A population study on the time trend of cigarette smoking, cessation, and exposure to secondhand smoking from 2001 to 2013 in Taiwan

Adverse Birth and Obstetric Outcomes in the Offspring of Male Adolescent and Young Adult Cancer Survivors: A Nationwide Population-Based Study

BACKGROUND

The growing population of male adolescent and young adult (AYA, ages 15-40 years) cancer survivors has heightened interest in their reproductive health. However, studies have reported conflicting findings on the potential risks of cancer and its treatments on birth and obstetric outcomes.

METHODS

We used encrypted identification numbers for both fathers and mothers to link three nationwide Taiwan datasets from 2004 to 2019, identifying 3,785 births with a paternal history of AYA cancer. For comparison, we included 37,850 matched fathers without a cancer history, matched by paternal age and infant birth year. We used multivariable logistic regression analysis to identify independent associations between adverse birth outcomes (e.g., preterm labor, low birthweight, and congenital malformations) and obstetric outcomes (e.g., fetal growth restriction, threatened labor, and threatened abortion) and being born to male AYA cancer survivors.

RESULTS

The offspring of male AYA cancer survivors did not exhibit a significantly increased risk of adverse birth (OR = 1.0; 95% confidence interval, 0.9-1.1) or obstetric (OR = 1.1; 95% confidence interval, 1.0-1.1) outcomes compared with offspring born to cancer-free matched fathers. Furthermore, the risk of preterm labor, low birthweight, congenital malformations, fetal growth restriction, and threatened labor or miscarriage was comparable between groups.

CONCLUSIONS

Paternal cancer history during adolescence or young adulthood does not seem to increase the risk of adverse birth or obstetric outcomes in offspring.

IMPACT

This study reassures the reproductive health of this population, providing valuable insights for oncology and reproductive medicine, potentially influencing patient counseling and guidelines.

Seasonal variations in peptic ulcer disease incidence in Taiwan, a country spanning both tropical and subtropical regions: a real-world database analysis

OBJECTIVE

Previous studies have shown that the incidence of peptic ulcer disease (PUD) exhibits seasonal variations. This study aimed to investigate the seasonal variation in PUD incidence in Taiwan, which spans both tropical and subtropical regions, using a nationwide database.

METHODS

A cross-sectional study was conducted using real-world claims data from Taiwan, which includes a representative sample of 2 million individuals. Patients hospitalised with a primary diagnosis of PUD between 2001 and 2019 were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for gastric ulcers (GUs), duodenal ulcers (DUs) and unspecified peptic ulcers. Descriptive statistics were used to present the seasonal variations in PUD incidence. Patients' gender, age, PUD type, geographical region and non-steroidal anti-inflammatory drugs (NSAIDs) usage across the four seasons (spring, summer, fall, winter) were compared using Pearson's χ2 test.

RESULTS

Among the 13 022 patients, new-onset PUD cases varied annually, peaking at 771 cases in 2004 and reaching a low of 614 cases in 2018. PUD incidence was higher in males than in females, and more common in elderly individuals aged ≥65 (59.5%). GU had the highest prevalence (56.1%), followed by DU (36.3%) and unspecified ulcers (7.7%). PUD incidence peaked in winter (26.8%), followed by spring (25.1%), fall (24.2%) and summer (23.9%). This seasonal trend was consistent across gender and age groups, with no significant impact on latitude, NSAID usage or PUD type.

CONCLUSION

Across the tropical and subtropical regions of Taiwan, seasonal variation in PUD incidence is observed with the highest rates occurring in winter, regardless of age or sex. However, NSAID usage tends to obscure this trend. The seasonal variation in DU incidence showed no significant differences between north and south Taiwan, suggesting that factors other than temperature may affect DU incidence compared with their effect on GU incidence.

Association between long-term PM2.5 exposure and mortality on Sumatra Island: Indonesian Family Life Survey (IFLS) 2000-2014

The concentration of PM2.5 (particulate matter with a diameter < 2.5 µm) on Sumatra Island has increased, mainly because of forest and peatland fires, transportation, and industry. Biomass burning releases partially burned carbon into the atmosphere, resulting in a smoky haze containing PM2.5. Air quality has deteriorated quickly, and PM2.5 has become a major health hazard in Indonesia. Studies on long-term exposure to PM2.5 have indicated its associations with both morbidity and mortality. Here, we measured long-term (2000-2014) exposure to PM2.5 on the basis of satellite-derived aerosol optical depth measurements (1 × 1 km2) used to predict ground-level PM2.5 concentrations. Additionally, population data on Sumatra Island residents from the fourth wave of the Indonesian Family Life Survey (IFLS) were obtained. We investigated the association between long-term PM2.5 exposure and mortality with a retrospective cohort study design. A total of 2409 subjects aged ≥ 40 years participated in the IFLS-3 beginning in November 2000, and we examined mortality outcomes until the IFLS-5 in September 2014. We used Cox regression models to calculate hazard ratios (HRs) of mortality associated with PM2.5 exposure. According to the adjusted model, the mortality HRs per 10 µg/m3 increase in PM2.5 concentration were 1.10 (95% CI 1.03, 1.17) for all natural causes, 1.17 (95% CI 1.05, 1.25) for cardiovascular causes, and 1.19 (95% CI 1.04, 1.36) for respiratory causes. Long-term exposure to PM2.5 was associated with all-natural, cardiovascular, and respiratory mortality on Sumatra Island, where PM2.5 levels exceed the WHO and US-EPA air quality standards.

The risk of secondary spontaneous pneumothorax in patients with chronic obstructive pulmonary disease in Taiwan

INTRODUCTION

Secondary spontaneous pneumothorax (SSP) is often linked to chronic obstructive pulmonary disease (COPD). The frequency of SSP occurrence in COPD patients varies among different research findings. SSPs are more commonly found in the elderly population diagnosed with COPD. Previous studies have reported a pneumothorax rate of 26 per 100,000 COPD patients. There is, however, a notable lack of detailed epidemiological information regarding SSP in Asia. Our study focused on determining the occurrence rate of SSP among COPD patients in Taiwan using an extensive national database. Additionally, this study aimed to identify comorbidities associated with SSP in this patient group.

METHODS

In this study, we used the Longitudinal Health Insurance Database, which contains records of 2 million people who were randomly chosen from among the beneficiaries of the Taiwan National Health Insurance program. The dataset includes information from 2005 to the end of 2017. Our focus was on individuals diagnosed with COPD, identified through ICD-9-CM codes in at least one hospital admission or two outpatient services, with the COPD diagnosis date as the index date. The exclusion criteria included individuals younger than 40 years, those with incomplete records, or those with a previous diagnosis of pneumothorax before the index date. We conducted a matched comparison by pairing COPD patients with control subjects of similar age, sex, and comorbidities using propensity score matching. The follow-up for all participants started from their index date and continued until they developed pneumothorax, reached the study's end, withdrew from the insurance program, or passed away. The primary objective was to evaluate and compare the incidence of pneumothorax between COPD patients and matched controls.

RESULTS

We enrolled 65,063 patients who were diagnosed with COPD. Their mean age (±SD) was 66.28 (±12.99) years, and approximately 60 % were male. During the follow-up period, pneumothorax occurred in 607 patients, equivalent to 9.3 % of the cohort. The incidence rate of SSP in COPD patients was 12.10 per 10,000 person-years, whereas it was 6.68 per 10,000 person-years in those without COPD. Furthermore, COPD patients with comorbidities such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer exhibited an increased incidence of SSP compared to COPD patients without such comorbidities. This was observed after conducting a multivariable Cox regression analysis adjusted for age, sex, and other comorbidities.

CONCLUSION

Our study revealed an elevated risk of SSP in patients with COPD. It has also been suggested that COPD patients with comorbidities, such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer, have an increased risk of developing SSP.

Comparison of secondhand smoking exposure between self-report and creatinine-corrected urine cotinine: Result from Korean NHANES 2009-2018

BACKGROUND/PURPOSE

Second-hand smoking (SHS) is usually examined by self-report (SR). However, there is a possibility that SR may not accurately measure SHS exposure. This study aimed to identify yearly trends and gender differences in SHS by SR and cotinine.

METHODS

We used data from the 2009-2018 Korea National Health and Nutrition Examination Survey (KNHANES) and included adults aged 19 years and older. We analyzed data of 47,907 respondents on SHS exposures in the past week and of 23,572 respondents who had both urine cotinine and creatinine measurements. SHS exposure was defined as those who answered 'yes' to whether or not they were exposed to smoking by SR. We performed descriptive analysis, Average annual percentage change (AAPC), and multiple regression analysis. All analyses were weighted reflecting the multi-stratified cluster sampling.

RESULTS

Exposure to SHS indoors at the work place (WSHS) (2009: 44.8%, 2018: 12.3%), indoors at home (HSHS) (2009: 14.1%, 2018: 3.9%), and indoors at public places (PSHS) (2013: 55.6%, 2018: 15.4%) decreased steadily over the years. WSHS and PSHS exposure was higher for males but HSHS was higher for females. However, the concentration of cotinine-to-creatinine ratio (Co/Cr) was higher among females regardless of SHS exposure status and environment. Multiple regression analysis showed that among males, the association between Co/Cr education level and WSHS was the strongest, and among females, the association was the strongest with HSHS. In addition, home exposure to SHS intensified the differences in Co/Cr levels between males and females.

CONCLUSION

Our study confirmed that cotinine-induced SHS showed different results by year and gender compared to SR. In particular, Co/Cr level in females was higher than in males regardless of exposure by SR, suggesting that SR did not correctly evaluate SHS. To reflect reality more accurately, biomarkers should be monitored along with SR.

National and Provincial Prevalence of Cigarette Smoking in Iran; A Systematic Analysis of 12 Years of STEPS Experience

BACKGROUND

Smoking is a modifiable risk factor for six of the eight leading causes of death. Despite the great burden, there is lack of data regarding the trend of cigarette smoking in Iran. We described the national and provincial prevalence of cigarette smoking and its 12-year time trend utilizing six rounds of Iranian stepwise approach for surveillance of non-communicable disease (STEPS) surveys.

METHODS

We gathered data from six STEPS surveys done in 2005, 2007, 2008, 2009, 2011, and 2016 in Iran. To estimate the data of missing years, we used two separate statistical models including the mixed model and spatio-temporal analysis.

RESULTS

The overall prevalence rate of cigarette smoking was 14.65% (12.81‒16.59) in 2005 and 10.63% (9.00‒12.57) in 2016 in Iran. The prevalence of cigarette smoking in 2005 and 2016 was 25.15% (23.18‒27.11) and 19.95% (17.93%‒21.97%) for men and 4.13% (2.43‒6.05) and 1.31% (0.06-3.18) for women, respectively. The prevalence of smoking in different provinces of Iran ranged from 20.73% (19.09‒22.47) to 9.67% (8.24‒11.34) in 2005 and from 15.34% (13.68‒17.12) to 6.41% (5.31‒7.94) in 2016. The overall trend of smoking was downward, which was true for both sexes and all 31 provinces. The declining annual percent change (APC) of the prevalence trend was -2.87% in total population, -9.91% in women, and -2.08% in men from 2005 to 2016.

CONCLUSION

Although the prevalence of smoking had a decreasing trend in Iran, this trend showed disparities among sexes and provinces and this epidemiological data can be used to modify smoking prevention programs.

Longitudinal analysis of the impact of smoking exposure on atopic indices and allergies in early childhood

Background

Exposure to smoking is recognized as a health hazard; however, a longitudinal analysis of the impact of smoking exposure in families on the allergic reactions related to childhood atopic diseases has not been well addressed.

Methods

Children who completed a three-year follow-up period from the birth cohort were included in this study. The history of smoking exposure was recorded, and the urine cotinine levels were measured at 1 and 6 months, and 1, 2, and 3 years of age. Specific IgE levels against food and mite allergens were measured at age 6 months, and 1, 2, and 3 years. Their relevance to family smoking exposure and the subsequent development of atopic diseases was also analyzed. This study was approved by the Ethics Committee of Chang Gung Memorial Hospital (No. 102-1842C).

Results

A total of 198 infants were enrolled in this study. The prevalence of passive smoking exposure among these children was as high as 45%. The urine cotinine levels were significantly higher in children with history of smoking exposure (P < 0.001). At 6 months of age, the food-specific IgE levels and the prevalence of eczema were significantly higher in children with smoking exposure than in those without smoking exposure (P < 0.05). By contrast, the urine cotinine levels were significantly higher in children with IgE sensitization (>100 kU/L, P < 0.05) at 3 years of age, which was also significantly associated with a higher prevalence of allergic rhinitis and development of asthma (P < 0.01).

Conclusion

Family smoking exposure appears to be strongly associated with food sensitization in infancy and with IgE production in later childhood. This could potentially increase the susceptibility of developing infantile eczema and subsequent childhood airway allergies.

Lifetime risk, life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for psoriasis in Taiwan: a nationwide cohort followed from 2000 to 2017

Background

Patients with psoriasis have a significant disease burden throughout the life course. Nevertheless, the lifetime risk and disease burden of psoriasis across the entire lifespan is rarely quantified in an easily understandable way.

Objective

To estimate the cumulative incidence rate, life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for incident psoriasis.

Design and methods

Using real-world nationwide data from the National Health Insurance Research Database of Taiwan for 2000-2017, along with the life tables of vital statistics, we estimated cumulative incidence rate, life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for those with psoriasis using a semi-parametric survival extrapolation method.

Results

A total of 217,924 new psoriasis cases were identified. The lifetime risk of psoriasis in patients aged 18-80 for both sexes decreased in Taiwan with a cumulative incidence rate of 7.93% in 2000 to 3.25% in 2017. The mean (±standard error) life expectancy after diagnosis was 27.11 (± 1.15) and 27.14 (±1.17) years for patients with moderate-to-severe psoriasis and psoriatic arthritis, respectively. Patients with moderate-to-severe psoriasis and psoriatic arthritis had a mean (±standard error) loss-of-life expectancy of 6.41 (±1.16) and 6.48 (±1.17) due to psoriasis, respectively. Male patients have higher lifetime and annual lifetime healthcare expenditures than female. Mean life expectancy, loss-of-life expectancy, and lifetime cost were relatively higher for younger patients.

Conclusion

Among psoriatic patients, patients with moderate-to-severe psoriasis and psoriatic arthritis had substantial years of life lost, particularly for younger patients. Our results provide a reliable estimation of lifetime disease burden, and these estimates will help health authorities in cost-effectiveness assessments of public health interventions and allocation of services resources to minimize loss-of-life expectancy, and lifetime healthcare expenditures in patients with psoriasis.

Sex Differences in Temporal Trends and Risk Factors of Aortic Dissection in Taiwan

Background Although sex differences in the epidemiological features of aortic dissection (AD) are known, whether there were sex differences in the associations of comorbidities and risk factors with AD is unclear. We evaluated the temporal trends and risk factors of AD by sex. Methods and Results Using claims data from a universal health insurance program linked to the National Death Registry in Taiwan, we identified 16 368 men and 7052 women with newly diagnosed AD from 2005 to 2018. In the case-control analysis, a matched control group without AD was selected for men and women separately. Conditional logistic regression was used to evaluate risk factors of AD and sex differences. Over the 14 years, the annual incidence of diagnosed AD was 12.69 and 5.34 per 100 000 in men and women, respectively. The 30-day mortality was greater in women than in men (18.1% versus 14.1%; adjusted odds ratio [95% CI], 1.19 [1.10-1.29]), and the sex difference was observed mainly in patients not treated with surgery. The 30-day mortality declined over time in male patients undergoing surgical treatments, but no significantly temporal change was found in other patient groups stratified by sex and surgery. After multivariable adjustments, atrial fibrillation, chronic kidney disease, and coronary artery bypass graft surgery were associated with a greater increase in the odds of AD occurrence in women than in men. Conclusions Greater 30-day mortality and stronger associations of atrial fibrillation, chronic kidney disease, and coronary artery bypass graft surgery with AD in women than in men require further attention.

Relationship between periodontal disease and dizziness in Taiwanese adults: A nationwide population-based cohort study

Periodontal disease is often neglected and overlooking its initial symptoms can lead to tooth loss and systemic diseases. Patients with otitis media are at high risk of vestibular and balance dysfunction, consequently, and vertigo. Vertigo and dizziness are conditions with high reported incidences; they worsen with age and can burden health systems. The present study investigated whether periodontal disease causes dizziness. Research data covering 2008 through 2013 were retrieved from the National Health Insurance Research Database of Taiwan. Patients who were newly diagnosed as having periodontal disease or dizziness after at least 1 hospital admission or 3 outpatient visits were enrolled as participants. For our controls, we randomly selected individuals without periodontal disease who were sex- and age-matched with the investigated participants. In total, we enrolled 445 patients with periodontal disease and 1780 controls. The Kaplan-Meier curve indicated that the cumulative incidence of dizziness was significantly higher among the patients with periodontal disease relative to the controls. After adjustment for sex, age, income level, urbanization level, month of onset, and comorbidities, Cox proportional-hazards analysis revealed that patients with periodontal disease had an increased risk of dizziness (hazard ratio [HR]: 1.306, 95% confidence interval (CI): 1.155, 1.475). Compared with the controls, the risk of dizziness among patients with periodontal disease was higher for both female (HR: 1.439, 95%: 1.203, 1.720) and male patients (HR: 1.284, 95%: 1.123, 1.468); this risk was higher even when January (HR: 1.302, 95% CI: 1.145, 1.480), February (HR: 1.337, 95% CI: 1.178, 1.518), or March was excluded (HR: 1.308, 95% CI: 1.151, 1.487) and for patients without Ménière disease. Therefore, periodontal disease is not only a risk factor for dizziness but also an independent risk factor for dizziness. Future studies could clarify the mechanisms linking periodontal disease to dizziness.

Recalibrating Risk Prediction Models by Synthesizing Data Sources: Adapting the Lung Cancer PLCO Model for Taiwan

BACKGROUND

Methods synthesizing multiple data sources without prospective datasets have been proposed for absolute risk model development. This study proposed methods for adapting risk models for another population without prospective cohorts, which would help alleviate the health disparities caused by advances in absolute risk models. To exemplify, we adapted the lung cancer risk model PLCOM2012, well studied in the west, for Taiwan.

METHODS

Using Taiwanese multiple data sources, we formed an age-matched case-control study of ever-smokers (AMCCSE), estimated the number of ever-smoking lung cancer patients in 2011-2016 (NESLP2011), and synthesized a dataset resembling the population of cancer-free ever-smokers in 2010 regarding the PLCOM2012 risk factors (SPES2010). The AMCCSE was used to estimate the overall calibration slope, and the requirement that NESLP2011 equals the estimated total risk of individuals in SPES2010 was used to handle the calibration-in-the-large problem.

RESULTS

The adapted model PLCOT-1 (PLCOT-2) had an AUC of 0.78 (0.75). They had high performance in calibration and clinical usefulness on subgroups of SPES2010 defined by age and smoking experience. Selecting the same number of individuals for low-dose computed tomography screening using PLCOT-1 (PLCOT-2) would have identified approximately 6% (8%) more lung cancers than the US Preventive Services Task Forces 2021 criteria. Smokers having 40+ pack-years had an average PLCOT-1 (PLCOT-2) risk of 3.8% (2.6%).

CONCLUSIONS

The adapted PLCOT models had high predictive performance.

IMPACT

The PLCOT models could be used to design lung cancer screening programs in Taiwan. The methods could be applicable to other cancer models.

The Association between Smoking and Mortality in Women with Breast Cancer: A Real-World Database Analysis

Smoking increases the cancer-specific and overall mortality risk in women with breast cancer (BC). However, the effect of smoking cessation remains controversial, and detailed research is lacking in Asia. We aimed to investigate the association between smoking status and mortality in women with BC using the population-based cancer registry. The Taiwan Cancer Registry was used to identify women with BC from 2011 to 2017. A total of 54,614 women with BC were enrolled, including 1687 smokers and 52,927 non-smokers. The outcome, mortality, was identified using Taiwan’s cause-of-death database. The association between smoking status and mortality was estimated using Cox proportional regression. Women with BC who smoked had a 1.25-fold higher (95% C.I.: 1.08–1.45; p = 0.0022) risk of overall mortality and a 1.22-fold higher (95% C.I.: 1.04–1.44; p = 0.0168) risk of cancer-specific mortality compared with non-smokers. The stratified analysis also indicated that women with BC who smoked showed a significantly higher overall mortality risk (HR: 1.20; 95% CI: 1.01–1.43; p = 0.0408) than women with BC who did not smoke among women without comorbidities. Additionally, current smokers had a 1.57-fold higher risk (95% CI: 1.02–2.42; p = 0.0407) of overall mortality compared with ever smokers among women with BC who smoked. It was shown that a current smoking status is significantly associated with an increase in overall and cancer-specific mortality risk in women with BC. Quitting smoking could reduce one’s mortality risk. Our results underscore the importance of smoking cessation for women with BC.

Pay-for-performance and continuity of care synergistically reduced amputation of lower extremity in patients with diabetes: a population-based cohort study

Background

Diabetic foot is a common and costly complication of diabetes. No existing study has looked at the effect of continuity of care on amputations of diabetes (DM) patients while considering pay-for-performance (P4P) participation. We investigated the impact of the P4P program and the continuity of care index (COCI) on the incidence of lower extremity amputations (LEA) among diabetics in Taiwan.

Methods

This was a population-based cohort study using insurance claims data from 1997 to 2013. We selected 15,650 DM patients in the P4P program along with age- and sex-matched non-P4P participants at a 1:4 ratio. Time-weighted average (TWA) of the COCI was calculated and included in the time-dependent Cox proportional hazard models to examine the impact of P4P and COCI on the risk of LEA, while controlling for individual and area level characteristics.

Results

During four-year follow-up, 1816 subjects experienced LEA. The cumulative LEA hazard rate of the P4P group (n = 153) was significantly lower than that of the non-P4P group (n = 1663) (hazard ratio = 0.37, 95% CI = 0.31–0.43, p < 0.0001, by log-rank test). In the time-dependent Cox proportional hazard model, the adjusted hazard ratios (aHR) for the P4P group was 0.35, (p < 0.0001). With the low COCI (< 0.360) group as the reference, the aHR of LEA was 0.49 (p < 0.0001) for the middle COCI group, (p < 0.0001), and the aHR of LEA for the high COCI (≥0.643) group was 0.23 (p < 0.0001).

Conclusions

Participating in the P4P program and increasing COCI might reduce the risk of amputation for DM patients, independently and synergistically.

Forecast of peak attainment and imminent decline after 2017 of oral cancer incidence in men in Taiwan

Oral cancer is the fourth most common cancer among men in Taiwan. The age-standardized incidence rate of oral cancer among men in Taiwan has increased since 1980 and became six times greater in 2014. To enable effective public health planning for oral cancer, research on the projection of oral cancer burden is essential. We conducted an age-period-cohort analysis on the incidence of oral cancer among men in Taiwan from 1997 to 2017 and extrapolated the trend to 2025. We found that the period trends for young adults aged between 25 and 44 have already peaked before 2017; the younger, the earlier, and then the trends declined. The cohort trends have peaked roughly at the 1972 birth cohort and then declined for all ages. Despite the increasing trend in the age-standardized incidence rate for oral cancer among men in Taiwan from 1997 to 2017, we forecast a peak attained, an imminent decline after 2017, and a decrease of 8.4% in age-standardized incidence rate from 2017 to 2025. The findings of this study contribute to developing efficient and comprehensive strategies for oral cancer prevention and control.

Influence of Personal, Environmental, and Community Factors on Cigarette Smoking in Adolescents: A Population-Based Study from Taiwan

Understanding the factors that influence cigarette smoking among adolescents is critical. We identified personal, community, and environmental factors associated with current cigarette smoking among adolescents. This population-based cross-sectional analysis study was conducted using the 2012 Taiwan Global Youth Tobacco Survey and the sociodemographic statistics of the city or county from Taiwan’s Ministry of the Interior. A total of 27,524 participants (age: 12–18-years) was included. The associated factors were identified through logistic regression. A path analysis was performed to examine the pathway from the associated factors to current cigarette smoking. According to this analysis, the following factors were prominently and positively associated with adolescent cigarette smoking: one personal factor (pocket money), five environmental factors (home secondhand smoke (SHS) exposure, smoker friends, outside SHS exposure, school SHS exposure, and smoker parents), and two community factors (free cigarettes from tobacco companies and indigenous population). By contrast, five personal factors (feeling less comfortable smoking at social occasions, feeling indifferent about smoking or not smoking at social occasions, female sex, feeling that quitting is difficult, and feeling that quitting after having smoked is harmful to health) and one environmental factor (school antismoking education) had negative effects. Thus, comprehensive interventions promoting the perception of harm caused by smoking and interrupting access to cigarettes through social networks can reduce cigarette smoking in adolescents.

Typical antipsychotics is associated with increased risk of severe exacerbation in asthma patients: a nationwide population-based cohort study

Background

Severe asthma exacerbation reduces patients’ quality of life, results in visits to the emergency department (ED) and hospitalization, and incurs additional medical costs. Antipsychotics block receptors with bronchodilation function; however, the association between antipsychotic use and severe asthma exacerbation is unknown. This study aimed to investigate the effects of antipsychotics on asthma-related ED visits and hospitalizations.

Methods

A case-crossover design was used in this study. Using the 2003–2017 Taiwan National Health Insurance Reimbursement Database, we established a cohort of 18,657 adults with asthma exacerbation leading to ED visits or hospitalization. Univariate and multivariate conditional logistic regressions were conducted to explore the association between antipsychotic use and severe asthma exacerbation. Subgroup analyses of different classes, doses, receptor functions of antipsychotics, different psychiatric disease, and sensitivity analyses of excluding patients with schizophrenia were also performed.

Results

Antipsychotic use was associated with a higher risk of severe asthma exacerbation (adjusted odds ratio [OR]: 1.27; 95% confidence interval [CI] 1.05–1.54; P = 0.013) compared with no use of antipsychotics. The use of typical antipsychotics increased the risk of severe asthma exacerbation (adjusted OR: 1.40, 95% CI 1.10–1.79, P = 0.007), whereas the use of atypical antipsychotics did not. These results did not change after the exclusion of patients with schizophrenia. There was a dose-dependent effect of antipsychotics (trend test, P = 0.025). Antipsychotics that block the M2 muscarinic or D2 dopaminergic receptors were associated with an increased risk of severe asthma exacerbation (adjusted OR: 1.39, 95% CI 1.10–1.76, P = 0.007 and adjusted OR: 1.33, 95% CI 1.08–1.63, P = 0.008, respectively). However, use of antipsychotics did not increase risk of severe asthma exacerbation in patients with psychiatric disorder.

Conclusions

The use of typical antipsychotics is associated with a dose-dependent increased risk of severe asthma exacerbation, especially for patients without psychiatric disorders. Further research on the impact of typical antipsychotics on asthma exacerbation is warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12890-022-01883-6.

Indoor Air Pollution Increases the Risk of Lung Cancer

(1) Background: Cooking and burning incense are important sources of indoor air pollutants. No studies have provided biological evidence of air pollutants in the lungs to support this association. Analysis of pleural fluid may be used to measure the internal exposure dose of air pollutants in the lung. The objective of this study was to provide biological evidence of indoor air pollutants and estimate their risk of lung cancer. (2) Methods: We analyzed 14 common air pollutants in the pleural fluid of 39 cases of lung adenocarcinoma and 40 nonmalignant controls by gas chromatography-mass spectrometry. (3) Results: When we excluded the current smokers and adjusted for age, the adjusted odds ratios (ORs) were 2.22 (95% confidence interval CI = 0.77-6.44) for habitual cooking at home and 3.05 (95% CI = 1.06-8.84) for indoor incense burning. In females, the adjusted ORs were 5.39 (95% CI = 1.11-26.20) for habitual cooking at home and 6.01 (95% CI = 1.14-31.66) for indoor incense burning. In pleural fluid, the most important exposure biomarkers for lung cancer were naphthalene, ethylbenzene, and o-xylene. (4) Conclusions: Habitual cooking and indoor incense burning increased the risk of lung adenocarcinoma.

Cough Characteristics and Healthcare Journeys of Chronic Cough Patients in Community-Based Populations in South Korea and Taiwan

PURPOSE

This study aimed to understand the cough characteristics and health journeys among community-based chronic cough (CC) patients, and their characteristics associated with healthcare visits.

METHODS

A population-based cross-sectional study was conducted in 2020, using the South Korea and Taiwan National Health and Wellness Survey (NHWS) and CC surveys. Patients with current CC were defined by daily coughing for > 8 weeks in the past 12 months and currently coughing at the time of survey. The survey items pertained to CC patients' treatment journey and cough characteristics.

RESULTS

Patients with current CC in South Korea and Taiwan, respectively, had cough duration for 3.45 ± 5.13 years and 5.75 ± 7.28 years and cough severity visual analogue scale (VAS) scores of 4.50 ± 2.15 and 4.46 ± 1.92 out of 0-10 scale, with 70.3% and 57.9% having spoken with a physician about cough. Compared to CC patients who had not visited healthcare professionals for cough, those who visited reported more severe cough (VAS: 3.89 ± 1.71 vs. 4.6 ± 2.02; p = 0.009), worse cough-specific quality of life (Leicester Cough Questionnaire: 16.20 ± 3.23 vs.13.45 ± 2.68, p < 0.001), greater symptom severity (Hull Airway Reflux Questionnaire: 16.73 ± 15.16 vs. 24.57 ± 13.38; p < 0.001), and more urinary incontinence (13.6 vs. 26.5%, p = 0.027). More than 50% of patients perceived cough medication(s) as not or a little useful and 25% felt their physicians did not well understand how CC impacts their life.

CONCLUSION

Cough is frequently severe and persistent among community-based CC patients. They experience several issues in their health journey, including treatment ineffectiveness and physician's understanding. Further efforts are warranted to reduce CC burden in the community.

Association of ambient ozone with pneumonia hospital admissions in Hong Kong and Taipei: A tale of two Southeast Asian cities

Ozone (O₃) is a reactive oxidant exerting both inflammatory and oxidative damages to the respiratory system. With the ground-level O₃ progressively increasing in the past decade, the reevaluation of the pneumonia hospitalization risk from exposure to O₃ is of public health interest. We conducted an ecological time-series study to examine the city-specific association between short-term O₃ exposure and pneumonia hospitalizations in Hong Kong and Taipei, respectively. We linked the daily pneumonia hospitalization count to air pollution concentrations and weather conditions according to the date of admission during 2010-2017. We applied a generalized additive distributed lag model to examine the association while adjusting for time-varying covariates. Stratified analysis by age group and the potential harvesting effect of O₃ were evaluated. We observed the harvesting effects of O₃ on pneumonia hospitalizations in children in both cities and adults in Taipei. The short-term effect of O₃ lasted for around one week. An interquartile range (IQR) increment of daytime 8-hour mean concentration of O₃ distributed over 0-6 lag days in Hong Kong (42.4 μg/m³) was associated with a 7.04% (95% CI: 5.35-8.76%) increase in hospital admissions for elderly pneumonia, while the corresponding cumulative excess risk per IQR increment of O₃ in Taipei (38.7 μg/m³) was 3.41% (95% CI: 1.63-5.22%). Different O₃ metrics, varying degrees of freedom for filtering the temporal trend, and three-pollutant models supported the robustness of the associations. We concluded that short-term O₃ exposure was associated with pneumonia hospitalizations in the elderly population. Understanding the pneumonia hospitalization risk of O₃ will help to inform public health policies in the planning of ozone control strategies and intervention measures to prevent ozone-related pneumonia in vulnerable elderly populations.

Community-based lung cancer screening by low-dose computed tomography in China: First round results and a meta-analysis

OBJECTIVE

To evaluate the efficiency of low-dose computed tomography (LDCT) screening for lung cancer in China by analyzing the baseline results of a community-based screening study accompanied with a meta-analysis.

METHODS

A first round of community-based lung cancer screening with LDCT was conducted in Tianjin, China, and a systematic literature search was performed to identify LDCT screening and registry-based clinical studies for lung cancer in China. Baseline results in the community-based screening study were described by participant risk level and the lung cancer detection rate was compared with the pooled rate among the screening studies. The percentage of patients per stage was compared between the community-based study and screening and clinical studies.

RESULTS

In the community-based study, 5523 participants (43.6% men) underwent LDCT. The lung cancer detection rate was 0.5% (high-risk, 1.2%; low-risk, 0.4%), with stage I disease present in 70.0% (high-risk, 50.0%; low-risk, 83.3%), and the adenocarcinoma present in 84.4% (high-risk, 61.5%; low-risk, 100%). Among all screen-detected lung cancer, women accounted for 8.3% and 66.7% in the high- and low-risk group, respectively. In the screening studies from mainland China, the lung cancer detection rate 0.6% (95 %CI: 0.3%-0.9%) for high-risk populations. The proportions with carcinoma in situ and stage I disease in the screening and clinical studies were 76.4% (95 %CI: 66.3%-85.3%) and 15.2% (95 %CI: 11.8%-18.9%), respectively.

CONCLUSIONS

The stage shift of lung cancer due to screening suggests a potential effectiveness of LDCT screening in China. Nearly 70% of screen-detected lung cancers in low-risk populations are identified in women.

Metformin as a potential protective therapy against tuberculosis in patients with diabetes mellitus: A retrospective cohort study in a single teaching hospital

AIMS/INTRODUCTION

The convergence of tuberculosis (TB) and diabetes mellitus (DM) is a new challenge in Asia as a result of the rising prevalence of diabetes mellitus with higher TB infection rates, and also because diabetes mellitus itself enhances TB disease activity and consequently the spread of TB. We aimed to address the risk presented by diabetes mellitus for TB infection.

MATERIALS AND METHODS

Patients with diabetes mellitus were retrospectively recruited. The baseline assessments included age, sex, body mass index, fasting blood glucose, glycated hemoglobin, urine albumin-to-creatinine ratio and estimated glomerular filtration rate. TB was determined by meeting the international classification of disease, for TB diagnosis and receiving anti-TB treatment for at least 2 months.

RESULTS

In total, 9,750 individuals with diabetes mellitus were recruited. The event rate of TB was 47 (0.48%). Younger age, lower proportion of men, higher fasting blood glucose and glycated hemoglobin values, and better renal function (estimated glomerular filtration rate and urine albumin-to-creatinine ratio) were observed in the metformin-exposed groups. Old age and male sex were associated with higher TB infection risk on multivariate analysis. Metformin users had a significantly lower risk for TB infection, whereas insulin users had a higher risk for TB infection. However, glycemic status had no effect on TB infection risk.

CONCLUSIONS

This study provides clinical evidence from a survey of TB in individuals with diabetes mellitus. Old age, male sex and insulin use were risk factors for TB infection. Metformin remains the first choice of treatment for diabetes mellitus and has a potential protective effect against TB infection.

Association between Self-Reported Survey Measures and Biomarkers of Second-Hand Tobacco Smoke Exposure in Non-Smoking Pregnant Women

Second-hand tobacco smoke (SHS) causes adverse health outcomes in adults. Further studies are needed to evaluate psychosocial SHS exposure measures in comparison to SHS exposure biomarkers, particularly in pregnant women. This study aimed to compare self-reported SHS exposure to urinary cotinine levels in pregnant women. A cross-sectional correlation design was conducted using a convenience sample of 70 non-smoking pregnant women. Measures included self-reported questionnaires and laboratory confirmation of cotinine levels in the urinary samples. Multiple regression analysis was used to assess the correlation after controlling for potential confounding variables. The average level of urinary cotinine among non-smoking pregnant women was 6.77 ng/mL. Medium-strength correlations were found among psychosocial SHS exposure measures and urine cotinine levels. Questions regarding ‘instances of smoking in front of the individual’ and ‘subjective perceived frequency of SHS exposure in past 7 days’ are feasible items for pregnant women in clinics (particularly the first question). Hence, we suggest that these simple questions should be used to assist pregnant women in reducing the harm associated with SHS exposure.

Sex differences in long-term cardiovascular outcomes among patients with acute myocardial infarction: A population-based retrospective cohort study

BACKGROUND

Whether a sex difference exists in long-term cardiovascular (CV) outcomes after acute myocardial infarction (AMI) is worth exploration. This study is sought to investigate the relationships among sex, age, and the long-term prognosis after AMI.

METHODS

This population-based retrospective cohort study used Taiwan's National Health Insurance Research Database to investigate the sex differences in in-hospital and long-term CV outcomes in patients with AMI. We enrolled patients who were first diagnosed with AMI from January 1, 2000 to December 31, 2013. The outcomes of interest included all-cause mortality, CV death, non-fatal stroke, non-fatal heart failure, and AMI recurrence during hospitalization and 5-year follow up. The CV outcomes were also analyzed by age stratification.

RESULTS

Overall, 201 921 patients with AMI were analyzed; 68.72% were men and 31.28% were women, with mean ages of 65.34 ± 14.12 and 73.05 ± 12.22 years, respectively. Major adverse cardiac events during hospitalization and up to 5 years were consistently greater in women than in men. Multivariable regression analysis revealed no sex difference existed in long-term all-cause and CV mortality. Men of all age groups consistently showed higher risk of both short- and long-term recurrence of AMI. Nonetheless, the female sex still independently predicted increased risk of non-fatal stroke and heart failure from hospitalization until 3-year follow up.

CONCLUSION

Women with AMI had poorer short-term and long-term outcomes. The sex differences in long-term all-cause and CV death disappear after multivariate analysis. Nonetheless, female AMI patients independently predicted higher risk of stroke and heart failure from hospitalization until a 3-year follow-up. To better understand the pathophysiology of female patients with AMI and develop more effective management, more studies in this field are necessary in the future.

Ensemble forecasting of a continuously decreasing trend in bladder cancer incidence in Taiwan

Bladder cancer is one of the most common malignancies involving the urinary system of about 1.65 million cases worldwide. To attain the 25 by 25 goal set by the World Health Organization (25% reduction in non-communicable diseases between 2015 and 2025), developing strategies to reduce cancer burdens is essential. The data of the study comprised the age-specific bladder cancer cases and total population numbers from age 25 to 85 and above from 1997 to 2016 in Taiwan. An ensemble age-period-cohort model was used to estimate bladder cancer incidence trends and forecast the trends to 2025. For men, the projected age-standardized incidence rates per 100,000 people in 2020 and 2025 are 13.0 and 10.4, respectively, with a 16.1% and 32.9% decrease projected from 2016 to 2020 and 2025, respectively. For women, the projected age-standardized incidence rates per 100,000 people in 2020 and 2025 are 4.7 and 3.7, respectively, with a 16.1% and 33.9% decrease projected from 2016 to 2020 and 2025, respectively. The age-specific bladder cancer incidence rates demonstrated a consistently downward trend after 2003 for all ages and both sexes. This study projects that the incidence rates of bladder cancer in Taiwan will continue to decrease, and more than a 25% reduction can be achieved from 2016 to 2025.

Relationships among cigarette smoking, urinary biomarkers, and urothelial carcinoma risk: a case-control study

Cigarette smoke is a known risk factor for urothelial carcinoma (UC). However, there is limited information about the distributions and effects of volatile organic compounds (VOCs) on smoking-related UC risk. With this hospital-based case-control study, we explored the associations between urinary levels of cotinine and VOC metabolites (acrylamide, 1,3-butadiene, and benzene) and the risk of UC. Urological examinations and pathological verifications were used to confirm the diagnoses of UC. All study participants provided smoking-related information via questionnaires and face-to-face interviews; they also provided urine samples for the measurement of VOC metabolites, cotinine, and 8-hydroxydeoxyguanosine (8-OHdG), which was used as an indicator of oxidative stress. We applied multiple logistic regression analysis to estimate the risk of UC, and we found that levels of urinary cotinine and 8-OHdG were higher in the UC group than in the control group. Furthermore, urinary levels of VOC metabolites, including N-acetyl-S-(2-carbamoylethyl)-L-cysteine (AAMA), N-acetyl-S-(2-carbamoyl-2-hydroxyethyl)-L-cysteine, N-acetyl-S-(4-hydroxy-2-buten-1-yl)-L-cysteine-3, trans,trans-muconic acid (t,t-MA), and S-phenylmercapturic acid (SPMA), increased with increasing levels of urinary cotinine. After adjusting for potential risk factors, dose-response relationships were observed between UC risk and urinary levels of AAMA, t,t-MA, SPMA, and 8-OHdG. Participants with high urinary levels of cotinine, AAMA, t,t-MA, SPMA, and 8-OHdG had risks of UC that were 3.5- to 6-fold higher than those of participants with lower levels. Future, large-scale investigations of the risks of UC should be explored, and repeated measurement of VOC metabolites should be assessed.

Sex Differences in the Heterogeneous Dynamic Incidence of Oral Cancer: A Comparison between Taiwan and Thailand

Background

This study aims at investigating differences in oral cancer (OC) incidence trends between two populations in Taiwan and Thailand.

Methods

We used the population-based cancer registry data from Taiwan (1979-2016) and Khon Kaen (KK), Thailand (1985-2016). We performed joinpoint analyses to detect the trend change points for the OC incidence and to quantify the time trends in both sexes and regions. Age-period-cohort curves were plotted to explain the incidence trends.

Results

In Taiwan, the estimated annual increases in OC were approximately 6.0% in males, although the increase slowed after 2009, and 2.6% in females. In KK, the OC incidence steadily decreased by -2.5% per year in females, but there was no obvious change in males. A strong period effect observed in those aged 45-69 years in Taiwanese males resulted in a peak incidence in the middle age group. Decreased period and cohort effects were observed in females in KK.

Conclusions

Taiwanese males are the predominant sex affected by OC in Taiwan, and the trend has decelerated since 2009. Age, period, and cohort effects were different between males and females in the two regions.

Cancer Incidence Characteristic Evolution Based on the National Cancer Registry in Taiwan

Introduction

Taiwan has committed itself to cancer prevention. This study investigates the impact of cancer prevention on cancer incidence in Taiwan.

Objective

This study describes the secular trends and present status of cancer incidence in Taiwan during the years of 1988 to 2016.

Methods

Age-standardized incidence rates (ASRs), age-specific incidence, and sex ratios for all cancers were calculated using data from the Taiwan Cancer Registry System for the years 1988 to 2016. Results and Conclusions. ASRs of cancer for males increased from 150.93 per 10⁵ individuals in 1988 to 330.03 per 10⁵ individuals in 2016, and, for females, they increased from 124.18 per 10⁵ individuals in 1988 to 269.5 per 10⁵ individuals in 2016. We found that cancer incidence has begun at younger ages and that the rates of cancer incidence are increasing faster. This study shows that the incidence of cancer in males has decreased slightly in recent years, while the incidence of cancer in females has continued to increase. The continuous promotion of health literacy, lifestyle modification, HBV and HPV vaccination, and cancer early screening can improve the effectiveness of cancer prevention.

Lung cancer survival and mortality in Taiwan following the initial launch of targeted therapies: an interrupted time series study

OBJECTIVES

Two oral targeted therapies, gefitinib and erlotinib, were first approved and then launched into the market for treatment of late-stage non-small cell lung cancer (NSCLC) in Taiwan in 2003 and 2006, respectively. The aim of this study were to determine the trends in lung cancer burden and examine changes in lung cancer-related survival rates and mortality following the launch of these new drugs.

SETTING

Yearly lung cancer-related data (1994-2013), including incidence, number of newly diagnosed patients, survival rate and mortality, were retrieved from the Taiwan Cancer Registry Database.

DESIGN AND OUTCOME MEASURES

Using a time series design with autoregressive integrated moving average model, we investigated and projected trends in the incidence and early diagnosis of lung cancer in Taiwan. We also estimated the changes in survival rates and mortality following the launch of targeted therapies using interrupted time series and segmented regression models.

RESULTS

The age-standardised incidence of lung cancer increased from 22.53 per 100 000 people in 1994 to 34.09 in 2013, and it was projected to reach 38.98 by 2020. The rate of early-stage NSCLC at diagnosis increased from 12.63% in 2004 to 23.99% in 2013, and it was projected to reach 32.95% by 2020. The 2-year lung cancer survival increased by 19.81% (95% CI 14.90% to 24.71%) 3 years following the launch of gefitinib. Lung cancer mortality declined by 5.97% (95% CI -8.20% to -3.73%) 3 years following the launch of gefitinib.

CONCLUSIONS

Lung cancer survival rate increased and mortality decreased significantly following the launch of gefitinib and erlotinib in Taiwan.

Reduction in the Incidence of Urological Cancers after the Ban on Chinese Herbal Products Containing Aristolochic Acid: An Interrupted Time-Series Analysis

Cancer is a public health problem worldwide. Taiwan has a higher incidence rate of urological cancers than many Asian countries do. Aristolochic acid has been considered a potent carcinogen. In this study, we examined whether the cessation of the sales and preparation of aristolochic acid-containing Chinese herbal products (AA-CHPs) in Taiwan contributed to a decline in the incidence rates of bladder cancer, carcinomas of the renal pelvis and other urinary organs, and kidney cancer. We conducted an interrupted time-series analysis of long-term trends in the incidence rates of the aforementioned cancers between 1995 and 2013 in Taiwan. The incidence rates of bladder cancer and carcinomas of the renal pelvis and other urinary organs decreased considerably after 2008 and 2011, respectively. Notably, these change-of-slope time points occurred after the year 2003, when a ban on AA-CHPs was imposed in Taiwan. The ban on AA-CHPs in Taiwan was possibly associated with the reduction in the incidence of bladder cancer and carcinomas of the renal pelvis and other urinary organs.

Gender and Age Differences and the Trend in the Incidence and Prevalence of Dementia and Alzheimer's Disease in Taiwan: A 7-Year National Population-Based Study

Background

Very few nationwide studies have focused on the variations in the incidence and prevalence of dementia and Alzheimer's disease (AD) in Asian countries. This study aims to describe the gender and age differences in the incidence and prevalence of dementia and AD in Taiwan.

Methods

The data on dementia and AD were acquired from the Taiwan National Health Insurance Research Database from 2004 to 2010. The sex and age-specific rates were standardized, and the differences of gender and age on dementia or AD were assessed using Poisson regression analysis.

Results

Over seven years, the prevalence of dementia and AD significantly increased from 4.7 to 7.6 per hundred people (β = 0.0784, p < 0.0001) and 2.3 to 3.5 per hundred people (β = 0.0696, p < 0.0001), respectively. However, the incidence of both dementia and AD decreased but not significantly from 10.9 to 10.7 and 4.9 to 4.6 per thousand person-years, respectively. Noticeably, both incidence and prevalence increased with age and were higher in women than in men.

Conclusions

The standardized incidence rates of dementia and AD are much lower than the data reported in some studies from Europe, the US, and Japan. Further studies are warranted to explore which factors are associated with the differences in the incidence of dementia and AD in Taiwan.

Traffic-related air pollutants increase the risk for age-related macular degeneration

The aim of this study was to investigate whether ambient nitrogen dioxide (NO2) and carbon monoxide (CO) increase the risk for age-related macular degeneration (AMD). This is a longitudinal population-based study using the data on Taiwan National Health Insurance Program between year 2000 and 2010. From the nationwide dataset, we enrolled subjects aged 50 or older and the annually total NO2 and CO exposure was calculated from 1998 to 2010 for each subject. The Cox proportional hazard regression was used to estimate the HRs with adjustment for other variables. A total of 39,819 AMD-free residents were enrolled, and 1442 participants developed AMD during the 11 -year follow-up. Compared with the lowest exposure quartile, the highest quartile of each air pollutant was associated with an increased risk for AMD. The adjusted HR was 1.91 (95% CI 1.64 to 2.23, p<0.001) for the highest NO2 quartile, and was 1.84 (95% CI 1.5 to 2.15, p<0.001) for the highest CO quartile. In this study, chronic exposure to the highest quartile of ambient NO2 or CO significantly increases the risk for AMD.

Trends in regional cancer mortality in Taiwan 1992-2014

BACKGROUND

Although the cancer mortality rate in Taiwan has been declining in recent years, no study has yet reported any regional differences in cancer mortality rates in Taiwan. We hypothesized that regional cancer mortality rates in Taiwan, an ethnically homogeneous society, exhibited no significant variations.

METHODS

We investigated the trends in Taiwan regional cancer mortality between 1992 and 2014. We analyzed regional age-standardized cancer mortality rates for lung, liver, colon, stomach, oral, breast, and prostate cancers using the Taiwan Longitudinal Health Insurance Database and Demographic Database. Furthermore, we applied Joinpoint regression analysis to evaluate the trends across different regions.

RESULTS

There are clear regional variations in mortality rates for liver, stomach, and oral cancers, but not for lung, colon, breast, and prostate cancers. The regional death rates of oral cancer, especially for eastern Taiwan, not only elevate the fastest (APC = 14.78% per year, P < 0.001) but also show the largest disparities between men and women. Regional death rates for stomach cancer, which declined most rapidly, are converging in both general and gender groups. Liver cancer is the only one with regional variations whose trends do not all go in the same direction. We also demonstrated that northern Taiwan has significant regional advantages with respect to cancer mortality.

CONCLUSIONS

Some but not all cancers in Taiwan show regional disparities. Liver, stomach, and oral cancers in Taiwan exhibit clear regional variations in mortality rates. In particular, the regional variations in oral cancer mortality rates are consistent with those in alcohol consumption.

Levels and temporal variations of urinary lead, cadmium, cobalt, and copper exposure in the general population of Taiwan

Toxic metal contamination in food products and the environment is a public health concern. Therefore, understanding human exposure to cadmium (Cd), lead (Pb), cobalt (Co), and copper (Cu) levels in the general population of Taiwan is necessary and urgent. We aimed to establish the human biomonitoring data of urine toxic metals, exposure profile changes, and factors associated with metal levels in the general population of Taiwan. We randomly selected 1601 participants older than 7 years of age (36.9 ± 18.7 years (7-84 years)) from the Nutrition and Health Survey in Taiwan (NAHSIT) conducted during 1993-1996 (93-96) and 2005-2008 (05-08) periods and measured the levels of four metals in the participants' urine samples using inductively coupled plasma-mass spectrometry. The median (range) levels of urinary Cd, Pb, Co, and Cu in participants from the NAHSIT 93-96 (N = 821)/05-08 (N = 780) were 0.60 (ND-13.90)/0.72 (ND-7.44), 2.28 (ND-63.60)/1.09 (0.04-48.88), 0.91 (0.08-17.30)/1.05 (0.05-22.43), and 16.87 (2.62-158.28)/13.66 (1.67-189.70) μg/L, respectively. We found that the urinary median levels of Pb and Cu in our participants were significantly lower in the NAHSIT 05-08 (Pb 1.09 μg/L, Cu 13.66 μg/L) than in the NAHSIT 93-96 (Pb 2.28 μg/L, Cu 16.87 μg/L; P < 0.01), whereas those of Cd and Co were significantly higher in the NAHSIT 05-08 (Cd 0.72 μg/L, Co 1.05 μg/L; P < 0.01). Youths had higher exposure levels of Pb, Co, and Cu than adults. Participants with alcohol consumption, betel quid chewing, or cigarette smoking had significantly higher median levels of urinary Pb or Cu (P < 0.01) than those without. Principal components and cluster analysis revealed that sex had different exposure profiles of metals. We concluded that levels of urinary Cd, Pb, Co, and Cu exposure in the general Taiwanese varied by age, sex, and lifestyles.

Patients with head and neck cancer may need more intensive pain management to maintain daily functioning: a multi-center study

PURPOSE

The purpose of this study is to investigate the prevalence of pain, pain management, and impact of recent pain on daily functioning in patients with head and neck cancer (HNC) and patients with other cancers.

METHODS

This multi-center survey was conducted by using Brief Pain Inventory questionnaire to evaluate pain status and its impact on daily functioning.

RESULTS

A total of 3289 patients were analyzed including 708 HNC patients and 2581 patients with other cancers. The overall pain prevalence was 69.17%. A higher percentage of HNC patients had recent pain (60.59 vs. 44.01%, P < 0.001), required pain management (86.29 vs. 72.03%, P < 0.001), and used any analgesics (53.81 vs. 34.52%, P < 0.001). HNC patients with pain management had a higher prevalence of recent pain (85.83 vs. 81.14%, P = 0.044) and a slightly lower satisfaction rate (74.00 vs. 79.70%, P = 0.070). Regarding the impact of pain on daily functioning, HNC patients had a lower mean interference score for general activity such as walking, normal work, sleep, and life enjoyment.

CONCLUSIONS

The HNC patients may need more intensive pain management to achieve optimal pain control and maintain daily functioning.

Association between proton pump inhibitors and the risk of hepatocellular carcinoma

BACKGROUND

Proton pump inhibitor (PPI) use has been reported to be associated with liver damage and might possibly be carcinogenic.

AIMS

We examined whether long-term PPI use increases the risk of hepatocellular carcinoma (HCC) in patients without viral hepatitis B or C.

METHODS

We conducted a nested case-control study in a cohort of patients without viral hepatitis in Taiwan from 2000 to 2013. In total, 29 473 HCC cases and 294 508 matched controls were included. Moreover, we identified prescriptions for PPI and durations between the PPI index date and cancer diagnosis date (or the corresponding date in controls).

RESULTS

The adjusted odds ratio (AOR) for HCC associated with PPI use was 2.86 (95% confidence interval [CI], 2.69-3.04). Considering the use of PPIs determined according to cumulative defined daily dose (cDDD) subgroups, a dose-response effect was observed in patients exposed to 29-180, 181-240, 241-300, and 300+ cDDDs of PPIs. The AORs were 2.74 (95% CI, 2.57-2.93), 2.98 (95% CI, 2.50-3.56), 3.23 (95% CI, 2.59-4.02), and 3.43 (95% CI, 2.94-4.00) in the 29-180, 181-240, 241-300, and 300+ cDDD groups, respectively, compared with the 0-28 cDDD group. A sensitivity analysis revealed a consistent association between PPI use and the risk of HCC in subpopulations stratified by risk factors associated with HCC.

CONCLUSIONS

This observational study demonstrated that PPIs might increase the risk of HCC.

The association between tinnitus and the risk of ischemic cerebrovascular disease in young and middle-aged patients: A secondary case-control analysis of a nationwide, population-based health claims database

Background

Tinnitus and ischemic cerebrovascular disease (ICVD) may share common pathophysiologic mechanisms. Nevertheless, no studies have investigated whether tinnitus is associated with a higher risk of ICVD. The aim of this study was to evaluate the risk of ICVD among young and middle-aged patients with tinnitus.

Methods

Using the Taiwan’s National Health Insurance Research Database, we identified 3,474 patients 20–45 years old with incident ICVD diagnosed between January 1, 2000 and December 31, 2010 and 17,370 controls, frequency matched on age interval, sex, and year of the index date. Risk of ICVD associated with tinnitus was assessed using multiple logistic regression analyses.

Results

Tinnitus was significantly associated with a higher risk of incident ICVD among young and middle-aged patients (adjusted odds ratio [OR] 1.66, 95% confidence interval [CI] 1.34–2.04), adjusting for sex, age, and comorbidities. In addition, sex-stratified analysis showed that the associations were significant in both male (adjusted OR 1.55, 95% CI 1.16–2.07) and female patients (adjusted OR 1.77, 95% CI 1.30–2.41). Furthermore, tinnitus was significantly associated with a higher risk of ICVD in the 20.0–29.9 years (adjusted OR 4.11, 95% CI 1.98–8.52) and 30.0–39.9 years (adjusted OR 2.19, 95% CI 1.57–3.05) age groups, but not in the 40.0–45.0 years age group.

Conclusions

Tinnitus could be a novel risk factor or clinical indicator for young ischemic stroke, and further investigations are warranted.