Temporal trends in incidence, prevalence, and death of aortic stenosis in Korea: a nationwide population-based study

Abstract

Aims: We aim to determine the temporal trends of incidence, prevalence, and death of aortic stenosis (AS, I35.0) in an East Asian population.

Methods and results: Data for 3773 patients who were newly diagnosed with AS from 2006 through 2017 were extracted from the National Health Insurance Service in Korea. The age-standardized incidence rate, prevalence rate, and death rate, survival rate (SR), and death risk of AS were calculated. Overall, the mean (standard deviation) age of AS patients was 69.9 (15.3) years [66.2 (15.7) years for men and 72.7 (14.4) years for women (P = 0.007)], and the proportion of men was 42.7%. The proportion of AS patients ≥60 years old was 80% (71.8% in men and 86% in women, P < 0.001). The proportion of patients who died of AS was 36.4% during the period from 2006 through 2017. The most common causes of death were disease of the circulatory system. The age-standardized incidence, prevalence, and death rates in 2017 were 0.85, 2.79, and 0.58 persons per 100 000 persons, respectively. The 10 year SR was 49.2%. The higher adjusted HRs [95% CI] for AS were observed in 70- to 79-year-old people (9.08 [1.27, 64.7], P = 0.027), in individuals 80 years of age or older (22.7 [3.18, 161.9], P = 0.001), in men (1.46 [1.31, 1.63], P < 0.001), among the middle socioeconomic group (1.19 [1.03, 1.37], P = 0.016), among the lower income levels (1.32 [1.17, 1.49], P < 0.001), in those with myocardial infarction (1.57 [1.16, 2.13], P = 0.003), with heart failure (1.63 [1.44, 1.85], P < 0.001), with ischaemic stroke (3.26 [1.20, 8.85], P = 0.015), with haemorrhagic stroke (2.51 [1.94, 3.25], P = 0.02), with chronic kidney disease (2.51 [1.94, 3.25], P < 0.001), and with malignant neoplasm (2.33 [1.64, 3.31], P < 0.001).

Conclusions: The proportion of AS at age ≥60 years was 80%. For AS, the age-standardized incidence rates were steady, prevalence rates increased, and death rates decreased by year over a decade. The 10 year SR of AS was about 50%. The most common cause of death in AS was disease of the circulatory system. Given the progressively higher incidence of AS with age continued efforts are required to increase awareness regarding AS-related symptoms and potential complications in aged people.

Keywords: Aortic stenosis; Cause of death; Death rate; Death risk; Incidence; Prevalence; Survival rates.

Figure 1

Distribution of aortic stenosis (AS) by sex‐ and age‐standardized incidence, prevalence, and death rate of AS overall and by sex, age group, and year per 100, 000 persons between 2006 and 2017. (A) Prevalence: the number of AS patients by sex and age‐standardized prevalence of AS overall (middle) and by sex (male: lower; female: upper). (B) Age‐standardized prevalence of AS by year and age group over 40 years per 100 000 persons between 2006 and 2017. (C) Incidence: the number of AS patients by sex and age‐standardized incidence of AS overall (middle) and by sex (male: lower; female: upper). (D) Age‐standardized incidence of AS by year and age group over 40 years per 100 000 persons between 2006 and 2017. (E) Death rate: the number of AS patients by sex and age‐standardized death rate of AS overall (middle) and by sex (male: lower; female: upper). (F) Age‐standardized death of AS by year and age group over 40 years per 100 000 persons between 2006 and 2017.

Figure 2

Survival curve of aortic stenosis (AS) in Korea. (A) AS survival rate overall, AS survival rate by sex (P = 0.702), and (B) AS survival rates by age group (P < 0.001).