ABSTRACT
More than 1 billion people suffer from chronic respiratory diseases worldwide, accounting for more than 4 million deaths annually. Inhaled corticosteroid is a popular medication for treating chronic respiratory diseases. Its side effects include decreased bone mineral density and osteoporosis. The aims of this study are to investigate the association of inhaled corticosteroids and fracture and to design a clinical support system for fracture prediction. The data of patients aged 20 years and older, who had visited healthcare centers and been prescribed with inhaled corticosteroids within 2002-2010, were retrieved from the National Health Insurance Research Database (NHIRD). After excluding patients diagnosed with hip fracture or vertebrate fractures before using inhaled corticosteroid, a total of 11645 patients receiving inhaled corticosteroid therapy were included for this study. Among them, 1134 (9.7%) were diagnosed with hip fracture or vertebrate fracture. The statistical results showed that demographic information, chronic respiratory diseases and comorbidities, and corticosteroid-related variables (cumulative dose, mean exposed daily dose, follow-up duration, and exposed duration) were significantly different between fracture and nonfracture patients. The clinical decision support systems (CDSSs) were designed with integrated genetic algorithm (GA) and support vector machine (SVM) by training and validating the models with balanced training sets obtained by random and cluster-based undersampling methods and testing with the imbalanced NHIRD dataset. Two different objective functions were adopted for obtaining optimal models with best predictive performance. The predictive performance of the CDSSs exhibits a sensitivity of 69.84-77.00% and an AUC of 0.7495-0.7590. It was concluded that long-term use of inhaled corticosteroids may induce osteoporosis and exhibit higher incidence of hip or vertebrate fractures. The accumulated dose of ICS and OCS therapies should be continuously monitored, especially for patients with older age and women after menopause, to prevent from exceeding the maximum dosage.
Subject(s)
Adrenal Cortex Hormones/adverse effects , Decision Support Systems, Clinical , Hip Fractures/diagnosis , Respiration Disorders/drug therapy , Spinal Fractures/diagnosis , Administration, Inhalation , Adrenal Cortex Hormones/administration & dosage , Adult , Aged , Algorithms , Area Under Curve , Bone Density/drug effects , Comorbidity , Databases, Factual , Female , Hip Fractures/complications , Humans , Insurance, Health/statistics & numerical data , Male , Middle Aged , Osteoporosis/chemically induced , Prevalence , Prospective Studies , Respiration Disorders/complications , Software , Spinal Fractures/complications , Support Vector Machine , Taiwan/epidemiology , Young AdultABSTRACT
BACKGROUND: Bronchiectasis is characterized by permanent dilatation of the bronchial tree caused by recurrent airway infection and inflammation. The association of atherosclerosis and inflammation is well established. However, studies on the relationship between bronchiectasis and stroke are scant. OBJECTIVE: We conducted a population-based cohort study to investigate the incidence and risk of ischemic stroke in patients with bronchiectasis. METHODS: Data of 1,295 patients newly diagnosed as bronchiectasis between 2000 and 2008 were retrieved from the Taiwan National Health Insurance Research Database. A total of 6,475 controls without bronchiectasis at a ratio of 5:1 were randomly selected from the general population based on frequency-matched age and sex to the patients. All participants were followed up to the date of ischemic stroke development, censoring, or the end of 2010. The Cox proportional hazard model was used to identify the risk of ischemic stroke in patients with bronchiectasis compared with those without bronchiectasis. RESULTS: The patients with bronchiectasis exhibited a higher incidence rate of ischemic stroke (9.18 vs 4.66 per 1,000 person-years) than the patients without bronchiectasis, with an adjusted hazard ratio of 1.74 (95% confidence interval =1.28-2.35). The patients with bronchiectasis and any comorbidities exhibited a 2.66-fold adjusted hazard ratio of ischemic stroke compared with those with neither bronchiectasis nor comorbidity (95% confidence interval =1.85-3.84). The patients with bronchiectasis carried a dose response of ischemic stroke according to the number of emergency visits and hospitalizations per year. CONCLUSION: This study indicated that bronchiectasis is an independent risk factor of ischemic stroke.