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

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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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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Association of Scrub Typhus With the Risk of Autoimmune Diseases: A Population-Based Cohort Study

American Journal of Epidemiology ◽

10.1093/aje/kwz074 ◽

2019 ◽

Vol 188 (7) ◽

pp. 1311-1318 ◽

Cited By ~ 4

Author(s):

Kuo-An Chu ◽

Weishan Chen ◽

Chung Y Hsu ◽

Yao-Min Hung ◽

James Cheng-Chung Wei

Keyword(s):

Autoimmune Diseases ◽

Proportional Hazards ◽

Scrub Typhus ◽

Population Based ◽

Cox Proportional Hazards ◽

Control Group ◽

Research Database ◽

Hazard Ratios ◽

Taiwan National Health Insurance ◽

The Relationship

Abstract Infection plays a major role in the development of autoimmune diseases. In this study, we investigated the relationship between scrub typhus and systemic autoimmune diseases. We enrolled 6,928 hospitalized patients with scrub typhus between 2000 and 2012 from the Taiwan National Health Insurance Research Database, and we compared them with 27,712 selected inpatients who had never been diagnosed with scrub typhus (1:4 ratio, matched by age, sex, and index year) in relation to the risk of developing autoimmune diseases. Cox proportional hazards regression analysis was used to analyze the risk of autoimmune diseases by sex, age, and comorbidities, with hazard ratios and 95% confidence intervals. The adjusted hazard ratio for autoimmune diseases for the scrub typhus group was 2.4 (95% confidence interval: 1.66, 3.48, P < 0.0001) compared with the control group. Subgroup analysis showed that women aged <40 years had a significant higher risk of autoimmune diseases. The risk was significantly higher within 3 years after scrub typhus infection. In conclusion, a higher risk of autoimmune diseases was found among the scrub typhus group, especially for female patients, those aged <40 years, and within the first 3 years after getting scrub typhus.

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Risk of herpes zoster in psoriasis patients receiving systemic therapies: a nationwide population-based cohort study

Scientific Reports ◽

10.1038/s41598-021-91356-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sze-Wen Ting ◽

Sze-Ya Ting ◽

Yu-Sheng Lin ◽

Ming-Shyan Lin ◽

George Kuo

Keyword(s):

Cohort Study ◽

Herpes Zoster ◽

Population Based ◽

Research Database ◽

Newly Diagnosed ◽

Increased Risk ◽

Taiwan National Health Insurance ◽

Reduced Risk ◽

Systemic Therapies

AbstractThe incidence of herpes zoster in psoriasis patients is higher than in the general population. However, the association between herpes zoster risk and different systemic therapies, especially biologic agents, remains controversial. This study investigated the association between herpes zoster risk and several systemic antipsoriasis therapies. This prospective open cohort study was conducted using retrospectively collected data from the Taiwan National Health Insurance Research Database. We included 92,374 patients with newly diagnosed psoriasis between January 1, 2001, and December 31, 2013. The exposure of interest was the “on-treatment” effect of systemic antipsoriasis therapies documented by each person-quarter. The outcome was the occurrence of newly diagnosed herpes zoster. During a mean follow-up of 6.8 years, 4834 (5.2%) patients were diagnosed with herpes zoster after the index date. Among the systemic antipsoriasis therapies, etanercept (hazard ratio [HR] 4.78, 95% confidence interval [CI] 1.51–15.17), adalimumab (HR 5.52, 95% CI 1.72–17.71), and methotrexate plus azathioprine (HR 4.17, 95% CI 1.78–9.82) were significantly associated with an increased risk of herpes zoster. By contrast, phototherapy (HR 0.76, 95% CI 0.60–0.96) and acitretin (HR 0.39, 95% CI 0.24–0.64) were associated with a reduced risk of herpes zoster. Overall, this study identified an association of both etanercept and adalimumab with an increased risk of herpes zoster among psoriasis patients. Acitretin and phototherapy were associated with a reduced risk.

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Association between Anemia and Stroke in Females: A Nationwide, Population-Based Cohort Study in Taiwan

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17207440 ◽

2020 ◽

Vol 17 (20) ◽

pp. 7440

Author(s):

Yuan Sui ◽

Chien-Tai Hong ◽

Li-Nien Chien ◽

Hung-Yi Liu ◽

Hung-Yi Chiou ◽

...

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Ischemic Stroke ◽

Stroke Risk ◽

Medical Condition ◽

Positive Association ◽

Population Based ◽

Reproductive Age ◽

Research Database ◽

Female Patients

Optimal stroke prevention strategies for women should take into account specific sex-related stroke risk factors. Anemia is a common medical condition in females, particularly in women of reproductive age. This study investigated whether anemia is an independent risk factor for stroke in females in a population-based cohort study. We investigated newly diagnosed anemic female patients with no history of central nervous system disease, psychiatric disorders, traumatic brain injury, major operations or hemorrhagic diseases identified from the Taiwan National Health Insurance Research Database. Non-anemic matched controls (1:1) were selected based on a propensity score estimated using a logistic regression model that included demographic characteristics and comorbidities. A competing risk analysis was applied to estimate the stroke risk in anemic patients compared to that of their matched controls. In our study, the adjusted sub-distribution hazard ratios (aSHRs) of overall, hemorrhagic and ischemic stroke in anemic female patients aged <50 years were 1.35 (95% confidence interval (CI): 1.19–1.52, p < 0.001), 1.31 (95% CI, 1.09-1.56, p < 0.003), and 1.35 (95% CI, 1.15–1.58, p < 0.001), respectively, compared to non-anemic female controls. However, a positive association between anemia and stroke was not found for those aged ≥50 years. Similar results were observed when the follow-up age was limited to 50 years to reduce the potential effects of menopause on stroke. In conclusion, the present population-based cohort study found that anemia is a potential risk factor for overall, hemorrhagic and ischemic stroke in females of reproductive age.

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Reduced risk of skin cancer and internal malignancies in vitiligo patients: a retrospective population-based cohort study in Taiwan

Scientific Reports ◽

10.1038/s41598-021-99786-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yu-Ching Weng ◽

Hsiu J. Ho ◽

Yi-Ling Chang ◽

Yun-Ting Chang ◽

Chun-Ying Wu ◽

...

Keyword(s):

Cohort Study ◽

Cell Carcinoma ◽

Systemic Disease ◽

Population Based ◽

Incidence Rates ◽

Research Database ◽

Hazard Ratios ◽

History Of ◽

Rate Ratios

AbstractThe relationship between cancer and vitiligo has been explored but with inconsistent results. To examine the long-term cancer risk in vitiligo patients, we conducted a retrospective nationwide cohort study. From the National Health Insurance Research Database of Taiwan, a total of 13,824 vitiligo patients were identified and matched with 55,296 reference subjects without vitiligo by age, gender, and propensity score estimated by major comorbidities from 1997 to 2013. Demographic characteristics and comorbidities were compared between these two groups. Incidence rate ratios and hazard ratios (HRs) were calculated to examine cancer risks. The 16-year incidence rates of overall cancers were 621.06 (566.56–675.55) and 726.99 (697.24–756.74) per 100,000 person-years in the vitiligo and reference groups. Patients with vitiligo showed a significantly decreased risk of overall cancers [adjusted HR, 0.85; 95% confidence interval (CI), 0.77 to 0.93, p < 0.001] compared with reference subjects without vitiligo after adjusting for age, sex, comorbidities, and treatments. The risks of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were significantly reduced (adjusted HR 0.21, 95% CI 0.11–0.38, p < 0.001), as well as internal malignancies (adjusted HR 0.89, 95% CI 0.81–0.99, p = 0.026). The results were consistent across different subgroups of patients, including male gender, ages more than 40 years, and those receiving long-term systemic disease-modifying antirheumatic drugs and phototherapies. Information related to phenotype, disease duration, vitiligo lesion sites, family history of vitiligo or cancer, occupation, and personal lifestyle was not included in the database. Vitiligo is associated with reduced risks of BCC and SCC, as well as internal malignancies.

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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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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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The implications of catheter ablation for solitary atrial flutter in preventing stroke risk: a nationwide population-based cohort study

EP Europace ◽

10.1093/europace/euaa164 ◽

2020 ◽

Vol 22 (10) ◽

pp. 1558-1566

Author(s):

Yu-Sheng Lin ◽

Victor Chien-Chia Wu ◽

Hui-Ting Wang ◽

Huang-Chung Chen ◽

Mien-Cheng Chen ◽

...

Keyword(s):

Atrial Flutter ◽

Primary Outcome ◽

Stroke Risk ◽

Population Based ◽

Research Database ◽

Confounding Factors ◽

Subdistribution Hazard ◽

Taiwan National Health Insurance ◽

History Of

Abstract Aims The implications of ablation for atrial fibrillation in preventing stroke are controversial, and no studies have investigated whether ablation prevents ischaemic stroke (IS) in atrial flutter (AFL). Methods and results This study analysed data contained in the Taiwan National Health Insurance Research Database for 16 765 patients with a first diagnosis of solitary AFL during 2001–2013. Eligible patients were divided into two groups according to whether or not they had received ablation. Propensity score matching (PSM) was performed to mitigate the effects of potential confounding factors. The primary outcome was occurrence of IS during follow-up. After 1:2 PSM, the analysis included 1037 patients in the ablation group and 2074 patients in the non-ablation group. The incidence of IS was lower in the ablation group compared to the non-ablation group [subdistribution hazard ratio (SHR) 0.61, 95% confidence interval (CI) 0.41–0.90] during the 2-year follow-up period but not thereafter (SHR 1.03, 95% CI 0.72–1.48). When grouping by stroke history, it revealed that ablation affected the incidence of stroke in patients without history of stroke (SHR 0.59, 95% CI 0.38–0.91) but not in patients with history of stroke. When each group was stratified by CHA2DS2-VASc score, ablation lowered the incidence of stroke in patients with CHA2DS2-VASc ≤3 (SHR 0.31, 95% CI 0.16–0.60) but not in patients with CHA2DS2-VASc ≥4 in the initial 2-year follow-up. Conclusion The different incidence of IS in patients with/without ablation indicates that ablation reduces the risk of IS in AFL patients.

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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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