Antiplatelet agents for the secondary prevention of ischaemic stroke in patients with or without renal dysfunction.

BACKGROUND AND PURPOSE: Studies on using antiplatelet agents for secondary prevention in ischaemic stroke patients with renal dysfunction are limited. The Taiwan Stroke Registry database was used to compare the efficacy of antiplatelet agents. METHODS: From the Taiwan Stroke Registry data, 39 174 acute ischaemic stroke patients were identified and were classified into three groups by antiplatelet agent: aspirin, clopidogrel and dual antiplatelet therapy (DAPT) with a combination of aspirin and clopidogrel. The re-stroke incidence and 1-year mortality were stratified by estimated glomerular filtration rate (eGFR) levels at admission: ≥90, 60-89 and <60 ml/min/1.73 m2 or on dialysis. RESULTS: Compared to the aspirin group, the re-stroke differences were not statistically significant for the clopidogrel group [adjusted subhazard ratio 0.95, 95% confidence interval (CI) 0.84-1.08] and the DAPT group (adjusted subhazard ratio 1.03, 95% CI 0.77-1.39) after controlling for the competing risk of death. The mortality rate increased as the eGFR level declined. In addition, compared to patients taking aspirin, there was no statistically significant difference in overall 1-year mortality for the clopidogrel group (adjusted hazard ratio 1.11, 95% CI 0.95-1.29) and for the DAPT group (adjusted hazard ratio 1.01, 95% CI 0.67-1.54). The results were consistent in different subgroups stratified by eGFR levels. CONCLUSIONS: There was no difference in the risks of recurrent stroke and 1-year mortality amongst ischaemic stroke patients with or without renal dysfunction receiving antiplatelet agents with aspirin, clopidogrel or dual agents with a combination of aspirin and clopidogrel, regardless of their renal dysfunction status.

Risk of osteoporosis and fracture in victims with burn injury.

Osteoporosis is a well-known bone disorder affecting people worldwide. Patients with osteoporosis have an increased risk of bone fracture. This study provides new information on the risk of developing osteoporosis post burn injury and the risk of fracture among those with osteoporosis developed. INTRODUCTION: The relationship between burn injury and hip fracture risk is unclear. Population-based evaluation on relationships between burn injury and osteoporosis development and subsequent fractures is limited. We conducted a retrospective cohort study as the investigation. METHODS: From the insurance data of Taiwan, we established a cohort of 43,532 patients with a burn injury in 2000-2012 and a comparison cohort of 174,124 individuals without such an injury, frequency matched by sex, age, and diagnosis date. Both cohorts were followed up to the end of 2013 to evaluate the occurrence of osteoporosis and hip fracture. RESULTS: The incidence of osteoporosis was greater in the burn cohort than in the comparison cohort (6.40 vs. 4.75 per 1,000 person-years) with an adjusted IRR of 1.35 (95% confidence interval = 1.32-1.39). The incidence rates in both cohorts were greater in women than in men, increased with age, income, and Charlson comorbidity index. Patients with burns involving 20%-49% of total body surface area and with burns confined to the lower/upper limbs had the greatest incidence rates, 8.32 and 8.58 per 1,000 person-years, respectively. Osteoporosis incidence increased further to 22.7 per 1,000 person-years for burn victims with comorbid diabetes. The risk of fracture was over five-fold greater for burn victims with osteoporosis developed than for comparisons without osteoporosis. CONCLUSION: Patients who have a burn injury deserve prevention intervention to reduce the risk of osteoporosis and fracture.

Relationship between fasting plasma glucose and incidence of diabetes in children and adolescents.

AIM: To investigate the appropriate fasting plasma glucose threshold by which to define prediabetes in children and adolescents, based on its ability to predict incident paediatric diabetes. METHODS: In a nationwide survey of diabetes and renal disease conducted between 1992 and 2000 in all school-aged children in Taiwan, those with abnormal results in repeated urine tests received further physical examination and blood tests. Students who had blood tests for at least two time points were selected for the present study (N = 12 119). The incidence of paediatric diabetes, adjusted hazard ratio and predictive power of fasting plasma glucose were analysed. RESULTS: The incidence of paediatric diabetes increased with increasing fasting plasma glucose levels. Groups with fasting plasma glucose >5.6 mmol/l had a higher adjusted hazard ratio. The adjusted hazard ratio of incident diabetes for participants with higher fasting plasma glucose rose continuously when using a higher threshold for fasting plasma glucose. The area under the receiver-operating characteristic curve for fasting plasma glucose was 0.628 for predicting paediatric diabetes. The association between fasting plasma glucose and incident paediatric diabetes and the area under the receiver-operating characteristic curve were similar in boys and girls and were higher in the age group 12-18 years. According to receiver-operating characteristic curve analysis, the optimal thresholds, sensitivity and specificity were 4.75 mmol/l, 65% and 51%, respectively, for those aged 6-11 years and 5.19 mmol/l, 60% and 73%, respectively, for those aged 12-18 years. CONCLUSION: Fasting plasma glucose is associated with the incidence of paediatric diabetes. The results of the present study can be used as reference data to suggest a cut-off value to define paediatric prediabetes.

Risk of hypertension after hysterectomy: a population-based study.

OBJECTIVE: Hysterectomy is the second most common surgery performed mainly for benign uterine pathologies in females. The association between hysterectomy and the subsequent risk of hypertension remains controversial. This study investigated the risk of developing hypertension in women who had a hysterectomy. DESIGN: Population-based retrospective cohort study. SETTING: We used the Taiwan National Health Insurance Research Database with claims data of 1 million randomly selected insured individuals. POPULATION: Women with and without hysterectomy and bilateral salpingo-oophorectomy, aged 30-49 years, were identified in 2000-2013 from the insurance data. METHODS: From the claims data, we identified 6674 women with hysterectomy without hypertension at the time of the surgery. The comparison cohort were 26 696 women randomly selected from women without hysterectomy and hypertension, matched by age and the year hysterectomy was performed. Adjusted hazard ratio (aHR) of hypertension was estimated after controlling for comorbidities. MAIN OUTCOME MEASURE: Prediction for hypertension following hysterectomy for benign disease. RESULTS: Both cohorts had a median age of 43.9 years. After a median follow up of 6.4 years, the incident hypertension was higher in the hysterectomy cohort than in the comparison cohort, with an adjusted hazard ratio (aHR) of 1.35 [95% confidence interval (CI) 1.27-1.44]. The incidence increased with age, with a higher aHR in hysterectomised women aged 40-49 years (aHR 1.37, 95% CI 1.06-1.83) than in those aged 30-39 years (aHR 1.22, 95% CI 1.02-1.46). CONCLUSION: Findings in this study suggest that women with hysterectomy are more likely to be diagnosed with hypertension in the follow-up period. TWEETABLE ABSTRACT: Women with hysterectomy before 50 years of age are at an increased risk of developing subsequent hypertension. PLAIN LANGUAGE SUMMARY: Hysterectomy is one of the most common surgeries for women with benign uterine disease. Hysterectomy may lead to a sudden decline in the production of sex hormone (estrogen and progesterone), which is responsible for vessel wall endothelial dysfunction leading to hardening of arteries and subsequent hypertension. However, the association between hysterectomy and risk of hypertension remains controversial. This study investigated whether premenopausal women have an elevated risk of hypertension after hysterectomy. This study employed the Taiwan National Health Insurance Research Database to identify 6674 women 30-49 years old who had a hysterectomy between 2000 and 2013, and a comparison group of 26 696 women who did not have a hysterectomy matched by age. Women in both the groups had no hypertension at baseline (recruiting date or within 1 year after recruiting date). By the end of 2013, we found that 1196 (17.9%) and 3613 (13.5%) women had developed hypertension in the hysterectomy and the comparison groups, respectively. The hypertension incidence was 1.4-fold greater in the hysterectomy group than in the control group (27.8 versus 20.2/1000 person-years).

Hip fracture risk in patients with burn injury: a retrospective cohort study in Taiwan.

This work aimed to evaluate the hip fracture risk for patients with burn injury. A total of 16,430 patients with burn injury had an adjusted hazard ratio of 1.54 to encounter a hip fracture, compared with controls without the injury. These results encourage future studies focusing on mechanisms leading to fracture associated with burn injury. INTRODUCTION: The relationship between burn injury and hip fracture risk is unclear. We conducted a retrospective cohort study to investigate this relationship. METHODS: From insurance data of Taiwan, we identified a cohort with 16,430 burn patients in 2000-2010 and a comparison cohort of 65,716 persons without the history of burn, frequency matched by sex, age, and diagnosis date. Both cohorts were followed up to the end of 2011 to evaluate the risk of hip fracture. RESULTS: Patients with burn injury were 1.62-fold more likely than comparisons to encounter a hip fracture (6.95 vs. 4.28 per 1000 person-years), with an adjusted hazard ratio (aHR) of 1.54 (95% confidence interval (CI) = 1.40-1.68). The fracture incidence increased with age and is slightly greater for women than for men in both cohorts. The fracture risk was greater for patients with burn in the eyes, face, and head with an incidence of 7.14 per 1000 person-years, or an aHR of 2.09 (95% CI = 1.53, 2.86). Diabetes and osteoporosis were also associated with an increased hip fracture risk. CONCLUSION: Burn injury is associated with an increased risk of hip fracture. Diabetes and osteoporosis are associated with an enhanced risk.

Increased risk of ischaemic stroke amongst patients with chronic osteomyelitis: a population-based cohort study in Taiwan.

BACKGROUND AND PURPOSE: Inflammatory processes, which kindle endothelial dysfunction and atherosclerosis, may facilitate the development of cardiovascular disease, including ischaemic stroke. Evident stroke risk factors may not be identified in up to 40% of stroke patients, especially in the younger population. Inflammation remains to be established as a stroke risk factor. In this study, it was assessed whether chronic osteomyelitis (COM), an infectious disease with chronic inflammation, increases stroke risk. METHODS: A national insurance claim data set of 22 million enrollees in Taiwan was used to identify 18 509 patients with COM and 74 034 randomly selected age- and gender-matched controls for a follow-up period of 11 years starting 1 January 2000 and ending 31 December 2010. Stroke risk was analyzed using the Cox proportional hazards regression model. RESULTS: Comorbidities known to increase stroke risk, including hypertension, diabetes, hyperlipidemia, coronary heart disease and peripheral arterial disease, were more frequently noted in the COM group who had significantly greater stroke risk than the control cohort. Comparing only those without comorbidities, COM carried greater stroke risk than the control group [hazard ratio (HR) = 1.40, 95% confidence interval (CI) 1.22-1.62, P < 0.001]. The younger population carried even greater risk (age < 45, HR = 2.73, 95% CI 1.71-4.35; age > 65, HR = 1.16, 95% CI 1.02-1.31). CONCLUSIONS: This is the first report linking COM to an increased risk of developing stroke. Results suggest that COM is a significant stroke risk factor and call for closer attention to this group of patients for more rigorous stroke prevention, especially in the younger age group.

Decreased prevalence of dementia associated with statins: a national population-based study.

BACKGROUND AND PURPOSE: Dementia is a neurodegenerative disorder that presents a progressive decline in cognitive function and loss of short-term memory with age. Several studies have shown that statin, an oral lipid-lowering drug, may reduce the risk of developing dementia. The objective of this study is to explore the association between statin and the development of dementia. METHODS: The data analyzed in this study were retrieved from the National Health Insurance Research Database in Taiwan. The sample consisted of 123 300 patients ≥ 20 years of age, including 61 650 dementia patients with statin use and 61 650 patients without statin use who were eligible for inclusion in this study. Univariate and multivariate Cox proportional hazard regression analyses were performed to measure the effects of statin use on the risk of dementia. RESULTS: The beneficial effect of statin on dementia was significant after adjusting for sociodemographic factors and comorbidities (adjusted hazard ratio of 0.92, 95% confidence interval 0.86-0.98). The sex- and age-specific analysis of adjusted hazard ratios showed a higher beneficial effect from statin treatment in women than in men, and the effect became more significant with age. CONCLUSION: Statin therapy may help prevent the development of dementia, and both hydrophilic and lipophilic statins produce similar effects. However, the preventive characters and associated mechanisms must be further explored and identified.

Subdural hematoma in diabetic patients.

BACKGROUND AND PURPOSE: Subdural hematoma (SDH) is associated with a high mortality rate. However, the risk of SDH in diabetic patients has not been well studied. The aim of the study was to examine the risk of SDH in incident diabetic patients. METHODS: From a universal insurance claims database of Taiwan, a cohort of 28,045 incident diabetic patients from 2000 to 2005 and a control cohort of 56,090 subjects without diabetes were identified. The incidence and hazard ratio of SDH were measured by the end of 2010. RESULTS: The mean follow-up years were 7.24 years in the diabetes cohort and 7.44 years in the non-diabetes cohort. The incidence of SDH was 1.57-fold higher in the diabetes cohort than in the non-diabetes cohort (2.04 vs. 1.30 per 1000 person-years), with an adjusted hazard ratio of 1.63 [95% confidence interval (CI) 1.43-1.85]. The stratified data showed that adjusted hazard ratios were 1.51 (95% CI 1.28-1.77) for traumatic SDH and 1.89 (95% CI 1.52-2.36) for non-traumatic SDH. The 30-day mortality rate for those who developed SDH in the diabetes cohort was 8.94%. CONCLUSIONS: This study demonstrates that incident diabetic patients are at higher risk of SDH than individuals without diabetes. Proper intervention for diabetic patients is necessary for preventing the devastating disorder.

5α-Reductase inhibitors increase acute coronary syndrome risk in patients with benign prostate hyperplasia.

BACKGROUND: This study explored the possible association between the use of two typical 5ARIs (finasteride and dutasteride) and the risk of acute coronary syndrome (ACS) in patients with benign prostate hyperplasia (BPH). METHODS: From the claims data of the Taiwan National Health Insurance (NHI) Taiwan, we identified 1843 ACS cases among BPH patients and randomly selected 7330 controls without ACS, with a similar mean age of 73 years. Multivariate logistic regression analysis estimated the odds ratio (OR) and 95 % confidence interval (CI) for the relationship between the 5ARIs medications and ACS risk. RESULTS: We found that BPH patients who had received treatment with both finasteride and dutasteride were at a higher risk of ACS with an OR of 3.47 (95 % CI 1.05-11.5), compared to patients without 5ARIs treatment. Furthermore, the dosage analysis showed that there were no significant associations between ACS risk and uses of a single drug medication regardless the dosages. The ORs for those who took only dutasteride were 1.07 (95 % CI 0.39-2.99) with low dose and 0.73 (95 % CI 0.38-1.44) with high dose. The ORs for those who took only finasteride were 1.30 (95 % CI 0.89-1.92) with low dose and 0.98 (95 % CI 0.19-5.13) with high dose. CONCLUSION: This population-based nested case-control study suggests that 5ARI use may increase ACS risk among patients with BPH when patients were exposed to both finasteride and dutasteride.

Correlation between use of simvastatin and lovastatin and female lung cancer risk: a nationwide case-control study.

BACKGROUND: The objective of this study was to determine the association between statin use and female lung cancer in Taiwan. METHODS: In this case-control study, we used information from the Taiwan National Health Institute Research Database on 17,329 patients (cases) aged 20 years or older recently diagnosed with lung cancer between 2005 and 2010 and 17,329 patients without lung cancer to assess the association between female lung cancer and statin use, even adjustment for its comorbidities. RESULTS: After adjusting for age and associated risk factors, we determined that women who engaged in long-term use of simvastatin at a defined daily dose (DDD) of over 150 have a reduced risk of lung cancer compared with those who did not use statins (odds ratio: 0.77, 95% confidence interval: 0.62-0.97) in women. However, lovastatin was not significantly associated with lung cancer in women. Among female patients with pre-existing comorbidities of respiratory diseases such as chronic obstructive pulmonary disease, hypertension, stroke and pulmonary tuberculosis, statins reduced the risk of lung cancer. CONCLUSIONS: Simvastatin use at a DDD of more than 150 is correlated with an approximately 20% reduction in the risk of lung cancer in women.

Mortality and cost of radiation therapy for oesophageal cancer according to hospital accreditation level: a nationwide population-based study.

This study examined and analysed the relationship between the cost-effectiveness and outcome of radiotherapy for oesophageal cancer among hospitals with varying accreditation levels. We selected 428 oesophageal cancer patients from medical and non-medical centres using the National Health Insurance Research Database, which is maintained by the Taiwanese National Health Research Institutes, and compared their medical expenditure and the outcome of their radiotherapy treatment. In this study cohort of patients with oesophageal cancer, 278 patients were treated in medical centres (mean age: 60.1 years) and 150 patients were treated in non-medical centres (mean age: 62.0 years, P = 0.16). The medical centre group exhibited significantly lower medical expenses, mortality and risk of death compared with the non-medical centre group (adjusted hazard ratio = 1.38, 95% confidence interval = 1.11-1.71). Our study determined that radiotherapy for oesophageal cancer costs significantly less, and medical centres had lower mortality rates than non-medical centres. These findings could provide professional organisations and healthcare policy makers with essential information for allocation of resources.

Survival outcome of patients with nasopharyngeal carcinoma: a nationwide analysis of 13 407 patients in Taiwan.

OBJECTIVES: We reported the contemporary survival outcome of patients with nasopharyngeal carcinoma (NPC) and analysed the factors affecting survival. DESIGN: A retrospective cohort study. SETTING: A nationwide population-based study in Taiwan. PARTICIPANTS: We identified 13 407 patients with newly diagnosed NPC from 2002 to 2010. MATERIAL AND METHODS: The multivariate Cox proportional hazards model was performed to measure the mortality-association risk factor in patients with NPC after adjusting for NPC treatment and socio-demographic characteristics. RESULTS: The 1-, 2-, 5- and 8-year overall survival (OS) rates were 89.6%, 80.4%, 65.2% and 56.5%, respectively. The factors associated with mortality risk were sex (men versus women, HR = 1.45), age (>60 versus ≤ 40 years, HR = 3.61), geographic region of residence (eastern Taiwan versus northern Taiwan HR = 1.39), income (<15 840 versus >25 000, HR = 1.87) and treatment modality (chemotherapy alone versus radiotherapy alone, HR = 2.25). CONCLUSION: The contemporary 5-year OS rate was 65.2% in Taiwan. Male patients, old age, residing in eastern Taiwan, low income and receiving chemotherapy alone were independent predictors for poor OS.

Paediatric head CT scan and subsequent risk of malignancy and benign brain tumour: a nation-wide population-based cohort study.

BACKGROUND: To evaluate the possible association between paediatric head computed tomography (CT) examination and increased subsequent risk of malignancy and benign brain tumour. METHODS: In the exposed cohort, 24 418 participants under 18 years of age, who underwent head CT examination between 1998 and 2006, were identified from the Taiwan National Health Insurance Research Database (NHIRD). Patients were followed up until a diagnosis of malignant disease or benign brain tumour, withdrawal from the National Health Insurance (NHI) system, or at the end of 2008. RESULTS: The overall risk was not significantly different in the two cohorts (incidence rate=36.72 per 100 000 person-years in the exposed cohort, 28.48 per 100 000 person-years in the unexposed cohort, hazard ratio (HR)=1.29, 95% confidence interval (CI)=0.90-1.85). The risk of benign brain tumour was significantly higher in the exposed cohort than in the unexposed cohort (HR=2.97, 95% CI=1.49-5.93). The frequency of CT examination showed strong correlation with the subsequent overall risk of malignancy and benign brain tumour. CONCLUSIONS: We found that paediatric head CT examination was associated with an increased incidence of benign brain tumour. A large-scale study with longer follow-up is necessary to confirm this result.

Herpes zoster infection associated with acute coronary syndrome: a population-based retrospective cohort study.

BACKGROUND: Vasculopathy in varicella zoster virus (VZV) infection and a proposed association between herpes virus infection and atherosclerosis suggest a possible link between VZV infection and vascular thrombosis. OBJECTIVES: To determine the risk of acute coronary syndrome (ACS) associated with herpes zoster infection. METHODS: We used the Taiwan National Health Insurance Research Database to identify 57,958 patients newly diagnosed with herpes zoster between 1999 and 2010; 231,832 patients without herpes zoster were examined as the control group. Both cohorts were followed up until the end of 2010 to measure the incidence of ACS. Cox proportional-hazards regression and Kaplan-Meier analyses were used to measure the hazard ratios (HR) and the cumulative incidences of ACS, respectively. RESULTS: The incidence of ACS was 1·24-fold higher in the herpes zoster group than in the control group [36·8 vs. 29·6 per 10,000 person-years, 95% confidence interval (CI) 1·16-1·33]. After adjusting for age, sex and comorbidities, the HR of ACS for the herpes zoster group compared with the control group was 1·15 (95% CI 1·07-1·24). Analysis by the time lag (≤ 3 months, ≤ 1 year, > 1 year) showed that the incidence of ACS remained significantly higher in the herpes zoster group than in the control group, with an adjusted HR of 1·10 (95% CI 1·02-1·19) after the 1-year follow-up period. The Kaplan-Meier survival curve showed that the risk of ACS was significantly higher in the herpes zoster group than in the control group (P < 0·001). CONCLUSION: Herpes zoster infection is associated with an increased risk of ACS.

Increased risk of lichen simplex chronicus in people with anxiety disorder: a nationwide population-based retrospective cohort study.

BACKGROUND: The cingulate cortex is the main area in the brain involved in pruritus processing and is deactivated after scratching. Lichen simplex chronicus (LSC) is a common pruritic skin disorder characterized by skin lichenification following excessive scratching. Psychological factors may contribute to both the development and persistence of LSC. OBJECTIVES: To estimate the hazard ratio (HR) of LSC in people with anxiety disorders compared with the general population. METHODS: In this nationwide population-based retrospective cohort study we identified a total of 69 386 people, who formed the anxiety cohort, by using the Taiwan National Health Insurance Research Database from 2000 to 2009. The comparison cohort was composed of randomly selected people frequency matched for age (within 5-year intervals), sex and index date (the date of anxiety diagnosis) based on a 1 : 2 ratio. The risk of LSC was estimated as HRs and 95% confidence intervals (CIs) using the Cox proportional hazards model. RESULTS: After adjusting for age, sex and LSC-associated comorbidities, the people with anxiety had a 1·41-fold greater risk of developing LSC compared with the people in the comparison cohort (HR 1·41, 95% CI 1·30-1·52, P < 0·0001). In particular, individuals with obsessive-compulsive disorder had a significantly increased risk of developing LSC (HR 1·72, 95% CI 1·03-2·88, P = 0·0395). CONCLUSIONS: This study demonstrates that having an anxiety disorder is associated with an increased risk of LSC. Psychological factors were found to contribute to LSC. We recommend combining the management of LSC and psychological disorders to achieve favourable outcomes.

Increased Incidence of juvenile onset systemic lupus erythematosus in children with atopic dermatitis.

Herein, we investigated the risk of juvenile-onset systemic lupus erythematosus (JSLE) in children with atopic dermatitis (AD). From 2000 to 2007, 192,357 children with newly diagnosed AD and 769,428 matched non-AD controls were identified. By the end of 2008, incidences and hazard ratios (HRs) of JSLE were measured. JSLE incidence in the AD cohort was 2.90-fold greater than that in the non-AD cohort (3.25 vs. 1.12 per 100,000 person-years), with a Cox model-measured adjusted HR of 2.92 (95% CI: 1.85-4.60); the risk of JSLE was greater for older children and girls. The AD-to-non-AD cohort HR was 6.6 (95% CI: 2.88-13.1) for children aged >12 years compared with 1.81 (95% CI: 0.98-3.32) for children aged ≤ 12 years. The HR of JSLE in AD children increased from 1.55 (95% CI: 0.88-2.76) for those with ≤ 3 clinical visits to 66.3 (95% CI: 33.1-132.8) for those with >6 visits (p < 0.0001, by trend test). The risk of developing SLE in the AD cohort was the highest within five years after AD diagnosis (HR: 4.02; 95% CI: 2.83-7.08). Children with AD are at a high risk of developing JSLE during their growth period.

Risk of accidental injuries amongst Parkinson disease patients.

BACKGROUND AND PURPOSE: To investigate the spectrum and risks of accidental injuries (AIs) amongst Parkinson disease (PD) patients. METHODS: The participants comprised PD patients aged 50 years and older who were initially diagnosed between 2000 and 2009, and a comparison group of non-PD patients. The incidence rates of accidental injury types amongst PD and non-PD patients were calculated; hazard ratios were calculated and adjusted for comorbidities, using 95% confidence intervals (CIs) of developing such outcomes in PD patients. RESULTS: In total, 4046 PD patients and 16 184 non-PD patients were followed over time. The PD patients demonstrated the following incidence rates and hazard ratios in comparison to the control cohort for accidental injuries: all injuries, 19.78 per 100 person-years (100 PYs), adjusted hazard ratio (HR) 1.30 (95% CI 1.24-1.36); head injury, 2.95 per 100 PYs, HR 1.88 (95% CI 1.64-2.15); bone fracture and dislocation, 4.61 per 100 PYs, HR 1.39 (95% CI 1.25-1.54); burns, 0.66 per 100 PYs, HR 1.01 (95% CI 0.78-1.32); injury to spinal cord, plexus and nerves, 0.15 per 100 PYs, HR 1.25 (95% CI 0.72-2.17); superficial injuries and contusions, 11.41 per 100 PYs, HR 1.20 (95% CI 1.12-1.27). The injury risk for the 69-79 years age group in PD compared with controls of the same age (HR 1.38) was significantly higher compared with that of the 50-69 age groups in PD and controls (HR 1.16). CONCLUSIONS: Parkinson disease patients demonstrate a significantly elevated risk of developing all accidental injury types except burn injuries and injuries to spinal cord, plexus and nerves, compared with age-matched controls. The risk increases as age increases.

Hearing loss may be a non-motor feature of Parkinson's disease in older people in Taiwan.

BACKGROUND AND PURPOSE: The aim of this study was to explore whether hearing loss is associated with the risk of Parkinson's disease in the elderly in Taiwan. METHODS: Using claims data of the Taiwan National Health Insurance Program, 4976 patients (aged 65 years or older) with newly diagnosed hearing loss from 2000 to 2010 were identified and 19 904 subjects without hearing loss were randomly selected as comparisons, frequency matched by sex, age and index year of diagnosing hearing loss. The incidence of Parkinson's disease by the end of 2010 and the associated risk factors were investigated. RESULTS: The incidence of Parkinson's disease in the hearing loss group was 1.77-fold higher than that in the non-hearing-loss group (3.11 vs. 1.76 per 1000 person-years). After controlling for confounding factors, the adjusted hazard ratio (HR) of Parkinson's disease was 1.53 (95% CI 1.17, 1.99) for the hearing loss group compared with the non-hearing-loss group. Male sex (HR = 1.33, 95% CI 1.02, 1.74), age (for each year, HR = 1.06, 95% CI 1.04, 1.09), hypertension (HR = 1.70, 95% CI 1.26, 2.30) and cerebrovascular disease (HR = 1.78, 95% CI 1.37, 2.32) were also significantly associated with the risk of Parkinson's disease. CONCLUSIONS: Hearing loss correlates with an increased risk of Parkinson's disease in the elderly. Further studies are needed to confirm whether hearing loss could be a non-motor feature of Parkinson's disease.

Increased breast cancer risk for patients with multiple sclerosis: a nationwide population-based cohort study.

BACKGROUND AND PURPOSE: Studies have suggested that multiple sclerosis (MS) might be linked to an overall reduced cancer rate, but a positive relationship is also found for several types of cancer. This study determines whether MS is associated with cancer risk in Taiwan. METHODS: Data from the National Health Insurance System of Taiwan were used to assess this issue. The MS cohort included 1292 patients, and each patient was randomly frequency-matched with four participants without MS, based on their age, sex and index year (control cohort). Cox proportional hazards regression analysis was conducted to estimate the influence of MS on cancer risk. RESULTS: A significantly higher risk of developing overall cancer was found amongst the MS cohort compared with the control cohort [adjusted hazard ratio (HR) 1.85, 95% confidence interval (CI) 1.26-2.74], as well as breast cancer (adjusted HR 2.23, 95% CI 1.11-4.46). CONCLUSIONS: The nationwide population-based cohort study revealed that Taiwanese patients with MS have a higher risk of developing overall cancer types and breast cancer in particular.

Subdural hematoma in patients with end-stage renal disease receiving hemodialysis.

BACKGROUND AND PURPOSE: Hemodialysis (HD) may increase the risk of acute subdural hematoma (SDH) with high fatality, but the extent of this disease in non-western populations is unclear. The incidence of and fatality from SDH in patients with end-stage renal disease (ESRD) on HD were examined for an Asian population. METHODS: A cohort of 4709 newly diagnosed ESRD patients on HD from 1998 to 2010 and a control cohort of 18 663 subjects without any kidney disease were identified from a universal insurance claims database in Taiwan. The incidence and hazard of SDH for the two cohorts and 30-day mortality from SDH were measured by the end of 2010. RESULTS: The incidence of SDH was 4.47-fold higher in the HD cohort than in the control cohort (56.3 vs. 12.6 per 10 000 person-years) with an adjusted hazard ratio (HR) of 3.81 (95% CI 2.77-5.25). HD patients with SDH had a high odds of 30-day mortality with an adjusted odds ratio of 6.34 (95% CI 2.37-16.9). CONCLUSIONS: ESRD patients with HD were demonstrated to be at high risk of subsequent SDH and to have a high mortality risk from SDH. Proper care for HD patients is necessary to prevent the devastating disorder.