scholarly journals Nationwide epidemiological approach to identify associations between keratoconus and immune-mediated diseases

2021 ◽  
pp. bjophthalmol-2021-318804
Author(s):  
Janneau L J Claessens ◽  
Daniel A Godefrooij ◽  
Gerko Vink ◽  
Laurence E Frank ◽  
Robert P L Wisse
Keyword(s):  
Inflammatory Responses ◽  
Conditional Logistic Regression ◽  
Bronchial Hyperresponsiveness ◽  
Treatment Strategies ◽  
Population Level ◽  
Population Based ◽  
Control Group ◽  
Inflammatory Disorder ◽  
Immune Mediated ◽  
Health Insurance Provider

BackgroundThe aetiology of keratoconus (KC) remains poorly understood. KC has typically been described as a non-inflammatory disorder of the cornea. Nonetheless, there is increasing presumptive evidence for the role of the immune system in the pathogenesis of KC.AimTo evaluate the association between KC and immune-mediated diseases on a population level. We hypothesise that KC is immune-mediated rather than a predominantly degenerative disease.MethodsData were obtained from the largest health insurance provider in the Netherlands. Dutch residents are obligatorily insured. The data contained all medical claims and sociodemographic characteristics from all KC patients plus all those data from a 1:6 age-matched and sex-matched control group. The primary outcome was the association between KC and immune-mediated diseases, as assessed by conditional logistic regression.ResultsBased on our analysis of 2051 KC cases and 12 306 matched controls, we identified novel associations between KC and Hashimoto’s thyroiditis (OR=2.89; 95% CI: 1.41 to 5.94) and inflammatory skin conditions (OR=2.20; 95% CI: 1.37 to 3.53). We confirmed known associations between KC and atopic conditions, including allergic rash (OR=3.00; 95% CI: 1.03 to 8.79), asthma and bronchial hyperresponsiveness (OR=2.51; 95% CI: 1.63 to 3.84), and allergic rhinitis (OR=2.20; 95% CI: 1.39 to 3.49).ConclusionKeratoconus appears positively associated with multiple immune-mediated diseases, which provides a population-based argument that systemic inflammatory responses may influence its onset. The identification of these particular diseases might shed light on potential comparable pathways through which this proinflammatory state is achieved, paving the way for pharmacological treatment strategies.

Association Between Drug Exposure and Occurrence of Parkinsonism in Korea: A Population-Based Case-Control Study

2019 ◽  
Vol 53 (11) ◽  
pp. 1102-1110 ◽  
Author(s):  
Siin Kim ◽  
Sang-Myung Cheon ◽  
Hae Sun Suh
Keyword(s):  
Cumulative Dose ◽  
Drug Exposure ◽  
Case Control Study ◽  
Conditional Logistic Regression ◽  
Population Level ◽  
Population Based ◽  
Case Control ◽  
Drug Induced ◽  
Increased Risk ◽  
Control Study

Background: Although drug-induced parkinsonism is reversible in most cases, some patients can suffer from persistent/recurrent symptoms. Therefore, prevention is the most efficient way to manage drug-induced parkinsonism. However, there is a paucity of studies exploring the relationship between parkinsonism and drug exposure. Objective: To examine the association between drug exposure and the risk of parkinsonism using Korean population-based data. Methods: We conducted a matched case-control study using the National Health Insurance Service—National Sample Cohort database. Cases and controls were defined as individuals with and without parkinsonism, respectively, between 2007 and 2013. Cases and controls were matched for sex, age group, income, type of insurance, and Charlson comorbidity index. Drug exposures, including propulsives, antipsychotics, and flunarizine, were identified at 1 year before the first date of parkinsonism and stratified by recency and cumulative dose. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% CIs. Results: We identified 5496 cases and 5496 controls. ORs for current use group of propulsives, antipsychotics, and flunarizine compared with those of the never use group were 2.812 (95% CI = 2.466-3.206), 3.009 (95% CI = 1.667-5.431), and 4.950 (95% CI = 2.711-9.037), respectively. ORs were greater in those more recently exposed and those exposed to higher cumulative doses. Conclusion and Relevance: At the population level, use of propulsives, antipsychotics, and flunarizine had a significant association with the increased risk of parkinsonism, depending on recency and cumulative dose. Drugs associated with parkinsonism should be used with careful monitoring to prevent drug-induced parkinsonism.

scholarly journals Increased Risk of Ulcerative Colitis in Patients with Periodontal Disease: A Nationwide Population-Based Cohort Study

2018 ◽  
Vol 15 (11) ◽  
pp. 2602 ◽  
Author(s):  
Chien-Yu Lin ◽  
Kuo-Sen Tseng ◽  
Jui-Ming Liu ◽  
Heng-Chang Chuang ◽  
Chi-Hone Lien ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Periodontal Disease ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Control Group ◽  
Research Database ◽  
Immune Mediated ◽  
Increased Risk ◽  
Inflammatory Processes

Both periodontal disease (PD) and inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are important diseases of the alimentary tract. Microbiome and immune-mediated inflammatory processes play important roles in these diseases. An association between PD and IBD may exist. This study investigated the risk of IBD in patients with PD. This study used data from the National Health Insurance Research Database of Taiwan from 1996 to 2013. A total of 27,041 patients with PD were enrolled as a study group, and 108,149 patients without PD were selected as the control group after matching by gender, age, insured region, urbanization, and income with a 1:4 ratio. Cox proportional hazards regression was used to calculate the risk of IBD. Of the 135,190 participants enrolled in this study, 5392 (4%) with newly diagnosed IBD were identified. The overall incidence of subsequent IBD was similar in both groups (3.8% vs. 4%, adjusted hazard ratio (aHR) = 1.01, 95% confidence interval (CI): 0.94–1.08). However, an increased risk of UC in the PD group was found after adjusting confounding factors (aHR: 1.56, 95% CI: 1.13–2.15; p < 0.05). This study demonstrated that patients with PD had approximately one-half higher risk of subsequent UC. Further studies are warranted to elucidate the relationship between PD and UC.

scholarly journals Irgm1-deficient mice exhibit Paneth cell abnormalities and increased susceptibility to acute intestinal inflammation

2013 ◽  
Vol 305 (8) ◽  
pp. G573-G584 ◽  
Author(s):  
Bo Liu ◽  
Ajay S. Gulati ◽  
Viviana Cantillana ◽  
Stanley C. Henry ◽  
Elyse A. Schmidt ◽  
...  
Keyword(s):  
Sodium Sulfate ◽  
Intestinal Inflammation ◽  
Inflammatory Responses ◽  
Paneth Cell ◽  
Dextran Sodium Sulfate ◽  
Inflammatory Disorder ◽  
Immune Mediated ◽  
Clinical Responses ◽  
Granule Morphology ◽  
Intracellular Infections

Crohn's disease (CD) is a chronic, immune-mediated, inflammatory disorder of the intestine that has been linked to numerous susceptibility genes, including the immunity-related GTPase ( IRG) M ( IRGM). IRGs comprise a family of proteins known to confer resistance to intracellular infections through various mechanisms, including regulation of phagosome processing, cell motility, and autophagy. However, despite its association with CD, the role of IRGM and other IRGs in regulating intestinal inflammation is unclear. We investigated the involvement of Irgm1, an ortholog of IRGM, in the genesis of murine intestinal inflammation. After dextran sodium sulfate exposure, Irgm1-deficient [Irgm1 knockout (KO)] mice showed increased acute inflammation in the colon and ileum, with worsened clinical responses. Marked alterations of Paneth cell location and granule morphology were present in Irgm1 KO mice, even without dextran sodium sulfate exposure, and were associated with impaired mitophagy and autophagy in Irgm1 KO intestinal cells (including Paneth cells). This was manifested by frequent tubular and swollen mitochondria and increased LC3-positive autophagic structures. Interestingly, these LC3-positive structures often contained Paneth cell granules. These results suggest that Irgm1 modulates acute inflammatory responses in the mouse intestine, putatively through the regulation of gut autophagic processes, that may be pivotal for proper Paneth cell functioning.

scholarly journals Use of serotonin reuptake inhibitors and risk of subsequent bone loss in a nationwide population-based cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sunyoung Kang ◽  
Minkyung Han ◽  
Chun Il Park ◽  
Inkyung Jung ◽  
Eun Hwa Kim ◽  
...  
Keyword(s):  
Bone Loss ◽  
Conditional Logistic Regression ◽  
Laboratory Data ◽  
Population Level ◽  
Population Based ◽  
Case Control ◽  
Newly Diagnosed ◽  
Confidential Interval ◽  
Increased Risk ◽  
Nested Case Control

AbstractThis study examined whether the use of SRIs is associated with an increased risk of bone loss using a nested case–control design with a nationwide population–based cohort in Korea. Using the Korean National Health Screening Cohort, subjects newly diagnosed with osteoporosis or osteopenia (n = 55,799) were matched with controls (n = 278,995) at a ratio of 1:5. We stratified the participants by their time-dependent use of SRIs and sex and controlled for various confounders, including lifestyle habits, laboratory data, and comorbidities. Conditional logistic regression showed that both recent and former users of SRIs had an increased risk of subsequent bone loss compared with non-users: men [recent users: odds ratio (OR) 1.35, 95% confidential interval (CI) 1.20, 1.53; former-users: OR 1.10, 95% CI 1.01, 1.20]; women (recent users: OR 1.38, 95% CI 1.28–1.48; former-users: OR 1.07, 95% CI 1.02, 1.21). The use of SRIs was associated with an increased risk of bone loss in both men and women. In particular, the association was stronger in recent users. These findings provide population-level evidence for the risk of bone loss associated with SRI exposure and highlight the importance of monitoring the bone health of SRI users.

scholarly journals Effect of Spironolactone on COVID-19 in Patients With Underlying Liver Cirrhosis: A Nationwide Case-Control Study in South Korea

2021 ◽  
Vol 8 ◽  
Author(s):  
Dongsub Jeon ◽  
Minkook Son ◽  
Jonggi Choi
Keyword(s):  
Liver Cirrhosis ◽  
Case Control Study ◽  
Conditional Logistic Regression ◽  
Population Based ◽  
Case Control ◽  
Cell Entry ◽  
Control Group ◽  
Case Group ◽  
Conditional Logistic Regression Analysis ◽  
Control Study

Purpose: On the basis that spironolactone is involved in ACE2 expression and TMPRSS2 activity, previous studies have suggested that spironolactone may influence the infectivity of COVID-19. Research has suggested that cell entry of SARS-CoV-2, the virus that induces COVID-19, is associated with the ACE2 receptor and TMPRSS2. The purpose of this study was to investigate whether spironolactone has a protective effect against COVID-19 and the development of associated complications in patients with liver cirrhosis.Methods: We conducted a nationwide case-control study on liver cirrhosis patients with or without COVID-19 from the population-based data acquired from the National Health Insurance Systems of Republic of Korea. After 1:5 case-control matching, multivariable adjusted conditional logistic regression analysis was performed.Results: Among the patients with liver cirrhosis, the case group with COVID-19 was found to be significantly less exposed to spironolactone compared with the control group without COVID-19. The adjusted odds ratio (OR) and 95% confidence interval (CI) between the two groups was 0.20 (0.07–0.54). In addition, regardless of cumulative dose of spironolactone, exposure to spironolactone was associated with lower COVID-19 infection. In terms of the development of complications due to COVID-19, spironolactone did not show any significant association between the patients with and without complications (P = 0.43). The adjusted OR and 95% CI between the two groups was 1.714 (0.246–11.938).Conclusion: We conclude that spironolactone may reduce susceptibility to COVID-19 but does not affect the development of its associated complications; however, further studies are needed to confirm the exact association between spironolactone and COVID-19 infection.

scholarly journals The Prevalence of Anticholinergic Drugs and Correlation with Pneumonia in Elderly Patients: A Population-Based Study in Taiwan

2020 ◽  
Vol 17 (17) ◽  
pp. 6260
Author(s):  
Chien-Ying Lee ◽  
Yih-Dih Cheng ◽  
Wei-Yuan Cheng ◽  
Tung-Han Tsai ◽  
Kuang-Hua Huang
Keyword(s):  
Elderly Patients ◽  
Conditional Logistic Regression ◽  
The Elderly ◽  
Population Based ◽  
Control Group ◽  
Anticholinergic Medication ◽  
Case Group ◽  
Anticholinergic Drugs ◽  
Final Sample ◽  
Study Population

Anticholinergic drugs may increase the risk of serious respiratory infection, especially in the elderly. The study aims to investigate the prevalence of anticholinergic drugs and the correlation of incident pneumonia associated with the use of anticholinergic drugs among the elderly in Taiwan. The study population was 275,005 elderly patients aged ≥65 years old, selected from the longitudinal health insurance database (LHID) in 2016. Among all the elderly patients, about 60% had received anticholinergic medication at least once. Furthermore, the study selected elderly patients who had not been diagnosed with pneumonia and had not received any anticholinergic drugs in the past year in order to evaluate the correlation between pneumonia and anticholinergic drugs. The study excluded elderly patients who died or had received related drugs of incident pneumonia during the study period and selected elderly patients receiving anticholinergic drugs as the case group. Propensity score matching (PSM) on a 1:1 scale was used to match elderly patients that were not receiving any anticholinergic drugs as the control group, resulting in a final sample of 32,215 patients receiving anticholinergic drugs and 32,215 patients not receiving any anticholinergic drugs. Conditional logistic regression was used to estimate the association between anticholinergic drugs and pneumonia after controlling for potential confounders. Compared with patients not receiving anticholinergic drugs, the adjusted odds ratio of patients receiving anticholinergic drugs was 1.33 (95% confidence interval: 1.18 to 1.49). Anticholinergic medication is common among elderly patients in Taiwan. Elderly patients receiving anticholinergic drugs may increase their risk of incident pneumonia. The safety of anticholinergic drugs in the elderly should be of concern in Taiwan.

scholarly journals P0578QUININE EXPOSURE AND THE RISK OF ACUTE KIDNEY INJURY: A POPULATION BASED OBSERVATIONAL STUDY OF OLDER PEOPLE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Andrew Duncan ◽  
Simona Hapca ◽  
Nicosha De Souza ◽  
Daniel Morales ◽  
Samira Bell
Keyword(s):  
Older Adults ◽  
Acute Kidney Injury ◽  
Case Series ◽  
Kidney Injury ◽  
Population Level ◽  
Population Based ◽  
Immune Mediated ◽  
Increased Risk ◽  
Episodes Of Care

Abstract Background and Aims Quinine can precipitate Acute Kidney Injury (AKI) by immune-mediated reactions. Cramps, for which quinine is traditionally prescribed, may be a symptom of conditions that are risk factors for AKI. The relationship between quinine and AKI at a population level is unclear. The aim of this study was to establish and quantify any observable association between the exposure to community prescriptions for quinine and AKI events in a population of older adults. Method We performed two observational studies of older adults (60+ years) who received quinine prescriptions in Tayside, Scotland, between January 2004 and December 2015. The first study was a retrospective longitudinal cohort study with the primary outcome AKI. Creatinine measurements less than seven days apart were grouped as episodes of care. Multivariable logistic regression was used to calculate odds ratios (OR) for AKI comparing between episodes with and without recent quinine exposure after adjustment for demographics, comorbidities and concomitant medications. A self-controlled case series (SCCS) was then conducted with follow-up divided into periods “on” and “off” quinine for the same individual, calculating incidence rate ratios (IRR) for AKI adjusting for age. Results The first study included 12,744 individuals who experienced 13,616 AKI events during cohort follow-up (crude incidence 12.5 per 100 person-years). Exposure to quinine before an episode of care was significantly associated with an increased probability of AKI (adjusted OR=1.27, 95% CI 1.21-1.33). The SCCS cohort included 5,907 people with quinine exposure with ≥1 AKI event. Exposure to quinine was associated with an increased relative incidence of AKI compared to unexposed periods (IRR=1.20, 95% CI 1.15-1.26), with the greatest risk observed within 30 days of quinine initiation (IRR=1.48, 95% CI 1.35-1.61). Conclusion Exposure to quinine in patients aged 60 years and over was associated with an increased risk of AKI, the incidence of which is unlikely to simply be explained be immune-mediated reactions only. Further research is required to determine exact reasons for the increased risk of AKI.

Coupling Financial Incentives With Direct Mail in Population-Based Practice

2016 ◽  
Vol 44 (1) ◽  
pp. 165-174 ◽  
Author(s):  
Jonathan S. Slater ◽  
Michael J. Parks ◽  
Michael E. Malone ◽  
George A. Henly ◽  
Christina L. Nelson
Keyword(s):  
Public Health ◽  
Financial Incentives ◽  
Financial Incentive ◽  
Controlled Trial ◽  
Public Health Practice ◽  
Population Level ◽  
Population Based ◽  
Direct Mail ◽  
Control Group ◽  
Fee For Service

Financial incentives are being used increasingly to encourage a wide array of health behaviors because of their well-established efficacy. However, little is known about how to translate incentive-based strategies to public health practice geared toward improving population-level health, and a dearth of research exists on how individuals respond to incentives through public health communication strategies such as direct mail. This study reports results of a population-based randomized controlled trial testing a direct mail, incentive-based intervention for promoting mammography uptake. The study population was composed of a random sample of Minnesota women enrolled in Medicare fee-for-service and overdue for breast cancer screening. Participants ( N = 18,939) were randomized into three groups: (1) Direct Mail only, (2) Direct Mail plus Incentive, and (3) Control. Both direct mail groups received two mailers with a message about the importance of mammography; however, Mail plus Incentive mailers also offered a $25 incentive for getting a mammogram. Logistic regression analyses measured intervention effects. Results showed the odds for receiving mammography were significantly higher for the Direct Mail plus Incentive group compared with both Direct Mail only and Control groups. The use of incentives also proved to be cost-effective. Additionally, the Direct Mail only group was more likely to receive mammography than the Control group. Findings offer experimental evidence on how the population-based strategy of direct mail coupled with a financial incentive can encourage healthy behavior, as well as how incentive-based programs can be translated into health promotion practice aimed at achieving population-level impact.

scholarly journals Effect Modification by Age and Comorbidities on the Association Between Periodontitis and Female Breast Cancer: A Population-based Case-control Study

2021 ◽  
Author(s):  
Chien-Chih Chen ◽  
Wei-Li Ho ◽  
Ching-Heng Lin ◽  
Hsin-Hua Chen
Keyword(s):  
Breast Cancer ◽  
Case Control Study ◽  
Conditional Logistic Regression ◽  
Population Based ◽  
Case Control ◽  
Female Breast Cancer ◽  
Control Group ◽  
Research Database ◽  
Female Breast ◽  
Control Study

Abstract Background: The association between periodontitis and female breast cancer is not clear. The purpose of this study is to assess that periodontitis was associated with the risk of female breast cancer.Methods: Using claims data taken from the 1997–2013 Taiwanese National Health Insurance Research Database (NHIRD), we identified 60,756 newly-diagnosed female breast cancer patients during the period 2003–2013 from all beneficiaries. We then randomly selected 243,024 women without breast cancer matching (1:4) for age and the year of the index date during 1997–2013 from a one million representative population acting as the control group. A conditional logistic regression analysis was used to examine the association between periodontitis and the risk of breast cancer, shown as an odds ratio (OR) with a 95% confidence interval (CI) after adjustments for the Charlson Comorbidity Index (CCI), geographic region and level of urbanization.Results: The mean ± standard deviation age was 53 ± 14 years. After adjusting for potential confounders, the risk of female breast cancer was found to be associated with a history of periodontitis (OR, 1.12; 95% CI, 1.10-1.14). Such an association was significantly different between patients aged < 65 years (OR, 1.09; 95% CI, 1.06–1.11) and patients aged ≥ 65 years (OR, 1.23; 95% CI, 1.18–1.28; p for interaction <0.001), as well as between patients where the CCI = 0 (OR, 1.17; 95% CI, 1.15–1.20) and patients with CCI > 0 (OR, 0.99; 95% CI, 0.96–1.03; p for interaction <0.001). The highest level of urbanization was also associated with the risk of breast cancer.Conclusions: This nationwide, population-based case-control study demonstrated that periodontitis was significantly associated with the risk of female breast cancer and such an association was modified by both age and comorbidities.

scholarly journals Non-cardiac depolarization-blocking drugs are associated with increased risk of out-of-hospital cardiac arrest in the community

2021 ◽  
Author(s):  
Talip E. Eroglu ◽  
Marieke Blom ◽  
Patrick Souverein ◽  
Anthonius de Boer ◽  
Hanno Tan
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Disease ◽  
Conditional Logistic Regression ◽  
Population Level ◽  
Population Based ◽  
P Value ◽  
Specific Patient ◽  
Increased Risk ◽  
Target Effect ◽  
Hospital Cardiac Arrest

Aim Depolarization-blocking drugs (DB-drugs) used for cardiac disease increase the risk of cardiac arrhythmia (ventricular tachycardia/ventricular fibrillation[VT/VF]) and out-of-hospital cardiac arrest (OHCA) in specific patient groups. However, it is unknown whether drugs for non-cardiac disease that block cardiac depolarization as off-target effect increase the risk of OHCA on a population level. Therefore, we aimed to investigate OHCA-risk of non-cardiac DB-drugs in the community. Methods We conducted a population-based case-control study. We included OHCA-cases from an Emergency Medical Services attended OHCA-registry in the Netherlands (ARREST:2009-2018), and age/sex/OHCA-date matched non-OHCA-controls. We calculated adjusted odds ratios (ORadj) of use of non-cardiac DB-drugs for OHCA, using conditional logistic regression. Stratified analyses were performed according to first-registered rhythm (VT/VF or non-VT/VF), sex and age (≤50, 50-70, or ≥70 years). Results We included 5,473 OHCA-cases of whom 427 (7.8%) used non-cardiac DB-drugs, and 21,866 non-OHCA-controls of whom 835 (3.8%) used non-cardiac DB-drugs, and found that non-cardiac DB-drug use was associated with increased OHCA-risk when compared to no-use (ORadj1.6[95%-CI:1.4-1.9]). Stratification by first-recorded rhythm revealed that this applied to OHCA with non-VT/VF (asystole) (ORadj2.5[95%-CI:2.1-3.0]), but not with VT/VF (ORadj1.0[95%-CI:0.8-1.2];P-value interaction<0.001). The risk was higher in women (ORadj 1.8[95%-CI:1.5-2.2] than in men (ORadj1.5[95%-CI:1.2-1.8];P-value interaction=0.030) and at younger age (ORadj≥70yrs1.4[95%-CI:1.2-1.7];ORadj50-70yrs1.7[95%-CI:1.4-2.1];ORadj≤50yrs3.2[95%-CI:2.1-5.0];P-value interaction<0.001). Conclusions Use of non-cardiac DB-drugs is associated with increased OHCA-risk in the general population. This increased risk occurred in patients in whom non-VT/VF was the first-registered rhythm, and it occurred in both sexes, but more prominently among women, and more strongly in younger patients (≤50 years).

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