Increased population prevalence of reflux and obesity in the United Kingdom compared with Sweden: a potential explanation for the difference in incidence of esophageal adenocarcinoma.

OBJECTIVES: The incidence of esophageal adenocarcinoma is five times higher in the UK than in Sweden. We examined the prevalence of established risk factors for esophageal adenocarcinoma in both populations.

METHODS: A population-based cross-sectional study comparing the prevalence of gastroesophageal reflux symptoms, obesity, and tobacco smoking between random samples of the English and Swedish populations aged 40-59 years. Data were collected through self-report questionnaires. Multivariable logistic regression yielded odds ratios with 95% confidence intervals, adjusting for potential confounding.

RESULTS: The sample was composed of 3633 English and 1483 Swedish people (response rates 43 and 62%, respectively). The prevalence of reflux symptoms occurring at least weekly was twice as common in the English compared with the Swedish sample. Obesity (BMI ≥30) was also nearly two-fold more common in the English sample. The frequency of tobacco smoking was similar in both countries. The combination of reflux symptoms and a BMI of at least 25 was three-fold more common in the English than in the Swedish sample.

CONCLUSION: The substantially higher prevalence of reflux symptoms and obesity in samples of the English population compared with the Swedish population might contribute to the known higher incidence of esophageal adenocarcinoma in the UK.