Association of Immunosuppressants with Mortality of Patients with Bullous Pemphigoid: A Nationwide Population-Based Cohort Study

Dermatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Chen-Yi Wu ◽  
Chun-Ying Wu ◽  
Chung-Pin Li ◽  
Yi-Hsian Lin ◽  
Yun-Ting Chang
Keyword(s):  
Bullous Pemphigoid ◽  
Significant Risk ◽  
Population Based ◽  
Chronic Obstructive ◽  
Research Database ◽  
Obstructive Pulmonary Disease ◽  
Risk Of Mortality ◽  
Multivariable Regression ◽  
Mortality Hazard Ratio ◽  
Reduced Risk

<b><i>Background:</i></b> Bullous pemphigoid (BP) is a common autoimmune blistering skin disease with substantial mortality. <b><i>Objective:</i></b> To identify whether the use of immunosuppressants was associated with reduced mortality in BP patients. <b><i>Methods:</i></b> The data for this study were obtained from the National Health Insurance Research Database in Taiwan from January 1, 1997 to December 31, 2013. Those BP patients receiving any immunosuppressant for ≥28 days per month for 3 consecutive months were defined as the immunosuppressant cohort. In total, 452 BP patients on immunosuppressants were matched 1:4 by age, sex, propensity score of comorbidities, and use of tetracycline with 1,808 BP patients taking only corticosteroids. <b><i>Results:</i></b> The immunosuppressant cohort had a significantly lower 5-year mortality rate than the corticosteroid cohort (0.57 vs. 0.67). In the multivariable regression analysis adjusted for covariates, the use of immunosuppressants significantly reduced the risk of mortality (hazard ratio [HR]: 0.78, 95% confidence interval [CI]: 0.68–0.90, <i>p</i> &#x3c; 0.001). Hyperlipidemia also reduced risk of mortality. However, age, diabetes, renal disease, chronic obstructive pulmonary disease, cerebrovascular disease, and dementia were significant risk factors for mortality. In the subgroup analysis, the risk of mortality decreased most substantially in those aged &#x3c;70 years (HR: 0.45, 95% CI: 0.28–0.72). <b><i>Conclusion:</i></b> Immunosuppressant use was associated with a 22% reduced risk of BP mortality. The effects were more substantial in those aged &#x3c;70 years, with a 55% reduced risk of mortality.

Abstract 14099: Beta-blockers Reduce Mortality in Patients With Heart Failure or Ischemic Heart Disease and Chronic Obstructive Pulmonary Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mohammed Ruzieh ◽  
Aaron Baugh ◽  
lama jebbawi ◽  
Andrew J Foy
Keyword(s):  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Beta Blockers ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Risk Of Mortality ◽  
Patients With Heart Failure ◽  
Reduced Risk

Introduction: In patients with heart failure (HF) and ischemic heart disease (IHD), beta-blockers (BB) are associated with improved mortality. However, in patients with co-morbid chronic obstructive pulmonary disease (COPD), this drug class is less utilized due to concerns about an unfavorable impact on the morbidity and mortality. Patients with COPD and heart disease have higher mortality than those with heart disease alone. There is a need to clarify the safety of BB in this population. Objective: To assess the effect of BB therapy on mortality in patients with heart disease and COPD. Methods: We performed a systematic search of MEDLINE and PubMed inception until May 30, 2020 to identify articles of BB use in patients with COPD. The risk ratio (RR) of mortality with BB use was calculated using the Mantel Haenszel random effect model. Statistical analysis was performed using Review Manager Web (RevMan Web). A two-sided p value of < 0.05 was considered statistically significant. Results: A total of 16 studies were included in this meta-analysis, comprising 133,538 patients (44,893 received BB, 88,381 received no control drug, and 264 received placebo). BB use was associated with reduced risk of mortality overall (14.8% vs. 19.9%, RR: 0.67, 95% CI: 0.57 - 0.79), in patients with IHD (18.6% vs. 26.6%, RR: 0.64, 95% CI: 0.50 - 0.82), and in patients with HF (8.1% vs. 23.6%, RR: 0.56, 95% CI: 0.41 - 0.75), Figure. BB were used to treat hypertension in one study, and it was associated with reduced risk of mortality (6.2% vs. 13.4%, RR: 0.46, 95% CI: 0.28 - 0.78). In contrast, βB use was not associated with statistically significant reduced risk of mortality when given without a specified cardiovascular indication (25.0% vs. 32.5%, RR: 0.82, 95% CI: 0.59 - 1.15), figure. Conclusion: Beta-blockers are associated with improved mortality in patients with HF or IHD and COPD. A diagnosis of COPD should not preclude treatment with beta-blockers, as previous concerns likely over-stated risk.

Chronic Pain Increases the Risk for Major Adverse Cardiac and Cerebrovascular Events: A Nationwide Population-Based Study in Asia

Pain Medicine ◽  
2020 ◽  
Vol 21 (9) ◽  
pp. 1985-1990 ◽  
Author(s):  
Kun-Ming Chung ◽  
Chung-Han Ho ◽  
Yi-Chen Chen ◽  
Chien-Chin Hsu ◽  
Chong-Chi Chiu ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Asian Population ◽  
Population Based ◽  
Renal Diseases ◽  
Chronic Obstructive ◽  
Research Database ◽  
Obstructive Pulmonary Disease ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
Taiwan National Health Insurance

Abstract Objective Chronic pain (CP) may increase the risk for major adverse cardiac and cerebrovascular events (MACCEs); however, this issue is still unclear in the Asian population. We conducted this study to delineate it. Design From the Taiwan National Health Insurance Research Database, we identified 17,614 participants (&lt;65 years) with CP and matched them by age and sex at a 1:2 ratio to participants without CP, who made up the comparison cohort. Several causes of CP and its underlying comorbidities were also analyzed. Outcome Measure A comparison of MACCE occurring in the two cohorts was performed via follow-up until 2015. Results The mean age (SD) was 50.2 (11.5) years and 50.4 (11.7) years in participants with and without CP, respectively. In both cohorts, the percentage of female participants was 55.5%. Common causes of CP were spinal disorders (23.9%), osteoarthritis (12.4%), headaches (11.0%), gout (10.2%), malignancy (6.2%), and osteoporosis (4.5%). After adjusting for hypertension, diabetes, chronic obstructive pulmonary disease, renal diseases, hyperlipidemia, liver diseases, dementia, and depression, participants with CP had a higher risk for MACCE than those without CP (adjusted hazard ratio [AHR] = 1.3, 95% confidence interval [CI] = 1.3 − 1.4). After conducting subgroup analyses, an increased risk was also found for all-cause mortality (AHR = 1.4, 95% CI = 1.1 − 1.8), acute myocardial infarction (AHR = 1.2, 95% CI = 1.0 − 1.4), and stroke (AHR = 1.3, 95% CI = 1.3 − 1.4). Conclusions CP is associated with increased occurrence of MACCE. Early detection and interventions for CP are suggested.

scholarly journals Deep Venous Thrombosis and Risk of Consequent Sepsis Event: A Retrospective Nationwide Population-Based Cohort Study

2021 ◽  
Vol 18 (15) ◽  
pp. 7879
Author(s):  
Ying-Tung Yeh ◽  
Sheng-En Tsai ◽  
Ying-Cheng Chen ◽  
Shun-Fa Yang ◽  
Han-Wei Yeh ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Insurance ◽  
Population Based ◽  
Chronic Obstructive ◽  
Research Database ◽  
Obstructive Pulmonary Disease ◽  
Adequate Treatment ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Patients At Risk

Deep vein thrombosis causes several acute and chronic vessel complications and puts patients at risk of subsequent sepsis development. This unique study aimed to estimate the risk of sepsis development in DVT patients compared with non-DVT patients. This population-based cohort study used records of a longitudinal health insurance database containing two million patients defined in Taiwan’s National Health Insurance Research Database (NHIRD). Our study included patients aged over 20 years with a new diagnosis of DVT with at least two outpatient department visits or an admission between 2001 and 2014. Patients with a diagnosis of sepsis before the index date were excluded. Propensity score matching (PSM) was used to homogenize the baseline characteristics between the two groups. To define the independent risk of the DVT group, a multivariate Cox proportional hazard model was used to estimate the hazard ratios. After PSM, the DVT group (n = 5753) exhibited a higher risk of sepsis (adjusted hazard ratio, aHR, 1.74; 95% CI, 1.59–1.90) compared with non-DVT group (n = 5753). Patients with an increased risk of sepsis were associated with being elderly aged, male, having diabetes, chronic kidney disease, chronic obstructive pulmonary disease, stroke, malignancy, and use of antibiotics. In conclusion, this population-based cohort study demonstrated an increased risk of sepsis in DVT patients compared with non-DVT patients. Thus, early prevention and adequate treatment of DVT is necessary in clinical practice.

scholarly journals Low Alanine Aminotransferase as a Risk Factor for Chronic Obstructive Pulmonary Disease in Males: A Retrospective Population-based Cohort Study

2021 ◽  
Author(s):  
Yong Jun Choi ◽  
Do Sun Kwon ◽  
Taehee Kim ◽  
Jae Hwa Cho ◽  
Hyung Jung Kim ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Risk Factor ◽  
Pulmonary Disease ◽  
Alanine Aminotransferase ◽  
Cox Regression ◽  
Significant Risk ◽  
Population Based ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Cox Regression Analysis

Abstract Alanine aminotransferase (ALT) levels reflect skeletal muscle volume and general performance scales, which are significantly associated with chronic obstructive pulmonary disease (COPD) development and prognosis. The aim of this study was to investigate the ALT levels as a risk factor for COPD development. This 13-year population-based retrospective cohort observational study included patients registered in the health check-up cohort database of the Korean National Health Insurance Service. A total of 422,452 participants were analysed. We classified groups according to the baseline ALT levels (groups 1–5: ALT (IU/L) < 10; 10–19; 20–29; 30–39; and ≥ 40, respectively). The incidence of COPD was highest in group 1, decreasing as the group number increased among in males. Cox regression analysis in males revealed that lower ALT level was a significant risk factor for COPD development (univariable, HR: 0.992, 95% CI: 0.991–0.994; multivariable, HR: 0.998, 95% CI: 0.996–0.999). In addition, in the low ALT level groups (< 40 IU/L), COPD was more likely to be developed (univariable, HR: 1.341, 95% CI: 1.263–1.424; multivariable, HR: 1.097, 95% CI: 1.030–1.168). Our findings suggest that males with low ALT levels should be carefully monitored for COPD development.

scholarly journals A Population-Based Cohort Study on Chronic Comorbidity Risk Factors for Adverse Dengue Outcomes

2021 ◽  
Author(s):  
Chia-En Lien ◽  
Yiing-Jenq Chou ◽  
Yi-Jung Shen ◽  
Theodore Tsai ◽  
Nicole Huang
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Age Groups ◽  
Cost Benefit ◽  
Population Based ◽  
Noncommunicable Diseases ◽  
Chronic Obstructive ◽  
Research Database ◽  
Obstructive Pulmonary Disease ◽  
Economic Analyses

The global burden of dengue is increasing against a background of rising global prevalence of chronic noncommunicable diseases (NCDs) and an epidemiological shift of dengue toward older age groups. The contribution of NCDs toward risk for adverse clinical and healthcare utilization outcomes was assessed in a national linked-database study. About 51,433 adult dengue cases between 2014 and 2015 were assessed for outpatient and inpatient claims data in Taiwan’s National Health Insurance Research Database for the 30 days after their dengue diagnosis. A multivariable logistic regression with generalized estimating equations was used to estimate the probability of adverse dengue outcomes in patients with NCDs compared with dengue patients without underlying diseases. Rheumatoid arthritis and related disease were associated with the highest risk of hospitalization after dengue diagnosis (odds ratio: 1.78; 95% CI: 1.37–2.30), followed by stroke, chronic kidney disease (CKD), liver cirrhosis, asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes, congestive heart failure, hypertension, and malignancy. Chronic kidney disease and diabetes were associated with higher risks of hospitalization, intensive care unit (ICU) use, and all-cause mortality. After adjusting for socioeconomic status and other variables, the number of coexisting chronic diseases was associated with increasing risk of adverse dengue outcomes. Specific NCDs were associated with longer hospitalizations, ICU admission, and higher healthcare costs. Quantifying the risks of adverse dengue outcomes and health expenditures among dengue patients with preexisting NCDs provides insights for improved clinical management and essential inputs for health economic analyses on the cost-benefit of risk-based routine or catch-up immunization programs.

scholarly journals Burden of Healthcare Utilization among Chronic Obstructive Pulmonary Disease Patients with and without Cancer Receiving Palliative Care: A Population-Based Study in Taiwan

2020 ◽  
Vol 17 (14) ◽  
pp. 4980 ◽  
Author(s):  
Li-Ting Kao ◽  
Kuo-Chen Cheng ◽  
Chin-Ming Chen ◽  
Shian-Chin Ko ◽  
Ping-Jen Chen ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Palliative Care ◽  
Pulmonary Disease ◽  
Healthcare Utilization ◽  
Population Based ◽  
Chronic Obstructive ◽  
Research Database ◽  
Physical Restraints ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients

Chronic obstructive pulmonary disease (COPD) is a chronic disease that burdens patients worldwide. This study aims to discover the burdens of health services among COPD patients who received palliative care (PC). Study subjects were identified as COPD patients with ICU and PC records between 2009 and 2013 in Taiwan’s National Health Insurance Research Database. The burdens of healthcare utilization were analyzed using logistic regression to estimate the difference between those with and without cancer. Of all 1215 COPD patients receiving PC, patients without cancer were older and had more comorbidities, higher rates of ICU admissions, and longer ICU stays than those with cancer. COPD patients with cancer received significantly more blood transfusions (Odds Ratio, OR: 1.66; 95% C.I.: 1.11–2.49) and computed tomography scans (OR: 1.88; 95% C.I.: 1.10–3.22) compared with those without cancer. Bronchoscopic interventions (OR: 0.26; 95% C.I.: 0.07–0.97) and inpatient physical restraints (OR: 0.24; 95% C.I.: 0.08–0.72) were significantly more utilized in patients without cancer. COPD patients without cancer appeared to receive more invasive healthcare interventions than those without cancer. The unmet needs and preferences of patients in the life-limiting stage should be taken into consideration for the quality of care in the ICU environment.

scholarly journals Association between chronic obstructive pulmonary disease and ventricular arrhythmia: a nationwide population-based cohort study

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Chun-Chao Chen ◽  
Cheng-Hsin Lin ◽  
Wen-Rui Hao ◽  
Chun-Chih Chiu ◽  
Yu-Ann Fang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Obstructive Pulmonary Disease ◽  
Ventricular Arrhythmia ◽  
Pulmonary Disease ◽  
Significant Risk ◽  
Incidence Rates ◽  
Chronic Obstructive ◽  
Research Database ◽  
Class Iii ◽  
Obstructive Pulmonary Disease

AbstractThe ventricular arrhythmia (VA)–chronic obstructive pulmonary disease (COPD) association and related risk factors remain unclear. Using 2001–2012 data from National Health Insurance Research Database, we retrospectively reviewed 71,838 patients diagnosed as having COPD and 71,838 age- and sex-matched controls. After adjustments for comorbidities, medication, urbanization level, and monthly income, patients with COPD had higher incidence rates of VA than did the controls (adjusted hazard ratio [aHR] [95% confidence interval (CI)]: 1.45 [1.25–1.68]). More hospitalization or emergency visits because of acute COPD exacerbation (aHRs [95% CIs] for first, second, and third visits: 1.28 [1.08–1.50], 1.75 [1.32–2.32], and 1.88 [1.46–2.41], respectively) and asthma–COPD overlap (aHR [95% CI]: 1.49 [1.25–1.79]) were associated with high VA risk in patients with COPD. In the multivariate analysis, heart failure (aHR [95% CI]: 2.37 [1.79–3.14]), diabetes (aHR [95% CI]:1.64 [1.29–2.08]), age ≥75 (aHR [95% CI]: 2.48 [1.68–3.67]), male (aHR [95% CI]: 1.69[1.34–2.12]), and class III antiarrhythmic drug use (aHR [95% CI]: 2.49 [1.88–3.28]) are the most significant risk factors of new onset of VA in patients with COPD.

scholarly journals Diabetes, metformin use, and colon cancer: a population-based cohort study in Taiwan

2012 ◽  
Vol 167 (3) ◽  
pp. 409-416 ◽  
Author(s):  
Chin-Hsiao Tseng
Keyword(s):  
Colon Cancer ◽  
Cohort Study ◽  
Cox Regression ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Population Based ◽  
Chronic Obstructive ◽  
Adjusted Relative Risk ◽  
Reverse Causality ◽  
Obstructive Pulmonary Disease

ObjectiveA retrospective cohort study, using a population-based reimbursement database, was conducted for investigating the relationship between diabetes and colon cancer and assessing whether metformin had a protective effect.MethodsOverall, 493 704 men and 502 139 women, covered by the National Health Insurance, without colon cancer were followed from 2003 to 2005. Cox regression evaluated the adjusted relative risk (RR), considering confounders and detection examinations.ResultsEven though diabetes patients had a significantly higher probability of receiving examinations that could lead to the detection of colon cancer, they had a significantly higher risk (24%) of this cancer after adjustment. Metformin users had a significantly lower risk (27%) of colon cancer. While comparing patients with diabetes for <1, 1–3, and ≥3 years to nondiabetes individuals, the adjusted RR (95% confidence interval) was 1.308 (1.020–1.679), 1.087 (0.900–1.313), and 1.185 (1.055–1.330) respectively. The higher risk among those with diabetes for <1 year suggested a possible reverse causality or a link with prediabetes. However, diabetes still might play some role in the development of colon cancer in those with diabetes for ≥3 years. The duration of metformin use showed an inverse trend, with a significant RR of 0.643 (0.490–0.845) in users for ≥3 years, when compared with nonusers. In addition, metformin may reduce colon cancer risk associated with chronic obstructive pulmonary disease (a surrogate for smoking).ConclusionsFollowing adjustment for potential detection bias and other covariates, diabetes remains a significant risk factor for colon cancer. Metformin may protect against colon cancer.

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