.35 to 33.16; p=0.001), while pneumonia had the highest non-cancer mortality risk (aHR, 2.28; 95% CI, 1.31 to 3.96; p=0.004).
Conclusions:In this nationwide study, achalasia was associated with increased risk of mortality.Esophageal cancer and pneumonia were the most common comorbidities and the major causes of death in patients with achalasia.
