Hip, Vertebral, and Wrist Fracture Risks and Schizophrenia: A Nationwide Longitudinal Study

Abstract Background: Fractures are a great health issue associated with morbidity, quality of life, life span, and health care expenditure. Fractures are correlated with cardiovascular disease, type 2 diabetes mellitus, cerebrovascular disease, and some psychiatric disorders. However, representative national data are few, and longitudinal cohort studies on the association between schizophrenia and the subsequent fracture risk are scant. We designed a nationwide population-based cohort study to investigate the association of schizophrenia with hip, vertebral, and wrist fractures over a 10-year follow-up. Methods: Data of patients with schizophrenia (International Classification of Diseases, Ninth Revision, Clinical Modification code 295) and matched over January 2000–December 2009) were extracted from Taiwan National Health Insurance Research Database. A Cox proportional-hazards regression model was constructed to calculate hazard ratios (HRs) for fractures between the schizophrenia and control cohorts. Results: Of 2,028 people with schizophrenia (mean age: 36.3 years, 49.4% female), 89 (4.4%) reported newly diagnosed fractures—significantly higher than the proportion in the control population (257, 3.2%; P = 0.007). The incidences of hip (1.2%, P = 0.009) and vertebral (2.6%, P = 0.011) fractures were significantly higher in the schizophrenia cohort than in the control cohort. In Cox regression analysis, hip (adjusted HR: 1.78, 95% confidence interval [CI]: 1.08–2.93) and vertebral (adjusted HR: 1.40, 95% CI: 1.01–1.95) fracture risks were significantly higher in patients with schizophrenia. Furthermore, a sex-based subgroup analysis revealed that the risk of hip fracture remained significantly higher in female patients with schizophrenia (HR: 2.68, 95% CI: 1.32–5.44) than in female controls. On the other hand, there was no significant interaction between effects of sex and schizophrenia on the risk of fractures. Conclusions: Over a 10-year follow-up, hip and vertebral fracture risks were higher in the people with schizophrenia than in the controls. The risk of fractures in patients with schizophrenia does not differ between female and male.

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Effect of Health Care Provider Delays on Short-Term Outcomes in Patients With Colorectal Cancer: Multicenter Population-Based Observational Study

Interactive Journal of Medical Research ◽

10.2196/15911 ◽

2020 ◽

Vol 9 (3) ◽

pp. e15911

Author(s):

Ahmed Abdulaal ◽

Chanpreet Arhi ◽

Paul Ziprin

Keyword(s):

Colorectal Cancer ◽

Observational Study ◽

Proportional Hazards ◽

Cox Regression ◽

Diagnostic Delay ◽

Population Based ◽

Cox Proportional Hazards ◽

Treatment Delays ◽

Cox Regression Analysis ◽

Kaplan Meier

Background The United Kingdom has lower survival figures for all types of cancers compared to many European countries despite similar national expenditures on health. This discrepancy may be linked to long diagnostic and treatment delays. Objective The aim of this study was to determine whether delays experienced by patients with colorectal cancer (CRC) affect their survival. Methods This observational study utilized the Somerset Cancer Register to identify patients with CRC who were diagnosed on the basis of positive histology findings. The effects of diagnostic and treatment delays and their subdivisions on outcomes were investigated using Cox proportional hazards regression. Kaplan-Meier plots were used to illustrate group differences. Results A total of 648 patients (375 males, 57.9% males) were included in this study. We found that neither diagnostic delay nor treatment delay had an effect on the overall survival in patients with CRC (χ23=1.5, P=.68; χ23=0.6, P=.90, respectively). Similarly, treatment delays did not affect the outcomes in patients with CRC (χ23=5.5, P=.14). The initial Cox regression analysis showed that patients with CRC who had short diagnostic delays were less likely to die than those experiencing long delays (hazard ratio 0.165, 95% CI 0.044-0.616; P=.007). However, this result was nonsignificant following sensitivity analysis. Conclusions Diagnostic and treatment delays had no effect on the survival of this cohort of patients with CRC. The utility of the 2-week wait referral system is therefore questioned. Timely screening with subsequent early referral and access to diagnostics may have a more beneficial effect.

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Effect of Health Care Provider Delays on Short-Term Outcomes in Patients With Colorectal Cancer: Multicenter Population-Based Observational Study (Preprint)

10.2196/preprints.15911 ◽

2019 ◽

Author(s):

Ahmed Abdulaal ◽

Chanpreet Arhi ◽

Paul Ziprin

Keyword(s):

Colorectal Cancer ◽

Observational Study ◽

Proportional Hazards ◽

Cox Regression ◽

Diagnostic Delay ◽

Population Based ◽

Cox Proportional Hazards ◽

Treatment Delays ◽

Cox Regression Analysis ◽

Kaplan Meier

BACKGROUND The United Kingdom has lower survival figures for all types of cancers compared to many European countries despite similar national expenditures on health. This discrepancy may be linked to long diagnostic and treatment delays. OBJECTIVE The aim of this study was to determine whether delays experienced by patients with colorectal cancer (CRC) affect their survival. METHODS This observational study utilized the Somerset Cancer Register to identify patients with CRC who were diagnosed on the basis of positive histology findings. The effects of diagnostic and treatment delays and their subdivisions on outcomes were investigated using Cox proportional hazards regression. Kaplan-Meier plots were used to illustrate group differences. RESULTS A total of 648 patients (375 males, 57.9% males) were included in this study. We found that neither diagnostic delay nor treatment delay had an effect on the overall survival in patients with CRC (χ23=1.5, P=.68; χ23=0.6, P=.90, respectively). Similarly, treatment delays did not affect the outcomes in patients with CRC (χ23=5.5, P=.14). The initial Cox regression analysis showed that patients with CRC who had short diagnostic delays were less likely to die than those experiencing long delays (hazard ratio 0.165, 95% CI 0.044-0.616; P=.007). However, this result was nonsignificant following sensitivity analysis. CONCLUSIONS Diagnostic and treatment delays had no effect on the survival of this cohort of patients with CRC. The utility of the 2-week wait referral system is therefore questioned. Timely screening with subsequent early referral and access to diagnostics may have a more beneficial effect.

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Sulfonylureas may be useful for glycemic management in patients with diabetes and liver cirrhosis

PLoS ONE ◽

10.1371/journal.pone.0243783 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243783

Author(s):

Fu-Shun Yen ◽

Jung-Nien Lai ◽

James Cheng-Chung Wei ◽

Lu-Ting Chiu ◽

Chii-Min Hwu ◽

...

Keyword(s):

Liver Cirrhosis ◽

Cardiovascular Events ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Decompensated Cirrhosis ◽

Research Database ◽

Major Cardiovascular Events ◽

Glycemic Management

This study aimed to investigate the long-term outcomes of sulfonylurea (SU) use in patients with T2DM and compensated liver cirrhosis. From January 1, 2000, to December 31, 2012, we selected the data of 3781 propensity-score-matched SU users and nonusers from Taiwan’s National Health Insurance Research Database. The mean follow-up time for this study was 5.74 years. Cox proportional hazards models with robust sandwich standard error estimates were used to compare the risks of main outcomes between SU users and nonusers. The incidence of mortality during follow-up was 3.24 and 4.09 per 100 person-years for SU users and nonusers, respectively. The adjusted hazard ratios and 95% confidence intervals for all-cause mortality, major cardiovascular events, and decompensated cirrhosis in SU users relative to SU nonusers were 0.79 (0.71–0.88), 0.69 (0.61–0.80), and 0.82 (0.66–1.03), respectively. The SU-associated lower risks of death and cardiovascular events seemed to have a dose–response trend. This population-based cohort study demonstrated that SU use was associated with lower risks of death and major cardiovascular events compared with SU non-use in patients with T2DM and compensated liver cirrhosis. SUs may be useful for glycemic management for patients with liver cirrhosis.

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Abstract P025: Perceived Stress and Incidence of Type 2 Diabetes: a 35-Year Follow-up Study of Middle Aged Swedish Men

Circulation ◽

10.1161/circ.125.suppl_10.ap025 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Masuma Novak

Keyword(s):

Type 2 Diabetes ◽

Proportional Hazards ◽

Cox Regression ◽

Cox Proportional Hazards ◽

Prior History ◽

Diabetes Incidence ◽

Middle Aged ◽

Cox Regression Analysis

OBJECTIVE_ To explore the incidence cases of diabetes over 35 years of follow-up in middle-aged Swedish men in relation to their severity of stress at baseline. RESEARCH DESIGHN AND METHODS_ This was a population-based random sample of 7 495 men derived from the Primary Prevention cohort study (Gothenburg) aged 47-55 years and without prior history of diabetes at baseline (1970-1973). Self-perceived psychological stress during the previous years was assessed with a single-item in the questionnaire. Incident diabetes from hospital discharge and death registries was collected during the 35 years follow-up. Cox proportional hazards regression was used to evaluate association of stress with incidence of diabetes. RESULTS_ During the follow up of 35 years, 884 men developed diabetes. The crude incidence rate was 46.32 per 1000 persons-years. At baseline, 15.5% men reported to experience permanent stress. The age-adjusted cumulative incidence of type diabetes in men who had permanent stress was 16%, compared with 12% for those with no or periodic stress. In age-adjusted Cox regression analysis, men with permanent stress had a higher risk of diabetes incident (hazard ratio 1.52 [95% CI 1.26-1.82]) compared with men with periodic or no stress (referent). The excess risk of diabetes incident associated with permanent stress remained significant after adjusting for age, socioeconomic status (SES), smoking, physical inactivity, alcohol abuse, height, BMI, serum-cholesterol, hypertension, systolic and diastolic blood pressure. CONCLUSIONS_ Perceived permanent stress in middle aged Swedish men was an important long-term predictor of diabetes incidence. The association of stress was independent of SES, lifestyle and other conventional type 2 diabetes risk factors. The significant impact of stress on diabetes, as demonstrated in this study, emphasizes need for prevention strategies including intervention programmes for people with permanent stress.

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Abstract 131: Cognitive Impairment Predicts Mortality in Patients with Heart Failure

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.9.suppl_2.131 ◽

2016 ◽

Vol 9 (suppl_2) ◽

Author(s):

Howard Lan ◽

Lee Ann Hawkins ◽

Helme Silvet

Keyword(s):

Heart Failure ◽

Cognitive Impairment ◽

Proportional Hazards ◽

Cox Regression ◽

Cox Proportional Hazards ◽

Mortality Data ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Study Population

Introduction: In our previously published study, we evaluated a Veteran cohort of 250 outpatients with heart failure (HF) and found 58% (144 of 250) incidence of previously undiagnosed cognitive impairment (CI). Previous studies have suggested that HF patients with CI have worse clinical outcomes including higher mortality but this has not been studied in the Veteran population. Methods: Current study was designed to prospectively follow this cohort of 250 patients. Cognitive function was previously evaluated in all patients at baseline using the St. Luis University Mental Status (SLUMS) exam. The primary outcome for this follow-up study was all-cause mortality. Data analysis including Cox regression analysis and Kaplan-Meier curves were generated using SPSS. Results: The study population was predominantly Caucasian (72%, 179 of 250) and male (99%, 247 of 250) with mean age of 69 ± 10 years. Mean follow up was 31 ± 11 months. During follow up, 26% (64 of 250) of patients died. Univariate and multivariate Cox proportional hazards regression analyses were performed and shown in Table 1. Using the SLUMS score, subjects were stratified into three groups: no CI (42%, 106 of 250), mild CI (42%, 104 of 250), and severe CI (16%, 40 of 250). Kaplan-Meier survival curves were generated to compare the three CI groups in Figure 1. Conclusion: Current study demonstrates that CI is an independent risk factor for mortality in outpatient HF patients. This is an important finding because CI is commonly unrecognized in this vulnerable population. Routine CI screening could help to identify those who are at greater risk for worse outcomes. Future studies are needed to derive possible interventions to improve outcomes in these patients.

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The Relationship between Scabies and Stroke: A Population-Based Nationwide Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16183491 ◽

2019 ◽

Vol 16 (18) ◽

pp. 3491 ◽

Cited By ~ 1

Author(s):

Meng-Huan Wu ◽

Chien-Yu Li ◽

Huichin Pan ◽

Yu-Chieh Lin

Keyword(s):

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Control Group ◽

Research Database ◽

Newly Diagnosed ◽

Nationwide Study ◽

The Relationship

Background: Scabies is a commonly occurring infectious skin infestation that substantially impacts the quality of life, while stroke, which consists of a neurological deficit resulting from a lack of blood flow to the brain, carries sizable economic costs. The pathophysiologic mechanisms underlying both diseases involve inflammatory processes that are mediated by the immune system; however, no prior research has been conducted to explore the relationship between the two conditions. Methods: This population-based nationwide study utilized data from the National Health Insurance Research Database (NHIRD) of Taiwan for a total of 6628 scabies patients, who comprised a scabies group, and a randomly selected cohort of 26,509 matching patients, who served as a control group. More specifically, the medical records for the patients in both groups were checked for seven years to identify any new cases of stroke within that seven-year follow-up period. The hazard ratio (HR) of stroke for the follow-up period was then calculated using Cox proportional hazards regressions, while comorbidities and demographic characteristics were likewise analyzed. Results: During the follow-up period, 2892 patients, or 8.7%, of the overall total of 33,137 patients included in the study were newly diagnosed with a stroke. Of those newly diagnosed stroke patients, 833 were from the scabies group, and 2059 were from the control group, accounting for 12.6% and 7.8%, respectively, of the individuals in each group. With a crude hazard ratio of 1.67, the patients in the scabies group had a significantly higher risk of subsequent stroke than those in the control group, although the adjusted hazard ratio (aHR) for the scabies patients, which was determined by adjusting for covariates, was only 1.32 (95% confidence interval (CI): 1.21–1.43). Conclusions: The results of the study indicated an elevated risk of stroke among scabies patients, an association that might be contributed to by immunopathological factors. This information could serve as a reminder to clinicians to remain alert to any indications of neurological impairment in patients previously infected with scabies.

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Association between Estimated Cardiorespiratory Fitness and All-cause Mortality in Underweight Older Adults

Exercise Science ◽

10.15857/ksep.2020.29.2.146 ◽

2020 ◽

Vol 29 (2) ◽

pp. 146-153

Author(s):

Inhwan Lee ◽

Byungroh Kim

Keyword(s):

Older Adults ◽

Cardiorespiratory Fitness ◽

Proportional Hazards ◽

Cox Regression ◽

Cox Proportional Hazards ◽

National Database ◽

Cox Regression Analysis ◽

All Cause Mortality ◽

Study Participants

PURPOSE: This study investigated the association between estimated cardiorespiratory fitness (eCRF) and all-cause mortality in underweight older adults.METHODS: Data from the 2006 Korean longitudinal study of aging (KLoSA) involving 348 study participants aged 60 years and older (58.0% women) was analyzed in this study. CRF was estimated with sex- and age-specific algorithms developed by the fitness registry and the importance of exercise national database (FRIEND). Participants were classified into lowest 25% (Q1), lower 25% (Q2), middle 25% (Q3), and highest 25% (Q4) on the basis of individual eCRF distributions. Cox proportional hazards regression was used to calculate hazard ratio (HR) and 95% confidence interval (CI) according to eCRF levels.RESULTS: During 7.8±3.2-year follow-up period, a total of 175 deaths occurred from all causes. Cox regression analysis showed that HR of all-cause mortality was 0.686 (95% CI, 0.474-0.991, p=.045) for Q2, 0.382 (95% CI, 0.253-0.575, p<.001) for Q3, and 0.248 (95% CI, 0.155-0.397, p<.001) for Q4 compared to Q1 as reference (HR=1). The HR of Q4 for all-cause mortality remained significant even after adjustments for covariates, including age and marital status.CONCLUSIONS: The current findings suggest that high eCRF is associated with a decreased risk of all-cause mortality in underweight older adults.

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Chronic Periodontitis Is Associated with the Risk of Bipolar Disorder: A Population-Based Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17103466 ◽

2020 ◽

Vol 17 (10) ◽

pp. 3466

Author(s):

Yung-Kai Huang ◽

Yu-Hsun Wang ◽

Yu-Chao Chang

Keyword(s):

Bipolar Disorder ◽

Cohort Study ◽

Chronic Periodontitis ◽

Cox Regression ◽

Population Based ◽

Cox Proportional Hazards ◽

Etiologic Factor ◽

Research Database ◽

Cox Regression Analysis ◽

Increased Risk

Bipolar disorder (BD) is a psychiatric mood disturbance manifested by manic, hypomanic, or major depressive periods. Chronic inflammation was evidenced as an important etiologic factor of BD. Chronic periodontitis (CP) is an inflammatory disease triggered by bacterial products, leading to the destruction of periodontium. The relationship between BD and CP is of interest to investigate. Therefore, a nationwide population-based cohort study was used to investigate the risk of BD and CP exposure from 2001 to 2012. We identified 61,608 patients with CP from the Taiwanese National Health Insurance Research Database (NHIRD). The 123,216 controls were randomly captured and matched by age, sex, index year, and co-morbidities. The association between CP exposure and BD risk was examined by Cox proportional hazards regression models. In this study, 61,608 CP patients and 123,216 controls were followed up for 7.45 and 7.36 years, respectively. In total, 138 BD patients were identified in the CP cohort and 187 BD cases were found in the non-CP cohort. The incidence rate of BD was significantly higher in the CP cohort than in the non-CP cohort (adjusted HR: 1.46, 95% CI: 1.17–1.81) according to the multivariate Cox regression analysis. Females had a 1.47-fold increased risk (95% CI: 1.16–1.86) for BD compared to males. Taken together, CP may be associated with an increased risk of subsequent BD in Taiwan.

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Association between Estimated Cardiorespiratory Fitness and All-cause Mortality in Underweight Older Adults

Exercise Science ◽

10.15857/es.2020.29.2.146 ◽

2020 ◽

Vol 29 (2) ◽

pp. 146-153

Author(s):

Inhwan Lee ◽

Byungroh Kim

Keyword(s):

Older Adults ◽

Cardiorespiratory Fitness ◽

Proportional Hazards ◽

Cox Regression ◽

Cox Proportional Hazards ◽

National Database ◽

Cox Regression Analysis ◽

All Cause Mortality ◽

Study Participants

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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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