Long-term Clinical Outcome of Major Adverse Vascular Events After Hypertensive Disorders of Pregnancy.

OBJECTIVE: To assess the association between hypertensive disorders of pregnancy and adverse events after pregnancy, including chronic kidney disease and major adverse cardiovascular events (cerebrovascular accident, coronary artery disease, or death). METHODS: A nationwide, population-based cohort study was conducted analyzing women with hypertensive disorders of pregnancy identified from Taiwan National Health Insurance Research Database from 2004 to 2015. Hypertensive disorders of pregnancy were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. The study cohort was comprised of women aged 20-40 years diagnosed with hypertensive disorders of pregnancy from 2006 to 2013. The comparison group comprised of four randomly selected women without hypertensive disorders of pregnancy, matched for age and index date for each woman with hypertensive disorders of pregnancy. All the women were followed from the date of cohort entry until they developed chronic kidney disease or major adverse cardiovascular events or until the end of 2015, whichever occurred first. A Cox proportional hazard model was used to estimate the risk of chronic kidney disease and major adverse cardiovascular events. RESULTS: We identified 29,852 women with a diagnosis of hypertensive disorders of pregnancy and 119,408 matched women without hypertensive disorders of pregnancy who fit the inclusion criteria. The crude hazard ratios (HRs) were 5.22 (95% CI 4.67-5.83) and 2.26 (95% CI 1.99-2.57) for chronic kidney disease and major adverse cardiovascular events. After adjusting for potential confounders, hypertensive disorders of pregnancy was associated with a higher risk of chronic kidney disease (adjusted HR, 4.26; 95% CI 3.80-4.78), and major adverse cardiovascular events (adjusted HR, 2.15; 95% CI 1.89-2.45). CONCLUSION: This population-based cohort study indicated that women with hypertensive disorders of pregnancy are at a higher risk of chronic kidney disease and major adverse cardiovascular events than women without hypertensive disorders of pregnancy. Further studies are required to clarify the nature of these associations and to improve public health interventions.

Impact of a New Home Care Payment Mechanism on Growth of the Home Care Workforce in Taiwan.

BACKGROUND AND OBJECTIVES: Taiwan implemented its first National 10-Year Long-Term Care Plan in 2008 and its second in 2017. Over the first 10 years, the number of home care workers grew too slowly to meet demand. To increase the home care workforce, the government introduced 2 new payment mechanisms in 2018. This study assesses these mechanisms' impact on growth in numbers of home care workers and use of home care services in Taiwan. RESEARCH DESIGN AND METHODS: Data were collected from the Ministry of Health and Welfare (2014-2019) and the Division of Long-Term Care (2017-2019). Generalized estimating equations compared rates of growth in the number of home care, institutional care, and foreign care workers and the number of care recipients receiving care from each group before and after 2018. RESULTS: Before 2018, rates of growth in all three groups of care workers increased slowly. After 2018, the rate of growth for home care workers increased to 31.8% from 9%, while growth in the other two groups remained stable. While there was greater workforce growth among home care than institutional care workers post-implementation of the payment mechanisms (p < .05), the number of home care recipients (p < .05) and monthly home care visits (p < .05) also increased. DISCUSSION AND IMPLICATIONS: The new payment mechanisms improved home care workers' autonomy and salaries and appear to have contributed to immediate increased recruitment and retention. Whether this increase continues over the long run will need to be determined.

Health-related quality of life and healthcare resource utilization in Taiwanese women with menopausal symptoms: a nation-wide survey.

BACKGROUND: Menopausal experience differs among women with different cultural and ethnic backgrounds and may impact quality of life. Some women with severe menopausal symptoms seek medical help to alleviate menopause-related symptoms. PURPOSE: This study examined the demographic characteristics and health-related quality of life (HRQOL) of Taiwanese women experiencing menopausal symptoms and examined associations between menopausal symptoms and, respectively, poor HRQOL and healthcare resource utilization. METHODS: This cross-sectional study used data from the 2005 National Health Interview Survey in Taiwan, which used a multistaged stratified systematic sampling scheme. A total of 4,437 women aged 35-64 years were analyzed. We used multivariable logistic regression models to identify variables significantly and independently associated with the presence of menopausal symptoms. We also used the model to assess the odds of poor HRQOL and healthcare resource utilization in women with menopausal symptoms compared with those without. RESULTS: Eight hundred and forty-six women (19.1%) reported experiencing menopausal symptoms. Age, religion, smoking, exercise, and comorbidity were independently associated with the presence of such symptoms. The propensity score-adjusted odds ratio of poor physical HRQOL, poor mental HRQOL, use of outpatient, traditional Chinese medicine and emergency room services, and hospitalization for women with menopausal symptoms were 1.85 (95% CI [1.54, 2.21]), 1.66 (95% CI [1.40, 1.97]), 1.39 (95% CI [1.18, 1.63]), 1.73 (95% CI [1.37, 2.18]), 1.44 (95% CI [1.15, 1.81]), and 1.36 (95% CI [1.02, 1.81]), respectively, compared with those without symptoms. CONCLUSIONS: Nearly one fifth of women aged 35-64 years in Taiwan experience menopausal symptoms. The presence of menopausal symptoms increases the likelihood of poor HRQOL and healthcare resource utilization even after controlling for possible confounders.