Seasonal Variations and a Demographic Analysis of Digital Evacuation Incidence for Constipation Management: A Japanese Population-based Cohort Study

Objective Digital evacuation (DE) is an intervention used to address severe constipation. Literature exists on easily administered laxatives; however, reports on mildly invasive DE usage are limited. This study aimed to elucidate the fundamental data regarding constipation management using a comprehensive national database of DE incidence. Methods This observational epidemiological study analyzed the age- and sex-stratified DE incidence per 1,000 person-years during 2014-2021 using the medical receipt database in Japan. The annual trends were evaluated using Poisson regression models. We examined the month-stratified incidence during 2019-2021 to assess potential seasonal variations using a one-way analysis of variance and unpaired t-tests with the Bonferroni correction for comparisons across the four seasons. Correlation coefficients were calculated to determine the relationship between the meteorological variables and DE incidence. Results Over the 8-year period, the DE incidence amounted to 32,361,846 procedures, with a median of 10.3 procedures per 1,000 person-years. A demographic analysis revealed a minor peak, nadir, and progressive increase peaking in the 0-4-year (22.1 procedures), 5-9-year (1.5 procedures), and ≥90-year (370.7 procedures) age groups, respectively. The age-adjusted DE incidence across all age groups per 1,000 person-years showed a declining annual trend [incidence rate ratio: 0.971 (p<0.0001)]. A seasonal analysis revealed a significant increase in DE procedures during winter compared with summer (p<0.0125). A correlation was observed between the DE incidence and certain meteorological variables, particularly the temperature. Conclusion This study highlights the notable demographic patterns and the impact of seasonal and meteorological factors on the DE incidence.