Table 3. The association between gastroesophageal reflux disease (GERD) and mortality after exclusion of deaths in the first two years of follow-up in the Golestan Cohort Study (GCS).
| GERD symptoms | Overall mortality | Circulatory mortality | Cancer mortality | Esophageal cancer (EC) mortality | ||||||||
| N | HR1 (95% CI) | HR2 (95% CI) | N | HR1 (95% CI) | HR2 (95% CI) | N | HR1 (95% CI) | HR2 (95% CI) | N | HR1 (95% CI) | HR2 (95% CI) | |
| Frequency | ||||||||||||
| Never | 916 | Referent | Referent | 479 | Referent | Referent | 204 | Referent | Referent | 44 | Referent | Referent |
| <Weekly | 888 | 0.93 (0.85–1.02) | 0.92 (0.84–1.01) | 432 | 0.85 (0.74–0.97) | 0.83 (0.73–0.95) | 201 | 0.93 (0.76–1.14) | 0.93 (0.76–1.14) | 35 | 0.81 (0.52–1.27) | 0.84 (0.53–1.32) |
| Weekly | 175 | 0.89 (0.76–1.05) | 0.84 (0.71–0.99) | 90 | 0.85 (0.68–1.07) | 0.76 (0.61–0.96) | 31 | 0.74 (0.51–1.09) | 0.75 (0.51–1.09) | 7 | 0.79 (0.35–1.77) | 0.83 (0.37–1.87) |
| Daily | 304 | 1.08 (0.94–1.23) | 1.00 (0.88–1.15) | 160 | 1.05 (0.87–1.26) | 0.92 (0.77–1.11) | 65 | 1.08 (0.81–1.45) | 1.09 (0.81–1.45) | 13 | 0.96 (0.50–1.84) | 1.01 (0.52–1.94) |
| p for trend | 0.73 | 0.45 | 0.87 | 0.12 | 0.90 | 0.93 | 0.69 | 0.83 | ||||
| First start | ||||||||||||
| Never | 915 | Referent | Referent | 478 | Referent | Referent | 204 | Referent | Referent | 44 | Referent | Referent |
| <1 year ago | 240 | 1.01 (0.88–1.17) | 1.00 (0.87–1.16) | 122 | 0.97 (0.79–1.19) | 0.95 (0.78–1.17) | 46 | 0.87 (0.62–1.21) | 0.87 (0.63–1.22) | 4 | 0.27 (0.08–0.86) | 0.28 (0.09–0.89) |
| 1 – 5 years ago | 525 | 0.93 (0.83–1.03) | 0.90 (0.80–1.00) | 257 | 0.85 (0.73–0.99) | 0.80 (0.69–0.94) | 118 | 0.95 (0.75–1.20) | 0.95 (0.76–1.21) | 23 | 0.88 (0.53–1.46) | 0.91 (0.54–1.52) |
| 6 – 10 years ago | 181 | 0.89 (0.76–1.05) | 0.85 (0.72–1.00) | 95 | 0.87 (0.70–1.09) | 0.79 (0.63–0.99) | 40 | 0.88 (0.63–1.25) | 0.89 (0.64–1.27) | 6 | 0.66 (0.28–1.56) | 0.70 (0.30–1.65) |
| >10 years ago | 408 | 0.97 (0.86–1.09) | 0.95 (0.84–1.07) | 197 | 0.87 (0.73–1.03) | 0.83 (0.70–0.98) | 92 | 0.98 (0.76–1.27) | 0.99 (0.77–1.28) | 21 | 1.17 (0.69–1.99) | 1.22 (0.72–2.08) |
| p for trend | 0.26 | 0.09 | 0.04 | 0.004 | 0.70 | 0.77 | 0.69 | 0.57 | ||||
| Severity | ||||||||||||
| Never | 916 | Referent | Referent | 479 | Referent | Referent | 204 | Referent | Referent | 44 | Referent | Referent |
| Mild | 173 | 0.84 (0.71–0.99) | 0.84 (0.71–0.99) | 94 | 0.85 (0.68–1.06) | 0.84 (0.67–1.05) | 36 | 0.79 (0.55–1.13) | 0.80 (0.56–1.15) | 7 | 0.71 (0.30–1.66) | 0.72 (0.31–1.70) |
| Moderate | 874 | 0.91 (0.83–1.00) | 0.89 (0.81–0.98) | 430 | 0.84 (0.74–0.96) | 0.80 (0.70–0.92) | 188 | 0.88 (0.72–1.08) | 0.88 (0.72–1.08) | 33 | 0.76 (0.48–1.20) | 0.79 (0.50–1.25) |
| Severe | 319 | 1.17 (1.03–1.33) | 1.11 (0.97–1.27) | 158 | 1.07 (0.89–1.29) | 0.97 (0.81–1.17) | 73 | 1.22 (0.93–1.61) | 1.23 (0.94–1.62) | 15 | 1.20 (0.66–2.18) | 1.28 (0.70–2.33) |
| p for trend | 0.61 | 0.74 | 0.34 | 0.05 | 0.77 | 0.76 | 0.77 | 0.95 | ||||
| Total | 2283 | 1161 | 501 | 99 | ||||||||
CI: Confidence interval; GERD: Gastroesophageal reflux disease; HR: Hazard ratio; N: Number of deaths.
HR1 (95% CIs) are adjusted for the sociodemographic and lifestyle factors shown in Table 1; HR2 (95% CIs) are additionally adjusted for hypertension, self-reported diabetes and heart disease. The severity of symptoms here is defined as: mild, the study participant did not feel the symptoms unless they actively paid attention; moderate, the study participant felt the symptoms without active attention, but they did not interfere with daily work; severe, symptoms interfering with daily work or causing nighttime awakenings.