Population-based cohort study examining the association between splenectomy and empyema in adults in Taiwan

ObjectiveThis study aimed to investigate the association between splenectomy and empyema in Taiwan.MethodsA population-based cohort study was conducted using the hospitalisation dataset of the Taiwan National Health Insurance Program. A total of 13 193 subjects aged 20–84 years who were newly diagnosed with splenectomy from 2000 to 2010 were enrolled in the splenectomy group and 52 464 randomly selected subjects without splenectomy were enrolled in the non-splenectomy group. Both groups were matched by sex, age, comorbidities and the index year of undergoing splenectomy. The incidence of empyema at the end of 2011 was calculated. A multivariable Cox proportional hazards regression model was used to estimate the HR with 95% CI of empyema associated with splenectomy and other comorbidities.ResultsThe overall incidence rate of empyema was 2.56-fold higher in the splenectomy group than in the non-splenectomy group (8.85 vs 3.46 per 1000 person-years). The Kaplan-Meier analysis revealed a higher cumulative incidence of empyema in the splenectomy group than in the non-splenectomy group (6.99% vs 3.37% at the end of follow-up). After adjusting for confounding variables, the adjusted HR of empyema was 2.89 for the splenectomy group compared with that for the non-splenectomy group. Further analysis revealed that HR of empyema was 4.52 for subjects with splenectomy alone.ConclusionThe incidence rate ratio between the splenectomy and non-splenectomy groups reduced from 2.87 in the first 5 years of follow-up to 1.73 in the period following the 5 years. Future studies are required to confirm whether a longer follow-up period would further reduce this average ratio. For the splenectomy group, the overall HR of developing empyema was 2.89 after adjusting for age, sex and comorbidities, which was identified from previous literature. The risk of empyema following splenectomy remains high despite the absence of these comorbidities.

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Survival outcomes in elderly patients with muscle invasive bladder cancer: An analysis of the National Cancer Database.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.4538 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 4538-4538

Author(s):

Benjamin Walker Fischer-Valuck ◽

Yuan Rao ◽

Soumon Rudra ◽

Caressa Hui ◽

Brian Baumann ◽

...

Keyword(s):

Elderly Patients ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

National Cancer Database ◽

Entire Cohort ◽

Proportional Hazards Regression ◽

Kaplan Meier ◽

Muscle Invasive

4538 Background: Many elderly patients are precluded from radical cystectomy (RC) due to existing comorbidities or morbidities associated with RC. Chemoradiation therapy (CRT) is an alternative treatment in this population, but remains widely under-utilized with many receiving chemotherapy (CT) or radiation therapy (RT) alone. This population-based analysis sought to determine if CMT has similar overall survival (OS) to RC, and if CRT is associated with improved OS compared to monotherapy in these patients. Methods: We queried the National Cancer Database (NCDB) for all newly diagnosed MIBC (cT2-T4a N0 M0) cases in patients aged 80 years or older from 2004 to 2013. All included patients underwent TURBT followed by RC, RT alone, CT alone, CRT, or no further treatment. Only patients with radiation doses ( > = 50Gy) were included as receiving RT. Kaplan-Meier, log-rank, and multivariate Cox proportional hazards regression was performed with OS as the primary outcome. Results: 10,055 patients aged > = 80 years were identified. 1,588 underwent RC, 839 received RT, 1,013 received CT, 1,035 had CRT, and 5580 had no further treatment. Mean age was 85.1 years (range, 80-90). 82.1% of patients had Stage II disease. Mean follow-up was 27.6 months (range, 0-137.8). Mean survival of the entire cohort was 28.0 months (95% CI, 27.2-28.8). Mean survival was 43.8 months (95% CI, 41.2-46.3) for patients with RC and 40.8 months (95% CI, 38.2-43.3) for CRT (P = 0.85). Mean survival was 29.1 months (95% CI, 26.8-31.4) and 30.7 months (95% CI, 28.2-33.2) for RT alone vs. CT alone, respectively (P < 0.0001 for both RC and CRT comparisons). 5-year OS for CT alone, RT alone, CRT, and RC was 15.7%, 15.1%, 24.0% and 29.6%, respectively. Multivariate analysis adjusting for age, year of diagnosis, gender, race, treatment location, treatment facility, insurance status, Charlson/Deyo Score, grade, and stage demonstrated an OS benefit in favor of CRT (HR 0.70; 95% CI, 0.63-0.77; P < 0.0001) and RC (HR 0.69; 95% CI, 0.63-0.76; P < 0.0001). Conclusions: For elderly patients with MIBC, both RC and CRT were associated with improved OS compared to CT or RT alone. CRT has similar OS compared to RC, and could be considered standard treatment in this population.

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Association of irritable bowel syndrome in patients with atrial fibrillation: a nationwide population-based investigation

Perfusion ◽

10.1177/0267659120912363 ◽

2020 ◽

Vol 35 (8) ◽

pp. 847-852

Author(s):

Wei-Syun Hu ◽

Cheng-Li Lin

Keyword(s):

Atrial Fibrillation ◽

Irritable Bowel Syndrome ◽

Proportional Hazards ◽

Female Gender ◽

Population Based ◽

Cox Proportional Hazards ◽

Regression Methods ◽

Proportional Hazards Regression ◽

Kaplan Meier ◽

Irritable Bowel

Objective: We seek to characterize the association between atrial fibrillation and irritable bowel syndrome. Methods: We identify 11,642 cases (atrial fibrillation) and 46,487 sex-, age-, and index year–matched controls (non-atrial fibrillation) from Longitudinal Health Insurance Database. Kaplan–Meier, Cox proportional hazards regression methods and competing risk analysis methods were used to assess the association of atrial fibrillation with outcome of irritable bowel syndrome. Results: After adjustment for gender, age, comorbidities and medications, patients with atrial fibrillation had a significant higher risk (adjusted hazard ratio = 1.12, p < 0.01) to develop irritable bowel syndrome than patients without atrial fibrillation. Compared to participants without atrial fibrillation, those with atrial fibrillation had 1.13-fold (p < 0.05) and 1.11-fold (p < 0.05) risk of irritable bowel syndrome in female and male subgroup, respectively. Among subjects aged ≥65 years, those with AF had 1.11-fold risk of irritable bowel syndrome than non-AF cohort (P < 0.01). Among participants with any one of the comorbidities, those with atrial fibrillation had 1.10-fold risk of irritable bowel syndrome than non-atrial fibrillation cohort (p < 0.05). Conclusion: We report that the presence of atrial fibrillation is associated with greater incidence of irritable bowel syndrome and the association is stronger among female gender, age 65 years or above, and with comorbidities.

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P2277Utility of cardiovascular implantable electronic device (CIED)-derived patient activity, a novel digital biomarker, to predict inappropriate therapy

European Heart Journal ◽

10.1093/eurheartj/ehz748.0754 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Rosero ◽

P Jones ◽

I Goldenberg ◽

W Zareba ◽

K Stein ◽

...

Keyword(s):

Proportional Hazards ◽

Electronic Device ◽

Cox Proportional Hazards ◽

Inappropriate Therapy ◽

Activity Data ◽

Proportional Hazards Regression ◽

Kaplan Meier ◽

Cardiovascular Implantable Electronic Device

Abstract Background The role of cardiovascular implantable electronic device (CIED)-derived activity to predict inappropriate implantable cardioverter-defibrillator (ICD) therapy is not known. The Multicenter Automatic Defibrillator Implantation Trial – Reduce Inappropriate Therapy (MADIT-RIT) enrolled 1500 patients with contemporary indication for an ICD or a CRT-D. We aimed to identify whether activity, as a digital biomarker, predicted inappropriate therapy. Methods In 1500 patients enrolled in MADIT-RIT, CIED-derived patient activity was acquired daily. CIED-derived activity was averaged for the first 30 days following randomization and utilized in this study to predict inappropriate therapy post- 30-day. Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression models were used to evaluate first inappropriate therapy by 30-day CIED-derived patient activity quintiles, and by 30-day device derived patient activity as a continuous measurement. Results There were a total of 1463 patients with activity data available (90%), 135 patients received at least one inappropriate therapy during the post-30 day follow-up period. Patients in the highest quintile (Q5) of CIED-derived activity (more active) were younger, more often males and more likely to have had a prior ablation of an atrial arrhythmia. Patients in the highest quintile of 30-day CIED-derived median activity had the highest risk of receiving inappropriate therapy, 21% at 2 years as compared 7–11% in the other four quintiles (Figure, p<0.001 for the overall duration). Patients with the highest level of 30-day median patient activity (Q5) had 1.75 times higher risk of any inappropriate therapy as compared with lower levels of activity, Q1-Q4 (HR=1.75, 95% CI: 1.23–2.50, p<0.002). Each 10% increase in CIED-derived 30-day median patient activity was associated with a significant, 73% increase in risk of receiving inappropriate therapy (HR=1.73, 95% CI: 1.17–2.54, p=0.005). Patients in the highest quintile for activity had a 68% increase in the risk of SVT excluding atrial fibrillation, atrial flutter or atrial tachycardia (HR=1.69, 95% CI: 1.26–2.25, p=0.004), despite 96% receiving beta-blocker medications. Inappropriate ICD Therapies by Activity Conclusions CIED-derived 30-day median patient activity predicted subsequent inappropriate therapy in ICD and CRT-D patients enrolled in MADIT-RIT. Patients with high levels of 30-day CIED-derived median patient activity were at a significantly higher risk of receiving inappropriate therapy. Activity, as a digital biomarker, may have utility in predicting and managing the risk of inappropriate therapy in this population. Acknowledgement/Funding Boston Scientific

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Predictors of 10-year hospital use in a community-dwelling population of Brazilian elderly: the Bambuí cohort study of aging

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2011001500003 ◽

2011 ◽

Vol 27 (suppl 3) ◽

pp. s336-s344 ◽

Cited By ~ 6

Author(s):

James Macinko ◽

Vitor Camargos ◽

Josélia O. A. Firmo ◽

Maria Fernanda Lima-Costa

Keyword(s):

Cohort Study ◽

Chronic Conditions ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Proportional Hazards Models ◽

Cox Proportional Hazards Models ◽

Male Sex

We use data from a population-based cohort of elderly Brazilians to assess predictors of hospitalizations during ten years of follow-up. Participants were 1,448 persons aged 60 years and over at baseline (1997). The outcome was self-reported number of hospitalizations per year. Slightly more than a fifth (23%) experienced no hospitalizations during the 10 year follow-up. About 30% had 1-2 events, 31% had between 3 and 7 events, and about 18% had 8 or more events during this time. Results of multivariable hurdle and Cox proportional hazards models showed that the risk of hospitalization was positively associated with male sex, increased age, chronic conditions, and visits to the doctors in the previous 12 months. Underweight was a predictor of any hospitalization, while obesity was an inconsistent predictor of hospitalization.

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Association between pneumoconiosis and pulmonary emboli

Thrombosis and Haemostasis ◽

10.1160/th14-10-0858 ◽

2015 ◽

Vol 113 (05) ◽

pp. 952-957

Author(s):

Chih-Hao Shen ◽

Hsuan-Ju Chen ◽

Te-Yu Lin ◽

Wen-Yen Huang ◽

Tsai-Chung Li ◽

...

Keyword(s):

Regression Models ◽

Proportional Hazards ◽

Pulmonary Thromboembolism ◽

Cox Proportional Hazards ◽

Vein Thrombosis ◽

Proportional Hazards Regression ◽

Taiwan National Health Insurance ◽

Deep Vein ◽

Insurance Database

SummaryStudies on the association between pneumoconiosis and deep-vein thrombosis (DVT) and pulmonary thromboembolism (PE) are few. This study was based on data obtained from the Taiwan National Health Insurance Database from 2000 to 2006, with a follow-up period extending to the end of 2011. We identified 3719 pneumoconiosis patients and 14876 non-pneumoconiosis patients who were selected by frequency matched based on sex, age, and the index year. We analysed the risks of DVT and PE by using Cox proportional hazards regression models by including sex, age, and CCI score. The risk of developing PE was 1.90-fold in the patients with pneumoconiosis compared with the comparison cohort after adjustments for age, sex, and CCI score. By contrast, we did not observe significant effect of pneumoconiosis on DVT. However, the cumulative incidence curves for DVT were similar in the pneumoconiosis patients and non-pneumoconiosis patients. The multiplicative increased risks of PE were significant in patients with pneumoconiosis and CCI score of one and more. In conclusion, physicians should include pneumoconiosis in evaluating pulmonary embolism risk.

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Vasoactive Biomarkers Associated With Long-Term Incidence of Symptomatic Peripheral Arterial Disease and Mortality

Angiology ◽

10.1177/0003319720987739 ◽

2021 ◽

pp. 000331972098773

Author(s):

Ardwan Dakhel ◽

Gunnar Engström ◽

Olle Melander ◽

Stefan Acosta ◽

Shahab Fatemi ◽

...

Keyword(s):

Cohort Study ◽

Peripheral Arterial Disease ◽

Proportional Hazards ◽

Arterial Disease ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Regression ◽

Proportional Hazards Regression ◽

Peripheral Arterial

We evaluated if plasma biomarkers can predict incident peripheral arterial disease (PAD) and mortality in a longitudinal cohort study. Men (n = 3618) and women (n = 1542) were included in the Malmö Preventive Project and underwent analysis of: C-terminal endothelin-1 (CT-proET-1), N-Terminal prosomatostatin (NT-proSST), midregional proatrial natriuretic peptide (MR-proANP), procalcitonin (PCT), and copeptin. Participants were followed up for incident PAD and mortality until December 31, 2016. Median follow-up was 11.2 years (interquartile range 9.4-12.2). Cumulative incidence of PAD was 4.3% (221/5160), 4.5% in men (164/3618) and 3.7% in women (57/1542; P = .174). In an adjusted Cox proportional hazards regression model, higher CT-proET-1 (hazard ratio [HR] 1.8; 95% confidence interval [CI] 1.4-2.3), NT-proSST (HR 1.5; 95% CI 1.2-2.0), and MR-proANP (HR 1.7; 95% CI 1.3-2.3) were independently associated with incident PAD, and higher CT-proET-1 (HR 1.3; 95% CI 1.2-1.5), NT-proSST (HR 1.2; 95% CI 1.1-1.3), MR-proANP (HR 1.4; 95% CI 1.3-1.6), PCT (HR 1.1; 95% CI 1.0-1.2), and copeptin (HR 1.2; 95% CI 1.1-1.4) were independently associated with mortality. Increased levels of CT-proET-1, NT-proSST, and MR-proANP were independently associated with incident PAD, whereas all the vasoactive biomarkers were independently associated with mortality during follow-up.

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Haemorrhage rates of ruptured and unruptured brain arteriovenous malformation after radiosurgery: a nationwide population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2019-036606 ◽

2020 ◽

Vol 10 (10) ◽

pp. e036606

Author(s):

Cien-Leong Chye ◽

Kuo-Wei Wang ◽

Han-Jung Chen ◽

Shyh-An Yeh ◽

James Taoqian Tang ◽

...

Keyword(s):

Cohort Study ◽

Proportional Hazards ◽

Gamma Knife Radiosurgery ◽

Bleeding Risk ◽

Population Based ◽

Cox Proportional Hazards ◽

Treatment Modalities ◽

Secondary Outcome ◽

Research Database ◽

Kaplan Meier

ObjectivesThe present nationwide population-based cohort study aims to assess the effectiveness of gamma knife radiosurgery (GKS) on ruptured and unruptured brain arteriovenous malformations (AVMs) by evaluating the haemorrhage rates.DesignA nationwide, retrospective cohort study.SettingTaiwan National Health Insurance Research Database (NHIRD).ParticipantsAn observational study of 1515 patients who were diagnosed with brain AVMs between 1997 and 2013 from the Taiwan NHIRD.Primary outcome and secondary outcome measuresWe performed a survival analysis using the Kaplan-Meier method. Multivariate Cox proportional hazards regression models were used to explore the relationship between treatment modalities (GKS vs non-GKS) and haemorrhage, adjusted for age and sex.ResultsThe GKS and non-GKS groups included 317 and 1198 patients, respectively. Patients in the GKS group (mean±SD, 33.08±15.48 years of age) tended to be younger than those in the non-GKS group (37.40±17.62) (p<0.001). The 15-year follow-up revealed that the rate of bleeding risk was lower in the GKS group than in the non-GKRS group (adjusted HR (aHR) 0.61; 95% CI 0.40 to 0.92). The bleeding risk of ruptured AVMs was significantly lower in GKS group than in the non-GKS group (aHR 0.34; 95% CI 0.19 to 0.62). On the other hand, the bleeding risk of unruptured AVMs was higher in the GKS group than in the non-GKS group (aHR 1.95; 95% CI 1.04 to 3.65). In the unruptured AVM group, the incidence of bleeding was significantly higher among patients in the GKS group that were of >40 years of age (aHR 3.21; 95% CI 1.12 to 9.14).ConclusionsGKS is safe and it reduces the risk of haemorrhage in patients with ruptured AVMs. The administration of GKS to patients with unruptured AVMs who are above the age of 40 years old male might increase the risk of haemorrhage.

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Association of early vertebroplasty with risk of hip replacement: a nationwide population-based cohort study

10.21203/rs.2.15960/v1 ◽

2019 ◽

Author(s):

Chiao-Zhu Li ◽

Chi-Tun Tang ◽

Chi-Hsiang Chung ◽

Chiao-Ching Li ◽

Chien-Yu Ou ◽

...

Keyword(s):

Hip Fracture ◽

Vertebral Fracture ◽

Hip Replacement ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Significant Difference ◽

Taiwan National Health Insurance ◽

A Prospective Study

Abstract Background Studies show that vertebral fractures could predict the risk of hip fractures. We aimed to evaluate the potential benefits of whether the timing of vertebroplasty (VP) for vertebral fracture associated with the risk of hip fracture for hip replacement. Methods We identified 142,782 patients from the Taiwan National Health Insurance Database with thoracolumbar vertebral fracture (TLCF) (ICD-9-CM: 805.2-805.9) who were followed up from 2000 to 2013. These patients were divided into those who underwent VP (VP group) (ICD-9-CM: 78.49) within 3 months and those who did not (non-VP group). After adjusting for the confounding factors, the Cox proportional hazards analysis was used to estimate the effect of early VP on reducing the risk of hip fracture. Results In the 14-year follow-up, the cumulative incidence rate of hip replacement in the VP group was lower than that in the non-VP group (0.362% and 0.533%, respectively, long-rank p<0.001). There was a significant difference between the two groups since the first-year follow-up. Conclusion Our study showed that early VP performed to avoid progression of the kyphotic changes following TLCF may reduce the risk of hip fracture. These results, obtained from retrospective data, indicate that a prospective study is warranted.

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Claudication, in contrast to angina pectoris, independently predicts mortality risk in the general population

VASA ◽

10.1024/0301-1526/a000172 ◽

2012 ◽

Vol 41 (2) ◽

pp. 105-113 ◽

Cited By ~ 5

Author(s):

G. Kieback ◽

Lorbeer ◽

Wallaschofski ◽

Ittermann ◽

Völzke ◽

...

Keyword(s):

Angina Pectoris ◽

Mortality Rate ◽

Cardiovascular Mortality ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Kaplan Meier ◽

All Cause Mortality ◽

Study Population

Background: The aim of our analyses was to investigate whether claudication and angina pectoris, each defined and based on the answer to a single question, are predictive of future mortality. Probands and methods: The study population consisted of 3995 subjects selected from the population-based Study of Health In Pomerania (SHIP). Kaplan-Meier analysis and multivariable Cox proportional hazards regression analysis were used to analyze the association of angina pectoris and claudication with all-cause and cardiovascular mortality adjusted for major cardiovascular risk factors. Results: At baseline, 417 individuals had symptoms of angina pectoris, and 323 had symptoms of claudication. During a median follow-up of 8.5 years, 277 individuals died. Individuals with claudication had a higher fully-adjusted all-cause mortality rate (Hazard Ratio (HR) 1.79; 95 % CI 1.34, 2.39, p < 0.001) and a higher sex- and age-adjusted cardiovascular mortality rate (HR 1.76; 95 % CI 1.03, 2.99, p = 0.038) compared to subjects without claudication. In contrast, subjects with angina pectoris had neither an elevated fully-adjusted all-cause mortality rate (HR 1.15; 95 % CI 0.82, 1.61, p = 0.413) nor sex- and age-adjusted cardiovascular mortality rate (HR 0.71; 95 % CI 0.34, 1.48, p = 0.363) compared to those without this symptom. Conclusions: Claudication, in contrast to angina pectoris, is a strong, independent predictor of all-cause mortality.

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Risk of pyogenic liver abscess and endoscopic sphincterotomy: a population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2017-018818 ◽

2018 ◽

Vol 8 (3) ◽

pp. e018818 ◽

Cited By ~ 5

Author(s):

Yen-Chun Peng ◽

Cheng-Li Lin ◽

Fung-Chang Sung

Keyword(s):

Cohort Study ◽

Liver Abscess ◽

Endoscopic Sphincterotomy ◽

Proportional Hazards ◽

Pyogenic Liver Abscess ◽

Population Based ◽

Cox Proportional Hazards ◽

Research Database ◽

Using Data

ObjectivesTo evaluate the risk of pyogenic liver abscess (PLA) in patients receiving endoscopic sphincterotomy (ES).SettingA population-based cohort study using data from Taiwans’ National Health Insurance Research Database was conducted. Patients aged 20 or older who had undergone an ES were considered as the ES cohort. The dates for the first hospitalisation of the patients receiving ES were defined as the index dates.ParticipantsPatients in the ES and non-ES cohorts were selected by 1:1 matching ratio based on a propensity score. A total of 8174 sex-matched, age-matched and index year-matched (1:1) pairs of patients receiving ES and 8174 patients without ES served as controls. Cox proportional hazards regression was employed to calculate the HRs and 95% CIs for the association between PLA and ES.ResultsThe overall incidence of PLA was significantly higher in the ES cohort than in the non-ES cohort (4.20 vs 0.94, respectively, per 1000 person-year) with the adjusted HR (aHR) 4.50 (95% CI 3.38 to 6.58) A stratified analysis during the follow-up years revealed that when the ES cohort was compared with the non-ES cohort, they displayed a higher risk of PLA during the first follow-up year (aHR 4.35, 95% CI 2.26 to 8.39) which continued significantly over the next 4–5 years of follow-up.ConclusionsPatients receiving ES are associated with having a higher risk of PLA.

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