Hysterectomy and unilateral salpingectomy associate with a higher risk of subsequent ovarian cancer: A population-based cohort study in Taiwan.

Studies on the relationship between gynecologic surgery and subsequent ovarian cancer have been carried out in limited Western ethnic groups. We aim to evaluate whether receiving hysterectomy and/or salpingectomy associated with ovarian cancer risk in Taiwan.From the Taiwan National Health Insurance Research Database, we identified a gynecologic surgery cohort consisting of women who had newly received hysterectomy (N = 181,151), salpingectomy (N = 45,410) or both hysterectomy and salpingectomy (N = 11,875) in 2000 to 2013. A comparison cohort of 953,744 women was randomly selected from women without the surgeries, frequency-matched by age and index date of the surgery case. They were followed up to identify subsequent ovarian cancer by the end of 2013.The overall ovarian cancer incidence was 4.4-fold greater in the gynecologic surgery cohort than in the comparison cohort (41.5 vs 9.43 per 10 person-years) with an adjusted hazard ratio of 3.86 (95% confidence interval = 2.56-5.84). Women with both hysterectomy and salpingectomy had the highest incidence and followed by women with hysterectomy or salpingectomy (52.5, 45.5, or 23.3 per 10 person-years, respectively). No ovarian cancer was noted in the subgroup with bilateral salpingectomies.We conclude that women with gynecologic surgery of hysterectomy and/or salpingectomy are at an increased risk of developing ovarian cancer, particularly among women who have had other gynecologic comorbidity. Women with gynecologic surgery and comorbidity deserve greater attention to prevent and screen for ovarian cancer.

Erythropoietin prevents dementia in hemodialysis patients: a nationwide population-based study.

Erythropoietic medications such as including erythropoietin (EPO) are known to be neuroprotective and to correlate with improved cognitive functions. However, it is not known whether supplementation with EPO reduces the risk of dementia in end-stage renal disease (ESRD) patients receiving hemodialysis (HD). Here, we determined whether EPO levels correlate with the incidence of different dementia subtypes, including Alzheimer's disease (AD), vascular dementia (VaD), and unspecified dementia (UnD), and whether such associations vary with annual cumulatively defined daily doses (DDDs) of EPO for ESRD patients receiving HD. This retrospective study included data from 43,906 adult ESRD patients who received HD between 1999 and 2010. Using hazard ratios and Cox regression models, we found that patients receiving EPO had a 39% lower risk of general dementia than those in the non-EPO group. Similarly, the risks of VaD and UnD was lower for patients in the EPO cohort. The risk of dementia was further reduced in HD patients treated with EPO in combination with iron. Our results suggest that the use of EPO medications in HD patients is associated with a reduced risk of VaD and UnD, but not AD, regardless of whether EPO is used alone or in combination with iron.

Metformin reduces prostate cancer risk among men with benign prostatic hyperplasia: A nationwide population-based cohort study.

Benign Prostate Hyperplasia (BPH) has been associated with prostate cancer prevalent among men after 50 years of age, however, it is unclear whether the antidiabetic drug, metformin, can reduce prostate cancer for men with BPH. The insurance claims data of men aged 50 years or older, with both type 2 diabetes mellitus (T2DM) and BPH diagnosed from 1997 to 2007 were analyzed. Individuals were followed up for at least 5 years. We identified 2906 and 2906 patients as the metformin cohort and nonmetformin cohort, respectively. The Cox method analysis showed that the metformin cohort had an adjusted hazard ratio (aHR) of 0.69 (95% confidence interval [CI] = 0.49-0.96, P = 0.0298) for prostate cancer, compared to the nonmetformin cohort after controlling for age, traditional Chinese medicine (TCM) use, prostate specific antigen, and Charlson comorbidity index. Patients using TCM for BPH (per 6 months) also had an aHR of 0.41 (95% CI = 0.24-0.69; P = 0.0009). In conclusion, both metformin medication and TCM use could be associated with reduced risk of prostate cancer for men with BPH and diabetes.

Risk of pyogenic liver abscess and endoscopic sphincterotomy: a population-based cohort study.

OBJECTIVES: To evaluate the risk of pyogenic liver abscess (PLA) in patients receiving endoscopic sphincterotomy (ES). SETTING: A population-based cohort study using data from Taiwans' National Health Insurance Research Database was conducted. Patients aged 20 or older who had undergone an ES were considered as the ES cohort. The dates for the first hospitalisation of the patients receiving ES were defined as the index dates. PARTICIPANTS: Patients in the ES and non-ES cohorts were selected by 1:1 matching ratio based on a propensity score. A total of 8174 sex-matched, age-matched and index year-matched (1:1) pairs of patients receiving ES and 8174 patients without ES served as controls. Cox proportional hazards regression was employed to calculate the HRs and 95% CIs for the association between PLA and ES. RESULTS: The overall incidence of PLA was significantly higher in the ES cohort than in the non-ES cohort (4.20 vs 0.94, respectively, per 1000 person-year) with the adjusted HR (aHR) 4.50 (95% CI 3.38 to 6.58) A stratified analysis during the follow-up years revealed that when the ES cohort was compared with the non-ES cohort, they displayed a higher risk of PLA during the first follow-up year (aHR 4.35, 95% CI 2.26 to 8.39) which continued significantly over the next 4-5 years of follow-up. CONCLUSIONS: Patients receiving ES are associated with having a higher risk of PLA.

Characteristics of Traditional Chinese Medicine Use in Pediatric Dislocations, Sprains and Strains.

BACKGROUND AND OBJECTIVES: Dislocations, sprains and strains are common childhood musculoskeletal injuries, requiring medical attention. We investigated the characteristics associated with using traditional Chinese medicine (TCM) for children suffering from these injuries. METHODS: From a nationwide representative insurance database of Taiwan, this cross-sectional study identified 50,769 children with dislocations, sprains and strains under 18 years of age, newly diagnosed between 1999 and 2009, without previous TCM experience. Children who initiated treatment with TCM (n = 24,063, 47.4%) were defined as TCM users, others were in the non-TCM group. Multivariable logistic regression models estimated odds ratios (ORs) of TCM use. RESULTS: Girls and children living in central Taiwan (vs. northern) were associated with higher TCM use. The adjusted ORs (95% confidence interval (CI)) of TCM uses were 1.60 (1.42-1.79) for patients of 3-5 years, 2.20 (1.99-2.42) of 6-12 years and 1.82 (1.64-2.01) of 13-17 years, compared with those of the <2 years group. TCM users were less likely to have outpatient visits for Western medicine care and hospitalizations in the previous year. The TCM group was nearly twice more likely than the non-user group to receive treatments at local clinics (99.1% vs. 53.3%, p < 0.001). CONCLUSIONS: This study reveals important demographic and medical factors associated with TCM uses for children with dislocations, sprains and strains. Interestingly, local clinics are the main healthcare facilities providing TCM services. Further studies are needed to evaluate the outcomes of TCM treatment for these musculoskeletal injuries.

Long-Term Therapy With Wu-Ling-San, a Popular Antilithic Chinese Herbal Formula, Did Not Prevent Subsequent Stone Surgery: A Nationwide Population-Based Cohort Study.

Traditional Chinese herbal medicine (CHM), which is widely used to treat pain and urolithiasis, is a promising therapy for urinary stone prevention. This study investigated the clinical efficacy of a popular CHM, Wu-Ling-San (WLS), in Taiwan for the prophylaxis of recurrent nephrolithiasis as assessed by surgical stone treatment via a nationwide population-based cohort study. The National Health Insurance Research Database, 2000-2010, which included one million patient records. All patients diagnosed with stone disease at the beginning of the study. The matched controls (4-fold the number of WLS patients) were stone patients who did not take WLS. Data analysis included the stone surgeries following the first treatment. We enrolled 11 900 patients with stone disease, and the incidence of stone patients in this database was 1.19%. The prevalence of comorbidities such as benign prostate hyperplasia, chronic kidney disease, diabetes mellitus, and urinary tract infection, but not hypertension, was significantly higher in WLS users. Several patients in both groups were prescribed potassium citrate. The stone treatment rate was significantly higher in WLS users (17.85%) than in the non-WLS users (14.47%). WLS users with an associated comorbidity had a higher treatment rate than the non-WLS users: 21.05% versus 16.70%, respectively. The surgery rate for upper urinary tract stones was higher in WLS users than in the non-WLS users (adjusted hazard ratio, 1.28; 95% confidence interval, 1.08-1.52; P < .05). The stone treatment rate (52.79%) was significantly higher in patients who used a very high amount of WLS (adjusted hazard ratio, 3.02; 95% confidence interval, 2.30-3.98). Stone patients using a high amount of WLS use had a high stone surgical rate. Long-term therapy with WLS did not have a preventive effect on stone surgical treatment. Long-term potassium citrate therapy as a preventive measure appeared to be underutilized in this study.

RISK OF AGE-RELATED MACULAR DEGENERATION IN END-STAGE RENAL DISEASE PATIENTS RECEIVING LONG-TERM DIALYSIS.

PURPOSE: This study investigated the risk of age-related macular degeneration (AMD) in patients with end-stage renal disease (ESRD) receiving long-term dialysis and compared the risk between various dialysis modalities using propensity score-matching methods. METHODS: From the National Health Insurance Research Database of Taiwan, the authors identified 27,232 patients with ESRD newly diagnosed from 2000 to 2010, including 9,287 patients on peritoneal dialysis (PD) and 17,945 patients on hemodialysis (HD). A total of 108,928 controls without kidney disease were randomly selected and frequency matched by age, sex, and index year of ESRD patients. The authors established an additional HD cohort matched by propensity scores of PD patients (N = 9,256 each). All cohorts were followed up until the end of 2011 to measure the incidence of AMD. RESULTS: The incidences of AMD were 1.84, 4.03, 5.37, and 3.50 per 1,000 person-years in the control, ESRD (PD and HD), PD, and HD cohorts, respectively. The hazard ratios for AMD were 1.72, 2.47, and 1.43 for the ESRD, PD, and HD cohorts, with 95% confidence intervals of 1.50 to 1.97, 2.05 to 2.98, and 1.22 to 1.68, respectively, compared with the control cohort. The patients on PD exhibited a hazard ratio of 1.74 (95% confidence interval = 1.27-2.38) for developing AMD compared with propensity score-matched patients on HD. CONCLUSION: Patients with ESRD may exhibit a higher risk of AMD than people without kidney disease. Patients on PD may be more likely to develop AMD than patients on HD.

Outcomes after stroke in patients receiving adjuvant therapy with traditional Chinese medicine: A nationwide matched interventional cohort study.

ETHNOPHARMACOLOGICAL RELEVANCE: The use of traditional Chinese medicine (TCM) was high in stroke patients but limited information was available on whether TCM is effective on post-stroke outcomes. The aim of this study is to compare the outcomes of stroke patients with and without receiving adjuvant TCM therapy. MATERIALS AND METHODS: Using Taiwan's National Health Insurance Research Database, we conducted a nationwide cohort study and selected hospitalized stroke patients receiving routine care with (n=1734) and without (n=1734) in-hospital adjuvant TCM therapy by propensity score matching procedures. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of poststroke complications and mortality associated with in-hospital adjuvant TCM therapy were calculated. The use of medical resource was also compared between stroke patients with and without adjuvant TCM therapy. RESULTS: Compared with hospitalized stroke patients receiving routine care alone, hospitalized stroke patients receiving routine care and adjuvant TCM therapy exhibited decreased risks of urinary tract infection (HR 0.82, 95% CI 0.68-1.00), pneumonia (HR 0.60, 95% CI 0.47-0.76), epilepsy (HR 0.67, 95% CI 0.49-0.96), gastrointestinal hemorrhage (HR 0.68, 95% CI 0.47-0.98), and mortality (HR 0.37, 95% CI 0.19-0.70) within 3 months after stroke admission. The corresponding 6-month HRs for urinary tract infection, pneumonia, gastrointestinal hemorrhage, and mortality were 0.83, 0.63, 0.64, and 0.40, respectively. Less use and expenditure of hospitalization were found in those received adjuvant TCM therapy. CONCLUSIONS: Hospitalized stroke patients who received routine care and adjuvant TCM therapy exhibited reduced adverse outcomes after admission within a 6-month follow-up period.

A Retrospective Cohort Study Comparing Stroke Recurrence Rate in Ischemic Stroke Patients With and Without Acupuncture Treatment.

Little was known about the effects of acupuncture on stroke recurrence. The aim of this study is to investigate whether ischemic stroke patients receiving acupuncture treatment have a decreased risk of stroke recurrence. A retrospective cohort study of 30,058 newly diagnosed cases of ischemic stroke in 2000 to 2004 was conducted based on the claims of Taiwan National Health Insurance Research Database. The use of acupuncture treatment and stroke recurrence were identified during the follow-up period from 2000 to 2009. This study compared the risk of stroke recurrence between ischemic stroke cohorts with and without acupuncture treatment by calculating adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of acupuncture associated with stroke recurrence in the Cox proportional hazard model. The stroke recurrence rate per 1000 person-years decreased from 71.4 without to 69.9 with acupuncture treatment (P < 0.001). Acupuncture treatment was associated with reduced risk of stroke recurrence (HR 0.88; 95% CI 0.84-0.91). The acupuncture effect was noted in patients with or without medical treatment for stroke prevention but its impact decreased with aging of stroke patients. Compared with stroke patients without acupuncture treatment and medication therapy, the hazard ratios of stroke recurrence for those had medication therapy only, acupuncture only, and both were 0.42 (95% CI 0.38-0.46), 0.50 (95% CI 0.43-0.57), and 0.39 (95% CI 0.35-0.43), respectively. This study raises the possibility that acupuncture might be effective in lowering stroke recurrence rate even in those on medications for stroke prevention. Results suggest the need of prospective sham-controlled and randomized trials to establish the efficacy of acupuncture in preventing stroke.

Increased risk of intracerebral hemorrhage among patients with chronic osteomyelitis.

OBJECT: Inflammation may provoke cerebral arteriolar ectasia, inducing microaneurysm formation and further promoting intracerebral hemorrhage (ICH). Chronic osteomyelitis (COM) is an inflammatory disorder for which study of its role in ICH is lacking. This study explored whether COM increases the risk of ICH. METHODS: From Taiwan national insurance inpatient claims, 22,052 patients who were newly diagnosed with COM between 1997 and 2010 were identified; 88, 207 age and sex frequency-matched subjects without COM were selected at random for comparison. Risks of ICH associated with COM and comorbidities, including hypertension, diabetes, hyperlipidemia, chronic kidney disease, and drug abuse, were assessed by the end of 2010. RESULTS: The incidence of ICH was 1.68 times higher in the COM cohort than in the comparison cohort, with an adjusted hazard ratio (HR) of 1.50 (95% CI 1.29-1.74) estimated in the multivariable Cox model. Age-specific analysis showed that the HR of ICH for COM patients decreased with age, with an adjusted HR of 3.28 (95% CI 1.88-5.75) in the < 40-year age group, which declined to 1.11 (95% CI 0.88-1.40) in the elderly. The incidence of ICH increased with the severity of COM; for those with severe COM the adjusted HR was 4.42 (95% CI 3.31-5.89). For subjects without comorbidities, the incidence of ICH was 1.20-fold (95% CI 1.00-1.45) higher in the COM cohort than in the comparison cohort. CONCLUSIONS: This study suggests for the first time that COM is an inflammatory factor associated with increased risk of ICH, especially in younger patients.

Occurrence of common allergic diseases in children with idiopathic nephrotic syndrome.

BACKGROUND: Clinical and immunological studies have consistently shown a possible link between atopy and idiopathic nephrotic syndrome (INS). However, whether allergic diseases occur after INS develops is unknown. METHODS: From Taiwan's National Health Insurance database, 1340 children with newly diagnosed INS and 5360 non-INS matched controls were identified in 2000-2007. By the end of 2008, the incidences and hazard ratios of four allergic diseases (allergic conjunctivitis, allergic rhinitis, atopic dermatitis, and asthma) were calculated. RESULTS: The incidence rates of all four allergic diseases were greater in the INS cohort than in the non-INS cohort in all age groups and decreased sharply as age increased in both cohorts. Children with INS had the highest adjusted hazard ratio (4.13; 95% confidence interval [CI], 2.50-6.83) for atopic dermatitis and the lowest adjusted hazard ratio (1.71; 95% CI, 1.39-2.09) for allergic rhinitis. Most of the allergic diseases appeared within 2-6 months after INS developed, and the incidences declined with increasing follow-up duration. CONCLUSIONS: Allergic disorders are common in children with INS, especially within the first year after diagnosis. The role of INS in the development of allergic disorders should be elucidated to establish innovative disease intervention programs.

Subsequent Cancer Risk of Women Receiving Hysterosalpingography: A Nationwide Population-Based Retrospective Cohort Study.

The objective of this study was to estimate the subsequent cancer risk of women after receiving hysterosalpingography (HSG) by conducting a nationwide retrospective cohort study. We identified a study cohort of 4,371 patients who had had a HSG examination and a comparison cohort of 17,484 women without HSG examination between 1998 and 2005. Both cohorts were followed up with until the end of 2010 to measure the incidence of cancer. The risk of developing cancer for patients with HSG was assessed using the Cox proportional hazard model. In the multivariate analyses, the HSG cohort did not have a significantly greater risk of cancer (Hazard Ratio [HR] = 1.02, 95% CI = 0.79-1.31) than the non-HSG cohort. The HR was highest for genital cancer (HR = 1.32, 95% CI = 0.77-2.25), followed by urinary system cancer (HR = 1.11, 95% CI = 0.23-5.40), and abdominal cancer not involving the GU system (HR = 1.04, 95% CI = 0.53-2.03), all of which were non-significant elevations. The cancer incidence rates, especially that for urinary system cancer, were increased in the HSG cohort, but the increase in cancer incidence was small and not statistically significant.

Association between zolpidem use and glaucoma risk: a Taiwanese population-based case-control study.

BACKGROUND: To date, the relationship between zolpidem use and subsequent risk of glaucoma in a Taiwanese population has not been assessed. METHODS: We used data from the National Health Insurance system to investigate whether zolpidem use was related to glaucoma risk. A 1:4 matched case-control study was conducted. The cases were patients newly diagnosed with glaucoma from 2001 to 2010. The controls were randomly selected non-glaucoma subjects matched by sex and age (± 5 years). Zolpidem exposure and/or the average dosage of zolpidem used (mg/year) were evaluated. Medical comorbidities were considered as confounding factors. Multiple logistic regression models were used to evaluate the potential risk of zolpidem exposure on glaucoma with/without adjustment for the effects of confounding variables. RESULTS: The exposure rate of zolpidem use in the glaucoma group was significantly higher than that of the control group (2.8% vs. 2.0%, P < 0.0001). The adjusted odds ratio (OR) of the risk of glaucoma for those with zolpidem use vs. those without was 1.19 (95% confidence interval [CI], 1.02-1.38). Compared to non-zolpidem users, zolpidem users with an average dose of more than 200 mg/year had significantly increased risk of glaucoma (OR 1.31, 95% CI 1.03-1.68). CONCLUSIONS: This study suggests that the use of zolpidem might increase the risk of subsequent glaucoma. Further confirmatory studies are recommended to clarify this important issue.

Pulmonary embolism is associated with current morphine treatment in patients with deep vein thrombosis.

OBJECTIVES: This study investigates the relationship between current morphine use and the risk of pulmonary embolism (PE) development in deep vein thrombosis (DVT) patients. METHODS: We conducted a population-based nested case-control retrospective analysis using the Longitudinal Health Insurance Database 2000 of Taiwan. A DVT cohort of 3668 patients with no history of PE from 1998 to 2010 and the other cohort of 174 patients who subsequently developed PE were evaluated. Morphine use was designated as 'current' if the prescription duration covered the index date or ended within 30 days before the index date. Logistic regression was used to estimate the odds ratios and 95% confidence intervals (CI), and the multivariable model was applied to control for age. RESULTS: Compared with non-morphine users, DVT patients who received morphine within 30 days of the index date had a 4.54-fold (95% CI = 2.30-8.97) chance of developing PE. The risk of PE development increased with an increase in cumulative dosage and in the average dosage of morphine. CONCLUSION: The incidence of PE in DVT patients in Taiwan is associated with current morphine treatment (≤30 days) and is dependent on dosage.

Adjunctive traditional Chinese medicine therapy for patients with chronic rhinosinusitis: a population-based study.

BACKGROUND: Chronic rhinosinusitis (CRS) is a chronic illness with a high prevalence worldwide. The purpose of this study was to investigate the characteristics of adjunctive traditional Chinese medicine (TCM) use in patients with CRS. METHODS: Data were retrieved from a dataset made available by the Taiwan National Health Insurance Research Database (NHIRD) containing the medical records of 1,000,000 randomly sampled beneficiaries insured in the year 2000. Patients newly diagnosed with CRS in the year 2000 were enrolled, and their medical records during the period 2000 to 2011 were collected and analyzed. RESULTS: A total of 14,806 CRS subjects were enrolled in this study: 10,512 were non-TCM users and 4294 were TCM users. TCM group had a significantly higher proportion of females, were younger, and a greater proportion lived in urban areas compared with the non-TCM group (all p < 0.0001). Ninety-seven percent (97%) of the TCM users received herbal remedies. The most common Chinese herbal formula used was Xin-Yi-Qing-Fei-Tang and the most commonly used single herb was Baizhi. The hazard ratio (HR) for functional endoscopic sinus surgery (FESS) was 0.17 for TCM users (95% confidence interval [CI], 0.15 to 0.20) compared with non-TCM users after adjusting for age, sex, urbanization, and comorbidities. CONCLUSION: Our investigation found that 29% of CRS patients used TCM in addition to Western medical treatment. A lower proportion of patients in the TCM group underwent ESS compared with that in the non-TCM group. These findings may be of value in further studies evaluating the efficacy and safety of TCM use in CRS patients.

Reduction of surgery rate in endometriosis patients who take Chinese medicine: a population-based retrospective cohort study.

OBJECTIVES: Female patients have frequently utilized Chinese medicine (CM) to treat symptoms that could possibly be related to endometriosis. The objective of this population-based retrospective cohort study was to evaluate the relationship between CM use and subsequent surgery among patients with endometriosis. DESIGN: A total of 8,283 CM users were identified among the 22,488 endometriosis patients found in the National Health Insurance reimbursement database between 2000 and 2010. A control group was identified and consisted of 8,283 matched nonusers with the same disease. A Cox proportional regression analysis was performed in order to assess risk factors for surgery for the CM users and nonusers. RESULTS: When compared to nonusers, CM users were significantly less likely to undergo surgery, with a hazard ratio of 0.47 (95% CI=0.421, 0.534) after adjusting for age, occupation, childbirth status, hypermenorrhea, iron-deficient anemia, dysmenorrhea, and amount of conventional medications. Among patients who had undergone surgery, the follow-up time was longer for CM users than for CM nonusers (p<0.001). Moreover, the most frequently used CM single and formula were Cyperus rotundus and Gui-zhi-fu-ling-wan, respectively. CONCLUSIONS: These results suggest that whatever the underlying reason, CM provides an alternative option that reduces the incidence rate of surgery in endometriosis patients.

Hyperlipidemia, statin use and the risk of developing depression: a nationwide retrospective cohort study.

OBJECTIVE: Depression is a highly prevalent disorder that is associated with disability. The aim of this study was to determine the relationship between depression and hyperlipidemia and whether the onset of depression is associated with administering statins to patients with hyperlipidemia. MATERIAL AND METHODS: The data analyzed in this study were retrieved from the National Health Insurance Research Database in Taiwan. We identified newly diagnosed hyperlipidemia in 26,852 patients without a history of depression as the exposure group in the period of 2000-2002, and a comparison group comprised 107,408 patients. The differences between the exposure group and the comparison group were examined using a chi-square test to calculate categorical variables. The hazard ratio and the 95% confidence interval for depression were used in the logistic regression. RESULTS: The hyperlipidemia patients demonstrated a high risk for depression and comorbidities, such as hypertension, diabetes and sleep disorder, which indicated synergistic effects related to a high risk of depression in hyperlipidemia patients. Hyperlipidemia patients who had received statins exhibited a lower risk of depression than did those who had not received statins. CONCLUSION: Our results suggested that hyperlipidemia increases the risk of depression and that using statins is associated with a decreased risk of depression in patients with hyperlipidemia.

Systemic sclerosis increases the risks of deep vein thrombosis and pulmonary thromboembolism: a nationwide cohort study.

OBJECTIVES: Few Asian studies have evaluated the risks of deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) in patients with SSc. We conducted a nationwide population-based cohort study to evaluate how SSc affected the incidence of DVT and PTE in Taiwan. METHODS: We identified patients with an SSc diagnosis in Taiwan between 1998 and 2010 using the Catastrophic Illness Patient Database and the National Health Insurance Research Database. Each SSc patient was frequency matched to four control patients based on age, sex and index year and all patients were observed from the index date until the appearance of a DVT or PTE event or 31 December 2010. We calculated the hazard ratios and 95% CIs of DVT and PTE in the SSc and comparison cohorts using the Cox proportional hazards regression model. RESULTS: We observed 1895 SSc patients and 7580 control patients for ∼10,128 and 46,488 person-years, respectively. The mean ages of the SSc and comparison cohorts were 50.3 and 49.9 years, respectively. After adjusting for age, sex and co-morbidities, the risks of DVT and PTE among the SSc patients were 10.5- and 7.00-fold higher than those of the control patients. The probability of developing DVT and PTE increased in the years following the SSc diagnosis. CONCLUSION: SSc patients exhibited a significantly higher risk of developing DVT and PTE compared with the general population. Thus multidisciplinary teams should guide the assessment, treatment and holistic care of SSc patients.

Decreased risk of stroke in patients with traumatic brain injury receiving acupuncture treatment: a population-based retrospective cohort study.

BACKGROUND: Patients with traumatic brain injury (TBI) face increased risk of stroke. Whether acupuncture can help to protect TBI patients from stroke has not previously been studied. METHODS: Taiwan's National Health Insurance Research Database was used to conduct a retrospective cohort study of 7409 TBI patients receiving acupuncture treatment and 29,636 propensity-score-matched TBI patients without acupuncture treatment in 2000-2008 as controls. Both TBI cohorts were followed until the end of 2010 and adjusted for immortal time to measure the incidence and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of new-onset stroke in the multivariable Cox proportional hazard models. RESULTS: TBI patients with acupuncture treatment (4.9 per 1000 person-years) had a lower incidence of stroke compared with those without acupuncture treatment (7.5 per 1000 person-years), with a HR of 0.59 (95% CI = 0.50-0.69) after adjustment for sociodemographics, coexisting medical conditions and medications. The association between acupuncture treatment and stroke risk was investigated by sex and age group (20-44, 45-64, and ≥65 years). The probability curve with log-rank test showed that TBI patients receiving acupuncture treatment had a lower probability of stroke than those without acupuncture treatment during the follow-up period (p<0.0001). CONCLUSION: Patients with TBI receiving acupuncture treatment show decreased risk of stroke compared with those without acupuncture treatment. However, this study was limited by lack of information regarding lifestyles, biochemical profiles, TBI severity, and acupuncture points used in treatments.

Long-term risk of acute coronary syndrome in patients with inflammatory bowel disease: a 13-year nationwide cohort study in an Asian population.

BACKGROUND: Whether patients with inflammatory bowel disease (IBD) exhibit a higher risk of developing acute coronary syndrome (ACS) remains debatable. METHODS: From the inpatient claims of Taiwan's National Health Insurance Research Database, we identified 11,822 patients with IBD symptoms in the 1998-2010 period and 47,288 control patients without the disorder, frequency matched by age, sex, and admission year. Both cohorts were followed-up until the end of 2010 to estimate the risk of ACS. RESULTS: The incidence of ACS was 87% higher in the patients with IBD than in the control patients (5.76 versus 3.08 per 1000 person-years). The multivariable Cox proportional hazards regression model measured adjusted hazard ratios of ACS at 1.72 (95% confidence interval, 1.53-1.94) for the patients with IBD. The age-specific data showed that the adjusted hazard ratio for patients with IBD, compared with control patients, was the highest for the 20- to 39-year age group, at 3.28 (95% confidence interval, 1.73-6.22), which decreased to 1.70 (95% confidence interval, 1.45-1.99). Patients with IBD who, on average, required 2 or more hospitalization per year were nearly 20-fold more likely to have ACS than those who required 1 hospitalization per year (80.7 versus 4.10 per 1000 person-years). CONCLUSIONS: The absolute risk of ACS increases sharply with age for patients with IBD, but young patients are at greater relative risk for the consequence. The risk of ACS was proportional to the severity of IBD. Careful follow-up observation and effective therapy should be sought for patients with IBD to reduce the risk of ACS.