Mortality Risk and Risk Factors in Patients with Posttraumatic Epilepsy: A Population-Based Cohort Study

Aim: Use the National Health Insurance Research Database of Taiwan to determine whether patients with posttraumatic epilepsy (PTE) have an increased risk of mortality. Methods: Patients ≥20 years old ever admitted because of head injury (per International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 850–854 and 959.01) during 2000–2012 were enrolled into a traumatic brain injury (TBI) cohort. The TBI cohort was divided into with PTE (ICD-9-CM code 345) and posttraumatic nonepilepsy (PTN) cohorts. We compared the PTE and PTN cohorts in terms of age, sex, and comorbidities. We calculated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of all-cause mortality risk in these cohorts. Results: Patients with PTE had a higher incidence rate (IR) of mortality than did patients with TBI alone (IR per 1000 person-years: 71.8 vs. 27.6), with an aHR 2.31 (95% CI = 1.96–2.73). Patients with PTE aged 20–49, 50–64, and ≥65 years had, respectively, 2.78, 4.14, and 2.48 times the mortality risk of the PTN cohort. Patients with any comorbidity and PTE had 2.71 times the mortality risk as patients in the PTN cohort. Furthermore, patients with PTE had 28.2 increased hospital days and 7.85 times as frequent medical visits per year compared with the PTN cohort. Conclusion: Taiwanese patients with PTE had approximately 2 times the mortality risk and an increased medical burden compared to patients with TBI only. Our findings provide crucial information for clinicians and the government to improve TBI outcomes.

Download Full-text

Hysterectomies Are Associated with an Increased Risk of Depression: A Population-Based Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm7100366 ◽

2018 ◽

Vol 7 (10) ◽

pp. 366 ◽

Cited By ~ 1

Author(s):

Tomor Harnod ◽

Weishan Chen ◽

Jen-Hung Wang ◽

Shinn-Zong Lin ◽

Dah-Ching Ding

Keyword(s):

International Classification Of Diseases ◽

Population Based ◽

Research Database ◽

Predisposing Factor ◽

Post Surgery ◽

Hazard Ratios ◽

Increased Risk ◽

Classification Of Diseases ◽

Hormone Use ◽

The Government

Using the National Health Insurance Research Database of Taiwan, we investigated whether undergoing a hysterectomy increases the risk of depression. A total of 7872 patients aged 30–49 years who underwent a hysterectomy from 2000 to 2013 were enrolled as the hysterectomy group. The comparison group was randomly selected from women who had never undergone a hysterectomy and was four times the size of the hysterectomy group. We calculated adjusted hazard ratios and 95% confidence intervals (CIs) for depression [The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 296.2, 296.3, 300.4, 311] in these cohorts after adjusting for age, comorbidities, oophorectomy, and hormone therapy. The overall incidence of depression was 1.02 and 0.66 per 100 person-years in the hysterectomy and comparison cohorts, respectively, yielding an adjusted hazard ratio of 1.35 (95% CI = 1.22–1.50) for depression risk. When we stratified patients by age, comorbidities, oophorectomy, and hormone use, hysterectomy increased the risk of depression. Hysterectomy, oophorectomy, and post-surgery hormone use were associated with an increased risk of depression when they occurred alone, but conferred a greater risk if they were considered jointly. Hysterectomy would be a predisposing factor for increased risk of subsequent depression. Our findings provide vital information for patients, clinicians, and the government for improving the treatment strategy in the future.

Download Full-text

Analyzing Mortality Risk and Medical Burden among Patients with Traumatic Brain Injury and Subsequent Dementia

Journal of Clinical Medicine ◽

10.3390/jcm8050686 ◽

2019 ◽

Vol 8 (5) ◽

pp. 686

Author(s):

Dorji Harnod ◽

Tomor Harnod ◽

Cheng-Li Lin ◽

Chia-Hung Kao

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mortality Risk ◽

International Classification Of Diseases ◽

Research Database ◽

Medical Visits ◽

Classification Of Diseases ◽

The Government ◽

Medical Burden ◽

Hospital Days

We used the National Health Insurance Research Database of Taiwan to determine whether patients with posttraumatic dementia (PTD) exhibit increased mortality and medical burden than those without it. Patients ≥20 years of age having head injury admission (per the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 850–854, 959.01) between 2000 and 2012 were enrolled as traumatic brain injury (TBI) cohort. A PTD cohort (with ICD-9-CM codes 290, 294.1, 331.0) and a posttraumatic nondementia (PTN) cohort were established and compared in terms of age, sex, and comorbidities. We calculated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of all-cause mortality risk, number of hospital days, and frequency of medical visits in these cohorts. Patients with PTD had a higher mortality rate than did patients with TBI alone (rate per 1000 person-years: 12.00 vs. 6.32), with an aHR of 1.54 (95% CI: 1.32–1.80). Patients with PTD who were aged ≥65 years (aHR = 1.54, 95% CI: 1.31–1.80) or male (aHR = 1.78, 95% CI: 1.45–2.18) exhibited greatly increased risks of mortality. Furthermore, patients with PTD had 19.9 more hospital days and required medical visits 4.49 times more frequently compared with the PTN cohort. Taiwanese patients with PTD had increased mortality risk and medical burden compared with patients who had TBI only. Our findings provide crucial information for clinicians and the government to improve TBI and PTD outcomes.

Download Full-text

Use of bladder antimuscarinics is associated with an increased risk of dementia: a retrospective population-based case–control study

Scientific Reports ◽

10.1038/s41598-021-84229-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tomor Harnod ◽

Yu-Cih Yang ◽

Lu-Ting Chiu ◽

Jen-Hung Wang ◽

Shinn-Zong Lin ◽

...

Keyword(s):

International Classification Of Diseases ◽

Population Based ◽

Exposure Dose ◽

Research Database ◽

Duration Of Treatment ◽

Dementia Risk ◽

Increased Risk ◽

Classification Of Diseases ◽

Taiwan National Health Insurance ◽

Bladder Antimuscarinics

AbstractThe association between bladder antimuscarinic use and dementia development is unclear. We used data from the Taiwan National Health Insurance Research Database to determine the association between the exposure dose and duration of bladder antimuscarinics and the subsequent dementia risk. We enrolled participants aged 55 years or more and defined a dementia cohort (International Classification of Diseases, Ninth Revision, Clinical Modification codes 290, 294.1, and 331.0). We used a propensity score matching method, and randomly enrolled two controls without dementia. We evaluated dementia risk with respect to the exposure dose and duration of treatment with seven bladder antimuscarinics (oxybutynin, propiverine, tolterodine, solifenacin, trospium, darifenacin, and fesoterodine) used for at least 1 year before the index date, after adjusting for age, sex, comorbidities, and medications. The dementia risk was 2.46-fold (95% confidence interval: 2.22–2.73) higher in Taiwanese patients who used bladder antimuscarinics for ≥ 1 year than in those who were not exposed to this treatment. The risk proportionally increased with increasing doses of antimuscarinics for less than 4 years. Taiwanese patients aged 55 years or more on bladder antimuscarinics exhibited a higher risk of dementia. Additional studies in other countries are required to determine whether this result is valid worldwide.

Download Full-text

Association Between Antibiotic Treatment of Chlamydia pneumoniae and Reduced Risk of Alzheimer Dementia: A Nationwide Cohort Study in Taiwan

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.701899 ◽

2021 ◽

Vol 13 ◽

Author(s):

Hsun Ou ◽

Wu-Chien Chien ◽

Chi-Hsiang Chung ◽

Hsin-An Chang ◽

Yu-Chen Kao ◽

...

Keyword(s):

Cohort Study ◽

Chlamydia Pneumoniae ◽

International Classification Of Diseases ◽

Population Based ◽

Community Acquired Pneumonia ◽

Research Database ◽

Alzheimer Dementia ◽

Hazard Ratios ◽

Classification Of Diseases

Background:Chlamydia pneumoniae (CPn) is a common community-acquired pneumonia. In the literature, CPn infection is demonstrated to exhibit an association with Alzheimer dementia (AD). We executed the present nationwide, population-based research with the goal of probing the association of CPn infection and antibiotic therapy with AD risk.Methods: We conducted a cohort study using a database extracted from Taiwan's National Health Insurance Research Database (NHIRD). All medical conditions for each enrolled individuals were categorized using the International Classification of Diseases, ninth Revision classifications. Hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between CPn pneumonia-associated hospitalizations and AD were estimated using Fine and Gray's survival analysis and adjusted for comorbidities. The effects of the antibiotics on the HRs for AD in the patients with CPn pneumonia-associated hospitalization were also analyzed.Results: Our analyses included 6,628 individuals, including 1,657 CPn-infected patients, as well as 4,971 controls matched by age, index date, and sex (1:3). In this study, patients hospitalized for CPn pneumonia exhibited a significantly higher AD risk (adjusted HR = 1.599, 95% CI = 1.284–1.971, p < 0.001). We also noted an association of macrolide use (≥15 days) and fluoroquinolone use (≥15 days) with decreased AD risk.Conclusions: We determined CPn pneumonia to be associated with a relatively high AD risk. The result in this study confirmed the findings from previous literatures, by using a large, nationwide, population-based database. Appropriate macrolide and fluoroquinolone treatment may attenuate this risk.

Download Full-text

Readmission after Adult Uvulopalatopharyngoplasty: A Population-Based Inpatient Cohort Study in Taiwan

Otolaryngology ◽

10.1177/0194599818813337 ◽

2018 ◽

Vol 160 (3) ◽

pp. 559-566 ◽

Cited By ~ 8

Author(s):

Ying-Shuo Hsu ◽

Wei-Chung Hsu ◽

Jenq-Yuh Ko ◽

Te-Huei Yeh ◽

Chia-Hsuan Lee ◽

...

Keyword(s):

Odds Ratio ◽

International Classification Of Diseases ◽

Population Based ◽

Factors Associated ◽

Risk Of Bleeding ◽

Increased Risk ◽

Classification Of Diseases ◽

Insurance Database ◽

Population Based Survey

Objective To investigate readmissions among adult inpatients who underwent uvulopalatopharyngoplasty (UPPP) in Taiwan. Design Population-based survey. Setting Retrospective study with the National Health Insurance Database. Methods All cases of inpatient adult UPPP (age >20 years) from 1997 to 2012 were identified through International Classification of Diseases, Ninth Revision, Clinical Modification. Factors associated with readmission within 30 days after surgery were analyzed. Results A total of 38,839 adults with UPPP were identified (mean age, 39.3 years; men, 73.7%). The incidence of UPPP was 14.6 per 100 000 adults, which increased from 1997 to 2012 (6.7 to 16.7 per 100,000, Ptrend < .001). The rates of readmission for any reason, readmission for bleeding, reoperation for bleeding, and 30-day mortality were 4.2%, 1.7%, 1.0%, and 0.14%, respectively. Young age increased the risk of reoperation for bleeding, and old age increased the risk of readmission for any reason and mortality. Men had an increased risk of readmission and reoperation. Hypertension was associated with an increased risk of readmission for any reason (odds ratio [OR], 1.29; 95% CI, 1.10-1.51), bleeding-related readmission (OR, 1.89; 95% CI, 1.52-2.36), and reoperation (OR, 2.47; 95% CI, 1.84-3.30). Concurrent hypopharyngeal surgery was associated with an increased risk of readmission for any reason (OR, 1.34; 95% CI, 1.07-1.66) and bleeding-related readmission (OR, 1.69; 95% CI, 1.25-2.27). Finally, the use of steroids was associated with an increased risk of bleeding-related readmission and reoperation. Conclusions The incidence of adult UPPP increased from 1997 to 2012 in Taiwan. Age, sex, comorbidity, concurrent hypopharyngeal surgery, and drug administration were associated with readmission after inpatient UPPP.

Download Full-text

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.

Download Full-text

Differences in Incidence and Risks of Suicide Attempt and Suicidal Drug Overdose between Patients with Epilepsy with and without Comorbid Depression

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16224533 ◽

2019 ◽

Vol 16 (22) ◽

pp. 4533

Author(s):

Chi-Yu Lin ◽

Tomor Harnod ◽

Cheng-Li Lin ◽

Wei-Chih Shen ◽

Chia-Hung Kao

Keyword(s):

Suicide Attempt ◽

Drug Overdose ◽

Research Database ◽

Comorbid Depression ◽

Hazard Ratios ◽

Increased Risk ◽

Crucial Information ◽

The Government ◽

Using Data ◽

Patients With Epilepsy

Objective: To determine the differences in the incidences and risks of suicide attempt (SA) and suicidal drug overdose (SDO) between patients with epilepsy with and without comorbid depression by using data from Taiwan’s National Health Insurance Research Database. Methods: We analyzed data of patients (≥20 years) who had received epilepsy diagnoses between 2000 and 2012; the diagnosis date of epilepsy was defined as the index date. The epilepsy patients were divided into the cohorts, with and without comorbid depression, and compared against a cohort from the non-affected population. We calculated adjusted hazard ratios and the corresponding 95% confidence intervals for SA and SDO in the three cohorts after adjustment for age, sex, and comorbidities. Results: The incidences of SA and SDO in the cohort with epilepsy and depression were 42.9 and 97.4 per 10,000 person-years, respectively. The epilepsy with depression cohort had 21.3 times of SA risk; and 22.9 times of SDO risk than did the comparison cohort had a 6.03-fold increased risk of SA and a 2.56-fold increased risk of SDO than did the epilepsy patients without depression. Moreover, patients’ age <65 years, and female sex would further increase the risk of SA in patients with epilepsy and comorbid depression. Conclusion: Risks of SA and SDO in patients with epilepsy are proportionally increased when depression is coexisted. Our findings provide crucial information for clinicians and the government for suicide prevention and to question whether prescribing a large number of medications to patients with epilepsy and depression is safe.

Download Full-text

Progress of Diabetic Severity and Risk of Dementia

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2015-1677 ◽

2015 ◽

Vol 100 (8) ◽

pp. 2899-2908 ◽

Cited By ~ 9

Author(s):

Wei-Che Chiu ◽

Wen-Chao Ho ◽

Ding-Lieh Liao ◽

Meng-Hung Lin ◽

Chih-Chiang Chiu ◽

...

Keyword(s):

Severity Index ◽

International Classification Of Diseases ◽

Population Based ◽

International Classification ◽

Diabetic Patients ◽

Research Database ◽

Classification Of Diseases ◽

New Onset

Context: Diabetes is a risk factor for dementia, but the effects of diabetic severity on dementia are unclear. Objective: The purpose of this study was to investigate the association between the severity and progress of diabetes and the risk of dementia. Design and Setting: We conducted a 12-year population-based cohort study of new-onset diabetic patients from the Taiwan National Health Insurance Research Database. The diabetic severity was evaluated by the adapted Diabetes Complications Severity Index (aDCSI) from the prediabetic period to the end of follow-up. Cox proportional hazard regressions were used to calculate the hazard ratios (HRs) of the scores and change in the aDCSI. Participants: Participants were 431,178 new-onset diabetic patients who were older than 50 years and had to receive antidiabetic medications. Main Outcome: Dementia cases were identified by International Classification of Diseases, ninth revision, code (International Classification of Diseases, ninth revision, codes 290.0, 290.1, 290.2, 290.3, 290.4, 294.1, 331.0), and the date of the initial dementia diagnosis was used as the index date. Results: The scores and change in the aDCSI were associated with the risk of dementia when adjusting for patient factors, comorbidity, antidiabetic drugs, and drug adherence. At the end of the follow-up, the risks for dementia were 1.04, 1.40, 1.54, and 1.70 (P < .001 for trend) in patients with an aDCSI score of 1, 2, 3, and greater than 3, respectively. Compared with the mildly progressive patients, the adjusted HRs increased as the aDCSI increased (2 y HRs: 1.30, 1.53, and 1.97; final HRs: 2.38, 6.95, and 24.0 with the change in the aDCSI score per year: 0.51–1.00, 1.01–2.00, and > 2.00 vs < 0.50 with P < .001 for trend). Conclusions: The diabetic severity and progression reflected the risk of dementia, and the early change in the aDCSI could predict the risk of dementia in new-onset diabetic patients.

Download Full-text

Epidemiology and Medication Pattern Change of Psoriatic Diseases in Taiwan from 2000 to 2013: A Nationwide, Population-based Cohort Study

The Journal of Rheumatology ◽

10.3899/jrheum.170516 ◽

2018 ◽

Vol 45 (3) ◽

pp. 385-392 ◽

Cited By ~ 9

Author(s):

James Cheng-Chung Wei ◽

Lin-Hong Shi ◽

Jing-Yang Huang ◽

Xue-Fen Wu ◽

Rui Wu ◽

...

Keyword(s):

Anatomical Therapeutic Chemical ◽

International Classification Of Diseases ◽

Population Based ◽

Incidence Rates ◽

Research Database ◽

Chi Square ◽

Classification Code ◽

Classification Of Diseases ◽

Taiwan National Health Insurance

Objective.To analyze the trend of prevalence and incidence rates for psoriatic arthritis (PsA) and psoriasis in Taiwan, and to determine the changes in medication patterns.Methods.Data were collected from the Taiwan National Health Insurance Research Database, which covered at least 95% of the population from 2000 to 2013. International Classification of Diseases, 9th edition (ICD-9) was used to identify PsA (ICD-9 696.0) and other psoriasis (ICD-9 696.1). Medications were identified by Anatomical Therapeutic Chemical Classification code. We calculated the annual age standardized prevalence and incidence rate of PsA and psoriasis in individuals aged ≥ 16 years from 2000 to 2013, and used the Poisson regression to test the trends by Wald chi-square statistic.Results.The prevalence (per 100,000 population) of psoriatic diseases between 2000 and 2013 increased from 11.12 to 37.75 for PsA, and from 179.2 to 281.5 for psoriasis. The incidence (per 100,000 person-yrs) increased from 3.64 to 6.91 in PsA, while there was no significant change in psoriasis. Prevalence and incidence in PsA were more rapidly increased than in psoriasis. Sex ratio (men to women) of PsA decreased from 2.0 to 1.5 in 2000 and 2013, respectively. There was an increase in the use of disease-modifying antirheumatic drugs (DMARD), especially biologics, which is significantly different from topical therapies.Conclusion.The prevalence and incidence rates of psoriatic disease, especially PsA, were increasing in Taiwan. The medication pattern showed an increase in DMARD and biologics, while use of topical therapies decreased.

Download Full-text

Gout Augments the Risk of Cardiovascular Disease in Patients With Psoriasis: A Population-Based Cohort Study

Frontiers in Immunology ◽

10.3389/fimmu.2021.703119 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zhiyong Chen ◽

Yiwen Xu ◽

Miao Chen ◽

Ran Cui ◽

Yu-Hsun Wang ◽

...

Keyword(s):

Risk Factors ◽

Propensity Score Analysis ◽

Population Based ◽

Research Database ◽

Kaplan Meier ◽

Hazard Ratios ◽

Score Analysis ◽

Increased Risk ◽

Traditional Risk Factors ◽

And Gender

ObjectivePatients with psoriasis (PsO) have a high frequency of concomitant gout and increased risk of cardiovascular diseases (CVD). We aimed to estimate the synergistic impact of gout on the risk of CVD in patients with PsO.MethodsA population-based cohort of patients registered in the National Health Insurance Research Database of Taiwan between 2000 and 2013 was stratified according to the presence of PsO and gout. Propensity score analysis was used to match age and gender at a ratio of 1:4. Cox proportional hazard models and subgroup analyses were used to estimate the hazard ratios (HRs) for CVD adjusted for traditional risk factors. The Kaplan–Meier method was used to plot the cumulative incidence curves.ResultsPatients with combined PsO and gout (n = 97), PsO alone (n = 388), gout alone (matched, n = 388) and matched controls (n = 388) were identified. Compared with the patients with PsO alone, the patients with combined PsO and gout had a significantly higher risk of CVD (relative risk 2.39, 95% CI 1.56 to 3.65). After adjustment for traditional risk factors, the risk of CVD was higher in patients with gout alone (HR 2.16, 95% CI 1.54 to 3.04) and in patients with combined PsO and gout (HR 2.72, 95% CI 1.73 to 4.28).ConclusionsGout augments the risk of CVD independently of traditional risk factors in patients with PsO.

Download Full-text