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

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.

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Traffic-related air pollutants increase the risk for age-related macular degeneration

Journal of Investigative Medicine ◽

10.1136/jim-2019-001007 ◽

2019 ◽

Vol 67 (7) ◽

pp. 1076-1081 ◽

Cited By ~ 1

Author(s):

Kuang-Hsi Chang ◽

Po-Yuan Hsu ◽

Chun-Ju Lin ◽

Cheng-Li Lin ◽

Suh-Hang Hank Juo ◽

...

Keyword(s):

Macular Degeneration ◽

Population Based ◽

Air Pollutant ◽

Age Related Macular Degeneration ◽

Cox Proportional Hazard ◽

Age Related ◽

Increased Risk ◽

Taiwan National Health Insurance ◽

Cox Proportional Hazard Regression ◽

Year 2000

The aim of this study was to investigate whether ambient nitrogen dioxide (NO2) and carbon monoxide (CO) increase the risk for age-related macular degeneration (AMD). This is a longitudinal population-based study using the data on Taiwan National Health Insurance Program between year 2000 and 2010. From the nationwide dataset, we enrolled subjects aged 50 or older and the annually total NO2 and CO exposure was calculated from 1998 to 2010 for each subject. The Cox proportional hazard regression was used to estimate the HRs with adjustment for other variables. A total of 39,819 AMD-free residents were enrolled, and 1442 participants developed AMD during the 11 -year follow-up. Compared with the lowest exposure quartile, the highest quartile of each air pollutant was associated with an increased risk for AMD. The adjusted HR was 1.91 (95% CI 1.64 to 2.23, p<0.001) for the highest NO2 quartile, and was 1.84 (95% CI 1.5 to 2.15, p<0.001) for the highest CO quartile. In this study, chronic exposure to the highest quartile of ambient NO2 or CO significantly increases the risk for AMD.

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Association Between Preeclampsia Risk and Fine Air Pollutants and Acidic Gases: A Cohort Analysis in Taiwan

Frontiers in Public Health ◽

10.3389/fpubh.2021.617521 ◽

2021 ◽

Vol 9 ◽

Author(s):

Shih-Yi Lin ◽

Yu-Cih Yang ◽

Jun-Wei Su ◽

Jie-Sian Wang ◽

Chang-Cheng Jiang ◽

...

Keyword(s):

Cohort Analysis ◽

Air Pollutant ◽

Research Database ◽

Proportional Hazard ◽

Acidic Gases ◽

Cox Proportional Hazard ◽

Taiwan National Health Insurance ◽

Daily Concentration ◽

Cox Proportional Hazard Regression ◽

Combined Data

Background: Fine air pollutant particles have been reported to be associated with risk of preeclampsia. The association between air pollutant exposure and preeclampsia risk in heavily air polluted Taiwan warrants investigation.Methods: We combined data from Taiwan National Health Insurance (NHI) Research Database (NHIRD) and Taiwan Air Quality Monitoring Database. Women aged 16–55 years were followed from January 1, 2000, until appearance of ICD-9 coding of preeclampsia withdrawal from the NHI program, or December 31, 2013. Daily concentration of NOx, NO, NO2, and CO was calculated by Kriging method. The Cox proportional hazard regression model was used for risk assessment.Results: For NOx, Relative to Quartile [Q] 1 concentrations, the Q2 (adjusted hazard ratio adjusted = 2.20, 95% CI = 1.50–3.22), Q3 (aHR = 7.28, 95% CI = 4.78–11.0), and Q4 (aHR = 23.7, 95% CI = 13.7–41.1) concentrations were associated with a significantly higher preeclampsia or eclampsia risk. Similarly, for NO, relative to Q1 concentrations, the Q2 (aHR = 1.82, 95% CI = 1.26–2.63), Q3 (aHR = 7.53, 95% CI = 5.12–11.0), and Q4 (aHR = 11.1, 95% CI = 6.72–18.3) concentrations were correlated with significantly higher preeclampsia or eclampsia risk. Furthermore, for NO2, relative to Q1 concentration, the Q2 (aHR = 1.99, 95% CI = 1.37–2.90), Q3 (aHR = 6.15, 95% CI = 3.95–9.57), and Q4 (aHR = 32.7, 95% CI = 19.7–54.3) concentrations also associated with a significantly higher preeclampsia or eclampsia risk.Conclusion: Women exposed to higher NOX, NO, NO2, and CO concentrations demonstrated higher preeclampsia incidence.

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

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-136667 ◽

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.

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Survival in adult inpatients with COVID-19

10.1101/2020.05.25.20110684 ◽

2020 ◽

Cited By ~ 3

Author(s):

Efrén Murillo-Zamora ◽

Carlos Hernández-Suárez

Keyword(s):

Latin American ◽

Noncommunicable Diseases ◽

Disease Evolution ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Increased Risk ◽

Determining Factors ◽

Hospital Entry ◽

History Of ◽

Cox Proportional Hazard Regression

AbstractWe conducted a nationwide and retrospective cohort study to assess the survival experience and determining factors in adult inpatients with laboratory-confirmed COVID-19. Data from 5,393 individuals were analyzed using the Kaplan-Meier method and a multivariate Cox proportional hazard regression model was fitted. The 7-day survival was 0.822 and went to 0.482, 0.280, and 0.145 on days 15, 21, and 30 of hospital stay, respectively. In the multiple analysis, factors associated with an increased risk of dying were: male gender, age, longer disease evolution before hospital entry, exposure to mechanical ventilator support, and personal history of chronic noncommunicable diseases (namely obesity, type-2 diabetes mellitus, and chronic kidney disease). To the best of our knowledge, this is the first study analyzing the survival probability in a large subset of Latin-American adults with COVID-19 and our results contribute to achieving a better understanding of disease evolution.

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Factors affecting progression to permanent atrial fibrillation in an unselected population of patients with non-permanent form of atrial fibrillation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0481 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

V.L Malavasi ◽

E Fantecchi ◽

V Tordoni ◽

L Melara ◽

A Barbieri ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cox Regression ◽

Area Under The Curve ◽

Roc Curves ◽

Factors Affecting ◽

Cox Proportional Hazard ◽

Significant Difference ◽

History Of ◽

Unselected Population ◽

Cox Proportional Hazard Regression

Abstract Background Natural history of atrial fibrillation (AF) shows a progression of arrhythmia from non-permanent to permanent AF. Permanent AF was found associated with a worse prognosis than non-permanent one. Aim To assess the factors associated with progression to permanent AF in an unselected population of AF patients with non-permanent AF. Methods In this prospective study we enrolled in- as well as out-patients with non-permanent AF and age ≥18 years, with at least one episode of ECG-documented AF within 1 year. The patients were followed-up at 1 month and every 6 months thereafter. Results Out of 523 patients, 314 (60%) were in non-permanent AF (80 [25.5%] paroxysmal AF, 165 [52.5%] persistent AF, 69 [2%] first diagnosed AF), mostly male (188, 59.9%), median age 71 years (IQ range 62–77), median CHA2DS2VASc 3 (1–4), median HATCH score 1 (1–2). After a median follow-up of 701 (IQ range 437–902) days, 66 patients (21%) showed permanent AF. CHA2DS2VASc and HATCH scores were incrementally associated to progression to permanent AF (CHA2DS2VASc χ2 p=0.001; HATCH χ2 p=0.017; p for trend CHA2DS2VASc <0.001, HATCH p=0.001). At multivariable Cox proportional hazard regression the following variables were significantly associated with AF progression: age (hazard ratio [HR] 1.041; 95% CI: 1.004–1.079; p=0.028), at least moderate left atrial (LA) enlargement (>42 ml/m2) (HR 2.092; 95% CI: 1.132–3.866; p=0.018), antiarrhythmics drugs after the enrollment (HR 0.087; 95% CI: 0.011–0.662; p=0.018), EHRA score >2 (HR 0.351; 95% CI: 0.158–0.779; p=0.010) and Valvular HD (HR 2.161; 95% CI: 1.057–4.420; p=0.035). Adding LA dilation to HATCH score (HATCH-LA) and assigning 2 points based on multivariable Cox regression, HATCH-LA was statistically better in ROC curves in prediction of AF progression vs HATCH score (area under the curve 0.695 vs 0.636; DeLong p=0.0225). Survival-free curves on freedom from permanent AF using as discriminator HATCH-LA score ≤2 vs >2 led to a statistically significant difference (χ2=16.080 p<0.001), but the same was not found for HATCH score (χ2 =3.099; p=0.078). Conclusions In patients without permanent AF, progression of AF was independentely related to age, LA dilation, AF symptoms severity, antiarrhythmic drugs and Valvular HD. HATCH score predicted AF progression and adding to it LA dilation (at least moderate) improved patients stratification for the risk of evolution to permanent AF. Funding Acknowledgement Type of funding source: None

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

Neurology ◽

10.1212/wnl.0000000000011632 ◽

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.

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PERBANDINGAN MODEL REGRESI COX PROPORTIONAL HAZARD MENGGUNAKAN METODE BRESLOW DAN EFRON (Studi Kasus: Penderita Stroke di RSUD Tugurejo Kota Semarang)

Jurnal Gaussian ◽

10.14710/j.gauss.v8i1.26624 ◽

2019 ◽

Vol 8 (1) ◽

pp. 93-105

Author(s):

Eri Setiani ◽

Sudarno Sudarno ◽

Rukun Santoso

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Regression Model ◽

Diastolic Blood Pressure ◽

Proportional Hazard ◽

Hazard Regression ◽

Cox Proportional Hazard ◽

History Of ◽

Cox Proportional Hazard Regression ◽

Sugar Levels

Cox proportional hazard regression is a regression model that is often used in survival analysis. Survival analysis is phrase used to describe analysis of data in the form of times from a well-defined time origin until occurrence of some particular even or end-point. In analysis survival sometimes ties are found, namely there are two or more individual that have together event. This study aims to apply Cox model on ties event using two methods, Breslow and Efron and determine factors that affect survival of stroke patients in Tugurejo Hospital Semarang. Dependent variable in this study is length of stay, then independent variables are gender, age, type of stroke, history of hypertension, systolic blood pressure, diastolic blood pressure, blood sugar levels, and BMI. The two methods give different result, Breslow has four significant variables there are type of stroke, history of hypertension, systolic blood pressure, and diastolic blood pressure, while Efron contains five significant variables such as type of stroke, history of hypertension, systolic blood pressure, diastolic blood pressure and blood sugar levels. From the smallest AIC criteria obtained the best Cox proportional hazard regression model is Efron method. Keywords: Stroke, Cox Proportional Hazard Regression model, Breslow method, Efron method.

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Hypertension Burden and the Risk of New-Onset Atrial Fibrillation

Hypertension ◽

10.1161/hypertensionaha.120.16659 ◽

2021 ◽

Vol 77 (3) ◽

pp. 919-928

Author(s):

So-Ryoung Lee ◽

Chan Soon Park ◽

Eue-Keun Choi ◽

Hyo-Jeong Ahn ◽

Kyung-Do Han ◽

...

Keyword(s):

Atrial Fibrillation ◽

Total Study Population ◽

Increased Risk ◽

Burden Scale ◽

History Of ◽

Study Population ◽

Korean National Health Insurance ◽

Stage 1 ◽

The Relationship

The association between the cumulative hypertension burden and the development of atrial fibrillation (AF) is unclear. We aimed to investigate the relationship between hypertension burden and the development of incident AF. Using the Korean National Health Insurance Service database, we identified 3 726 172 subjects who underwent 4 consecutive annual health checkups between 2009 and 2013, with no history of AF. During the median follow-up of 5.2 years, AF was newly diagnosed in 22 012 patients (0.59% of the total study population; 1.168 per 1000 person-years). Using the blood pressure (BP) values at each health checkup, we determined the burden of hypertension (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg), stratified as 0 to 4 per the hypertension criteria. The subjects were grouped according to hypertension burden scale 1 to 4: 20% (n=742 806), 19% (n=704 623), 19% (n=713 258), 21% (n=766 204), and 21% (n=799 281). Compared with normal people, subjects with hypertension burdens of 1, 2, 3, and 4 were associated with an 8%, 18%, 26%, and 27% increased risk of incident AF, respectively. On semiquantitative analyses with further stratification of stage 1 (systolic BP of 130–139 mm Hg or diastolic BP of 80–89 mm Hg) and stage 2 (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg) hypertension, the risk of AF increased with the hypertension burden by up to 71%. In this study, both a sustained exposure and the degree of increased BP were associated with an increased risk of incident AF. Tailored BP management should be emphasized to reduce the risk of AF.

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Increased risk of dementia in patients with Schizophrenia: A population-based cohort study in Taiwan

European Psychiatry ◽

10.1016/j.eurpsy.2018.05.005 ◽

2018 ◽

Vol 53 ◽

pp. 7-16 ◽

Cited By ~ 12

Author(s):

Ching-En Lin ◽

Chi-Hsiang Chung ◽

Li-Fen Chen ◽

Mei-Ju Chi

Keyword(s):

Antipsychotic Agents ◽

Population Based ◽

Competing Risk ◽

First Year ◽

Traumatic Head Injury ◽

Chronic Lung Diseases ◽

Dementia Risk ◽

Increased Risk ◽

Cox Proportional Hazard Regression ◽

Persons With Schizophrenia

AbstractBackground:The extent to which schizophrenia is associated with the risk of all-cause dementia is controversial. This study investigated the risk of dementia by type in patients with schizophrenia.Methods:Data were collected from the Taiwanese National Health Insurance Database 2005 and analyzed using multivariate Cox proportional hazard regression models to determine the effect of schizophrenia on the dementia risk after adjusting for demographic characteristics, comorbidities, and medications. Fine and Gray's competing risk analysis was used to determine the risk of dementia, as death can act as a competing risk factor for dementia.Results:We assessed 6040 schizophrenia patients and 24,160 propensity scale-matched control patients. Schizophrenia patients exhibited a 1.80-fold risk of dementia compared to controls (adjusted hazard ratio [aHR] = 1.80, 95% confidence interval [CI] = 1.36 ∼ 2.21,p <0.001) after adjusting for covariates. Cardiovascular disease (aHR = 5.26; 95% CI = 4.50 ∼ 6.72;p <0.001), hypertension (aHR = 1.83; 95% CI = 1.77 ∼ 2.04;p= 0.002), traumatic head injury (aHR = 1.35; 95% CI = 1.24 ∼ 1.78;p <0.001), chronic lung diseases (aHR = 1.64; 95% CI = 1.13 ∼ 2.56;p <0.001), alcohol-related disorders (aHR = 3.67; 95% CI = 2.68 ∼ 4.92;p <0.001), and Parkinson’s disease (aHR = 1.72; 95% CI = 1.25 ∼ 2.40;p <0.001) were significantly associated with dementia risk. Notably, first-generation antipsychotics (aHR = 0.80; 95% CI = 0.56 ∼ 0.95;p=0.044) and second-generation antipsychotics (aHR = 0.24; 95% CI = 0.11 ∼ 0.60;p <0.001) were associated with a lower dementia risk. Sensitivity tests yielded consistent findings after excluding the first year and first 3 years of observation. Patients with schizophrenia had the highest risk of developing Alzheimer’s [dementia/disease?] among dementia subtypes (aHR = 2.10; 95% CI = 1.88 ∼ 3.86;p< 0.001), followed by vascular dementia (aHR = 1.67; 95% CI = 1.27 ∼ 2.12;p< 0.001) and unspecified dementia (aHR = 1.30; 95% CI = 1.04 ∼ 2.01;p< 0.001).Conclusions:Schizophrenia was significantly associated with the risk of all-cause dementia. Data are scarce on the mechanisms through which antipsychotic agents protect persons with schizophrenia from developing dementia. Further research is recommended to elucidate the neurobiological mechanisms underlying the association between schizophrenia and dementia, and whether antipsychotics protect against the development of dementia in schizophrenia.

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Depression and Dementia: The Role of Cortisol and Vascular Brain Lesions. AGES-Reykjavik Study

Journal of Alzheimer s Disease ◽

10.3233/jad-215241 ◽

2021 ◽

pp. 1-11

Author(s):

Lotte Gerritsen ◽

Emma L. Twait ◽

Palmi V. Jonsson ◽

Vilmundur Gudnason ◽

Lenore J. Launer ◽

...

Keyword(s):

Brain Mri ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Diagnostic Interview ◽

Late Life Depression ◽

Cox Proportional Hazard ◽

Dementia Risk ◽

Increased Risk ◽

Cox Proportional Hazard Models

Background: Late-life depression (LLD) is related to an increased risk of developing dementia; however, the biological mechanisms explaining this relationship remain unclear. Objective: To determine whether the relationship between LLD and dementia can be best explained by the glucocorticoid cascade or vascular hypothesis. Methods: Data are from 4,354 persons (mean age 76±5 years) without dementia at baseline from the AGES-Reykjavik Study. LLD was assessed with the MINI diagnostic interview (current and remitted major depressive disorder [MDD]) and the Geriatric Depression Scale-15. Morning and evening salivary cortisol were collected (glucocorticoid cascade hypothesis). White matter hyperintensities (WMH; vascular hypothesis) volume was assessed using 1.5T brain MRI. Using Cox proportional hazard models, we estimated the associations of LLD, cortisol levels, and WMH volume with incident all-cause dementia, AD, and non-AD dementia. Results: During 8.8±3.2 years of follow-up, 843 persons developed dementia, including 397 with AD. Current MDD was associated with an increased risk of developing all-cause dementia (HR = 2.17; 95% CI 1.66–2.67), with risks similar for AD and non-AD, while remitted MDD was not (HR = 1.02; 95% CI 0.55–1.49). Depressive symptoms were also associated with increased risk of dementia, in particular non-AD dementias. Higher levels of evening cortisol increased risk of dementia, but this was independent of MDD. WMH partially explained the relation between current MDD and dementia risk but remained increased (HR = 1.71; 95% CI 1.34–2.08). Conclusion: The current study highlights the importance of LLD in developing dementia. However, neither the glucocorticoid cascade nor the vascular hypotheses fully explained the relation between depression and dementia.

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