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Andersson NW, Thiesson EM, Lassaunière R, Hansen JV, Hviid A. SARS-CoV-2 Infection and Postacute Risk of Non-Coronavirus Disease 2019 Infectious Disease Hospitalizations: A Nationwide Cohort Study of Danish Adults Aged ≥50 Years. Clin Infect Dis 2024; 78:603-612. [PMID: 37740392 DOI: 10.1093/cid/ciad531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Reports suggest that the potential long-lasting health consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may involve persistent dysregulation of some immune populations, but the potential clinical implications are unknown. We investigated the associated risk of hospitalization due to non-coronavirus disease 2019 (COVID-19) infectious diseases following the postacute phase of SARS-CoV-2 infection. METHODS By cross-linking data from the comprehensive Danish test and surveillance system for COVID-19 together with nationwide healthcare and demographic registers, we established a study cohort of 2 430 694 individuals aged ≥50 years, from 1 January 2021 to 10 December 2022, with no evidence of SARS-CoV-2 infection prior to study entry. Using Poisson regression, we compared the outcome rates of non-COVID-19 infectious disease hospitalizations following the acute phase of (a first) SARS-CoV-2 infection (defined as ≥29 days since the day of infection) in recovered individuals with rates among SARS-CoV-2-uninfected individuals. RESULTS Among 2 430 694 included individuals (mean age, 66.8 [standard deviation, 11.3] years), 930 071 acquired SARS-CoV-2 infection during follow-up totaling 4 519 913 person-years. The postacute phase of SARS-CoV-2 infection was associated with an incidence rate ratio (IRR) of 0.90 (95% confidence interval [CI]: .88-.92) for any infectious disease hospitalization. Findings (IRR [95% CI]) were similar for upper respiratory tract (1.08 [.97-1.20]), lower respiratory tract (0.90 [.87-.93]), influenza (1.04 [.94-1.15]), gastrointestinal (1.28 [.78-2.09]), skin (0.98 [.93-1.03]), urinary tract (1.01 [.96-1.08]), certain invasive bacterial (0.96 [.91-1.01]), and other (0.96 [.92-1.00]) infectious disease hospitalizations and in subgroups. CONCLUSIONS Our study does not support an increased susceptibility to non-COVID-19 infectious disease hospitalization following SARS-CoV-2 infection.
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Affiliation(s)
| | | | - Ria Lassaunière
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Denmark
| | | | - Anders Hviid
- Department of Epidemiology Research, Statens Serum Institut, Denmark
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Choi JY, Kim KU, Kim DK, Kim YI, Kim TH, Lee WY, Park SJ, Park YB, Song JW, Shin KC, Um SJ, Yoo KH, Yoon HK, Lee CY, Lee HS, Leem AY, Choi WI, Lim SY, Rhee CK. Pulmonary Rehabilitation Is Associated With Decreased Exacerbation and Mortality in Patients With COPD: A Nationwide Korean Study. Chest 2024; 165:313-322. [PMID: 37806492 DOI: 10.1016/j.chest.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Poor uptake to pulmonary rehabilitation (PR) is still challenging around the world. There have been few nationwide studies investigating whether PR impacts patient outcomes in COPD. We investigated the change of annual PR implementation rate, medical costs, and COPD outcomes including exacerbation rates and mortality between 2015 and 2019. RESEARCH QUESTION Does PR implementation improve outcomes in patients with COPD in terms of direct cost, exacerbation, and mortality? STUDY DESIGN AND METHODS Data of patients with COPD extracted from a large Korean Health Insurance Review and Assessment service database (2015-2019) were analyzed to determine the trends of annual PR implementation rate and direct medical costs of PR. Comparison of COPD exacerbation rates between pre-PR and post-PR, and the time to first exacerbation and mortality rate according to PR implementation, were also assessed. RESULTS Among all patients with COPD in South Korea, only 1.43% received PR. However, the annual PR implementation rate gradually increased from 0.03% to 1.4% during 4 years, especially after health insurance coverage commencement. The direct medical cost was significantly higher in the PR group than the non-PR group, but the costs in these groups showed decreasing and increasing trends, respectively. Both the incidence rate and frequency of moderate-to-severe and severe exacerbations were lower during the post-PR period compared with the pre-PR period. The time to the first moderate-to-severe and severe exacerbations was longer in the PR group than the non-PR group. Finally, PR implementation was associated with a significant decrease in mortality. INTERPRETATION We concluded that health insurance coverage increases PR implementation rates. Moreover, PR contributes toward improving outcomes including reducing exacerbation and mortality in patients with COPD. However, despite the well-established benefits of PR, its implementation rate remains suboptimal.
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Affiliation(s)
- Joon Young Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ki Uk Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine, Seo-gu, Busan, South Korea
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Yu-Il Kim
- Division of Pulmonary Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Tae-Hyung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
| | - Won-Yeon Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Yonsei University Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Seong Ju Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Yong Bum Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Gangdong Sacred Heart Hospital, The Hallym University, Seoul, South Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyeong-Cheol Shin
- Division of Pulmonology and Allergy, Department of Internal Medicine, Regional Center for Respiratory Disease, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Soo-Jung Um
- Division of Respiratory Medicine, Department of Internal Medicine, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, South Korea
| | - Kwang Ha Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Chang Youl Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, South Korea
| | - Ho Sung Lee
- Division of Respiratory Medicine, Soonchunhyang University CheonAn Hospital, Cheonan, Chungcheongnam-do, South Korea
| | - Ah Young Leem
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Won-Il Choi
- Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Deogyang-gu, Goyang-si, Gyeongji-do, South Korea
| | - Seong Yong Lim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Nørgaard M, Mailhac A, Fagerlund K, Strunz-McKendry T, Agerbæk M, Jensen JB. Treatment patterns, survival, and healthcare utilisation and costs in patients with locally advanced and metastatic bladder cancer in Denmark 2015-2020. Acta Oncol 2023; 62:1784-1790. [PMID: 37787748 DOI: 10.1080/0284186x.2023.2263154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/20/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Treatment patterns in locally advanced and metastatic urothelial bladder cancer (La/mUBC) is changing, but little is known about current treatment patterns, survival, and costs of these patients. Our aim was to describe treatment patterns, survival, and healthcare utilisation/costs in Danish La/mUBC patients in a routine clinical care setting. METHODS Registry-based nationwide cohort study including all bladder cancer patients aged 18 years or older with a La/mUBC tumour in the pathology register and a concomitant bladder cancer diagnosis in the Danish National Patient Registry in the period 2015-2020. We categorised the patients according to (1) La/mUBC at time of first bladder cancer diagnosis (de novo La/mUBC) and (2) non-invasive or localised muscle-invasive bladder cancer at time of diagnosis which had progressed to La/mUBC. All patients were included at date of pathology-confirmed La/mUBC. Follow-up ended 30 September 2022. RESULTS We identified 1278 patients (69% men) with La/mUBC and no other previous cancer. Of these, 212 (17%) had de novo La/mUBC, while 1066 (83%) had progressed to La/mUBC. Median age was 72 years. Patients were followed for a median of 13.0 months (interquartile range 4.7;32.0). During follow-up, 651 (51%) patients started first-line treatment, of these, 285 progressed to second-line treatment, and 112 also started third-line treatment. Median survival was 13.0 months from La/mUBC diagnosis, 12.1 months from start of first-line treatment, 9.8 months from start of second-line treatment, and 8.6 months from start of third-line treatment. The mean number of days admitted to hospital was 3.47, 3.97, and 4.07 per month following initiation of first-line, second-line, and third-line treatment, respectively. CONCLUSION Patients with La/mUBC have a poor prognosis, and in routine clinical care only around half of the patients received systemic anti-cancer treatment suggesting an unmet need for novel treatments. The overall costs only increased slightly from first to third-line treatment.
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Affiliation(s)
- Mette Nørgaard
- Department of Clinical Epidemiology, Arhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Aurélie Mailhac
- Department of Clinical Epidemiology, Arhus University Hospital, Aarhus, Denmark
| | | | | | - Mads Agerbæk
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Bjerggaard Jensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
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Andersson NW, Corn G, Dohlmann TL, Melbye M, Wohlfahrt J, Lund M. LDL-C Reduction With Lipid-Lowering Therapy for Primary Prevention of Major Vascular Events Among Older Individuals. J Am Coll Cardiol 2023; 82:1381-1391. [PMID: 37758432 DOI: 10.1016/j.jacc.2023.07.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/24/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Reducing low-density lipoprotein (LDL) cholesterol with lipid-lowering therapy has consistently been shown to lower the risk of cardiovascular disease in primary prevention trials where the majority of individuals are aged <70 years. For older individuals, however, evidence is less clear. OBJECTIVES In this study, the authors sought to compare the clinical effectiveness of lowering LDL cholesterol by means of lipid-lowering therapy for primary prevention of cardiovascular disease among older and younger individuals in a Danish nationwide cohort. METHODS We included individuals aged ≥50 years who had initiated lipid-lowering therapy from January 1, 2008, to October 31, 2017, had no history of atherosclerotic cardiovascular disease, and had a baseline and a within-1-year LDL cholesterol measurement. We assessed the associated risk of major vascular events among older individuals (≥70 years) by HRs per 1 mmol/L reduction in LDL cholesterol compared with younger individuals (<70 years). RESULTS For both the 16,035 older and the 49,155 younger individuals, the median LDL cholesterol reduction was 1.7 mmol/L. Each 1 mmol/L reduction in LDL cholesterol in older individuals was significantly associated with a 23% lower risk of major vascular events (HR: 0.77; 95% CI: 0.71-0.83), which was equal to that of younger individuals (HR: 0.76; 95% CI: 0.71-0.80; P value for difference = 0.79). Similar results were observed across all secondary analyses. CONCLUSIONS Our study supports a relative clinical benefit of lowering LDL cholesterol for primary prevention of major vascular events in individuals aged ≥70 years similarly as in individuals aged <70 years.
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Affiliation(s)
| | - Giulia Corn
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Danish Cancer Institute, Copenhagen, Denmark
| | - Tine Lovsø Dohlmann
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Mads Melbye
- Danish Cancer Institute, Copenhagen, Denmark; K.G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and Technology, Trondheim, Norway; Department of Genetics, Stanford University School of Medicine, Stanford, California, USA; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jan Wohlfahrt
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Danish Cancer Institute, Copenhagen, Denmark
| | - Marie Lund
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Pharmacology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Khan SU. The Promise of Primary Prevention in Older Adults. J Am Coll Cardiol 2023; 82:1392-1394. [PMID: 37758433 DOI: 10.1016/j.jacc.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
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Choi JW. Association between smoking status and death from COVID-19 in South Korea: A nationwide cohort study. Tob Induc Dis 2023; 21:97. [PMID: 37492764 PMCID: PMC10364242 DOI: 10.18332/tid/168672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
INTRODUCTION This study examined the association between smoking status and death from COVID-19. METHODS This study used nationwide cohort data collected from the Korean National Health Insurance Service, linking to information on all individuals who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The smoking status of subjects who participated twice in national health screenings between 2015 and 2018 was measured. This study investigated death from COVID-19 among those who tested positive from 1 January to 30 May 2020. RESULTS This study included 4259 patients who tested positive for SARS-CoV-2 in Korea. After adjusting for all potential confounding factors, current smokers (adjusted odds ratio, AOR=3.75; 95% CI: 1.23-11.36) and recent quitters (AOR=3.74; 95% CI: 1.12-12.53) were associated with an increased risk of death from COVID-19 compared to never smokers. Compared with current smokers, long-term quitters (AOR=0.33; 95% CI: 0.11-0.95) and never smokers (AOR=0.27; 95% CI: 0.09-0.81) were associated with a reduced risk of death from COVID-19. CONCLUSIONS Smoking was associated with an increased risk of death among patients with COVID-19. Given the lower possibility of death in long-term quitters with COVID-19, continuous smoking cessation among smokers or recent quitters is needed.
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Affiliation(s)
- Jae Woo Choi
- Community Care Research Center, Health Insurance Research Institute, National Health Insurance Service, Wonju, Republic of Korea
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Grymonprez M, De Backer TL, Capiau A, Vauterin D, Mehuys E, Boussery K, Steurbaut S, Lahousse L. Trends in oral anticoagulant use in patients with atrial fibrillation in Belgium from 2013 to 2019: A nationwide cohort study. Br J Clin Pharmacol 2023; 89:1360-1373. [PMID: 36321924 DOI: 10.1111/bcp.15582] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/03/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
AIM Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly preferred over vitamin K antagonists (VKAs) in atrial fibrillation (AF) management. However, differences in oral anticoagulant (OAC) prescribing according to patient's age, sex and physician's specialty may be present. Therefore, incident and prevalent use of OACs, NOACs and VKAs, stratified by age, sex and prescriber, and factors associated with the choice of OAC were investigated. METHODS Using two Belgian nationwide healthcare databases, AF patients ≥45 years old with ≥1 OAC prescription claim between 2013 and 2019 were identified. OAC use was investigated per half-year. Factors influencing NOAC vs. VKA initiation were identified by multivariable logistic regression. RESULTS Among 448 661 included OAC-treated AF patients, 297 818 were newly treated. Incident OAC use ranged from 45-49 to 42-44 users/10 000 persons between 2013 and 2019, whereas prevalent OAC use increased from 337 to 435 users/10 000 persons. Incident and prevalent NOAC use exceeded VKA use since 2013 and 2015, respectively, and NOACs represented 92% of incident and 81% of prevalent OAC users in 2019. Apixaban was the most frequently used NOAC since 2016. NOACs were significantly more prescribed by cardiologists and to older patients, whereas VKAs were more initiated in patients with cardiovascular, renal and hepatic comorbidities. Prevalent OAC use increased less in women than men (25.3% vs. 33.0% between 2013 and 2019) and female subjects had 5% significantly lower odds of NOAC vs. VKA initiation than men. CONCLUSION Since 2013, prevalent anticoagulant use increased almost one third in Belgium, while incident use was stable. Potential (N)OAC underuse in women requires further exploration.
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Affiliation(s)
- Maxim Grymonprez
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Tine L De Backer
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Andreas Capiau
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Delphine Vauterin
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Els Mehuys
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Koen Boussery
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Stephane Steurbaut
- Centre for Pharmaceutical Research, Research group of Clinical Pharmacology and Clinical Pharmacy, Vrije Universiteit Brussel, Jette, Belgium.,Department of Hospital Pharmacy, UZ Brussel, Jette, Belgium
| | - Lies Lahousse
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Cai K, Zhou B, Huang H, Tao R, Sun J, Yan C, Lee PMY, Svendsen K, Fu B, Li J, Huang L. Risk of malignancy following exposure to Epstein-Barr Virus associated infectious mononucleosis: A nationwide population-based cohort study. Front Oncol 2022; 12:991069. [PMID: 36591501 PMCID: PMC9795179 DOI: 10.3389/fonc.2022.991069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/27/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose Epstein-Barr virus (EBV) infection has been shown to contribute to oncogenesis and often causes acute clinical manifestation of Infectious mononucleosis (IM). It is unknown whether IM could increase the risk of subsequent malignancies. We aimed to evaluate the association of IM caused by EBV (EBV-IM) with overall and subtypes of malignancy in a large population-based cohort study. Methods This study included 1,419,407 individuals born in Denmark between 1973 and 2016 identified from national registers and 23,057 individuals had IM. The 5,394 of them had confirmed EBV-IM and they were birth date- and sex- matched (1:63) to 1,396,350 non-IM individuals. Cox regression was used to examine the associations of EBV-IM with malignancy. Results Individuals with a history of confirmed EBV-IM had an 88% increased overall risk of malignancy (hazard ratio [HR]:1·88, 95% confidence interval [CI]: 1·42-2·49) and a five-fold risk of hematologic malignancies (HR 5·04, 95% CI: 3·07-8·25), compared to those without IM. Similar estimates were observed in the sibling analysis. The overall risk of malignancy was greater for EBV-IM with complications (HR 8·93, 95% CI: 3·35-23·81) than that for EBV-IM without complications (HR 1·35, 95% CI: 1·20-1·53). EBV-IM duration was related to increased risk of malignancy in a dose-response way. Notably, the significant elevated risk of overall malignancy was observed in the first two years after EBV-IM onset (rate ratio [RR] 4·44, 95% CI: 2·75-7·17) and attenuated thereafter. Conclusion EBV-IM was associated with an increased risk in malignancy, particularly hematologic malignancies and in the first two years following IM exposure. Our findings suggest an important time-window for early screening of the EBV-attributed malignancy.
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Affiliation(s)
- Kang Cai
- Department of Infectious Diseases, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Baosong Zhou
- School of Data Science, Fudan University, Shanghai, China
| | - Heyu Huang
- Department of Infectious Diseases, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Tao
- Department of Infectious Diseases, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Sun
- School of Data Science, Fudan University, Shanghai, China
| | - Chonghuai Yan
- Department of Infectious Diseases, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Priscilla Ming Yi Lee
- Department of Clinical Epidemiology-Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Katrine Svendsen
- Research Unit for Mental Public Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Bo Fu
- School of Data Science, Fudan University, Shanghai, China,*Correspondence: Bo Fu, ; Lisu Huang, ;
| | - Jiong Li
- Department of Clinical Epidemiology-Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lisu Huang
- Department of Infectious Diseases, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Department of Infectious Diseases, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China,*Correspondence: Bo Fu, ; Lisu Huang, ;
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Choi JH, Paik WH, Jang DK, Kim MK, Ryu JK, Kim YT, Han K, Lee SH. Acute Pancreatitis Increases the Risk of Gastrointestinal Cancer in Type 2 Diabetic Patients: A Korean Nationwide Cohort Study. Cancers (Basel) 2022; 14. [PMID: 36428788 DOI: 10.3390/cancers14225696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
The association between acute pancreatitis (AP) and gastrointestinal cancers in diabetic patients is currently not well understood. The study aim was to investigate the association between AP and gastrointestinal cancers in diabetic patients. Data from the Korean National Health Insurance Service database were analyzed. Participants with diabetes who underwent a health examination between 2009 and 2012 were followed up till December 2018. The primary outcome was the occurrence of gastrointestinal cancer. A total of 2,263,184 patients were included in the final analysis. Patients with a history of AP (n = 2390) were found to have a significantly higher risk of gastrointestinal cancer, except for esophageal cancer, as follows: gastric cancer (aHR = 1.637, 95% CI: 1.323-2.025), colorectal cancer (aHR = 2.183, 95% CI: 1.899-2.51), liver cancer (aHR = 2.216, 95% CI: 1.874-2.621), pancreatic cancer (aHR = 4.558, 95% CI: 4.078-5.095), bile duct cancer (aHR = 3.996, 95% CI: 3.091-5.269), and gallbladder cancer (aHR = 2.445, 95% CI: 1.459-4.099). The history of AP is associated with the increased risk of gastrointestinal cancer in diabetic patients. It is necessary to investigate the history of AP and more actively recommend screening for gastrointestinal cancers in such patients.
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Zhang Y, Zhang Y, Yang S, Ye Z, Wu Q, Liu M, Zhou C, He P, Jiang J, Liang M, Wang G, Hou F, Liu C, Qin X. U-Shaped Relation of Dietary Thiamine Intake and New-Onset Hypertension. Nutrients 2022; 14. [PMID: 36014758 DOI: 10.3390/nu14163251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background: To examine the relation of dietary thiamine intake with risk of new-onset hypertension in the general adults. Methods: A total of 12,177 participants without hypertension at baseline from China Health and Nutrition Survey (CHNS) were included. The study outcome was new-onset hypertension, which was defined as a systolic blood pressure ≥140 mm Hg or a diastolic blood pressure ≥90 mm Hg or under antihypertensive treatment or diagnosed by physician during the follow-up. Results: A total of 4269 participants occurred new-onset hypertension over a median follow-up of 6.1 years. Overall, there was a U-shaped relation (p for nonlinearity <0.001) of dietary thiamine intake with new-onset hypertension, with an inflection point at 0.93 mg/day. Accordingly, in the threshold effect analysis, there was an inverse association between dietary thiamine intake (per SD increment: HR, 0.62; 95% CI: 0.53, 0.72) and new-onset hypertension in participants with dietary thiamine intake <0.93 mg/day, and a positive association between dietary thiamine intake (per SD increment: HR, 1.38; 95% CI: 1.32, 1.44) and new-onset hypertension in those with dietary thiamine intake ≥0.93 mg/day. Conclusion: The association between dietary thiamine intake and the risk of new-onset hypertension followed a U-shaped relation in the general Chinese population, with an inflection point at 0.93 mg/day of dietary thiamine intake.
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Laursen M, Dohrn N, Gögenur I, Klein MF. Neoadjuvant chemotherapy in patients undergoing colonic resection for locally advanced nonmetastatic colon cancer: A nationwide propensity score matched cohort study. Colorectal Dis 2022; 24:954-964. [PMID: 35285992 DOI: 10.1111/codi.16116] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 02/08/2023]
Abstract
AIM Neoadjuvant chemotherapy (NCT) for nonmetastatic colon cancer is not routinely used, and is currently only recommended as a treatment option for a subgroup of patients with T4b colon cancers in clinical guidelines. However, NCT may cause downstaging of the tumour, increase resectability, eradicate micrometastases and thereby improve long-term outcomes for patients with nonmetastatic colon cancer. The aim of this study was to investigate the short-term postoperative outcomes in a nationwide cohort of patients with locally advanced colon cancer (LACC) receiving NCT. METHOD Using the Danish Colorectal Cancer Group Database, data were retrieved on patients diagnosed with LACC (defined as clinical T3 with extramural tumour invasion >5 mm or T4) and treated with resection with a curative intent between 2015 and 2019. Propensity score matching (PSM) in a 1:1 ratio was performed to compare short-term surgical and oncological outcomes in patients receiving NCT with patients operated on without receiving NCT. RESULTS A total of 179 LACC patients were treated with NCT and 1131 were not. After PSM, 145 patients remained in each group. We found no significant differences in any short-term postoperative outcomes between the two groups. We found significant differences in favour of NCT regarding radicality and pathological N category [86% vs. 81% R0 (P = 0.029) and 51% vs. 46% pN0 (P = 0.017), respectively]. CONCLUSION Neoadjuvant chemotherapy for LACC does not result in worse short-term postoperative outcomes and may increase the R0 rate as well as node-negative disease. Results on long-term benefits including survival are awaited from several ongoing randomized controlled trials.
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Affiliation(s)
- Magnus Laursen
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Niclas Dohrn
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.,Department of Surgery, Zealand University Hospital, University of Copenhagen, Køge, Denmark
| | - Ismail Gögenur
- Department of Surgery, Zealand University Hospital, University of Copenhagen, Køge, Denmark
| | - Mads Falk Klein
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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12
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Kim YJ, Lee JS, Lee Y, Lee H, Kim JY, Tchah H. Vitrectomy and All-Cause and Cause-Specific Mortality in Elderly Patients With Vitreoretinal Diseases: A Nationwide Cohort Study. Front Med (Lausanne) 2022; 9:851536. [PMID: 35547211 PMCID: PMC9082070 DOI: 10.3389/fmed.2022.851536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/16/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To determine the all-cause and cause-specific mortality in elderly patients with vitreoretinal diseases based on vitrectomy status. Methods Elderly patients (aged ≥ 60 years) diagnosed with vitreoretinal diseases between 2003 and 2012 using the Korean National Health Insurance Service-Senior cohort (2002–2015) were included in this nationwide population-based retrospective cohort study. The exposure of interest was vitrectomy, and information on mortality from patient inclusion until December 2015 was obtained. Cox regression modeling was used to assess the association between vitrectomy and mortality. An additional subgroup analysis was performed to investigate the effects of the underlying retinal disease characteristics and comorbidities on mortality. Results The study cohort included 152,283 patients (3,313 and 148,970 in the vitrectomy and non-vitrectomy groups, respectively). The adjusted model showed vitrectomy was associated with a decreased risk of pulmonary-cause mortality [hazard ratio (HR), 0.51; P < 0.001]; however, no association was observed for all-cause mortality (HR, 0.93; P = 0.325). Vitrectomy was associated with increased mortality risk (all-cause: HR, 1.26; P < 0.001 and vascular causes: HR, 1.41; P = 0.003) among patients with retinal vascular diseases and decreased mortality risk (all-cause: HR, 0.64; P < 0.001 and pulmonary causes: HR, 0.35; P = 0.011) among patients with macular diseases. There were significant interactions between age and vitrectomy with respect to all-cause mortality among patients with either vitreoretinal disease. Conclusions In elderly patients with retinal diseases, the vitrectomy group showed the lower mortality from pulmonary causes with no association for all-cause mortality.
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Affiliation(s)
- Yoon Jeon Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.,Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yunhan Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hungwon Tchah
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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13
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Kwon YS, Lee JJ, Lee SH, Kim C, Yu H, Sohn JH, Kim DK. Risk of Dementia in Patients Who Underwent Surgery under Neuraxial Anesthesia: A Nationwide Cohort Study. J Pers Med 2021; 11:1386. [PMID: 34945858 PMCID: PMC8708516 DOI: 10.3390/jpm11121386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022] Open
Abstract
The incidence of dementia in patients with surgery under neuraxial anesthesia and the possibility of surgery under neuraxial anesthesia as a risk factor for dementia were investigated. We performed a retrospective matched cohort study with nationwide, representative cohort sample data of the Korean National Health Insurance Service in South Korea between 1 January 2003, and 31 December 2004. The participants were divided into control (n = 4488) and neuraxial groups (n = 1122) using propensity score matching. After 9 years of follow-up, the corresponding incidences of dementia were 11.5 and 14.8 cases per 1000 person-years. The risk of dementia in the surgery under neuraxial group was 1.44-fold higher (95% confidence interval [95%CI], 1.17-1.76) than that in the control group. In the subgroup analysis of dementia, the risk of Alzheimer's disease in those who underwent surgery under neuraxial anesthesia was 1.48-fold higher (95%CI, 1.17-1.87) than that in those who did not undergo surgery under anesthesia. Our findings suggest that patients who underwent surgery under neuraxial anesthesia had a higher risk of dementia and Alzheimer's disease than those who did not undergo surgery under neuraxial anesthesia.
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Affiliation(s)
- Young-Suk Kwon
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (Y.-S.K.); (J.-J.L.)
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.-H.L.); (C.K.); (H.Y.)
| | - Jae-Jun Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (Y.-S.K.); (J.-J.L.)
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.-H.L.); (C.K.); (H.Y.)
| | - Sang-Hwa Lee
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.-H.L.); (C.K.); (H.Y.)
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea
| | - Chulho Kim
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.-H.L.); (C.K.); (H.Y.)
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea
| | - Hyunjae Yu
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.-H.L.); (C.K.); (H.Y.)
| | - Jong-Hee Sohn
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.-H.L.); (C.K.); (H.Y.)
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea
| | - Dong-Kyu Kim
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.-H.L.); (C.K.); (H.Y.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea
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14
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Shin W, Lee DH, Kim MK, Lee SH, Cho DY, Bang M. Clinical effectiveness of early treatment with paliperidone palmitate in schizophrenia: A retrospective real-world study in South Korea. Early Interv Psychiatry 2021; 15:1759-1767. [PMID: 33445224 DOI: 10.1111/eip.13116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/20/2020] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
AIM Long-acting injectable antipsychotic agents (LAIs) including paliperidone palmitate (PP) have shown promising results in preventing relapse and rehospitalization in schizophrenia. This study aimed to ascertain the comparative real-world effectiveness between the early and late administration of PP and oral formulations of risperidone and paliperidone (ORPs) in patients experiencing a first episode or relapse of schizophrenia. METHODS We identified patients with schizophrenia admitted to a psychiatric ward at least once and treated with ORPs or PP using the Korea National Insurance Claims Database. Patients were divided into three groups based on the clinical data: (1) patients treated with PP within 30 days of the initiation of treatment (early-PP), (2) patients treated with PP after 30 days of the initiation of therapy (late-PP) and (3) patients treated with only ORPs and not received PP (only-ORP). The primary outcomes were determined as psychiatric rehospitalization during the entire duration of treatment after the first discharge. RESULTS A total of 3790 patients (1096 early-PP, 799 late-PP and 1895 only-ORP) were finally included in the analysis. The mean of number and total length of rehospitalization stays during the entire duration in early-PP group were significantly lower than those of late-PP group and only-ORP group (number: 2.32 stays/year, 3.24 stays/year and 4.23 stays/year, p < .001; total length: 50.34 days/year, 72.26 days/year and 105.14 days/year, p < .001). CONCLUSIONS Early treatment with PP was associated with a greater reduction in psychiatric rehospitalization during the treatment period than late treatment with PP and ORP in schizophrenia.
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Affiliation(s)
- Wonsuk Shin
- Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Dong Hyeon Lee
- Department of Physiology, CHA University School of Medicine, Seongnam, South Korea
| | - Min-Kyoung Kim
- Department of Psychiatry, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang, South Korea
| | - Sang-Hyuk Lee
- Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea.,Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Doo-Yeoun Cho
- Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
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15
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Hsu CL, Hung CL, Huang SJ, Yin CH, Chu CH, Kuo TJ, Hung YM. Impact of Rehabilitation Intensity on 3-Year Mortality among Children with Moderate to Severe Cerebral Palsy: A Population-Based Cohort Study. Int J Environ Res Public Health 2021; 18:9932. [PMID: 34574857 DOI: 10.3390/ijerph18189932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/17/2022]
Abstract
Though numerous studies demonstrated the positive effect of rehabilitation on cerebral palsy (CP) children, there was no literature addressing the role of rehabilitation on mortality among children with CP. Therefore, we aimed to evaluate the impact of rehabilitation intensity on mortality among children with moderate to severe CP. This retrospective cohort study was conducted by National Health Insurance Research Database in Taiwan. Children (<12 years) with newly diagnosed moderate to severe CP between 1 January 2000 and 31 December 2013 were included. All patients were followed up for 3 years after CP diagnosis or death or until 31 December 2013. The intensity of rehabilitation therapy within 6 months after CP diagnosis was categorized into <6 times and ≥6 times. The Cox proportional hazard analysis was used to determine the association between rehabilitation intensity and all-cause mortality after adjusting age, sex, other demographic factors and comorbidities. Among 3936 severe CP children, 164 (4.2%) died during the 3-year follow-up period. The mortality rate was higher among patients receiving rehabilitation < 6 times within 6 months than those ≥6 times within 6 months after adjusting demographic profile and comorbidities (adjust HR (aHR): 1.96, 95% CI 1.33–2.89, p < 0.001). We found that patients who were younger (aHR: 0.84, 95% CI 0.76–0.92, p < 0.001), who were receiving inpatient care more than twice in 1 year before their CP diagnosis (aHR: 2.88; 95% CI: 1.96–4.23; p < 0.001), and who have pneumonia (aHR: 1.41, 95% CI 1.00–1.96, p = 0.047), epilepsy (aHR: 1.41, 95% CI: 1.02–1.95, p = 0.039) and dysphagia (aHR: 1.55, 95% CI: 1.06–2.26, p = 0.024) have higher risk of mortality. Rehabilitation ≥ 6 times within 6 months has a potentially positive impact on pediatric CP survival. Besides having a younger age, being hospitalized more than twice within a year before diagnosis and having pneumonia, epilepsy and dysphagia were modifiable risk factors in clinical practice for these children.
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16
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Ou H, Chien WC, Chung CH, Chang HA, Kao YC, Wu PC, Tzeng NS. Association Between Antibiotic Treatment of Chlamydia pneumoniae and Reduced Risk of Alzheimer Dementia: A Nationwide Cohort Study in Taiwan. Front Aging Neurosci 2021; 13:701899. [PMID: 34489674 PMCID: PMC8416516 DOI: 10.3389/fnagi.2021.701899] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Chlamydia pneumoniae (CPn) is a common community-acquired pneumonia. In the literature, CPn infection is demonstrated to exhibit an association with Alzheimer dementia (AD). We executed the present nationwide, population-based research with the goal of probing the association of CPn infection and antibiotic therapy with AD risk. Methods: We conducted a cohort study using a database extracted from Taiwan's National Health Insurance Research Database (NHIRD). All medical conditions for each enrolled individuals were categorized using the International Classification of Diseases, ninth Revision classifications. Hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between CPn pneumonia-associated hospitalizations and AD were estimated using Fine and Gray's survival analysis and adjusted for comorbidities. The effects of the antibiotics on the HRs for AD in the patients with CPn pneumonia-associated hospitalization were also analyzed. Results: Our analyses included 6,628 individuals, including 1,657 CPn-infected patients, as well as 4,971 controls matched by age, index date, and sex (1:3). In this study, patients hospitalized for CPn pneumonia exhibited a significantly higher AD risk (adjusted HR = 1.599, 95% CI = 1.284-1.971, p < 0.001). We also noted an association of macrolide use (≥15 days) and fluoroquinolone use (≥15 days) with decreased AD risk. Conclusions: We determined CPn pneumonia to be associated with a relatively high AD risk. The result in this study confirmed the findings from previous literatures, by using a large, nationwide, population-based database. Appropriate macrolide and fluoroquinolone treatment may attenuate this risk.
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Affiliation(s)
- Hsun Ou
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan
| | - Pei-Chuan Wu
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
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17
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Lee YB, Kim HS. Height and Risk of Vitiligo: A Nationwide Cohort Study. J Clin Med 2021; 10:jcm10173958. [PMID: 34501405 PMCID: PMC8432081 DOI: 10.3390/jcm10173958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
Adult height is linked to the risk of several diseases, but its association with vitiligo has not been established. This study aimed to investigate the relationship between adult height and vitiligo incidence. Korean nationwide claims data from 15,980,754 individuals (20 years of age or older) who received a health checkup during the period 2005–2008, were examined. Subjects were categorized into age- and gender-specific height quintiles. Participants were followed until vitiligo diagnosis or until the end of 2015. The Cox proportional-hazards model for cumulative risk was computed for height categories. During the follow-up period, 29,196 cases (136,020,214 person-years) of newly diagnosed vitiligo were reported. A positive association was found between height and risk of vitiligo in which the hazard ratio between the highest and lowest quintiles of height was 1.36 (95% confidence interval: 1.31–1.42). While more diverse cohort studies are needed, our findings suggest that taller stature increases the risk of vitiligo.
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Affiliation(s)
- Young-Bok Lee
- Department of Dermatology, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea;
| | - Hei-Sung Kim
- Department of Dermatology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: ; Tel.: +82-32-280-5100
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18
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Guivarch C, Sacri AS, Levy C, Bocquet A, Lapidus N, Hercberg S, Hebel P, Chevé A, Copin C, Zouari M, Gouya L, de Montalembert M, Cohen JF, Chalumeau M. Clinical Prediction of Iron Deficiency at Age 2 Years: A National Cross-sectional Study in France. J Pediatr 2021; 235:212-9. [PMID: 33836187 DOI: 10.1016/j.jpeds.2021.03.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/11/2021] [Accepted: 03/31/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the diagnostic accuracy of existing clinical criteria and to develop prediction tools for iron deficiency in 2-year-old children. STUDY DESIGN In a national cross-sectional study conducted in primary care pediatricians' practices throughout France, 2-year-old children were consecutively included (2016-2017). Multivariable logistic regression modeling and bootstrapping were used to develop several clinical models to predict iron deficiency (serum ferritin <12 μg/L). These models used the best criteria and combinations among the American Academy of Pediatrics' (AAP) criteria adapted to the European context (n = 10), then all potential predictors (n = 19). One model was then simplified into a simple prediction tool. RESULTS Among 568 included infants, 38 had iron deficiency (6.7%). In univariable analyses, no significant association with iron deficiency was observed for 8 of the 10 adapted AAP criteria. Three criteria (both parents born outside the European Union, low weight at 1 year old, and weaning to cow's milk without supplemental iron) were retained in the AAP model, which area under the receiver operating characteristic curve, sensitivity, and specificity were 0.62 (95% CI, 0.58-0.67), 30% (95% CI, 22%-39%), and 95% (95% CI, 92%-97%), respectively. Four criteria were retained in a newly derived simple prediction tool (≥1 criterion among the 3 previous plus duration of iron-rich formula consumption <12 months), which area under the receiver operating characteristic curve, sensitivity, and specificity were 0.72 (95% CI, 0.65-0.79), 63% (95% CI, 47%-80%), and 81% (95% CI, 70%-91%), respectively. CONCLUSIONS All prediction tools achieved acceptable diagnostic accuracy. The newly derived simple prediction tool offered potential ease of use. TRIAL REGISTRATION ClinicalTrials.gov NCT02484274.
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Cho YK, Lee J, Kim HS, Park JY, Lee WJ, Kim YJ, Jung CH. The risk of Alzheimer's disease according to dynamic changes in metabolic health and obesity: a nationwide population-based cohort study. Aging (Albany NY) 2021; 13:16974-89. [PMID: 34237705 DOI: 10.18632/aging.203255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 06/18/2021] [Indexed: 12/29/2022]
Abstract
We evaluated the association of metabolic health and obesity phenotypes with the risk of Alzheimer's disease (AD). This study enrolled 136,847 elderly participants aged 60 or above from the Korean National Health Insurance System. At baseline examinations in 2009 and 2010, subjects were categorized into four groups: the metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO) groups. Based on the phenotypic transition after 2 years, the subjects were further categorized into 16 subgroups. They were followed from 2009 to 2015 to monitor for AD development. The MHO phenotype protected subjects from AD, relative to the MHNO phenotype (HR, 0.73; 95% CI, 0.65-0.81). Among subjects initially classified as MHO, 41.8% remained MHO, with a significantly lower risk of AD compared with the stable MHNO group (HR, 0.62; 95% CI, 0.50-0.77). Among MUO subjects at baseline, those who changed phenotype to MUNO were at higher risk of AD (HR, 1.47; 95% CI, 1.28-1.70), and the transition to the MHO phenotype protected subjects from AD (HR, 0.62; 95% CI, 0.50-0.78). The MHO phenotype conferred a decreased risk of AD. Maintenance or recovery of metabolic health might mitigate AD risk among obese individuals.
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20
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Andersson NW, Skov L, Andersen JT. Fetal safety of chloroquine and hydroxychloroquine use during pregnancy: a nationwide cohort study. Rheumatology (Oxford) 2021; 60:2317-2326. [PMID: 33232466 DOI: 10.1093/rheumatology/keaa592] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/12/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The antimalaria 4-aminoquinoline drugs chloroquine and HCQ are used in the treatment of a wide range of CTDs. Data to inform on the safety of their use in pregnancy are limited. METHODS In a Danish nationwide cohort study from 1996 through 2016, we identified 4-aminoquinoline-exposed pregnancies from a cohort of 1 240 875 pregnancies to investigate the associated risks of major birth defects, preterm birth, and small size for gestational age (SGA). Distinct study cohorts of propensity-score-matched 4-aminoquinoline-exposed and unexposed pregnancies (in a 1:1 ratio) were established for each outcome analysis. The association with the outcomes was assessed by prevalence odds ratios (ORs) estimated through logistic regression. The associated risks for chloroquine and HCQ were individually assessed through additional analyses. RESULTS A total of 1487 pregnancies exposed to 4-aminoquinolines (1184 chloroquine- and 303 HCQ-exposed) were identified. Among the 983 pregnancies exposed to 4-aminoquinolines in the first trimester, 34 infants (3.5%) were diagnosed with major birth defects as compared with 36 (3.7%) among the matched unexposed pregnancies (prevalence OR, 0.94; 95% CI: 0.59, 1.52). Exposure to 4-aminoquinolines in pregnancy was neither associated with an increased risk of preterm birth (prevalence OR, 0.97; 95% CI: 0.73, 1.28) or SGA (prevalence OR, 1.18; 95% CI: 0.93, 1.50), compared with unexposed pregnancies. No significant associations between exposure to chloroquine or HCQ individually and risk of the outcomes were identified. CONCLUSION Among pregnancies exposed to 4-aminoquinolines (chloroquine and HCQ), no increased risk of major birth defects, preterm birth, or SGA was identified.
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Affiliation(s)
- Niklas Worm Andersson
- Department of Epidemiology Research, Statens Serum Institut.,Department of Clinical Pharmacology, Bispebjerg and Frederiksberg, Copenhagen University Hospital.,Department of Dermatology and Allergy, Herlev and Gentofte Hospital
| | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jon Trærup Andersen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg, Copenhagen University Hospital.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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21
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Mitha A, Chen R, Johansson S, Razaz N, Cnattingius S. Maternal body mass index in early pregnancy and severe asphyxia-related complications in preterm infants. Int J Epidemiol 2021; 49:1647-1660. [PMID: 32588048 PMCID: PMC7746401 DOI: 10.1093/ije/dyaa088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about the associations between maternal body mass index (BMI) and asphyxia-related morbidity in preterm infants (<37 weeks). We aimed to investigate associations between maternal BMI in early pregnancy and severe asphyxia-related neonatal complications in preterm infants (<37 weeks) and to examine whether possible associations were mediated by overweight- or obesity-related complications. METHODS In this Swedish population-based cohort of 62 499 singleton non-malformed preterm infants born from 1997 to 2011, risks of low Apgar scores (0-3) at 5 and 10 minutes, neonatal seizures and intraventricular haemorrhage (IVH) were estimated through two analytical approaches. In the conventional approach, the denominator for risk was all live births at a given gestational age. In the fetuses-at-risk (FAR) approach, the denominator for risk was ongoing pregnancies at a given gestational age. RESULTS Using the conventional approach, adjusted risk ratios per 10-unit BMI increase were 1.32 [95% confidence interval (CI) 1.13-1.54] and 1.37 (95% CI 1.12-1.67) for low Apgar scores at 5 and 10 minutes, respectively; 1.28 (95% CI 1.00-1.65) for neonatal seizures; and 1.18 (95% CI 1.01-1.37) for IVH. Using the FAR approach, corresponding risks were higher. These associations varied by gestational age (<32 and 32-36 weeks). Associations between maternal BMI and asphyxia-related outcomes were partly mediated through lower gestational age. CONCLUSIONS Increasing maternal BMI in early pregnancy is associated with increased risks of severe asphyxia-related complications in preterm infants. Our findings add to the evidence to support interventions to reduce obesity in woman of reproductive age.
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Affiliation(s)
- Ayoub Mitha
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153-Obstetrical, perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRA, Hôpital Tenon, Bâtiment Recherche, Rue de la Chine, Paris, France
| | - Ruoqing Chen
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Corresponding author. Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden. E-mail:
| | - Stefan Johansson
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Neda Razaz
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sven Cnattingius
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Rosskamp M, Verbeeck J, Gadeyne S, Verdoodt F, De Schutter H. Socio-Economic Position, Cancer Incidence and Stage at Diagnosis: A Nationwide Cohort Study in Belgium. Cancers (Basel) 2021; 13:cancers13050933. [PMID: 33668089 PMCID: PMC7956180 DOI: 10.3390/cancers13050933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Socio-economic position is associated with cancer incidence, but the direction and magnitude of this relationship differs across cancer types, geographical regions, and socio-economic parameters. In this nationwide cohort study, we evaluated the association between different individual-level socio-economic and -demographic factors, cancer incidence, and stage at diagnosis in Belgium. Methods: The 2001 census was linked to the nationwide Belgian Cancer Registry for cancer diagnoses between 2004 and 2013. Socio-economic parameters included education level, household composition, and housing conditions. Incidence rate ratios were assessed through Poisson regression models. Stage-specific analyses were conducted through logistic regression models. Results: Deprived groups showed higher risks for lung cancer and head and neck cancers, whereas an inverse relation was observed for malignant melanoma and female breast cancer. Typically, associations were more pronounced in men than in women. A lower socio-economic position was associated with reduced chances of being diagnosed with known or early stage at diagnosis; the strongest disparities were found for male lung cancer and female breast cancer. Conclusions: This study identified population groups at increased risk of cancer and unknown or advanced stage at diagnosis in Belgium. Further investigation is needed to build a comprehensive picture of socio-economic inequality in cancer incidence.
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Affiliation(s)
- Michael Rosskamp
- Belgian Cancer Registry, Rue Royale 215, B-1210 Brussels, Belgium; (J.V.); (F.V.); (H.D.S.)
- Correspondence: ; Tel.: +32-2-250-1010
| | - Julie Verbeeck
- Belgian Cancer Registry, Rue Royale 215, B-1210 Brussels, Belgium; (J.V.); (F.V.); (H.D.S.)
| | - Sylvie Gadeyne
- Sociology Department, Interface Demography, Vrije Universiteit Brussel, Pleinlaan 5, B-1050 Brussels, Belgium;
| | - Freija Verdoodt
- Belgian Cancer Registry, Rue Royale 215, B-1210 Brussels, Belgium; (J.V.); (F.V.); (H.D.S.)
| | - Harlinde De Schutter
- Belgian Cancer Registry, Rue Royale 215, B-1210 Brussels, Belgium; (J.V.); (F.V.); (H.D.S.)
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23
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Miao M, Liu H, Yuan W, Madsen N, Yu Y, László KD, Liang H, Ji H, Li J. Association of Maternal Hypothyroidism With Cardiovascular Diseases in the Offspring. Front Endocrinol (Lausanne) 2021; 12:739629. [PMID: 34531830 PMCID: PMC8438132 DOI: 10.3389/fendo.2021.739629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND No previous study has examined the effect of maternal hypothyroidism on a broad spectrum of cardiovascular disease (CVD) endpoints in the offspring. METHODS A nationwide population-based cohort study based on the linkage of several Danish nationwide registries was conducted to explore whether maternal hypothyroidism is associated with offspring's CVD. Altogether 1,041,448 singletons born between the 1st of January 1978 and the 31st of December 1998 were investigated from the age of 8 years to the 31st of December 2016. Exposure was maternal diagnosis of hypothyroidism across lifespan and the outcome of interest was a CVD diagnosis in the offspring. Cox regression models were performed to estimate the hazard ratios (HRs) of CVD. RESULTS Offspring born to mothers with hypothyroidism had an increased risk of CVD (hazard ratios (HR)=1.23, 95% confidence interval (CI): 1.12-1.35), and of several subcategories of CVD including hypertension, arrhythmia, and acute myocardial infarction in offspring. The magnitude of association was the most pronounced in an exposure occur during pregnancy (HR=1.71, 95% CI: 1.10-2.67), which is consistent across all the subgroup analysis, including sibling analysis. CONCLUSIONS Maternal hypothyroidism is associated with an increased risk of CVD in offspring. Thyroid hormone insufficiency during pregnancy may predominantly contribute to the observed associations; however, the effects of a shared genetic background and a time-stable familial environment/lifestyle factors cannot be excluded.
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Affiliation(s)
- Maohua Miao
- National Health Commission Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Hui Liu
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Medical Informatics Center, Peking University, Beijing, China
| | - Wei Yuan
- National Health Commission Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Nicolas Madsen
- Acute Care Cardiology Unit, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Yongfu Yu
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Krisztina D. László
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Hong Liang
- National Health Commission Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Honglei Ji
- National Health Commission Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Jiong Li
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- *Correspondence: Jiong Li,
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Cho YK, Lee J, Kim HS, Park JY, Lee WJ, Kim YJ, Jung CH. Metabolic health is a determining factor for incident colorectal cancer in the obese population: A nationwide population-based cohort study. Cancer Med 2020; 10:220-229. [PMID: 33216467 PMCID: PMC7826459 DOI: 10.1002/cam4.3607] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 12/13/2022] Open
Abstract
Background The association of the risk of colorectal cancer (CRC) with obesity or obesity‐induced metabolic disturbances remains controversial. We assessed the association of metabolic health status with incident CRC among subjects with obesity. Methods This study included 319,397 subjects from the Korean National Health Insurance Service‐National Health Screening Cohort. Transitions in metabolic health status and obesity were examined during 2009–2010 and 2011–2012. We categorized subjects with obesity into four separate groups according to their dynamic metabolic health status: metabolically healthy obesity (MHO), MHO to metabolically unhealthy obesity (MUO), MUO to MHO, and stable MUO. Subjects were followed up from 2009 to 2015 for incident CRC. Results The stable MHO group showed no increased risk of incident CRC (hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.83–1.14). However, the MHO to MUO group had a higher risk of incident CRC than the stable metabolically healthy nonobese (MHNO) group (HR, 1.34; 95% CI, 1.15–1.57). Among patients with MUO at baseline, those in the subgroup who transitioned to MHO group were not at increased risk of CRC (HR, 1.06; 95% CI, 0.91–1.25), whereas those who remained in the stable MUO group had a higher risk of incident CRC than those in the stable MHNO group (HR, 1.29; 95% CI, 1.19–1.41). Conclusions The transition of metabolic health was a determining factor for CRC among subjects with obesity. Hence, maintenance or recovery of metabolic health should be addressed to prevent CRC in individuals with obesity.
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Affiliation(s)
- Yun Kyung Cho
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Jiwoo Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hwi Seung Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joong-Yeol Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Je Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang Hee Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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25
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Weng YC, Juan CK, Ho HJ, Chang YL, Wu CY, Chen YJ. Atopic dermatitis does not increase the risk of inflammatory bowel disease: A nationwide cohort study. J Dermatol 2020; 48:168-174. [PMID: 33124113 DOI: 10.1111/1346-8138.15661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/25/2020] [Indexed: 12/16/2022]
Abstract
Coexistence of inflammatory bowel disease (IBD) in atopic dermatitis (AD) patients has been reported. The long-term risk of IBD in AD patients remains unclear. Our aim for the study is to examine the long-term risk of IBD in AD patients. This is a nationwide cohort study. From the National Health Insurance Research Database of Taiwan (1997-2013), a total of 36 400 AD patients were identified and matched with 364 000 reference subjects without AD by age, sex and number of hospital visits. Demographic characteristics and comorbidities were compared. Cox proportional hazards regression analysis was conducted to examine the risk of IBD. The 16-year cumulative incidences of IBD were 0.047% (95% confidence interval [CI], 0.040-0.054) and 0.047% (95% CI, 0.025-0.096) in non-AD and AD cohorts, respectively (P = 0.973). There were 17 cases of IBD (0.05%), including 10 ulcerative colitis and seven Crohn's disease, among AD patients compared with 169 IBD cases (0.05%) among controls (P > 0.999). Infections (adjusted hazard ratio [HR], 2.71; 95% CI, 1.96-3.95; P < 0.001) and age (adjusted HR, 1.03; 95% CI, 1.02-1.03; P < 0.001) were independently associated with IBD, after adjusting for major comorbidities and conducting multivariate analyses. AD was not associated with IBD development. In conclusion, AD is not independently associated with IBD development.
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Affiliation(s)
- Yu-Ching Weng
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chao-Kuei Juan
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiu J Ho
- Institute of Biomedical Informatics, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Ling Chang
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Ying Wu
- Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Biomedical Informatics, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Division of Translational Research and Center of Excellence for Cancer Research, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Public Health, China Medical University, Taichung, Taiwan.,National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan.,Taiwan Microbiota Consortium, Taipei, Taiwan
| | - Yi-Ju Chen
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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Choi KW, Kim Y, Fava M, Mischoulon D, Na EJ, Kim SW, Shin MH, Chung MK, Jeon HJ. Increased Morbidity of Major Depressive Disorder After Thyroidectomy: A Nationwide Population-Based Study in South Korea. Thyroid 2019; 29:1713-1722. [PMID: 31422760 DOI: 10.1089/thy.2019.0091] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: The number of thyroidectomies in South Korea has been increasing rapidly due to extensive checkups for thyroid cancer. However, few studies have examined the association between thyroidectomy and major depressive disorder (MDD). We investigated the association between thyroidectomy and the risk of MDD. Methods: A population-based electronic medical records database from South Korea was used to identify 187,176 individuals who underwent partial or total thyroidectomy between 2009 and 2016. A self-controlled case series design and Cox regression analyses were used to identify risk factors for MDD. Results: Among the 187,176 individuals who underwent thyroidectomy, 16,744 (8.9%) were diagnosed with MDD during the observation period. Of those, 3837 (22.9%) underwent partial thyroidectomy and 12,907 (77.1%) underwent total thyroidectomy. An elevated MDD risk was found during the one-year period before thyroidectomy, with incidence rate ratios (IRRs) of 1.29 ([95% confidence interval [CI] 1.18-1.41], p < 0.0001) for subjects with partial thyroidectomy and 1.27 ([95% CI 1.21-1.33], p < 0.0001) for subjects with total thyroidectomy. After total thyroidectomy, the IRR increased for 31-60 days (IRR 1.81; [95% CI 1.59-2.06], p < 0.0001) and remained elevated for up to 540 days, whereas after partial thyroidectomy, the IRR increased for 31-60 days (IRR 1.68; [95% CI 1.32-2.13], p < 0.0001) but returned to baseline levels after 270 days. Total thyroidectomy was associated with a prolonged risk of MDD compared with partial thyroidectomy in patients with cancer, which was different from the results in patients without cancer. Conclusion: The incidence of MDD increased in the period immediately after thyroidectomy and remained high for one to two years. This study highlights the importance of relatively long-term regular psychiatric assessments in patients who undergo partial or total thyroidectomy.
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Affiliation(s)
- Kwan Woo Choi
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yuwon Kim
- Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine Seoul, South Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eun Jin Na
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Korean Psychological Autopsy Center (KPAC), Seoul, Korea
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung-Hee Shin
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine Seoul, South Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Korean Psychological Autopsy Center (KPAC), Seoul, Korea
- Department of Health Sciences & Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Medical Device Management & Research, and Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
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Lin TL, Wu CY, Chang YT, Juan CK, Chen CC, Yu SH, Chen YJ. Risk of skin cancer in psoriasis patients receiving long-term narrowband ultraviolet phototherapy: Results from a Taiwanese population-based cohort study. Photodermatol Photoimmunol Photomed 2019; 35:164-171. [PMID: 30536640 DOI: 10.1111/phpp.12443] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/22/2018] [Accepted: 11/29/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Narrowband ultraviolet B (NB-UVB) phototherapy is a widely used treatment for various dermatoses. The risk of skin cancer following long-term NB-UVB phototherapy has rarely been explored in skin phototypes III-V. METHODS We conducted a nationwide-matched cohort study and identified a total of 22 891 psoriasis patients starting NB-UVB phototherapy from the Taiwan National Health Insurance Database during the period 2000-2013. Cumulative incidences of skin cancers were compared between subjects receiving less than 90 UVB treatments (S-cohort, N = 13 260) and age- as well as propensity score-matched subjects receiving more than or equal to 90 UVB treatments (L-cohort, N = 3315). RESULTS There were no significant differences in the overall cumulative incidences of skin cancers between the two cohorts (log-rank t test, P = 0.691) during the follow-up periods. The S-cohort had a significantly lower prevalence of actinic keratosis when compared with the L-cohort (0.54% vs 1.00%, P = 0.005). CONCLUSION Long-term NB-UVB phototherapy does not increase skin cancer risk compared with short-term NB-UVB phototherapy in psoriasis patients with skin phototypes III-V.
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Affiliation(s)
- Teng-Li Lin
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Ying Wu
- Faculty of Medicine and Graduate Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Translational Research, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Public Health and Graduate Institute of Clinical Medical Sciences, China Medical University, Taichung, Taiwan
| | - Yun-Ting Chang
- Faculty of Medicine and Graduate Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chao-Keui Juan
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chi-Chiang Chen
- Faculty of Medicine and Graduate Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shi-Hang Yu
- Division of Translational Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Ju Chen
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine and Graduate Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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Hallager S, Lundh A, Ladelund S, Gerstoft J, Laursen AL, Clausen MR, Balslev U, Weis N. The Prevalence of Human Immunodeficiency Virus Coinfection Among Patients Newly Diagnosed With Chronic Hepatitis B or C in Denmark: A Nationwide Cohort Study. Open Forum Infect Dis 2018; 5:ofy310. [PMID: 30581882 PMCID: PMC6297860 DOI: 10.1093/ofid/ofy310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/17/2018] [Indexed: 01/26/2023] Open
Abstract
Background Early identification of patients with chronic viral hepatitis coinfected with human immunodeficiency virus (HIV) is essential for optimal care. The objectives of this study were to estimate the prevalence of HIV coinfection among patients newly diagnosed with chronic viral hepatitis, HIV testing prevalence, and identify factors associated with coinfection. Methods Patients with chronic viral hepatitis newly enrolled in The Danish Database for Hepatitis B and C between 2002 and 2015 were identified. The HIV coinfection prevalence was calculated, and risk factors associated with HIV coinfection were estimated by logistic regression. Results In total, 8490 patients were included: 3091 had chronic hepatitis B (CHB), 5305 had chronic hepatitis C (CHC), and 94 had CHB and CHC. The prevalence of HIV coinfection was 4.4% (95% confidence interval [CI], 4.0–4.9) and was higher among CHC and CHB-CHC patients than CHB patients with a prevalence of 5.3% (95% CI, 4.7–5.9), 6.4% (95% CI, 2.4–13.4), and 2.9 (95% CI, 2.3–3.5), respectively (P < .0001). The HIV testing prevalence increased from 65% to 88% between 2002 and 2014 concurrently with a decrease in the HIV coinfection prevalence from 7.8% (95% CI, 5.5–10.7) to 1.6% (95% CI, 0.7–3.2). Age 35–50 years, male sex, and sexual route of viral hepatitis transmission were associated with HIV coinfection with odds ratios of 4.42 (95% CI, 1.40–13.94), 2.21 (95% CI, 1.74–2.81), and 8.81 (95% CI, 6.30–12.33), respectively. Conclusions The prevalence of HIV coinfection among patients with newly diagnosed chronic viral hepatitis decreased concurrently with an increase in HIV testing prevalence.
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Affiliation(s)
- Sofie Hallager
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Andreas Lundh
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.,Centre for Evidence-Based Medicine Odense (CEBMO) and Odense Patient Data Exploratory Network (OPEN), Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Steen Ladelund
- Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Alex Lund Laursen
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
| | - Mette Rye Clausen
- Department of Hepatology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ulla Balslev
- Department of Infectious Diseases, Copenhagen University Hospital, Herlev, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Denmark
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Abstract
OBJECTIVE Most patients with uraemia must undergo chronic dialysis while awaiting kidney transplantation; however, the role of the pretransplant dialysis modality on the outcomes of kidney transplantation remains obscure. The objective of this study was to clarify the associations between the pretransplant dialysis modality, namely haemodialysis (HD) or peritoneal dialysis (PD), and the development of post-transplant de novo diseases, allograft failure and all-cause mortality for kidney-transplant recipients. DESIGN Retrospective nationwide cohort study. SETTING Data retrieved from the Taiwan National Health Insurance Research Database. PARTICIPANTS The National Health Insurance database was explored for patients who received kidney transplantation in Taiwan during 1998-2011 and underwent dialysis >90 days before transplantation. OUTCOME MEASURES The pretransplant characteristics, complications during kidney transplantation and post-transplant outcomes were statistically analysed and compared between the HD and PD groups. Cox regression analysis was used to evaluate the HR of the dialysis modality on graft failure and all-cause mortality. The primary outcomes were long-term post-transplant death-censored allograft failure and all-cause mortality started after 90 days of kidney transplantation until the end of follow-up. The secondary outcomes were events during kidney transplantation and post-transplant de novo diseases adjusted by propensity score in log-binomial model. RESULTS There were 1812 patients included in our cohort, among which 1209 (66.7%) and 603 (33.3%) recipients received pretransplant HD and PD, respectively. Recipients with chronic HD were generally older and male, had higher risks of developing post-transplant de novo ischaemic heart disease, tuberculosis and hepatitis C after adjustment. Pretransplant HD contributed to higher graft failure in the multivariate analysis (HR 1.38, p<0.05) after adjustment for the recipient age, sex, duration of dialysis and pretransplant diseases. There was no significant between-group difference in overall survival. CONCLUSIONS Pretransplant HD contributed to higher risks of death-censored allograft failure after kidney transplantation when compared with PD.
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Affiliation(s)
- Huan-Tang Lin
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Fu-Chao Liu
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jr-Rung Lin
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Clinical Informatics and Medical Statistics Research Center, Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan
| | - See-Tong Pang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Urology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Huang-Ping Yu
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Anesthesiology, Xiamen Changgung Hospital, Taoyuan, Taiwan
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Ma CM, Lin LH, Chang HY, Chou PC, Liao PC, Chen HY, Man KM, Chiang JH, Chang YJ, Tsai MY, Chen WC, Chen YH. Association of congenital anomalies with fracture of spine, trunk, and upper and lower limbs among young people: A population-based matched cohort study in Taiwan. Medicine (Baltimore) 2017; 96:e7980. [PMID: 28885353 PMCID: PMC6392606 DOI: 10.1097/md.0000000000007980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
According to the Traditional Chinese Medicine (TCM) theory, congenital anomalies are caused by kidney malfunctions, which decreased the bone quality, and may eventually result in bone fractures. This retrospective cohort study investigated the relationship between congenital anomalies and fracture of spine, trunk, and upper and lower limbs in young people. We utilized data from the National Health Insurance Research Database of Taiwan. This study included patients with congenital anomalies (International Classification of Diseases/ICD-9 code: 740-759) and a comparison group of patients without congenital anomalies. Cases evaluated were fracture of spine and trunk (ICD-9 codes: 805-809), fracture of upper limbs (ICD-9 codes: 810-819), and fracture of lower limbs (ICD-9 codes: 820-829). Our study shows that in comparison to the control group, patients with congenital anomalies are 1.11 times more likely to develop fractures. This is the first documented research study that supports the TCM theory that "the Kidney governs the bones, and healthy bones give the body stabilization and prevent fracture."
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Affiliation(s)
- Chia-Man Ma
- Department of Dermatology, Department of Urology, Taichung Veterans General Hospital, Taichung
| | - Lih-Hwa Lin
- Division of Chinese Medicine, An Nan Hospital, China Medical University, Tainan
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, Research Center for Chinese Medicine & Acupuncture, College of Medicine, China Medical University, Taichung
| | - Hsing-Yi Chang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli
| | - Pei-Chi Chou
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, Research Center for Chinese Medicine & Acupuncture, College of Medicine, China Medical University, Taichung
- Departments of Chinese Medicine, Obstetrics and Gynecology, Anesthesiology, Urology, and Medical Research, Management Office for Health Data, China Medical University Hospital, Taichung
| | - Po-Chi Liao
- Department of Dermatology, Department of Urology, Taichung Veterans General Hospital, Taichung
| | - Huey-Yi Chen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, Research Center for Chinese Medicine & Acupuncture, College of Medicine, China Medical University, Taichung
- Departments of Chinese Medicine, Obstetrics and Gynecology, Anesthesiology, Urology, and Medical Research, Management Office for Health Data, China Medical University Hospital, Taichung
| | - Kee-Ming Man
- Departments of Chinese Medicine, Obstetrics and Gynecology, Anesthesiology, Urology, and Medical Research, Management Office for Health Data, China Medical University Hospital, Taichung
- Department of Medicinal Botanicals and Health Applications, Da-Yeh University, Changhua
| | - Jen-Huai Chiang
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, Research Center for Chinese Medicine & Acupuncture, College of Medicine, China Medical University, Taichung
- Departments of Chinese Medicine, Obstetrics and Gynecology, Anesthesiology, Urology, and Medical Research, Management Office for Health Data, China Medical University Hospital, Taichung
| | - Yin-Jen Chang
- Departments of Chinese Medicine, Obstetrics and Gynecology, Anesthesiology, Urology, and Medical Research, Management Office for Health Data, China Medical University Hospital, Taichung
| | - Ming-Yen Tsai
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, Research Center for Chinese Medicine & Acupuncture, College of Medicine, China Medical University, Taichung
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Wen-Chi Chen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, Research Center for Chinese Medicine & Acupuncture, College of Medicine, China Medical University, Taichung
- Departments of Chinese Medicine, Obstetrics and Gynecology, Anesthesiology, Urology, and Medical Research, Management Office for Health Data, China Medical University Hospital, Taichung
| | - Yung-Hsiang Chen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, Research Center for Chinese Medicine & Acupuncture, College of Medicine, China Medical University, Taichung
- Departments of Chinese Medicine, Obstetrics and Gynecology, Anesthesiology, Urology, and Medical Research, Management Office for Health Data, China Medical University Hospital, Taichung
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung , Taiwan
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Yang YS, Kornelius E, Chiou JY, Lai YR, Lo SC, Peng CH, Huang CN. Low-Dose Aspirin Reduces Breast Cancer Risk in Women with Diabetes: A Nationwide Retrospective Cohort Study in Taiwan. J Womens Health (Larchmt) 2017; 26:1278-1284. [PMID: 28537451 DOI: 10.1089/jwh.2016.6040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Low-dose aspirin is commonly used for preventing cardiovascular disease in people with diabetes, but its association with cancer remains controversial. This study used a nationwide population-based reimbursement database to investigate the relationship between low-dose aspirin use and breast cancer incidence in women with diabetes. METHODS This retrospective cohort study was conducted using data retrieved from the National Health Insurance Research Database in Taiwan from January 1, 1998 to December 31, 2011. Women diagnosed as having diabetes with low-dose aspirin use (75-165 mg daily) were identified as the study population, whereas those without low-dose aspirin use were selected as the comparison group. RESULTS We analyzed 148,739 patients with diabetes. Their mean age (standard deviation) was 63.3 (12.8) years. A total of 27,378 patients were taking aspirin. Overall, the use of aspirin in patients with diabetes reduced the risk of breast cancer by 18% (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.71-0.94) after adjustment for potential confounders, namely age and comorbidities. Specifically, a cumulative dose of aspirin exceeding 88,900 mg was observed to reduce the risk of breast cancer by 47% (HR, 0.53, 95% CI, 0.43-0.67); however, low (<8,600 mg) and medium (8,600-88,900 mg) cumulative doses of aspirin did not reduce the risk of breast cancer. CONCLUSIONS Our findings suggest that a cumulative aspirin dosage of more than 88,900 mg daily was associated with a reduced risk of breast cancer in women with diabetes. However, additional studies are necessary to confirm these findings.
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Affiliation(s)
- Yi-Sun Yang
- 1 Institute of Medicine, School of Medicine, Chung Shan Medical University , Taichung, Taiwan .,2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital , Taichung, Taiwan
| | - Edy Kornelius
- 1 Institute of Medicine, School of Medicine, Chung Shan Medical University , Taichung, Taiwan .,2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital , Taichung, Taiwan
| | - Jeng-Yuan Chiou
- 3 School of Health Policy and Management, Institute of Medicine, Chung Shan Medical University , Taichung, Taiwan
| | - Yung-Rung Lai
- 4 Department of Pharmacy, Chung Shan Medical University Hospital , Taichung, Taiwan
| | - Shih-Chang Lo
- 2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital , Taichung, Taiwan
| | - Chiung-Huei Peng
- 5 Division of Basic Medical Research, Hung Kuang University , Taichung, Taiwan
| | - Chien-Ning Huang
- 1 Institute of Medicine, School of Medicine, Chung Shan Medical University , Taichung, Taiwan .,2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital , Taichung, Taiwan
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Lin LH, Siu JJY, Liao PC, Chiang JH, Chou PC, Chen HY, Ho TJ, Tsai MY, Chen YH, Chen WC. Association of chronic obstructive pulmonary disease and hemorrhoids: A nationwide cohort study. Medicine (Baltimore) 2017; 96:e6281. [PMID: 28272246 PMCID: PMC5348194 DOI: 10.1097/md.0000000000006281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
According to traditional Chinese medicine (TCM) theory, a specific physiological and pathological relationship exists between the lungs and the large intestine. The aim of this study is to delineate the association of chronic obstructive pulmonary disease (COPD) and hemorrhoids in order to verify the "interior-exterior" relationship between the lungs and the large intestine. A retrospective cohort study is conceived from the National Health Insurance Research Database, Taiwan. The 2 samples (COPD cohort and non-COPD cohort) were selected from the 2000 to 2003 beneficiaries of the NHI, representing patients age 20 and older in Taiwan, with the follow-up ending on December 31, 2011. The COPD cohort (n = 51,506) includes every patient newly diagnosed as having Chronic Obstructive Pulmonary Disease (COPD, ICD-9-CM: 490-492, 494, 496), who have made at least 2 confirmed visits to the hospital/clinic. The non-COPD cohort (n = 103,012) includes patients without COPD and is selected via a 1:2 (COPD: non-COPD) matching by age group (per 5 years), gender, and index date (diagnosis date of COPD for the COPD cohort). Compared with non-COPD cohorts, patients with COPD have a higher likelihood of having hemorrhoids and the age-, gender- and comorbidies-adjusted hazard ratio (HR) for hemorrhoids is 1.56 (95% confidence intervals [CI]:1.50-1.62). The adjusted HR of hemorrhoids for females is 0.79 (95% CI: 0.77-0.83), which is significantly less than that for males. The elderly groups, 40 to 59 years and aged 60 or above, have higher adjusted HRs than younger age groups (20-39 years), 1.19 (95% CI: 1.14-1.26), and 1.18 (95% CI: 1.12-1.24), respectively. Patients with COPD may have a higher likelihood to have hemorrhoids in this retrospective cohort study. This study verifies the fundamental theorem of TCM that there is a definite pathogenic association between the lungs and large intestine.
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Affiliation(s)
- Lih-Hwa Lin
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Division of Chinese Medicine, An Nan Hospital, China Medical University, Tainan
| | - Justin Ji-Yuen Siu
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Departments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital
| | - Po-Chi Liao
- Department of Urology, Taichung Veterans General Hospital
| | - Jen-Huai Chiang
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Departments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital
| | - Pei-Chi Chou
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Departments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital
| | - Huey-Yi Chen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Departments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital
| | - Tsung-Jung Ho
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Division of Chinese Medicine, An Nan Hospital, China Medical University, Tainan
- Division of Chinese Medicine, China Medical University Beigang Hospital, Yunlin
| | - Ming-Yen Tsai
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yung-Hsiang Chen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Departments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung
| | - Wen-Chi Chen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Departments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital
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Abstract
OBJECTIVES Isolated minor rib fractures (IMRFs) after blunt chest traumas are commonly observed in emergency departments. However, the relationship between IMRFs and subsequent pneumonia remains controversial. This nationwide cohort study investigated the association between IMRFs and the risk of pneumonia in patients with blunt chest traumas. DESIGN Nationwide population-based cohort study. SETTING Patients with IMRFs were identified between 2010 and 2011 from the Taiwan National Health Insurance Research Database. PARTICIPANTS Non-traumatic patients were matched through 1:8 propensity-score matching according to age, sex, and comorbidities (namely diabetes, hypertension, cardiovascular disease, asthma and chronic obstructive pulmonary disease (COPD)) with the comparison cohort. We estimated the adjusted HRs (aHRs) by using the Cox proportional hazard model. A total of 709 patients with IMRFs and 5672 non-traumatic patients were included. MAIN OUTCOME MEASURE The primary end point was the occurrence of pneumonia within 30 days. RESULTS The incidence of pneumonia following IMRFs was 1.6% (11/709). The aHR for the risk of pneumonia after IMRFs was 8.94 (95% CI=3.79 to 21.09, p<0.001). Furthermore, old age (≥65 years; aHR=5.60, 95% CI 1.97 to 15.89, p<0.001) and COPD (aHR=5.41, 95% CI 1.02 to 3.59, p<0.001) were risk factors for pneumonia following IMRFs. In the IMRF group, presence of single or two isolated rib fractures was associated with an increased risk of pneumonia with aHRs of 3.97 (95% CI 1.09 to 14.44, p<0.001) and 17.13 (95% CI 6.66 to 44.04, p<0.001), respectively. CONCLUSIONS Although the incidence of pneumonia following IMRFs is low, patients with two isolated rib fractures were particularly susceptible to pneumonia. Physicians should focus on this complication, particularly in elderly patients and those with COPD.
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Affiliation(s)
- Sai-Wai Ho
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ying-Hock Teng
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Han-Wei Yeh
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ming-Chih Chou
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chao-Bin Yeh
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
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Wu CY, Chang YT, Juan CK, Shieh JJ, Lin YP, Liu HN, Lin JT, Chen YJ. Risk of inflammatory bowel disease in patients with rosacea: Results from a nationwide cohort study in Taiwan. J Am Acad Dermatol 2017; 76:911-7. [PMID: 28073582 DOI: 10.1016/j.jaad.2016.11.065] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 11/23/2016] [Accepted: 11/29/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND A link between rosacea and inflammatory bowel disease (IBD) has been proposed with unknown mechanisms. Epidemiologic evidence of this association needs to be examined. METHODS In this nationwide cohort study, a total of 89,356 patients with rosacea and 178,712 matched patients without rosacea between 1997 and 2013 were identified in the Taiwanese National Health Insurance Research Database. Cumulative incidences of IBD were compared between these 2 cohorts. Frailty Cox proportional hazard model was used and subgroup analyses were conducted to examine the risk factors for IBD. RESULTS The 15-year cumulative incidences of IBD were 0.036% (95% confidence interval [CI] 0.00%-1.57%) and 0.019% (95% CI 0.00%-0.83%) in rosacea and nonrosacea cohorts, respectively (P = .05). Rosacea (adjusted hazard ratio 1.94, 95% CI 1.04-3.63, P = .04) and male gender (adjusted hazard ratio 3.52, 95% CI 2.03-6.11, P < .01) were independently associated with IBD, after adjustment for major comorbidities. Multivariate subgroup analyses revealed consistent results. The incidence rates of IBD decreased with increasing antibiotic use in patients with rosacea, but without statistical significance. LIMITATION Information related to lifestyle, diet, alcohol, and smoking was not included in the database. CONCLUSION Patients with rosacea may have an increased risk of IBD.
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Lee YT, Lee HC, Hu CJ, Huang LK, Chao SP, Lin CP, Su ECY, Lee YC, Chen CC. Periodontitis as a Modifiable Risk Factor for Dementia: A Nationwide Population-Based Cohort Study. J Am Geriatr Soc 2016; 65:301-305. [PMID: 27685603 DOI: 10.1111/jgs.14449] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine whether periodontitis is a modifiable risk factor for dementia. DESIGN Prospective cohort study. SETTING National Health Insurance Research Database in Taiwan. PARTICIPANTS Individuals aged 65 and older with periodontitis (n = 3,028) and an age- and sex-matched control group (n = 3,028). MEASUREMENTS Individuals with periodontitis were compared age- and sex-matched controls with for incidence density and hazard ratio (HR) of new-onset dementia. Periodontitis was defined according to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 523.3-5 diagnosed by dentists. To ensure diagnostic validity, only those who had concurrently received antibiotic therapies, periodontal treatment other than scaling, or scaling more than twice per year performed by certified dentists were included. Dementia was defined according to ICD-9-CM codes 290.0-290.4, 294.1, 331.0-331.2. RESULTS After adjustment for confounding factors, the risk of developing dementia was calculated to be higher for participants with periodontitis (HR = 1.16, 95% confidence interval = 1.01-1.32, P = .03) than for those without. CONCLUSION Periodontitis is associated with greater risk of developing dementia. Periodontal infection is treatable, so it might be a modifiable risk factor for dementia. Clinicians must devote greater attention to this potential association in an effort to develop new preventive and therapeutic strategies for dementia.
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Affiliation(s)
- Yao-Tung Lee
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chaur-Jongh Hu
- Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Brain and Consciousness Research Center, Taipei Medical University, Taipei City, Taiwan
| | - Li-Kai Huang
- Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Brain and Consciousness Research Center, Taipei Medical University, Taipei City, Taiwan
| | - Shu-Ping Chao
- Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Brain and Consciousness Research Center, Taipei Medical University, Taipei City, Taiwan
| | - Chia-Pei Lin
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Emily Chia-Yu Su
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City, Taiwan
| | - Yi-Chen Lee
- Department of Health Administration, Tzu-Chi University of Science and Technology, Hualien, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Liang CM, Hsu CN, Tai WC, Yang SC, Wu CK, Shih CW, Ku MK, Yuan LT, Wang JW, Tseng KL, Sun WC, Hung TH, Nguang SH, Hsu PI, Wu DC, Chuah SK. Risk factors influencing the outcome of peptic ulcer bleeding in chronic kidney disease after initial endoscopic hemostasis: A nationwide cohort study. Medicine (Baltimore) 2016; 95:e4795. [PMID: 27603387 PMCID: PMC5023910 DOI: 10.1097/md.0000000000004795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Patients with chronic kidney disease (CKD) who had peptic ulcer bleeding (PUB) may have more adverse outcomes. This population-based cohort study aimed to identify risk factors that may influence the outcomes of patients with CKD and PUB after initial endoscopic hemostasis. Data from 1997 to 2008 were extracted from the National Health Insurance Research Database in Taiwan. We included a cohort dataset of 1 million randomly selected individuals and a dataset of patients with CKD who were alive in 2008. A total of 18,646 patients with PUB were screened, and 1229 patients admitted for PUB after endoscopic hemostasis were recruited. The subjects were divided into non-CKD (n = 1045) and CKD groups (n = 184). We analyzed the risks of peptic ulcer rebleeding, sepsis events, and mortality among in-hospital patients, and after discharge. Results showed that the rebleeding rates associated with repeat endoscopic therapy (11.96% vs 6.32%, P = 0.0062), death rates (8.7%, vs 2.3%, P < 0.0001), hospitalization cost (US$ 5595±7200 vs US$2408 ± 4703, P < 0.0001), and length of hospital stay (19.6 ± 18.3 vs 11.2 ± 13.1, P < 0.0001) in the CKD group were higher than those in the non-CKD group. The death rate in the CKD group was also higher than that in the non-CKD group after discharge. The independent risk factor for rebleeding during hospitalization was age (odds ratio [OR], 1.02; P = 0.0063), whereas risk factors for death were CKD (OR, 2.37; P = 0.0222), shock (OR, 2.99; P = 0.0098), and endotracheal intubation (OR, 5.31; P < 0.0001). The hazard ratio of rebleeding risk for aspirin users after discharge over a 10-year follow-up period was 0.68 (95% confidence interval [CI]: 0.45-0.95, P = 0.0223). On the other hand, old age (P < 0.0001), CKD (P = 0.0090), diabetes (P = 0.0470), and congestive heart failure (P = 0.0013) were the independent risk factors for death after discharge. In-hospital patients with CKD and PUB after endoscopic therapy had higher recurrent bleeding, infection, and mortality rates, and the need for second endoscopic therapy. Age was the independent risk factor for recurrent bleeding during hospitalization. After being discharged with a 10-year follow-up period, nonaspirin user was a significant factor for recurrent bleeding.
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Affiliation(s)
- Chih-Ming Liang
- Division of Hepatogastroenterology, Department of Internal Medicine
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Gang Gung Memorial Hospital, Kaohsiung
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung
| | - Wei-Chen Tai
- Division of Hepatogastroenterology, Department of Internal Medicine
- Chang Gung University, College of Medicine, Kaohsiung
| | - Shih-Cheng Yang
- Division of Hepatogastroenterology, Department of Internal Medicine
| | - Cheng-Kun Wu
- Division of Hepatogastroenterology, Department of Internal Medicine
| | - Chih-Wei Shih
- Division of Hepatogastroenterology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi
| | - Ming-Kun Ku
- Division of Gastroenterology, Fu-Ying University Hospital, Pin-Tung
| | - Lan-Ting Yuan
- Divisions of Gastroenterology, Yuan General Hospital, Kaohsiung
| | - Jiunn-Wei Wang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, and Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
| | - Kuo-Lun Tseng
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, and Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
| | - Wei-Chih Sun
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Kaohsiung
| | - Tsung-Hsing Hung
- Division of Gastroenterology; Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
| | - Seng-Howe Nguang
- Division of Gastroenterology; Pin-Tung Christian Hospital, Pin-Tung, Taiwan
| | - Pin-I Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Kaohsiung
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, and Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
- Correspondence: Seng-Kee Chuah and Deng-Chyang Wu, Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung 833, Taiwan (e-mails: and )
| | - Seng-Kee Chuah
- Division of Hepatogastroenterology, Department of Internal Medicine
- Chang Gung University, College of Medicine, Kaohsiung
- Correspondence: Seng-Kee Chuah and Deng-Chyang Wu, Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung 833, Taiwan (e-mails: and )
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Thiel GT, Nolte C, Tsinalis D, Steiger J, Bachmann LM. Investigating kidney donation as a risk factor for hypertension and microalbuminuria: findings from the Swiss prospective follow-up of living kidney donors. BMJ Open 2016; 6:e010869. [PMID: 27006347 PMCID: PMC4809071 DOI: 10.1136/bmjopen-2015-010869] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess the role of nephrectomy as a risk factor for the development of hypertension and microalbuminuria. DESIGN Prospective, long-term follow-up study. SETTING Swiss Organ Living-Donor Health Registry. PARTICIPANTS All living kidney donors in Switzerland between 1993 and 2009. INTERVENTIONS Data on health status and renal function before 1 year and biennially after donation were collected. PRIMARY AND SECONDARY OUTCOME MEASURES Comparison of 1-year and 5-year occurrences of hypertension among normotensive donors with 1-year and 5-year estimates from the Framingham hypertension risk score. Multivariate random intercept models were used to investigate changes of albumin excretion after donation, correcting for repeated measurements and cofactors such as age, male gender and body mass index. RESULTS A total of 1214 donors contributed 3918 data entries with a completed biennial follow-up rate of 74% during a 10-year period. Mean (SD) follow-up of donors was 31.6 months (34.4). Median age at donation was 50.5 years (IQR 42.2-58.8); 806 donors (66.4%) were women. Donation increased the risk of hypertension after 1 year by 3.64 (95% CI 3.52 to 3.76; p<0.001). Those participants remaining normotensive 1 year after donation return to a risk similar to that of the healthy Framingham population. Microalbuminuria before donation was dependent on donor age but not on the presence of hypertension. After nephrectomy, hypertension became the main driver for changes in albumin excretion (OR 1.19; 95% CI 0.13 to 2.25; p=0.03) and donor age had no effect. CONCLUSIONS Nephrectomy propagates hypertension and increases susceptibility for the development of hypertension-induced microalbuminuria.
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Affiliation(s)
- Gilbert T Thiel
- SOL-DHR (Swiss Organ Living Donor Health Registry), University Hospital in Basel, Switzerland, Basel, Switzerland
| | - Christa Nolte
- SOL-DHR (Swiss Organ Living Donor Health Registry), University Hospital in Basel, Switzerland, Basel, Switzerland
| | - Dimitrios Tsinalis
- SOL-DHR (Division of Nephrology, Kantonsspital St Gallen, Switzerland),St Gallen, Switzerland
| | - Jürg Steiger
- SOL-DHR (Swiss Organ Living Donor Health Registry), University Hospital in Basel, Switzerland, Basel, Switzerland
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Tsai MS, Lee PH, Lin CL, Peng CL, Kao CH. Type II diabetes mellitus is associated with a reduced risk of cholangiocarcinoma in patients with biliary tract diseases. Int J Cancer 2014; 136:2409-17. [PMID: 25348605 DOI: 10.1002/ijc.29292] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/20/2014] [Indexed: 12/15/2022]
Abstract
It has not yet been reported whether Type II diabetes mellitus (DM) is associated with an increased cholangiocarcinoma (CC) risk in patients with biliary tract diseases. We identified 123,050 patients concomitantly diagnosed with biliary tract diseases and DM between 1998 and 2010. The control cohort consisted of 122,721 individuals with biliary tract diseases but not DM. Both cohorts were followed-up until the end of 2010 to estimate the risk of CC. We also compared the risk of CC between DM and non-DM cohorts without biliary tract diseases. Overall, the incidence of CC was 21% lower among the DM patients than among the control patients (1.11 vs. 1.41 per 1,000 person-years). DM cohorts exhibited significantly reduced risks for both intrahepatic and extrahepatic CC. A multivariable Cox proportional hazards regression model was used, and the adjusted hazard ratio (HR) of CC was 0.74 (95% confidence interval [CI], 0.66-0.82) for the DM cohort in comparison with the control cohort. The age-specific data indicated that compared with the control patients, the adjusted HRs for the DM patients were significantly lower among patients 50-64 (adjusted HR = 0.67; 95% CI = 0.55-0.82) and 65-74 years old (adjusted HR = 0.70; 95% CI, 0.59-0.84). Furthermore, DM was associated with a lower risk of CC among patients with biliary diseases, regardless of the presence of comorbidities and the status of cholecystectomy. In the patients without biliary tract diseases, DM is associated with significantly increased risk of CC (adjusted HR = 1.58; 95% CI, 1.37-1.82).
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Affiliation(s)
- Ming-Shian Tsai
- Department of General Surgery, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
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Chung WS, Lin CL, Sung FC, Hsu WH, Yang WT, Lu CC, Kao CH. Systemic sclerosis increases the risks of deep vein thrombosis and pulmonary thromboembolism: a nationwide cohort study. Rheumatology (Oxford) 2014; 53:1639-45. [PMID: 24717920 DOI: 10.1093/rheumatology/keu133] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Few Asian studies have evaluated the risks of deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) in patients with SSc. We conducted a nationwide population-based cohort study to evaluate how SSc affected the incidence of DVT and PTE in Taiwan. METHODS We identified patients with an SSc diagnosis in Taiwan between 1998 and 2010 using the Catastrophic Illness Patient Database and the National Health Insurance Research Database. Each SSc patient was frequency matched to four control patients based on age, sex and index year and all patients were observed from the index date until the appearance of a DVT or PTE event or 31 December 2010. We calculated the hazard ratios and 95% CIs of DVT and PTE in the SSc and comparison cohorts using the Cox proportional hazards regression model. RESULTS We observed 1895 SSc patients and 7580 control patients for ∼10,128 and 46,488 person-years, respectively. The mean ages of the SSc and comparison cohorts were 50.3 and 49.9 years, respectively. After adjusting for age, sex and co-morbidities, the risks of DVT and PTE among the SSc patients were 10.5- and 7.00-fold higher than those of the control patients. The probability of developing DVT and PTE increased in the years following the SSc diagnosis. CONCLUSION SSc patients exhibited a significantly higher risk of developing DVT and PTE compared with the general population. Thus multidisciplinary teams should guide the assessment, treatment and holistic care of SSc patients.
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Affiliation(s)
- Wei-Sheng Chung
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - Wu-Huei Hsu
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Ta Yang
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - Chuan-Chin Lu
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
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Abstract
The cariostatic benefit from water fluoridation is indisputable, but the knowledge of possible adverse effects on bone and fracture risk due to fluoride exposure is ambiguous. The association between long-term (chronic) drinking water fluoride exposure and hip fracture (ICD-7-9: '820' and ICD-10: 'S72.0-S72.2') was assessed in Sweden using nationwide registers. All individuals born in Sweden between January 1, 1900 and December 31, 1919, alive and living in their municipality of birth at the time of start of follow-up, were eligible for this study. Information on the study population (n = 473,277) was linked among the Swedish National In-Patient Register (IPR), the Swedish Cause of Death Register, and the Register of Population and Population Changes. Estimated individual drinking water fluoride exposure was stratified into 4 categories: very low, < 0.3 mg/L; low, 0.3 to 0.69 mg/L; medium, 0.7 to 1.49 mg/L; and high, ≥ 1.5 mg/L. Overall, we found no association between chronic fluoride exposure and the occurrence of hip fracture. The risk estimates did not change in analyses restricted to only low-trauma osteoporotic hip fractures. Chronic fluoride exposure from drinking water does not seem to have any important effects on the risk of hip fracture, in the investigated exposure range.
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Affiliation(s)
- P Näsman
- Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital, Solna, Sweden
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