The Risk of Mortality among Psoriatic Patients with Varying Severity: A Nationwide Population-Based Cohort Study in Taiwan

Background: Previous studies showed conflicting results regarding the mortality risk in psoriasis patients with respect to disease severity and presence of psoriatic arthritis. This study aimed to determine the mortality risk in patients with mild and severe psoriasis and patients with psoriatic arthritis (PsA). Methods: A nationwide population-based cohort study was conducted based on data from the Taiwan National Health Insurance Research Database between 2002 and 2012. Incident psoriasis subjects were classified into two groups: psoriasis without arthritis and psoriasis with arthritis. Patients who had received systemic therapy and/or phototherapy were classified as having severe psoriasis; otherwise, patients were classified as having mild psoriasis. Control subjects without psoriasis were selected to match each psoriasis patient from the database within the same observational period. Cox proportional hazards analysis was used to compare the hazard ratio (HR) of time to death. Results: A total of 106,701 patients with psoriasis were included in this study. After controlling for demographics and comorbidities, psoriasis patients had a higher mortality risk compared with the control group (HR 1.41; 95% confidence interval (CI) 1.36 to 1.46). Compared with psoriasis alone, the mortality risk was not increased for PsA (HR = 1.01; 95% CI 0.93 to 1.10). Besides, severe psoriasis did not increase mortality risk compared with mild psoriasis (HR = 1.0; 95% CI 0.95 to 1.06). Conclusions: Patients with psoriasis had a higher mortality risk compared with control subjects, whereas psoriasis severity and presence of PsA had no impact on mortality risk in psoriasis patients.

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Migraine and subsequent chronic kidney disease risk: a nationwide population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2017-018483 ◽

2017 ◽

Vol 7 (12) ◽

pp. e018483 ◽

Cited By ~ 10

Author(s):

Shuo-Chun Weng ◽

Chia-Lin Wu ◽

Chew-Teng Kor ◽

Ping-Fang Chiu ◽

Ming-Ju Wu ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Disease Risk ◽

Population Based ◽

Interactive Effects ◽

Control Group ◽

Research Database ◽

Control Subjects

ObjectiveWe compared the incidence and risk of chronic kidney disease (CKD) between subjects with new-onset migraine and matched controls without migraine in this large-scale retrospective cohort study.DesignPopulation-based cohort study.Setting8880 subjects with migraine and 503 070 subjects without migraine were enrolled between January 1, 2000 and December 31, 2013, all diagnosed to be without kidney disease. All the participants were registered in the National Health Insurance Research Database.ParticipantsFinally, data from 7156 subjects with migraine and 7156 propensity-score-matched control subjects were analysed.Primary outcome measureWe used Cox proportional hazards regression to estimate adjusted HRs for incident CKD; subgroup analyses were performed to assess the interactive effects of migraine with demographics, comorbidities and long-term medications.ResultsThe incidence of CKD was higher in the migraine group than in the control group. The risk of developing CKD was significantly higher in subjects with migraine than without migraine (P=0.031). Subjects with migraine aged <65 years (age 40–64 (adjusted HR (aHR) 1.35; 95% CI 1.05 to 1.73); age <40 (aHR 1.55; 95% CI 1.02 to 2.36)), with ≥1 comorbid diseases (1–2 diseases (aHR 1.30; 95% CI 1.01 to 1.68); ≥3 diseases (aHR 1.45; 95% CI 1.01 to 2.07)), and not receiving anti-migraine agents (aHR 1.26; 95% CI 1.04 to 1.54) were at a higher risk of developing CKD compared with the control subjects. The interaction between migraine and comorbidities was not significant; age, male gender and long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) were independent risk factors for CKD in subjects with migraine.ConclusionMigraine may be an independent risk factor for CKD. Young subjects with migraine, and those with comorbid conditions or without medical control, are likely to be at higher risk for CKD. Ageing, male sex and NSAIDs tend to have an association with CKD in subjects with migraine.

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The risk of psoriasis in patients with uveitis: A nationwide population-based cohort study

PLoS ONE ◽

10.1371/journal.pone.0255492 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255492

Author(s):

Yu-Yen Chen ◽

Hsin-Hua Chen ◽

Tzu-Chen Lo ◽

Pesus Chou

Keyword(s):

Cohort Study ◽

Psoriatic Arthritis ◽

Cox Regression ◽

Population Based ◽

Severe Psoriasis ◽

Study Cohort ◽

Research Database ◽

Insurance Cost ◽

Hazard Ratios ◽

Increased Risk

Objective To evaluate whether the risk of subsequent psoriasis and psoriatic arthritis development is increased in patients with uveitis. Methods In Taiwan’s national health insurance research database, we identified 195,125 patients with new-onset uveitis between 2001 and 2013. We randomly selected 390,250 individuals without uveitis who were matched 2:1 to uveitis cases based on age, sex and year of enrolment. The characteristics of the two groups were compared. Using multivariate Cox regression, hazard ratios (HRs) for psoriasis or psoriatic arthritis corresponding to uveitis were computed after adjustment for age, sex, insurance cost and comorbidities. In subgroup analyses, separate HRs for mild psoriasis, severe psoriasis and psoriatic arthritis were calculated. Results The mean age of the study cohort was 50.2 ± 17.2 years. Hypertension, diabetes, hyperlipidaemia and obesity were more prevalent in the uveitis group (all p < 0.0001). The hazard of psoriasis or psoriatic arthritis development was significantly greater in the uveitis group than in the non-uveitis group (p < 0.0001); this increased risk persisted after adjustment for confounders [adjusted HR = 1.41; 95% confidence interval (CI), 1.33–1.48]. Adjusted HRs showed an increasing trend from mild psoriasis (1.35; 95% CI, 1.28–1.44) to severe psoriasis (1.59; 95% CI, 1.30–1.94) and psoriatic arthritis (1.97; 95% CI, 1.60–2.42). Conclusions This nationwide population-based cohort study revealed that patients with uveitis have an increased risk of subsequent psoriasis or psoriatic arthritis development.

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Risk of Psoriasis in Patients with Polycystic Ovary Syndrome: A National Population-Based Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm9061947 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1947

Author(s):

Tsung-Hsien Lee ◽

Cheng-Hsuan Wu ◽

Ming-Li Chen ◽

Hei-Tung Yip ◽

Chun-I Lee ◽

...

Keyword(s):

Cohort Study ◽

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Population Based ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Control Group ◽

Research Database ◽

Ovary Syndrome ◽

Pcos Group

Both polycystic ovary syndrome (PCOS) and psoriasis are associated with insulin resistance and metabolic syndrome. Nonetheless, the incidence of psoriasis in patients with PCOS is unclear. We used the Longitudinal Health Insurance Research Database (LHID) in Taiwan from 2000 to 2012 to perform a retrospective population-based cohort study to elucidate the occurrence of psoriasis in PCOS patients. Patients with PCOS without psoriasis in the index year (the year of PCOS diagnosis) were recruited as the PCOS group. Those without PCOS nor psoriasis (control group) were selected using propensity score matching at a ratio of 4:1. Hazard ratios (HRs) were obtained using the Cox proportional hazards regression model. In total, 4707 and 18,828 patients were included in the PCOS and control groups, respectively. The incidence rates of psoriasis in the control and PCOS groups were 0.34 and 0.70 per 1000 person-years, respectively. The risk of psoriasis was higher in the PCOS group by an HR of 2.07 (95% confidence interval [CI] = 1.25–3.43) compared with the control group. In conclusion, the incidence of psoriasis in the PCOS group was higher than that in the control group. Further studies should be conducted to investigate the mechanism underlying the association, and to benefit the long-term management of patients with PCOS.

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The incidence of mental disorder increases after hip fracture in older people: a nationwide cohort study

BMC Geriatrics ◽

10.1186/s12877-021-02195-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ling-Yin Kuo ◽

Po-Ting Hsu ◽

Wen-Tien Wu ◽

Ru-Ping Lee ◽

Jen-Hung Wang ◽

...

Keyword(s):

Cohort Study ◽

Hip Fracture ◽

Geriatric Patients ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Control Group ◽

Research Database ◽

Fracture Group ◽

Related Risk ◽

And Control

Abstract Background People living with dementia seem to be more likely to experience delirium following hip fracture. The association between mental disorders (MD) and hip fracture remains controversial. We conducted a nationwide study to examine the prevalence of MD in geriatric patients with hip fractures undergoing surgery and conducted a related risk factor analysis. Material and methods This retrospective cohort study used data from Taiwan’s National Health Insurance Research Database between 2000 and 2012 and focused on people who were older than 60 years. Patients with hip fracture undergoing surgical intervention and without hip fracture were matched at a ratio of 1:1 for age, sex, comorbidities, and index year. The incidence and hazard ratios of age, sex, and multiple comorbidities related to MD and its subgroups were calculated using Cox proportional hazards regression models. Results A total of 1408 patients in the hip fracture group and a total of 1408 patients in the control group (no fracture) were included. The overall incidence of MD for the hip fracture and control groups per 100 person-years were 0.8 and 0.5, respectively. Among MD, the incidences of transient MD, depression, and dementia were significantly higher in the hip fracture group than in the control group. Conclusions The prevalence of newly developed MD, especially transient MD, depression, and dementia, was higher in the geriatric patients with hip fracture undergoing surgery than that in the control group. Prompt and aggressive prevention protocols and persistent follow-up of MD development is highly necessary in this aged society.

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Risk of Erectile Dysfunction After Traumatic Brain Injury: A Nationwide Population-Based Cohort study in Taiwan

American Journal of Men s Health ◽

10.1177/1557988317750970 ◽

2018 ◽

Vol 12 (4) ◽

pp. 913-925 ◽

Cited By ~ 10

Author(s):

Yun-Ju Yang ◽

Wu-Chien Chien ◽

Chi-Hsiang Chung ◽

Kun-Ting Hong ◽

Yi-Lin Yu ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Erectile Dysfunction ◽

Health Insurance ◽

Brain Injury ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Control Group ◽

Research Database ◽

Confounding Factors

Introduction: In our study, we aimed to investigate the association between a traumatic brain injury (TBI) and subsequent erectile dysfunction (ED). This is a population-based study using the claims dataset from The National Health Insurance Research Database. Methods: We included 72,642 patients with TBI aged over 20 years, retrospectively, selected from the longitudinal health insurance database during 2000–2010, according to the ICD-9-CM. The control group consisted of 217,872 patients without TBI that were randomly chosen from the database at a ratio of 1:3, with age- and index year matched. Cox proportional hazards analysis was used to estimate the association between the TBI and subsequent ED. Results: After a 10-year follow-up, the incidence rate of ED was higher in the TBI patients when compared with the non-TBI control group (24.66 and 19.07 per 100,000, respectively). Patients with TBI had a higher risk of developing ED than the non-TBI cohort after the adjustment of the confounding factors, such as age, comorbidity, residence of urbanization and locations, seasons, level of care, and insured premiums (adjusted hazard ratio (HR) = 2.569, 95% CI [1.890, 3.492], p < .001). Conclusion: This is the first study using a comprehensive nationwide database to analyze the association of ED and TBI in the Asian population. After adjusted the confounding factors, patients with TBI have a significantly higher risk of developing ED, especially organic ED, than the general population. This finding might remind clinicians that it’s crucial in early identification and treatment of ED in post-TBI patients.

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Association of chronic kidney disease with mortality risk in patients with lung cancer: a nationwide Taiwan population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2017-019661 ◽

2018 ◽

Vol 8 (1) ◽

pp. e019661 ◽

Cited By ~ 7

Author(s):

Yu-Feng Wei ◽

Jung-Yueh Chen ◽

Ho-Shen Lee ◽

Jiun-Ting Wu ◽

Chi-Kuei Hsu ◽

...

Keyword(s):

Lung Cancer ◽

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Renal Disease ◽

Mortality Risk ◽

Population Based ◽

Research Database ◽

Cox Regression Analysis ◽

Increased Risk

ObjectiveOur population-based research aimed to clarify the association between chronic kidney disease (CKD) and mortality risk in patients with lung cancer.DesignRetrospective cohort studySettingNational health insurance research database in TaiwanParticipantsAll (n=1 37 077) Taiwanese residents who were diagnosed with lung cancer between 1997 and 2012 were identified. Eligible patients with baseline CKD (n=2269) were matched with controls (1:4, n=9076) without renal disease according to age, sex and the index day of lung cancer diagnosis.MethodsThe cumulative incidence of death was calculated by the Kaplan-Meier method, and the risk determinants were explored by the Cox proportional hazards model.ResultsMortality occurred in 1866 (82.24%) and 7135 (78.61%) patients with and without CKD, respectively (P=0.0001). The cumulative incidences of mortality in patients with and without chronic renal disease were 72.8% vs 61.6% at 1 year, 82.0% vs 76.6% at 2 years and 88.9% vs 87.2% at 5 years, respectively. After adjusting for multiple confounding factors including age and comorbidities, Cox regression analysis revealed that CKD was associated with an increased risk of mortality (adjusted HR 1.38; 95% CI 1.29 to 1.47). Stratified analysis further showed that the association was consistent across patient subgroups.ConclusionComorbidity associated with CKD is a risk factor for mortality in patients with lung cancer.

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Associations Between Anemia, Cognitive Impairment, and All-Cause Mortality in Oldest-Old Adults: A Prospective Population-Based Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.613426 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jia Wangping ◽

Han Ke ◽

Wang Shengshu ◽

Song Yang ◽

Yang Shanshan ◽

...

Keyword(s):

Cohort Study ◽

Cognitive Impairment ◽

Mortality Risk ◽

Proportional Hazards ◽

Oldest Old ◽

Population Based ◽

Cox Proportional Hazards ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality

Objective: To evaluate the combined effects of anemia and cognitive function on the risk of all-cause mortality in oldest-old individuals.Design: Prospective population-based cohort study.Setting and Participants: We included 1,212 oldest-old individuals (men, 416; mean age, 93.3 years).Methods: Blood tests, physical examinations, and health questionnaire surveys were conducted in 2012 were used for baseline data. Mortality was assessed in the subsequent 2014 and 2018 survey waves. Cox proportional hazards models were used to evaluate anemia, cognitive impairment, and mortality risk. We used restricted cubic splines to analyze and visualize the association between hemoglobin (Hb) levels and mortality risk.Results: A total of 801 (66.1%) deaths were identified during the 6-year follow-up. We noted a significant association between anemia and mortality (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14–1.54) after adjusting for confounding variables. We also observed a dose-response relationship between the severity of anemia and mortality (P < 0.001). In the restricted cubic spline models, Hb levels had a reverse J-shaped association with mortality risk (HR 0.88, 95% CI 0.84–0.93 per 10 g/L-increase in Hb levels below 130 g/L). The reverse J-shaped association persisted in individuals without cognitive impairment (HR 0.88, 95% CI 0.79–0.98 per 10 g/L-increase in Hb levels below 110 g/L). For people with cognitive impairment, Hb levels were inversely associated with mortality risk (HR 0.83, 95% CI 0.78–0.89 per 10 g/L-increase in Hb levels below 150 g/L). People with anemia and cognitive impairment had the highest risk of mortality (HR 2.60, 95% CI 2.06–3.27).Conclusion: Our results indicate that anemia is associated with an increased risk of mortality in oldest-old people. Cognitive impairment modifies the association between Hb levels and mortality.

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Associations between concussion and risk of diagnosis of psychological and neurological disorders: a retrospective population-based cohort study

Family Medicine and Community Health ◽

10.1136/fmch-2020-000390 ◽

2020 ◽

Vol 8 (3) ◽

pp. e000390

Author(s):

Marc P Morissette ◽

Heather J Prior ◽

Robert B Tate ◽

John Wade ◽

Jeff R S Leiter

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cohort Study ◽

Proportional Hazards ◽

Geographical Location ◽

International Classification Of Diseases ◽

Population Based ◽

Cox Proportional Hazards ◽

Control Group ◽

Increased Risk

ObjectiveTo investigate associations between concussion and the risk of follow-up diagnoses of attention-deficit hyperactivity disorder (ADHD), mood and anxiety disorders (MADs), dementia and Parkinson’s disease.DesignA retrospective population-based cohort study.SettingAdministrative health data for the Province of Manitoba between 1990–1991 and 2014–2015.ParticipantsA total of 47 483 individuals were diagnosed with a concussion using International Classification of Diseases (ICD) codes (ICD-9-CM: 850; ICD-10-CA: S06.0). All concussed subjects were matched with healthy controls at a 3:1 ratio based on age, sex and geographical location. Associations between concussion and conditions of interest diagnosed later in life were assessed using a stratified Cox proportional hazards regression model, with adjustments for socioeconomic status and pre-existing medical conditions.Results28 021 men (mean age ±SD, 25±18 years) and 19 462 women (30±21 years) were included in the concussion group, while 81 871 men (25±18 years) and 57 159 women (30±21 years) were included in the matched control group. Concussion was associated with adjusted hazard ratios of 1.39 (95% CI 1.32 to 1.46, p<0.001) for ADHD, 1.72 (95% CI 1.69 to 1.76; p<0.001) for MADs, 1.72 (95% CI 1.61 to 1.84; p<0.001) for dementia and 1.57 (95% CI 1.41 to 1.75; p<0.001) for Parkinson’s disease.ConclusionConcussion was associated with an increased risk of diagnosis for all four conditions of interest later in life.

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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15112602 ◽

2018 ◽

Vol 15 (11) ◽

pp. 2602 ◽

Cited By ~ 6

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.

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Cognitive enhancers associated with decreased risk of injury in patients with dementia: a nationwide cohort study in Taiwan

Journal of Investigative Medicine ◽

10.1136/jim-2017-000595 ◽

2017 ◽

Vol 66 (3) ◽

pp. 684-692 ◽

Cited By ~ 8

Author(s):

Pei-Chun Chao ◽

Wu-Chien Chien ◽

Chi-Hsiang Chung ◽

Ching-Wen Chu ◽

Chin-Bin Yeh ◽

...

Keyword(s):

Cohort Study ◽

Cox Regression ◽

Geographic Region ◽

Cox Proportional Hazards ◽

Psychotropic Medications ◽

Control Group ◽

Research Database ◽

Cognitive Enhancers ◽

Cox Regression Analysis ◽

Risk Of Injury

This study aimed to investigate the associations among dementia, psychotropic medications and the risk of overall injuries. In this nationwide matched cohort study, a total of 144 008 enrolled patients ≥age of 50, with 36 002 study subjects who suffered from dementia and 108 006 controls matched for sex and age, from the Inpatient Dataset, for the period 2000–2010 in Taiwan were selected from the National Health Insurance Research Database, according to International Classification of Diseases, 9th Revision, Clinical Modification. When adjusting for the confounding factors, a Cox proportional hazards analysis was used to compare the risk of developing psychiatric disorders during the 10 years of follow-up. Of the study subjects, 6701 (18.61%) suffered injury when compared with 20 919 (19.37%) in the control group. The Cox regression analysis revealed that the study subjects were more likely to develop an injury (HR: 2.294, 95% CI=2.229 to 2.361, P<0.001) after adjusting for sex, age, monthly income, urbanization level, geographic region, and comorbidities. Psychotropic medications in the subjects with dementia were associated with the risk of injury (adjusted HR=0.217, 95% CI: 0.206 to 0.228, P<0.001). Cognitive enhancers, including acetylcholinesterase inhibitors and memantine, were associated with the risk of injury in the study subjects after being adjusted for all comorbidities and medications (adjusted HR=0.712(95% CI=0.512 to 0.925, P<0.01)). In conclusion, patients who suffered dementia had a higher risk of developing injury, and the cognitive enhancers were associated with the decreased risk of injury.

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