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Haemorrhoids

Korea diagnoses haemorrhoids at 13.9 per 1,000 person-years and operates at 5.7. Different things predict each

A 467,567-person national cohort measured diagnosis and surgery as separate events. High income predicted being diagnosed. Alcohol predicted being operated on.

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In short

In a retrospective analysis of 467,567 participants in the Korean National Health Insurance Service-National Health Screening Cohort between 2002 and 2015, the incidence density of haemorrhoids was 13.9 per 1,000 person-years in the diagnostic model and 5.7 per 1,000 person-years in the surgical model, with incidence highest in people in their forties and in metropolitan areas, and with a high income level a risk factor in the diagnostic model while alcohol consumption was a risk factor in the surgical model.

Key takeaways

  • 467,567 participants in the National Health Insurance Service-National Health Screening Cohort were analysed for 2002 to 2015.
  • Incidence density was 13.9 per 1,000 person-years for diagnosis and 5.7 per 1,000 person-years for surgery.
  • Incidence was highest among people in their forties, and higher in men than in women in both models.
  • Incidence was higher in metropolitan areas than elsewhere in both models.
  • A high income level was a risk factor in the diagnostic model; alcohol consumption was a risk factor in the surgical model.
  • The adjusted hazard ratio was higher in men and fell as age rose.
  • People exercising one to four times a week had a higher incidence than non-exercisers in both models.

Counts of haemorrhoidal disease usually collapse two different events into one figure. Being diagnosed is one thing; being operated on is another. This cohort measured them separately, and what predicted each turned out not to match.

13.9 vs 5.7

haemorrhoid incidence per 1,000 person-years — diagnosis against surgery — among 467,567 Koreans followed from 2002 to 2015Hong J et al., Asian Journal of Surgery, 2022

Why the split is the finding

If the same forces drove both, the surgical curve would be a scaled copy of the diagnostic one and separating them would tell you nothing. It is not a copy. A high income level was a risk factor for being diagnosed and not for being operated on. Alcohol consumption was a risk factor for surgery and not for diagnosis.

The most economical reading is that the two models are measuring different things. A diagnosis in claims data is partly a measure of who presents to a doctor, and income buys that access. An operation sits closer to disease severity, and alcohol plausibly acts on the disease rather than on the decision to seek care. The study cannot separate access from severity directly, so this is an interpretation of the pattern and not a result of it.

The exercise result reads backwards

People who exercised one to four times a week had a higher incidence than those who did not exercise, in both models. Read literally that makes exercise a risk factor for haemorrhoids, which nothing else in the literature supports.

Forties, men, cities

Incidence peaked in the forties in both models and was higher in men throughout, and the adjusted hazard ratio fell as age rose. That last point is easy to misread. It does not say that older people get fewer haemorrhoids; it says that among people in this screening cohort, new diagnoses and new operations were concentrated earlier in adult life than the popular picture of the condition suggests.

Taken with the screening-population prevalence of 16.6 percent found in a separate Korean cohort of 194,620 adults, the two figures answer different questions and should not be averaged. One says how many people have the condition at a given moment. This one says how many acquire a diagnosis, or an operation, each year — and roughly two in five of those diagnosed end up in the surgical model.

Sources

  1. 1

    Hong J, Kim I, Song J, Ahn BK

    Socio-demographic factors and lifestyle associated with symptomatic hemorrhoids: Big data analysis using the National Health insurance Service-National Health screening cohort (NHIS-HEALS) database in Korea

    Asian Journal of Surgery 2022;45(1):353-359

    doi:10.1016/j.asjsur.2021.06.020 · PMID:34187725

    https://doi.org/10.1016/j.asjsur.2021.06.020
  2. 2

    Hong YS, Jung KU, Rampal S, Zhao D, Guallar E, Ryu S, Chang Y, Kim HO, Kim H, Chun HK, Sohn CI, Shin H, Cho J

    Risk factors for hemorrhoidal disease among healthy young and middle-aged Korean adults

    Scientific Reports 2022;12(1):129

    doi:10.1038/s41598-021-03838-z · PMID:34996957

    https://doi.org/10.1038/s41598-021-03838-z