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Original article
All-cause and cancer-specific mortality in GORD in a population-based cohort study (the HUNT study)
  1. Eivind Ness-Jensen1,2,3,
  2. Eivind Gottlieb-Vedi1,
  3. Karl Wahlin1,
  4. Jesper Lagergren1,4
  1. 1Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
  2. 2HUNT Research Centre, Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, Levanger, Norway
  3. 3Medical Department, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
  4. 4Division of Cancer Studies, King's College London, London, UK
  1. Correspondence to Dr Eivind Ness-Jensen, Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm 171 76, Sweden; eivind.ness-jensen{at}ki.se

Abstract

Objective Gastro-oesophageal reflux is a public health concern which could have associated oesophageal complications, including adenocarcinoma, and possibly also head-and-neck and lung cancers. The aim of this study was to test the hypothesis that reflux increases all-cause and cancer-specific mortalities in an unselected cohort.

Design The Nord-Trøndelag health study (HUNT), a Norwegian population-based cohort study, was used to identify individuals with and without reflux in 1995–1997 and 2006–2008, with follow-up until 2014. All-cause mortality and cancer-specific mortality were assessed from the Norwegian Cause of Death Registry and Cancer Registry. Multivariable Cox regression was used to calculate HRs with 95% CIs for mortality with adjustments for potential confounders.

Results We included 4758 participants with severe reflux symptoms and 51 381 participants without reflux symptoms, contributing 60 323 and 747 239 person-years at risk, respectively. Severe reflux was not associated with all-cause mortality, overall cancer-specific mortality or mortality in cancer of the head-and-neck or lung. However, for men with severe reflux a sixfold increase in oesophageal adenocarcinoma-specific mortality was found (HR 6.09, 95% CI 2.33 to 15.93) and the mortality rate was 0.27 per 1000 person-years. For women, the corresponding mortality was not significantly increased (HR 3.68, 95% CI 0.88 to 15.27) and the mortality rate was 0.05 per 1000 person-years.

Conclusions Individuals with severe reflux symptoms do not seem to have increased all-cause mortality or overall cancer-specific mortality. Although the absolute risk is small, individuals with severe reflux symptoms have a clearly increased oesophageal adenocarcinoma-specific mortality.

  • ACID-RELATED DISEASES
  • ADENOCARCINOMA
  • CANCER
  • EPIDEMIOLOGY
  • GASTROESOPHAGEAL REFLUX DISEASE

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Footnotes

  • Contributors EN-J contributed to the study concept and design, statistical analyses and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, approved the final version of the manuscript and is guarantor for the overall content of the manuscript. EG-V contributed to the study concept and design, statistical analyses and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. KW contributed to the statistical analysis and interpretation of data, critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. JL contributed to the study concept and design, critical revision of the manuscript for important intellectual content and approved the final version of the manuscript.

  • Funding EN-J, KW and JL are funded by the Swedish Research Council.

  • Competing interests None declared.

  • Ethics approval The Regional Committee for Medical and Health Research Ethics, Central Norway.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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