scholarly journals Prehemodialysis arteriovenous access creation is associated with better cardiovascular outcomes in patients receiving hemodialysis: a population-based cohort study

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e6680
Author(s):  
Cheng-Chieh Yen ◽  
Mei-Yin Liu ◽  
Po-Wei Chen ◽  
Peir-Haur Hung ◽  
Tse-Hsuan Su ◽  
...  
Keyword(s):  
Cohort Study ◽  
Population Based ◽  
Sensitivity Analyses ◽  
Major Adverse Cardiovascular Events ◽  
First Year ◽  
Research Database ◽  
All Cause Mortality ◽  
Arteriovenous Access ◽  
Stage Renal Disease ◽  
Related Mortality

Background Cardiovascular (CV) disease contributes to nearly half of the mortalities in patients with end-stage renal disease. Patients who received prehemodialysis arteriovenous access (pre-HD AVA) creation had divergent CV outcomes. Methods We conducted a population-based cohort study by recruiting incident patients receiving HD from 2001 to 2012 from the Taiwan National Health Insurance Research Database. Patients’ characteristics, comorbidities, and medicines were analyzed. The primary outcome of interest was major adverse cardiovascular events (MACEs), defined as hospitalization due to acute myocardial infarction, stroke, or congestive heart failure (CHF) occurring within the first year of HD. Secondary outcomes included MACE-related mortality and all-cause mortality in the same follow-up period. Results The patients in the pre-HD AVA group were younger, had a lower burden of underlying diseases, were more likely to use erythropoiesis-stimulating agents but less likely to use renin–angiotensin–aldosterone system blockers. The patients with pre-HD AVA creation had a marginally lower rate of MACEs but a significant 35% lower rate of CHF hospitalization than those without creation (adjusted hazard ratio (HR) 0.65, 95% confidence interval (CI) [0.48–0.88]). In addition, the pre-HD AVA group exhibited an insignificantly lower rate of MACE-related mortality but a significantly 52% lower rate of all-cause mortality than the non-pre-HD AVA group (adjusted HR 0.48, 95% CI [0.39–0.59]). Sensitivity analyses obtained consistent results. Conclusions Pre-HD AVA creation is associated with a lower rate of CHF hospitalization and overall death in the first year of dialysis.

Body mass index and risk of all-cause mortality in normotensive and hypertensive adults: The Rural Chinese Cohort Study

2021 ◽  
pp. 1-25
Author(s):  
Qionggui Zhou ◽  
Xuejiao Liu ◽  
Yang Zhao ◽  
Pei Qin ◽  
Yongcheng Ren ◽  
...  
Keyword(s):  
Cohort Study ◽  
Population Based ◽  
Normal Weight ◽  
Sensitivity Analyses ◽  
Hypertension Status ◽  
Moderation Effect ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Chinese Cohort ◽  
The Impact

Abstract Objective: The impact of baseline hypertension status on the BMI–mortality association is still unclear. We aimed to examine the moderation effect of hypertension on the BMI–mortality association using a rural Chinese cohort. Design: In this cohort study, we investigated the incident of mortality according to different BMI categories by hypertension status. Setting: Longitudinal population-based cohort Participants: 17,262 adults ≥18 years were recruited from July to August of 2013 and July to August of 2014 from a rural area in China. Results: During a median 6-year follow-up, we recorded 1109 deaths (610 with and 499 without hypertension). In adjusted models, as compared with BMI 22-24 kg/m2, with BMI ≤18, 18-20, 20-22, 24-26, 26-28, 28-30 and >30 kg/m2, the HRs (95% CI) for mortality in normotensive participants were 1.92 (1.23-3.00), 1.44 (1.01-2.05), 1.14 (0.82-1.58), 0.96 (0.70-1.31), 0.96 (0.65-1.43), 1.32 (0.81-2.14), and 1.32 (0.74-2.35) respectively, and in hypertensive participants were 1.85 (1.08-3.17), 1.67 (1.17-2.39), 1.29 (0.95-1.75), 1.20 (0.91-1.58), 1.10 (0.83-1.46), 1.10 (0.80-1.52), and 0.61 (0.40-0.94) respectively. The risk of mortality was lower in individuals with hypertension with overweight or obesity versus normal weight, especially in older hypertensives (≥60 years old). Sensitivity analyses gave consistent results for both normotensive and hypertensive participants. Conclusions: Low BMI was significantly associated with increased risk of all-cause mortality regardless of hypertension status in rural Chinese adults, but high BMI decreased the mortality risk among individuals with hypertension, especially in older hypertensives.

Incidence and risk of major heart diseases in middle-aged adults with moderate to severe vision impairment: a population-based cohort study

2018 ◽  
Vol 103 (8) ◽  
pp. 1054-1059 ◽  
Author(s):  
Chun-Mei Hsueh ◽  
Jing-Hwa Wey ◽  
Jong-Shiuan Yeh ◽  
Chien-Hua Wu ◽  
Tsan-Hon Liou ◽  
...  
Keyword(s):  
Cohort Study ◽  
Heart Diseases ◽  
Population Based ◽  
Vision Impairment ◽  
Major Adverse Cardiovascular Events ◽  
Research Database ◽  
Middle Aged ◽  
Visual Disability ◽  
Aged People ◽  
Middle Aged Adults

Background/aimTo estimate the incidence and risk of major adverse cardiovascular events (MACEs), including heart failure and ischaemic heart disease, among middle-aged people with a visual disability (VD).MethodsWe used a national health insurance research database to conduct a population-based cohort study from 1 January 2000 to 31 December 2013. Patients with VD aged 35~65 years were recruited. For each VD patient, five age-matched, sex-matched and comorbidity-matched patients were randomly selected and recruited as controls. Control patients had no documented disability.ResultsThis study recruited 978 patients with VD (mean age±SD, 55.1±7.8 years; 48.9% male) and 4677 controls. Compared with the same sex of the controls, women with VD had higher incidence of MACE 1 (7.9 vs 2.8/1000 person-years, p<0.001), MACE 2 (27.5 vs 16.9/1000 person-years, p<0.001), MACE 3 (3.7 vs 1.4/1000 person-years, p<0.005) and MACE 4 (4.5 vs 2.5/1000 person-years, p<0.05), and men with VD had higher incidence of MACE 1 (4.6 vs 2.0/1000 person-years, p<0.005). Compared with the controls, patients with VD had lower cumulative MACE 1~MACE 4-free probabilities and had an independently higher risk of MACE 1~MACE 4 during the 13-year study, yielding an adjusted hazard ratio range of 1.31~2.75. Those persons with VD who had diabetes and hypertension had greater risks of MACE 1~MACE 4.ConclusionsMiddle-aged adults with VD were at risk of MACEs. A programme for MACE prevention is important for middle-aged people with VD. This is especially true for women and for those who also have diabetes and hypertension.

scholarly journals Complications and mortality in patients with schizophrenia and diabetes: Population-based cohort study

2015 ◽  
Vol 207 (5) ◽  
pp. 450-457 ◽  
Author(s):  
Chi-Shin Wu ◽  
Mei-Shu Lai ◽  
Susan Shur-Fen Gau
Keyword(s):  
Cohort Study ◽  
Microvascular Complications ◽  
Population Based ◽  
Macrovascular Complications ◽  
Research Database ◽  
Long Term Outcome ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Complications And Mortality

BackgroundThe long-term outcome of patients with both diabetes and schizophrenia remains unclear.AimsTo explore whether having schizophrenia increases the risk of advanced complications and mortality in people with diabetes.MethodThis is a population-based matched cohort study using Taiwan's National Health Insurance Research Database. A total of 11 247 participants with diabetes and schizophrenia and 11 247 participants with diabetes but not schizophrenia were enrolled. We used Cox proportional hazard models to determine the effect of schizophrenia on macrovascular and microvascular complications, and all-cause mortality.ResultsThe adjusted hazard ratios were 1.49 (95% CI 1.32–1.68) for macrovascular complications, 1.05 (95% CI 0.91–1.21) for microvascular complications and 3.68 (95% CI 3.21–4.22) for all-cause mortality in patients with diabetes and schizophrenia compared with those patients with diabetes but not schizophrenia.ConclusionsPatients with both diabetes and schizophrenia had an increased risk of macrovascular complications and all-cause mortality but did not have statistically significant elevated risk of microvascular complications.

scholarly journals Risk of dementia in patients with toxoplasmosis: a nationwide, population-based cohort study in Taiwan

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Hung-Yi Yang ◽  
Wu-Chien Chien ◽  
Chi-Hsiang Chung ◽  
Ruei-Yu Su ◽  
Chung-Yu Lai ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cohort Study ◽  
Health Insurance ◽  
Population Based ◽  
First Year ◽  
Research Database ◽  
Competing Risk Analysis ◽  
Urbanization Level ◽  
Underlying Mechanisms ◽  
Insurance Database

Abstract Background Approximately 25–30% of individuals worldwide are infected with Toxoplasma gondii (T. gondii), which is difficult to detect in its latent state. We aimed to evaluate the association between toxoplasmosis, the risk of dementia, and the effects of antibiotics in Taiwan. Methods This nationwide, population-based, retrospective cohort study was conducted using the Longitudinal Health Insurance Database containing the records of 2 million individuals retrieved from Taiwan’s National Health Insurance Research Database. Fine–Gray competing risk analysis was used to determine the risk for the development of dementia in the toxoplasmosis cohort relative to the non-toxoplasmosis cohort. A sensitivity analysis was also conducted. The effects of antibiotics (sulfadiazine or clindamycin) on the risk of dementia were also analyzed. Results We enrolled a total of 800 subjects, and identified 200 patients with toxoplasmosis and 600 sex- and age-matched controls without toxoplasmosis infection in a ratio of 1:3, selected between 2000 and 2015. The crude hazard ratio (HR) of the risk of developing dementia was 2.570 [95% confidence interval (CI) = 1.511–4.347, P < 0.001]. After adjusting for sex, age, monthly insurance premiums, urbanization level, geographical region, and comorbidities, the adjusted HR was 2.878 (95% CI = 1.709–4.968, P < 0.001). Sensitivity analysis revealed that toxoplasmosis was associated with the risk of dementia even after excluding diagnosis in the first year and the first 5 years. The usage of sulfadiazine or clindamycin in the treatment of toxoplasmosis was associated with a decreased risk of dementia. Conclusions This finding supports the evidence that toxoplasmosis is associated with dementia and that antibiotic treatment against toxoplasmosis is associated with a reduced risk of dementia. Further studies are necessary to explore the underlying mechanisms of these associations. Graphical Abstract

scholarly journals Effect of Influenza Vaccination on Mortality and Risk of Hospitalization in Elderly Individuals with and without Disabilities: A Nationwide, Population-Based Cohort Study

Vaccines ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 112 ◽  
Author(s):  
Yu-Chia Chang ◽  
Ho-Jui Tung ◽  
Yu-Tung Huang ◽  
Chin-Te Lu ◽  
Ernawaty Ernawaty ◽  
...  
Keyword(s):  
Cohort Study ◽  
The Elderly ◽  
Population Based ◽  
Influenza Vaccines ◽  
Research Database ◽  
Elderly Individuals ◽  
Relative Risks ◽  
All Cause Mortality ◽  
The Disabled ◽  
Influenza Vaccinations

Purpose: The effects of influenza vaccines are unclear for elderly individuals with disabilities. We use a population-based cohort study to estimate the effects of influenza vaccines in elderly individuals with and without disabilities. Methods: Data were taken from the National Health Insurance Research Database and Disabled Population Profile of Taiwan. A total of 2,741,403 adults aged 65 or older were identified and 394,490 were people with a disability. These two groups were further divided into those who had or had not received an influenza vaccine. Generalized estimating equations (GEE) were used to compare the relative risks (RRs) of death and hospitalization across the four groups. Results: 30.78% elderly individuals without a disability and 34.59% elderly individuals with a disability had vaccinated for influenza. Compared to the unvaccinated elderly without a disability, the vaccinated elderly without a disability had significantly lower risks in all-cause mortality (RR = 0.64) and hospitalization for any of the influenza-related diseases (RR = 0.91). Both the unvaccinated and vaccinated elderly with a disability had significantly higher risks in all-cause mortality (RR = 1.81 and 1.18, respectively) and hospitalization for any of the influenza-related diseases (RR = 1.73 and 1.59, respectively). Conclusions: The elderly with a disability had higher risks in mortality and hospitalization than those without a disability; however, receiving influenza vaccinations could still generate more protection to the disabled elderly.

scholarly journals Protective Effect of Seasonal Influenza Vaccination in Elderly Individuals with Disability in Taiwan: A Propensity Score–Matched, Nationwide, Population-Based Cohort Study

Vaccines ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 140
Author(s):  
Yu-Chia Chang ◽  
Huang Yu-Tung ◽  
Long-Sheng Chen ◽  
Ho-Jui Tung ◽  
Kuang-Hua Huang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Propensity Score ◽  
Protective Effect ◽  
Influenza Vaccination ◽  
Population Based ◽  
Medical Expenditure ◽  
Research Database ◽  
Elderly Individuals ◽  
All Cause Mortality

This is the first and largest population-based cohort study to demonstrate that influenza vaccination reduced all-cause mortality and influenza-related hospitalization in elderly individuals with a disability. Purpose: To estimate the protective effect of influenza vaccination in elderly individuals with a disability by conducting a propensity score-matched (PSM), nationwide, population-based cohort study. Methods: Data from Taiwan’s National Health Insurance Research Database were used in this study. Generalized estimating equations (GEEs) were used to compare outcomes between the vaccinated and unvaccinated cohorts. The GEE logit was used to estimate the relative risks of death and hospitalization after influenza vaccination. Adjusted odds ratios (aORs) were used to estimate relative risk. Results: The matching process yielded a final cohort of 272 896 elderly individuals with a disability (136 448 individuals in each cohort). In multivariate GEE analyses, aOR (vaccinated vs. unvaccinated) and 95% confidence interval (CI) of death were 0.70 (0.68–0.72). The aORs (95% CIs) of hospitalization for influenza and pneumonia, respiratory diseases, respiratory failure, heart disease, hemorrhagic stroke, and ischemic stroke were 0.98 (0.95–1.01), 0.96 (0.94–0.99), 0.85 (0.82–0.89), 0.96 (0.93–0.99), 0.85 (0.75–0.97), and 0.89 (0.84–0.95), respectively. The length of stay and medical expenditure exhibited greater reduction in vaccinated elderly individuals with a severe and very severe disability than in unvaccinated elderly individuals. Conclusions: Influenza vaccination reduced all-cause mortality, influenza-related hospitalization, length of stay, and medical expenditure in elderly individuals with a disability. The decrease in the length of stay and medical expenditure because of influenza vaccination was proportional to the severity of disability.

Risk of Overall and Site-specific Cancers in Behçet Disease: A Nationwide Population-based Study in Taiwan

2015 ◽  
Vol 42 (5) ◽  
pp. 879-884 ◽  
Author(s):  
Li-Hui Wang ◽  
Wei-Ming Wang ◽  
Sheng-Min Hsu ◽  
Sheng-Hsiang Lin ◽  
Chi-Chang Shieh
Keyword(s):  
Cohort Study ◽  
Cancer Risk ◽  
Risk Analysis ◽  
Population Based ◽  
Behçet Disease ◽  
First Year ◽  
Research Database ◽  
Behcet Disease ◽  
Site Specific ◽  
The Relationship

Objective.The relationship between autoimmune disease and cancer is complex while large-scale epidemiological studies of cancer risk in Behçet disease (BD) have not been reported. Therefore, we conducted a nationwide population-based cohort study.Methods.By using the National Health Insurance Research Database of 23 million people in Taiwan, we identified 1314 new patients with BD without previous cancer from 2000–2009 as a cohort. Standardized incidence ratios (SIR) of overall and site-specific cancers in patients with BD in comparison with the general population were calculated from 2000–2011.Results.Among the 1314 patients with BD, 30 developed cancers (9 men and 21 women). In overall cancer risk analysis, patients with BD had a higher risk (SIR 1.5, 95% CI 1.03–2.11). Among them, female patients with BD (SIR 1.8, 95% CI 1.14–2.7), but not male patients with BD (SIR 1.08, 95% CI 0.53–1.98), have a higher risk of overall cancer. In site-specific cancer risk analysis, patients with BD had a higher risk of non-Hodgkin lymphoma (SIR 8.3, 95% CI 2.1–22.7), hematological malignancy (SIR 4.2, 95% CI 1.3–10.2), and female breast cancer (SIR 2.2, 95% CI 1.004–4.1). The cancer risk was highest within the first-year followup (SIR 2.7, 95% CI 1.3–5.1), with 75% of the hematological malignancies found within the first year.Conclusion.This nationwide cohort study of cancer risk in patients with BD provides important information about the relationship between BD and malignancies. The results can be useful for cancer surveys in the future.

scholarly journals Non-Typhoidal Salmonella and the Risk of Kawasaki Disease: A Nationwide Population-Based Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Thomas Yen-Ting Chen ◽  
Mei-Chia Chou ◽  
Jung-Nien Lai ◽  
Li-Ting Chiu ◽  
Renin Chang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Kawasaki Disease ◽  
Comparison Group ◽  
Allergic Diseases ◽  
Population Based ◽  
Sensitivity Analyses ◽  
Research Database ◽  
Data Set ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression

ObjectiveThe aim of this study was to investigate the relationship between non-typhoidal Salmonella (NTS) infection and the risk of Kawasaki disease (KD) by using a nationwide population-based data set in Taiwan.MethodsIn this retrospective cohort study, we enrolled 69,116 patients under 18 years of age, with NTS from January 1st, 2000, to December 31st, 2013, using the population-based National Health Insurance Research Database of Taiwan. A comparison group without NTS was matched (at a 1:4 ratio) by propensity score. The two cohorts were followed from the initial diagnosis of NTS until the date of KD development or December 31st, 2013. Cox proportional hazard regression analysis was conducted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) after adjusting for covariates. Also, we conducted sensitivity analyses to examine our findings.ResultsAfter adjusting for covariates, the risk of KD for the children with NTS was significantly higher than that of the comparison group (hazard ratio = 1.31; 95% confidence interval = 1.03-1.66; p &lt; 0.01). Stratified analysis showed that the associated risk of the investigated outcome was significant in children aged ≤2 years (aHR= 1.31, 95% C.I. 1.02-1.69), in female patients (aHR= 1.46, 95% C.I. 1.03-2.08), and in those without allergic diseases.ConclusionsNTS is associated with an increased risk of KD in Taiwanese children.

scholarly journals COVID19-related and all-cause mortality risk among middle-aged and older adults across the first epidemic wave of SARS-COV-2 infection: a population-based cohort study in Southern Catalonia, Spain, March–June 2020

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Angel Vila-Corcoles ◽  
Eva Satue-Gracia ◽  
Angel Vila-Rovira ◽  
Cinta de Diego-Cabanes ◽  
Maria Jose Forcadell-Peris ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Nursing Home ◽  
Population Based ◽  
Considerable Proportion ◽  
Middle Aged ◽  
Mortality Risks ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Related Mortality

Abstract Background Direct and indirect COVID19-related mortality is uncertain. This study investigated all-cause and COVID19-related deaths among middle-aged and older adults during the first wave of COVID-19 pandemic period, assessing mortality risks by pre-existing socio-demographic and medical underlying conditions. Methods Population-based cohort study involving 79,083 individuals ≥50 years-old in Tarragona (Southern Catalonia, Spain). Baseline cohort characteristics (age/sex, comorbidities and medications/vaccinations history) were established at study start (01/03/2020) and main outcomes were COVID19-related deaths (those occurred among patients with laboratory-confirmed COVID19) and all-cause deaths occurred among cohort members between 01/03/2020–30/06/2020. Mortality risks were assessed by Cox regression analyses. Results Cohort members were followed for 1,356,358 persons-weeks, occurring 576 all-cause deaths (124 COVID19-related deaths). Of the 124 deceased patients with a laboratory-confirmed COVID19, 112 (90.3%) died by (due to) COVID-19, while 12 (9.7%) died with COVID-19 (but likely due to other concomitant causes). All-cause mortality rate among cohort members across study period was 42.5 deaths per 100,000 persons-week, being 22.8 among healthy/unrelated-COVID19 subjects, 236.4 in COVID19-excluded/PCR-negative subjects, 493.7 in COVID19-compatible/PCR-unperformed subjects and 4009.1 in COVID19-confirmed patients. Increasing age, sex male, nursing-home residence, cancer, neurologic, cardiac or liver disease, receiving diuretics, systemic corticosteroids, proton-pump inhibitors and benzodiazepines were associated with increased risk of all-cause mortality; conversely, receiving renin-angiotensin inhibitors and statins were associated with reduced risk. Age/years (hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 1.06–1.10), sex male (HR: 1.82; 95% CI: 1.24–2.70), nursing-home residence (HR: 12.56; 95% CI: 8.07–19.54) and number of pre-existing comorbidities (HR: 1.14; 95% CI: 1.01–1.29) were significant predictors for COVID19-related mortality, but none specific comorbidity emerged significantly associated with an increased risk in multivariable analysis evaluating it. Conclusion COVID19-related deaths represented more than 20 % of all-cause mortality occurred among middle-aged and older adults during the first wave of the pandemic in the region. A considerable proportion (around 10 %) of these COVID19-related deaths could be attributed to other concomitant causes. Theoretically COVID19-excluded subjects (PCR-negative) suffered ten-times greater all-cause mortality than healthy/unrelated-COVID19 subjects, which points to the existence of considerable number of false negative results in earlier PCR testing and could explain part of the global excess all-cause mortality observed during the pandemic.

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