Incidence of renal and perinephric abscess in diabetic patients: a population-based national study

SUMMARYThis population-based cohort study aimed to investigate the incidence and relative hazard of renal and perinephric abscess (RA) in the diabetic population in Taiwan. More than a half million diabetic patients and sex- and age-matched controls were identified from the 1997 Taiwan National Health Insurance data and were linked to in-patient claims from 1997 to 2007. Person-year approach with Poisson assumption was used to estimate the incidence density (ID) of RA. The hazard ratios (HRs) of hospitalization due to RA in relation to diabetes were analysed using a Cox proportional hazard model. The ID for the diabetic and control subjects was 4·6 and 1·1/10 000 person-years, respectively, in 11 years of follow-up, representing an adjusted HR of 3·81 (95% confidence interval 3·44–4·23). This study confirmed the association of diabetes with RA, and argued that more aggressive urological care should be administered to diabetic patients.

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Risk of Endometriosis and Subsequent Ovary and Breast Cancers in Nurses: A Population-Based Cohort Study in Taiwan

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16183469 ◽

2019 ◽

Vol 16 (18) ◽

pp. 3469 ◽

Cited By ~ 4

Author(s):

Hsing-Chi Hsu ◽

Kai-Yu Tseng ◽

Hsiang-Chi Wang ◽

Fung-Chan Sung ◽

Wei-Fen Ma

Keyword(s):

Breast Cancer ◽

Ovarian Cancer ◽

Subsequent Development ◽

Population Based ◽

Research Database ◽

Breast Cancers ◽

Hazard Ratios ◽

Taiwan National Health Insurance ◽

And Control ◽

Incident Cases

Background: Endometriosis has been associated with the subsequent development of ovarian and breast cancers. This study evaluated whether nurses were at increased risks of developing endometriosis and subsequent ovarian and breast cancers. Methods: From Taiwan National Health Insurance Research Database during 2000 to 2011, we established 3 study cohorts, consisting of 23,801 nurses, 11,973 other hospital employees, and 143,096 general women free of endometriosis and cancer. Women in all cohorts were followed to the end of 2011 to measure the occurrences of endometriosis and subsequent ovarian and breast cancers. The incident endometriosis cases and related hazard ratio (HR) and 95% confidence interval (CI) were calculated. The incident cases of ovarian cancer and breast cancer and related odds ratio were calculated. Results: The incidence of endometriosis was the highest in the nurse cohort (4.23 per 100, n = 966) followed by other health professionals (3.74 per 100, n = 427) and control cohort (3.06 per 100, n = 4193), with adjusted hazard ratios of 1.28 (95% CI = 1.20–1.38) and 1.13 (95% CI = 1.02–1.25), respectively, comparing to controls. Among those who developed endometriosis, nurses had higher subsequent ovarian cancer and lower breast cancer, but not significant. Conclusions: Nurses are at a higher risk of developing endometriosis. However, the link between endometriosis and subsequent cancers is weak.

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Population-Based Cohort Study Reveals Distinct Associations Between Female Lung Cancer and Breast Cancer in Taiwan

JCO Clinical Cancer Informatics ◽

10.1200/cci.18.00065 ◽

2018 ◽

pp. 1-14

Author(s):

Emily Pei-Ying Lin ◽

Ching-Heng Lin ◽

Ching-Yao Yang ◽

Tzu-Pin Lu ◽

Shih-Ni Chang ◽

...

Keyword(s):

Breast Cancer ◽

Lung Cancer ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

University Hospital ◽

Health Insurance Data ◽

Increased Risk ◽

Genomic Studies ◽

Taiwan National Health Insurance

Purpose Associations between Asian lung cancer (LC) and breast cancer (BC) are unknown. This study evaluates associations between LC and BC in the Taiwan population. Methods This study was based on the Taiwan National Health Insurance data and Taiwan Cancer Registry. The cohorts included women with newly diagnosed LC or BC between 2000 and 2011 and an age- and sex-stratified random sample as a noncancer comparison cohort during the same period. Cox proportional hazards regression analysis was used to determine the risks. The National Taiwan University Hospital (NTUH) cohort, which comprised patients with confirmed pathology diagnoses of double BC/LC, was reviewed. Results In 32,824 women with LC, there were increased risks for synchronous BC in patients younger than age 50 years (hazard ratio, 5.80; 95% CI, 1.83 to 18.73), age 50 to 59 years (HR, 2.37; 95% CI, 1.02 to 5.54), and age 60 to 69 years (HR, 4.42; 95% CI, 1.91 to 10.2). In the 88,446 women with BC, there were increased risks for synchronous LC in patients age 40 to 59 years (HR, 5.86; 95% CI, 3.05 to 11.3) and older than 60 years (HR, 1.98; 95% CI, 1.04 to 3.77). In the 128-patient NTUH double LC/BC cohort, 77 (60%) had both cancers diagnosed within 5 years of each other. Conclusion LC is associated with an increased risk for synchronous BC in Taiwan and vice versa. Radiotherapy might not be a major risk factor for LC in BC survivors. Etiology for double LC/BC deserves additional exploration and cross-racial genomic studies.

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Association of Neovascular Glaucoma with Risk of Stroke: A Population-Based Cohort Study

Journal of Ophthalmology ◽

10.1155/2017/1851568 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Cheng-Wen Su ◽

Yue-Cune Chang ◽

Cheng-Li Lin ◽

Hsin-Yi Chen

Keyword(s):

Ischemic Stroke ◽

Hemorrhagic Stroke ◽

Cox Regression ◽

Neovascular Glaucoma ◽

Population Based ◽

Incidence Density ◽

Cerebrovascular Accidents ◽

Nationally Representative ◽

And Control ◽

The Relationship

Neovascular glaucoma (NVG), caused by ocular ischemia, is a serious ocular disease complicated by intractably increased intraocular pressure. Cerebrovascular accidents are classified into ischemic and hemorrhagic stroke. Based on the similar pathogenic mechanisms of NVG and ischemic stroke, we investigated the relationship between NVG and stroke by using a nationally representative sample. This study included 416 NVG patients and 4160 controls. Medical comorbidities were also evaluated. The cumulative incidence of ischemic stroke was 15.6% higher in the NVG cohort than in the control cohort (p<0.001); the incidence density rates of stroke were 3.80 and 1.19 per 10,000 person-years in the NVG and control cohorts, respectively. According to the multivariable Cox regression results, the estimated adjusted hazard ratio (aHR) of stroke was 2.07 (95% confidence interval (CI) = 1.41–3.02) for the NVG cohort. Furthermore, the NVG cohort was 2.24-fold more likely to develop ischemic stroke (95% CI = 1.51–3.32). The risk of ischemic stroke was higher in patients with hypertension (aHR = 2.09, 95% CI = 1.55–2.82) and in patients with diabetic retinopathy (aHR = 1.69, 95% CI = 1.05–2.72). Notably, patients with NVG have a higher risk of ischemic stroke, but not hemorrhagic stroke.

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The Temporal Relationship between Selected Mental Disorders and Substance-Related Disorders: A Nationwide Population-Based Cohort Study

Psychiatry Journal ◽

10.1155/2018/5697103 ◽

2018 ◽

Vol 2018 ◽

pp. 1-12 ◽

Cited By ~ 2

Author(s):

Mu-Lin Chiu ◽

Chi-Fung Cheng ◽

Wen-Miin Liang ◽

Pen-Tang Lin ◽

Trong-Neng Wu ◽

...

Keyword(s):

Mental Disorders ◽

Personality Disorders ◽

Large Scale ◽

Later Life ◽

Population Based ◽

Research Database ◽

Kaplan Meier ◽

Hazard Ratios ◽

Taiwan National Health Insurance ◽

Substance Related Disorders

Introduction. Previous studies have examined the association between specific mental disorders, particularly mood and anxiety disorders, and substance-related disorders; but the temporal link between them remains unclear. This study aimed to examine whether individuals with specific mental disorders, including affective psychoses, neurotic disorders, schizophrenia, personality disorders, and adjustment reaction, have higher risks for subsequently developing substance-related disorders compared to those without. Methods. A large-scale study with longitudinal data was conducted using the Taiwan National Health Insurance Research Database (NHIRD) consisting of 2,000,118 patients’ medical records from 2000 to 2009. A total of 124,423 people diagnosed with selected mental disorders and the same number of people without the diagnoses of the selected disorders were identified between January 1, 2001, and December 31, 2006, and followed up for the diagnoses of substance-related disorders till the end of 2009. We estimated the risk for subsequently developing substance-related disorders among patients with the selected mental disorders compared to those without by using Cox proportional hazard models. The cumulative incidence of substance-related disorders was calculated using the Kaplan-Meier method. Results. The risk for developing substance-related disorders in patients with selected mental disorders is about 5 times (HR=5.09, 95% CI: 4.74-5.48) higher than those without after adjusting for potential confounding variables. From the multivariate analyses of subsamples stratified by age, sex, and urban and income levels, we found all adjusted hazard ratios were significantly higher than 1.0, ranging from 2.12 (95% CI: 1.72-2.62) to 14.55 (95% CI: 7.89-26.83). For children and adolescents aged 10-19 years, those with specific mental disorders had 14.55-fold higher risk for developing substance-related disorders in later life compared to their counterparts. Furthermore, patients with personality disorders had the highest risk (HR=25.05). Conclusions. The earlier onset of the selected mental disorders is a potential risk for developing substance-related disorders in later life, particularly for personality disorders. Health professionals should pay more attention to this at-risk population, especially to adolescents with mental disorders.

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Subclinical Diastolic Dysfunction in Diabetic Population

Macedonian Medical Review ◽

10.1515/mmr-2016-0026 ◽

2016 ◽

Vol 70 (3) ◽

pp. 140-144

Author(s):

Slavica Mitrovska

Keyword(s):

Diastolic Dysfunction ◽

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Doppler Imaging ◽

Control Group ◽

Diabetic Patients ◽

Significant Difference ◽

Diabetic Population ◽

And Control

Abstract Introduction. Left ventricular dysfunction is very frequent in asymptomatic diabetic population. Tissue Doppler Imaging (TDI) is a new echocardiographic technique, able to record early changes of left ventricular dysfunction and to identify asymptomatic diabetic patients at high risk of developing heart failure. Aim. To assess the role of TDI in early detection of diastolic dysfunction in asymptomatic diabetic patients. Methods. Cross-sectional study that involved a total number of 48 subjects. The target group consisted of 25 asymptomatic diabetic patients and control group was composed of 23 subjects without diabetes. All subjects underwent echocardiography (conventional 2D and Pulsed-Wave Doppler and contemporary-TDI) to analyze left ventricular function. We compared the results from both echo-techniques and analyzed the relation of echo-cardiographic parameters with risk factors. Results. We found statistically significant difference between TDI and PW Doppler (E/E'vs E/A) in target (Z=−3.17, p<0.001) and control group (Z=−2.4, p<0.003). There was no significant difference in E/A between the groups (Z=0.0, p<1.0). TDI identified significantly lower E' (Z= 2.03, p<0.04) and higher E/E' (Z= −2.12, p<0.03) in target vs control group. LVDD strongly correlated with duration of DM (p<0.00001), age (p<0.00001), female gender (p<0.0001) and obesity indices (BMI, BSA) (p<0.00001, p<0.00001) in both groups. Conclusion. TDI unmasks the presence of subclinical LV dysfunction in asymptomatic diabetic patients and has a valuable prognostic importance.

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Primary aldosteronism is associated with risk of urinary bladder stones in a nationwide cohort study

Scientific Reports ◽

10.1038/s41598-021-86749-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Mu-Chi Chung ◽

Cheng-Li Lin ◽

Ming-Ju Wu ◽

Cheng-Hsu Chen ◽

Jeng-Jer Shieh ◽

...

Keyword(s):

Cohort Study ◽

Primary Aldosteronism ◽

Risk Model ◽

Population Based ◽

Bladder Stones ◽

Risk Of Death ◽

Cox Proportional Hazard ◽

Hazard Ratios ◽

Taiwan National Health Insurance ◽

Cox Proportional Hazard Models

AbstractWe analyzed database from the Taiwan National Health Insurance to investigate whether primary aldosteronism (PA) increases the risk of bladder stones. This retrospective nationwide population-based cohort study during the period of 1998–2011 compared patients with and without PA extracted by propensity score matching. Cox proportional hazard models and competing death risk model were used to estimate the hazard ratios (HRs), sub-hazard ratios (SHRs) and corresponding 95% confidence intervals (CIs). There were 3442 patients with PA and 3442 patients without PA. The incidence rate of bladder stones was 5.36 and 3.76 per 1000 person-years for both groups, respectively. In adjusted Cox hazard proportional regression models, the HR of bladder stones was 1.68 (95% CI 1.20–2.34) for patients with PA compared to individuals without PA. Considering the competing risk of death, the SHR of bladder stones still indicates a higher risk for PA than a comparison cohort (SHR, 1.79; 95% CI 1.30–2.44). PA, age, sex, and fracture number were the variables significantly contributing to the formation of bladder stones. In conclusion, PA is significantly associated with risk of bladder stones.

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Efficacy of aspirin, clopidogrel, and ticlopidine in stroke prevention: A population-based case-cohort study in Taiwan

PLoS ONE ◽

10.1371/journal.pone.0242466 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0242466

Author(s):

Yi-Sin Wong ◽

Ching-Fang Tsai ◽

Yueh-Han Hsu ◽

Cheung-Ter Ong

Keyword(s):

Cohort Study ◽

Stroke Prevention ◽

Recurrent Stroke ◽

Population Based ◽

Primary Diagnosis ◽

Antiplatelet Drugs ◽

Study Endpoint ◽

Research Database ◽

Hazard Ratios ◽

Taiwan National Health Insurance

Background In real-world practice settings, there is insufficient evidence on the efficacy of antiplatelet drugs, including clopidogrel, aspirin, and ticlopidine, in stroke prevention. Purpose To compare the efficacies between aspirin and clopidogrel and aspirin and ticlopidine in stroke prevention. Methods This population-based case-cohort study utilized the data obtained from a randomized sample of one million subjects in the Taiwan National Health Insurance Research Database. Patients who were hospitalized owing to the primary diagnosis of ischemic stroke from January 1, 2000 to December 31, 2010 and treated with aspirin, ticlopidine, or clopidogrel were included in the study. Propensity score matching with a 1:4 ratio was performed to compare aspirin with ticlopidine and clopidogrel. The criteria for inclusion were the use of one of the three antiplatelet drugs for more than 14 days within the first month after the stroke and then continued use of the antiplatelet drugs until the study endpoint of recurrent stroke. Results During the 3-year follow-up period, the recurrent stroke rates were 1.62% (42/2585), 1.48% (3/203), and 2.55% (8/314) in the aspirin, ticlopidine, and clopidogrel groups, respectively. Compared with the patients treated with aspirin, those treated with clopidogrel and ticlopidine showed competing risk-adjusted hazard ratios of recurrent stroke of 2.27 (1.02–5.07) and 0.62 (0.08–4.86), respectively. Conclusion Compared with the patients treated with aspirin, those treated with clopidogrel were at a higher risk of recurrent stroke. For stroke prevention, aspirin was superior to clopidogrel whereas ticlopidine was not inferior to aspirin.

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Flavor Disorder Is Associated with Obstructive Sleep Apnea: A Nationwide Population-Based Cohort Study

10.21203/rs.3.rs-138487/v1 ◽

2021 ◽

Author(s):

Chien-Han Tsao ◽

Hsin-Hsin Huang ◽

Yao-Min Hung ◽

Hung ◽

James Cheng-Chung Wei ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Cohort Study ◽

Sleep Apnea ◽

Airway Remodeling ◽

Upper Airway ◽

Population Based ◽

Research Database ◽

Hazard Ratios ◽

Obstructive Sleep ◽

Taiwan National Health Insurance

Abstract Background: Flavor sensation was the joint perception of smell and taste sensation was associated with the pleasure of life. Obstructive sleep apnea (OSA) had been demonstrated the presence of upper airway remodeling which altered sensory and motor function due to hypoxia or snore vibration. This study aims to investigate whether OSA is associated with the risk of flavor disorder (FD). Methods: We conducted a nationwide cohort study using the Taiwan National Health Insurance Research Database, one million subjects were sampled with data collected from 1999 to 2013 and 9,191 identified diagnosed OSA patients were included. Each patient was matched with non-OSA controls from the general population by propensity score matching (1:1) based on age, gender, hypertension, hyperlipidemia, ankylosing spondylitis, and Charlson comorbidity index, 8,037 OSA and an equal number of non-OSA subjects were used to compared in this study. The incidence of FD was assessed at the end of 2013 and cumulative incidences, hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. Results: The adjusted HR (aHR)of FD for the OSA group was 2.082-fold (95% CI = 1.149–3.773, p=0.0155) higher than non-OSA group. The stratified analyses revealed aHR of FD for the hyperlipidemia group was 2.264-fold (95% CI = 1.061–4.832, p=0.035). Subgroup analysis showed the subjected of female OSA had more risk to develop FD (aHR:2.345, 95% CI = 1.026–5.357, p=0.043). Conclusion: A higher risk of developing FD was found among the newly diagnosed OSA cohort during the longer than 10-year follow-up period

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High 1-year risk of stroke in patients with hepatocellular carcinoma: a nationwide registry-based cohort study

Scientific Reports ◽

10.1038/s41598-021-89867-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jin-Yi Hsu ◽

Peter Pin-Sung Liu ◽

An-Bang Liu ◽

Huei-Kai Huang ◽

Ching-Hui Loh

Keyword(s):

Hepatocellular Carcinoma ◽

Cohort Study ◽

Stroke Risk ◽

Population Based ◽

Research Database ◽

Hazard Ratios ◽

Taiwan National Health Insurance ◽

Baseline Characteristics ◽

Coagulation Dysfunction ◽

The Relationship

AbstractPatients with hepatocellular carcinoma (HCC) might be more vulnerable to develop stroke than other cancer patients because of HCC-associated coagulation dysfunction. However, limited studies have investigated the relationship between HCC and stroke. This nationwide population-based cohort study enrolled all patients with HCC diagnosed between 2011 and 2015 from the Taiwan Cancer Registry and Taiwan National Health Insurance Research Database; an age- and sex-matched cohort without cancer was included. The primary outcome was the 1-year risk for first-ever stroke after the index date. The Fine and Gray competing risk regression model was used to estimate the 1-year stroke risk with adjusted hazard ratios (aHRs). After propensity score matching, each cohort has 18,506 patients with similar baseline characteristics. Compared with the cancer-free cohort, the aHRs in the HCC cohort for overall, ischemic, and hemorrhagic strokes were 1.59 [95% confidence interval (CI), 1.35–1.88], 1.38 [95% CI, 1.15–1.65], and 2.62 [95% CI, 1.79–3.84], respectively. On subgroup analysis, HCC patients without cirrhosis, those with stage 3 or 4 cancer had a higher stroke risk than cancer-free cohort. Therefore, stroke prevention should be considered in patients with HCC, especially in those without cirrhosis and with stage 3 or 4 cancer.

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The Interaction of Diabetic Peripheral Neuropathy and Carpal Tunnel Syndrome

Hand ◽

10.1177/15589447211014607 ◽

2021 ◽

pp. 155894472110146

Author(s):

Ushasi Naha ◽

Adam Miller ◽

Michael J. Patetta ◽

Diego M. Barragan Echenique ◽

Alfonso Mejia ◽

...

Keyword(s):

Peripheral Neuropathy ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Diabetic Peripheral Neuropathy ◽

Clinic Visit ◽

Diabetic Patients ◽

Tunnel Syndrome ◽

Diabetic Population ◽

Multivariable Analyses ◽

And Control

Background Diabetes mellitus (DM) increases the risk for carpal tunnel syndrome (CTS) and is associated with its own neuropathic complications. Diabetic peripheral neuropathy (DPN) is a common complication seen in diabetic patients. In this study, we examine the relationship between the severity of DPN and CTS. Methods Type 2 diabetic and control patients (n = 292) were recruited at a clinic visit. The Michigan Neuropathy Screening Instrument (MNSI) questionnaire was used to collect data related to peripheral neuropathy. The MNSI scores were compared for patients with CTS with and without DM in univariable and multivariable analyses. χ2 analyses were performed to quantitatively measure the associations between peripheral neuropathy and the presence of CTS. Results Of the 292 patients, 41 had CTS, and 19 of these had both CTS and DM. Of the 138 diabetic patients, 85 had peripheral neuropathy. There was no association between a diagnosis of CTS and an MNSI score indicative of peripheral neuropathy. In the diabetic population, CTS was inversely associated with DPN ( P = .017). The MNSI scores between diabetic and control patients with CTS were comparable. Conclusion The severity of peripheral neuropathy in diabetic patients with and without CTS is comparable. Diabetic patients without peripheral neuropathy have an association with higher incidence of CTS in this study, suggesting that there are disparate mechanisms causing DPN and CTS. Nevertheless, diabetes and CTS are risk factors for developing the other, and future studies should further explore how DPN and CTS differ to tailor patient interventions based on their comorbidities.

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