scholarly journals Increased risk of non-multiple sclerosis demyelinating syndromes in patients with preexisting septicaemia: a nationwide retrospective cohort study

2019 ◽  
Vol 95 (1124) ◽  
pp. 307-313
Author(s):  
Chung-Hsing Chou ◽  
Jiunn-Tay Lee ◽  
Chia-Kuang Tsai ◽  
Li-Ming Lien ◽  
Jiu-Haw Yin ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Epidemiological Data ◽  
Population Based ◽  
Research Database ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression ◽  
The Relationship

BackgroundGrowing evidence shows links between septicaemia and non-multiple sclerosis demyelinating syndromes (NMSDS); nevertheless, epidemiological data are still very limited. This study aimed to explore the relationship between septicaemia and NMSDS in a general population.MethodsThe study included 482 781 individuals diagnosed with septicaemia and 1 892 825 age/sex-matched non-septicaemia patients for the comparison. Data were drawn from a population-based nationwide National Health Insurance Research Database Taiwan, from 1 January 2002 to 31 December 2011. The two cohorts of patients with and without septicaemia were followed up for the occurrence of NMSDS. The Cox-proportional hazard regression model was performed to estimate adjusted HR after multivariate adjustment.ResultsIndividuals with septicaemia had a 4.17-fold (95% CI 3.21 to 5.4, p < 0.001) higher risk to develop NMSDS compared with those without septicaemia. Patients aged <65 years had a greater NMSDS risk (<45 years: HR = 6.41, 95% CI 3.65 to 11.3, p < 0.001; 45–64 years: HR = 6.66, 95% CI 3.98 to 11.2, p < 0.001). Furthermore, females with septicaemia and individuals with higher severity of septicaemia were associated with increased risks of developing NMSDS.ConclusionsOur results indicated that patients with septicaemia were likely to develop NMSDS. A possible contributing role of septicaemia in increasing the hazard of NMSDS is proposed, based on the outcome that individuals with higher severity of septicaemia carried elevated threat of encountering NMSDS.

scholarly journals Interface of Multiple Sclerosis, Depression, Vascular Disease, and Mortality

Neurology ◽  
2021 ◽  
Vol 97 (13) ◽  
pp. e1322-e1333 ◽  
Author(s):  
Raffaele Palladino ◽  
Jeremy Chataway ◽  
Azeem Majeed ◽  
Ruth Ann Marrie
Keyword(s):  
Multiple Sclerosis ◽  
Vascular Disease ◽  
Population Based ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Depression Status ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Cox Proportional Hazard Regression

Background and ObjectivesTo assess whether the association among depression, vascular disease, and mortality differs in people with multiple sclerosis (MS) compared with age-, sex-, and general practice–matched controls.MethodsWe conducted a population-based retrospective matched cohort study between January 1, 1987, and September 30, 2018, that included people with MS and matched controls without MS from England, stratified by depression status. We used time-varying Cox proportional hazard regression models to test the association among MS, depression, and time to incident vascular disease and mortality. Analyses were also stratified by sex.ResultsWe identified 12,251 people with MS and 72,572 matched controls. At baseline, 21% of people with MS and 9% of controls had depression. Compared with matched controls without depression, people with MS had an increased risk of incident vascular disease regardless of whether they had comorbid depression. The 10-year hazard of all-cause mortality was 1.75-fold greater in controls with depression (95% confidence interval [CI] 1.59–1.91), 3.88-fold greater in people with MS without depression (95% CI 3.66–4.10), and 5.43-fold greater in people with MS and depression (95% CI 4.88–5.96). Overall, the interaction between MS status and depression was synergistic, with 14% of the observed effect attributable to the interaction. Sex-stratified analyses confirmed differences in hazard ratios.DiscussionDepression is associated with increased risks of incident vascular disease and mortality in people with MS, and the effects of depression and MS on all-cause mortality are synergistic. Further studies should evaluate whether effectively treating depression is associated with a reduced risk of vascular disease and mortality.

scholarly journals The elevated risk of sight-threatening cataract in diabetes with retinopathy: a retrospective population-based cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chan-Wei Nien ◽  
Chia-Yi Lee ◽  
Hung-Chi Chen ◽  
Shih-Chun Chao ◽  
Hung-Jui Hsu ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Multivariable Analysis ◽  
Population Based ◽  
Cumulative Probability ◽  
Control Group ◽  
Study Group ◽  
Research Database ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Regression

Abstract Background The effect of diabetic retinopathy (DR) on the development of sight-threatening cataracts was assessed using the National Health Insurance Research Database of Taiwan. Methods Patients diagnosed with diabetes mellitus (DM) and DR were enrolled in the study group. Age- and sex-matched DM individuals without DR and patients without DM served as the DM control group and non-DM control group, respectively, both with 1:4 ratios. The outcome was set as the performance of cataract surgery. Cox proportional hazard regression was used to calculate the adjusted hazard ratio (aHR) of DR considering multiple factors underlying cataract formation. Results A total of 3297 DR patients, 13,188 DM control patients and 13,188 non-DM control subjects were enrolled. The study group included 919 events of sight-threatening cataracts (27.87%), the DM control group included 1108 events (8.40%), and the non-DM control group included 957 events (7.26%). A multivariable analysis indicated that the study group presented a higher aHR of cataract surgery (2.93, 95% CI: 2.60–3.30) and a higher cumulative probability of cataract surgery than both the DM control and non-DM control groups (both log rank P < 0.001). In addition, both the proliferative DR (3.90, 95% CI: 3.42–4.45) and nonproliferative DR (2.35, 95% CI: 2.08–2.65) subgroups showed a higher aHR of cataract surgery than the DM control group. Conclusion The presence of DR increases the risk of sight-threatening cataracts that warrant surgery, and the effect is prominent among patients with both proliferative DR and nonproliferative DR.

scholarly journals Pediatric Ischemic Stroke and Epilepsy: A Nationwide Cohort Study

Stroke ◽  
2021 ◽  
Author(s):  
Heléne E.K. Sundelin ◽  
Torbjörn Tomson ◽  
Johan Zelano ◽  
Jonas Söderling ◽  
Peter Bang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Population Based ◽  
Proportional Hazard ◽  
Future Planning ◽  
Population Based Study ◽  
First Degree Relatives ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression

Background and Purpose: The risk of epilepsy after stroke has not been thoroughly explored in pediatric ischemic stroke. We examined the risk of epilepsy in children with ischemic stroke as well as in their first-degree relatives. Methods: In Swedish National Registers, we identified 1220 children <18 years with pediatric ischemic stroke diagnosed 1969 to 2016, alive 7 days after stroke and with no prior epilepsy. We used 12 155 age- and sex-matched individuals as comparators. All first-degree relatives to index individuals and comparators were also identified. The risk of epilepsy was estimated in children with ischemic stroke and in their first-degree relatives using Cox proportional hazard regression model. Results: Through this nationwide population-based study, 219 (18.0%) children with ischemic stroke and 91 (0.7%) comparators were diagnosed with epilepsy during follow-up corresponding to a 27.8-fold increased risk of future epilepsy (95% CI, 21.5–36.0). The risk of epilepsy was still elevated after 20 years (hazard ratio [HR], 7.9 [95% CI, 3.3–19.0]), although the highest HR was seen in the first 6 months (HR, 119.4 [95% CI, 48.0–297.4]). The overall incidence rate of epilepsy was 27.0 per 100 000 person-years (95% CI, 21.1–32.8) after ischemic stroke diagnosed ≤day 28 after birth (perinatal) and 11.6 per 100 000 person-years (95% CI, 9.6–13.5) after ischemic stroke diagnosed ≥day 29 after birth (childhood). Siblings and parents, but not offspring, to children with ischemic stroke were at increased risk of epilepsy (siblings: HR, 1.64 [95% CI, 1.08–2.48] and parents: HR, 1.41 [95% CI, 1.01–1.98]). Conclusions: The risk of epilepsy after ischemic stroke in children is increased, especially after perinatal ischemic stroke. The risk of epilepsy was highest during the first 6 months but remained elevated even 20 years after stroke which should be taken into account in future planning for children affected by stroke.

Increased risk of arterial thromboembolic events in transfusion-naïve thalassemia: a nationwide population-based study

2019 ◽  
Vol 67 (5) ◽  
pp. 826-832 ◽  
Author(s):  
Xuan Liu ◽  
Jianyun Wen ◽  
Yiqi Xu ◽  
Yongsheng Ruan ◽  
Tiantian Yi ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Population Based ◽  
Research Database ◽  
Thromboembolic Events ◽  
Arterial Embolism ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Thalassemia Minor ◽  
Arterial Thromboembolic Events ◽  
Cox Proportional Hazard Regression

Transfusion-naïve thalassemia minor/trait is often associated with decreased risk of coronary artery diseases. The present study aimed to evaluate the effect of transfusion-naïve thalassemia on the incidence of arterial thromboembolic events using the National Health Insurance Research Database, Taiwan (2001–2010). Data from patients with transfusion-naïve thalassemia (n=2356) frequency matched with non-thalassemia subjects (n=9424) according to sex, age, and index year at a ratio of 1:4 were included. The risk of arterial thromboembolic events, cerebrovascular ischemic events, arterial embolism/thrombosis, peripheral embolism, myocardial infarction, myocardial ischemia, and angina pectoris in transfusion-naïve thalassemia were analyzed using Cox proportional hazard regression models. The transfusion-naïve thalassemia group had significantly higher risk of arterial thromboembolic events (aHR=1.28, 95% CI 1.07 to 1.52) and myocardial ischemia (aHR=1.41, 95% CI 1.13 to 1.76) as compared with the non-thalassemia group. In addition, they also had a significantly higher cumulative incidence of arterial thromboembolic event and myocardial ischemia. Interestingly, a higher risk of arterial thromboembolic events (aHR=1.58, 95% CI 1.22 to 2.04) and myocardial ischemia (aHR=1.73, 95% CI 1.25 to 2.41) was observed in men with thalassemia as compared with those without. Furthermore, patients with comorbidities had an increased risk of arterial thromboembolic events than did those without comorbidities. The effect of thalassemia on arterial thromboembolic events may be mainly attributed to the influence of thalassemia on myocardial ischemia, as no significant differences were observed in other outcomes evaluated in the present study. In conclusion, the present study confirms the increased risk of arterial thromboembolic events, mainly attributed to the dramatic increase in myocardial ischemia, inminor patients with transfusion-naïve thalassemia.

scholarly journals Frailty predicts a higher risk of incident urolithiasis in 525 368 patients with diabetes mellitus: a population-based study

2020 ◽  
Vol 8 (1) ◽  
pp. e000755 ◽  
Author(s):  
Chia-Ter Chao ◽  
Jui Wang ◽  
Jenq-Wen Huang ◽  
Kuan-Yu Hung ◽  
Kuo-Liong Chien
Keyword(s):  
Renal Stones ◽  
Population Based ◽  
Diabetic Patients ◽  
Proportional Hazard ◽  
Hazard Regression ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Cox Proportional Hazard Regression

ObjectivePatients with diabetes have an increased risk for urolithiasis, but the associated risk factors remain an active area of research. We investigated whether frailty influenced the probability of patients with diabetes developing urolithiasis.Research design and methodsUsing data from the Longitudinal Cohort of Diabetic Patients from 2004 to 2010, we identified those without and with frailty based on a validated, modified FRAIL scale. Patients were followed until they developed urolithiasis, and we used Kaplan-Meier and Cox proportional hazard regression analyses to examine the relationship between frailty, its severity, and the risk of urolithiasis, accounting for demographic profiles, comorbidities, frailty status changes over follow-up, and medications, with risk competition by mortality.ResultsAmong 525 368 patients with diabetes, 64.4% were not frail, while 28.5%, 6.6%, and 0.6% had 1, 2, and ≥3 FRAIL items at baseline. After 4.2 years of follow-up, 13.4% experienced incident urolithiasis. Cox proportional hazard regression analysis showed that patients with diabetes having at least one FRAIL criterion exhibited a significantly higher risk for urolithiasis compared with non-frail patients (for 1, 2, and ≥3 items, hazard ratio (HR)s: 1.04, 1.23, and 1.46; 95% confidence intervals (CIs) 0.99 to 1.09, 1.12 to 1.35, and 1.12 to 1.91, respectively). This increase in urolithiasis risk remained significant if we restricted analyses to renal stones or recurrent urolithiasis as the study outcomes.ConclusionsFrailty may pose a risk for incident urolithiasis in patients with diabetes. Treating frailty may potentially reduce their risk for urolithiasis.

scholarly journals Conjugated equine estrogen used in postmenopausal women associated with a higher risk of stroke than estradiol

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wei-Chuan Chang ◽  
Jen-Hung Wang ◽  
Dah-Ching Ding
Keyword(s):  
Postmenopausal Women ◽  
Population Based ◽  
Research Database ◽  
Proportional Hazard ◽  
Conjugated Equine Estrogen ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Taiwanese Women ◽  
Taiwan National Health Insurance ◽  
Cox Proportional Hazard Regression

AbstractThis study aimed to evaluate the risk of ischemic stroke (IS) in hormone therapy (HT) with oral conjugated equine estrogen (CEE) and estradiol (E2) in postmenopausal women in Taiwan. A retrospective cohort study was conducted using the Taiwan National Health Insurance Research Database, a population-based healthcare claims dataset. Eligible women, aged 40–65 years, who received HT with E2 and CEE orally were enrolled. The primary outcome was IS. Propensity score matching with menopausal age and comorbidities was used. Cox proportional hazard regression models were used to calculate the incidence and hazard ratios (HRs) for IS. The mean menopausal ages of the E2 and CEE groups were 50.31 ± 4.99 and 50.45 ± 5.31 years, respectively. After adjusting for age and comorbidities, the incidence of IS was 1.17-fold higher in the women treated with CEE than in those treated with E2 (4.24 vs. 3.61/1000 person-years), with an adjusted HR (aHR) of 1.23 (95% confidence interval [CI] 1.05–1.44). Moreover, HT with CEE initiated within 5 years of menopause had a higher HR than E2 (aHR = 1.20; 95% CI 1.02–1.42). In conclusion, HT with oral CEE might be associated with a higher risk of IS than E2 in postmenopausal Taiwanese women. The use of HT with CEE should be cautioned with the risk of IS.

Association of Dementia-Related Psychosis With Long-term Care Use and Death

Neurology ◽  
2021 ◽  
Vol 96 (12) ◽  
pp. e1620-e1631
Author(s):  
James B. Wetmore ◽  
Yi Peng ◽  
Heng Yan ◽  
Suying Li ◽  
Muna Irfan ◽  
...  
Keyword(s):  
Long Term Care ◽  
Fold Increase ◽  
Proportional Hazard ◽  
Comorbid Conditions ◽  
Term Care ◽  
Risk Of Death ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression

ObjectiveTo determine the association of dementia-related psychosis (DRP) with death and use of long-term care (LTC); we hypothesized that DRP would be associated with increased risk of death and use of LTC in patients with dementia.MethodsA retrospective cohort study was performed. Medicare claims from 2008 to 2016 were used to define cohorts of patients with dementia and DRP. Outcomes were LTC, defined as nursing home stays of >100 consecutive days, and death. Patients with DRP were directly matched to patients with dementia without psychosis by age, sex, race, number of comorbid conditions, and dementia index year. Association of DRP with outcomes was evaluated using a Cox proportional hazard regression model.ResultsWe identified 256,408 patients with dementia. Within 2 years after the dementia index date, 13.9% of patients developed DRP and 31.9% had died. Corresponding estimates at 5 years were 25.5% and 64.0%. Mean age differed little between those who developed DRP (83.8 ± 7.9 years) and those who did not (83.1 ± 8.7 years). Patients with DRP were slightly more likely to be female (71.0% vs 68.3%) and white (85.7% vs 82.0%). Within 2 years of developing DRP, 16.1% entered LTC and 52.0% died; corresponding percentages for patients without DRP were 8.4% and 30.0%, respectively. In the matched cohort, DRP was associated with greater risk of LTC (hazard ratio [HR] 2.36, 2.29–2.44) and death (HR 2.06, 2.02–2.10).ConclusionsDRP was associated with a more than doubling in the risk of death and a nearly 2.5-fold increase in risk of the need for LTC.

scholarly journals Risk of Dementia in Patients with Leptospirosis: A Nationwide Cohort Analysis

2019 ◽  
Vol 16 (17) ◽  
pp. 3168
Author(s):  
Chun-Hsiang Chiu ◽  
Po-Chung Chen ◽  
Ying-Chuan Wang ◽  
Cheng-Li Lin ◽  
Feng-You Lee ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Cohort Analysis ◽  
Frequency Matching ◽  
Cox Proportional Hazard ◽  
Dementia Risk ◽  
Increased Risk ◽  
Taiwan National Health Insurance ◽  
History Of ◽  
Cox Proportional Hazard Regression ◽  
The Relationship

Background: Studies have linked some bacterial infections with an increased likelihood for development of dementia. However, there is a paucity of data on the relationship between dementia and leptospirosis. In view of this, we conducted a retrospective cohort study to determine whether leptospirosis is a risk factor for dementia. Methods: Data were collected from the Taiwan National Health Insurance Research Databases (2000–2010) to investigate the incidence of and risk factors for dementia in patients with leptospirosis. Patients with leptospirosis who did not have a history of dementia were enrolled in the study. For each leptospirosis patient, four controls were randomly selected after frequency matching of age, sex, and index date. Cox proportional hazard regression models were used for the analyses of dementia risk. Results: A greater risk of dementia was observed in the leptospirosis cohort than in the non-leptospirosis cohort both in patients without any comorbidity (adjusted HR (aHR) = 1.23, 95% CI = 1.06–1.43) and with a comorbidity (aHR = 2.06, 95% CI = 1.7–2.5). Compared with the non-leptospirosis cohort without these comorbidities, the leptospirosis cohort with ≥2 comorbidities exhibited a significantly increased risk of dementia (aHR = 6.11, 95% CI = 3.15–11.9), followed by those with any one comorbidity (adjusted HR = 3.62, 95% CI = 1.76–7.46). Conclusions: Patients with leptospirosis were at a 1.89-fold greater risk of subsequent dementia, but potential genetic susceptibility bias in the study group is a major confound.

Effect of air pollution on gout development: a nationwide population-based observational study

QJM ◽  
2020 ◽  
Author(s):  
W -S Hu ◽  
C -L Lin
Keyword(s):  
Air Pollution ◽  
Fine Particulate Matter ◽  
Population Based ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Yearly Average ◽  
Cox Proportional Hazard Regression ◽  
Particulate Matter 2.5 ◽  
Total Hydrocarbons

Summary Objective To investigate the effect of air pollution on gout development. Methods A total of 170318 participants were enrolled. These pollutants were considered: carbon monoxide (CO), fine particulate matter 2.5 (PM2.5), total hydrocarbons (THC) and methane (CH4). The yearly average concentrations were calculated from 2000 to 2011. Univariate and multivariate analyses by Cox proportional hazard regression models were adopted to estimate hazard ratios for gout in the Q2–Q4 concentrations of air pollutants compared with the Q1 concentration. Results In THC, relative to the Q1 concentration, the risk of gout was higher in participants exposed to the Q2–Q4 concentrations [adjusted hazard ratio (aHR), 1.10 with 95% confidence interval (CI), 1.01–1.19 in the Q2 concentration of THC; aHR, 4.20 with 95% CI, 3.93–4.49 in the Q3 concentration of THC; aHR, 5.65 with 95% CI, 5.29–6.04 in the Q4 concentration of THC]. In regard to CH4, when the Q1 concentration was defined as the reference, the risks of gout were increased for participants exposed to the Q2, Q3 and Q4 concentrations (aHR, 1.16 with 95% CI, 1.06–1.26 in the Q2 concentration of CH4; aHR, 2.37 with 95% CI, 2.20–2.55 in the Q3 concentration of CH4; aHR, 8.73 with 95% CI, 8.16–9.34 in the Q4 concentration of CH4). Conclusions Association between air pollution and risk of gout was noted.

Prediction of Cardiovascular Events in Patients with Ankylosing Spondylitis and Psoriatic Arthritis: Role of Lipoproteins in a High-risk Population

2012 ◽  
Vol 39 (7) ◽  
pp. 1433-1440 ◽  
Author(s):  
ANNE GRETE SEMB ◽  
TORE K. KVIEN ◽  
DAVID A. DeMICCO ◽  
RANA FAYYAD ◽  
CHUAN-CHUAN WUN ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Density Lipoprotein ◽  
High Risk Population ◽  
Proportional Hazard ◽  
Mortality And Morbidity ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Increased Risk

Objective.To evaluate lipids and apolipoproteins as predictors of cardiovascular mortality and morbidity (CVD) in patients with spondyloarthritis (SpA).Methods.In the pooled cohort of participants in the IDEAL, TNT, and CARDS trials, 50 had ankylosing spondylitis (AS), 36 had psoriatic arthritis (PsA), and 21,641 did not have AS or PsA (non-SpA). We compared lipid levels at baseline between AS or PsA and non-SpA, and hazard ratios (HR) for CVD were calculated in a Cox proportional hazard model.Results.Atherogenic lipids were lower in samples from AS, but not in PsA, compared to non-SpA. The HR for 1 SD increase in baseline lipids for future CVD was for total cholesterol 1.39 (95% CI 0.82, 2.36) in AS, 1.01 (95% CI 0.44, 2.31) in PsA, and 1.10 (95% CI 1.07, 1.14) in non-SpA. Both high-density lipoprotein (HDL) and apolipoprotein (ApoA-1) were significantly associated with CVD in AS (HR 3.67, 95% CI 1.47, 9.06, and HR 1.89, 95% CI 1.02, 3.54, respectively), in contrast to PsA (HDL: HR 1.03, 95% CI 0.49, 2.15; ApoA-1: HR 0.79, 95% CI 0.34, 1.89) and non-SpA (HDL: HR 0.86, 95% CI 0.84, 0.89; ApoA-1: HR 0.88, 95% CI 0.85, 0.91).Conclusion.HDL and ApoA-1 were surprisingly associated with increased risk of future CVD in patients with AS, whereas these lipids were protective in non-SpA.

Sign in / Sign up

Export Citation Format

Share Document