Association of Kawasaki disease with urbanization level and family characteristics in Taiwan: A nested case-control study using national-level data.

Kawasaki disease (KD) is an inflammatory vasculitis disorder of unknown etiology. It is a rare but fatal disease and the leading cause of acquired coronary heart disease in children under the age of 5 years. We examined the association of KD with the demographics of family members, parents' characteristics, and perinatal factors in Taiwanese children. This nested case-control study used data from Taiwan's Health and Welfare Data Science Center and initially included children born in Taiwan between January 1, 2006, and December 31, 2015 (n = 1,939,449); the children were observed for KD development before the age of 5 years (n = 7870). The control group consisted of children without KD who were matched with each KD case by sex and birth date at a ratio of 8:1. The odds ratio (ORs) of the aforementioned associations were estimated using conditional logistic regression. The risk of KD decreased in children with younger parents [<25 years; younger maternal age, OR = 0.72, 95% confidence interval (CI), 0.66-0.79; younger paternal age, OR = 0.68, 95% CI, 0.59-0.78], lower socioeconomic status, more than 2 siblings (OR = 0.80, 95% CI, 0.73-0.89), and siblings with a history of KD (OR = 4.39, 95% CI, 3.29-5.86). Children living in suburban (OR = 0.95, 95% CI, 0.90-1.00) and rural (OR = 0.81, 95%CI, 0.74-0.90) areas exhibited a lower risk of KD than children living in urban areas. In conclusion, a higher incidence rate of KD was observed in children aged <5 years who had an urban lifestyle, had siblings with KD, were born to older mothers, and belonged to high-income and smaller families. Parental allergic or autoimmune diseases were not associated with the risk of KD.

A chronological review of COVID-19 case fatality rate and its secular trend and investigation of all-cause mortality and hospitalization during the Delta and Omicron waves in the United States: a retrospective cohort study.

Introduction: Coronavirus disease 2019 (COVID-19) has caused more than 690 million deaths worldwide. Different results concerning the death rates of the Delta and Omicron variants have been recorded. We aimed to assess the secular trend of case fatality rate (CFR), identify risk factors associated with mortality following COVID-19 diagnosis, and investigate the risks of mortality and hospitalization during Delta and Omicron waves in the United States. Methods: This study assessed 2,857,925 individuals diagnosed with COVID-19 in the United States from January 2020, to June 2022. The inclusion criterion was the presence of COVID-19 diagnostic codes in electronic medical record or a positive laboratory test of the SARS-CoV-2. Statistical analysis was bifurcated into two components, longitudinal analysis and comparative analysis. To assess the discrepancies in hospitalization and mortality rates for COVID-19, we identified the prevailing periods for the Delta and Omicron variants. Results: Longitudinal analysis demonstrated four sharp surges in the number of deaths and CFR. The CFR was persistently higher in males and older age. The CFR of Black and White remained higher than Asians since January 2022. In comparative analysis, the adjusted hazard ratios for all-cause mortality and hospitalization were higher in Delta wave compared to the Omicron wave. Risk of all-cause mortality was found to be greater 14-30 days after a COVID-19 diagnosis, while the likelihood of hospitalization was higher in the first 14 days following a COVID-19 diagnosis in Delta wave compared with Omicron wave. Kaplan-Meier analysis revealed the cumulative probability of mortality was approximately 2-fold on day 30 in Delta than in Omicron cases (log-rank p < 0.001). The mortality risk ratio between the Delta and Omicron variants was 1.671 (95% Cl 1.615-1.729, log-rank p < 0.001). Delta also had a significantly increased mortality risk over Omicron in all age groups. The CFR of people aged above 80 years was extremely high as 17.33%. Conclusion: Male sex and age seemed to be strong and independent risk factors of mortality in COVID-19. The Delta variant appears to cause more hospitalization and death than the Omicron variant.

Additive effect of frailty with distinct multimorbidity patterns on mortality amongst middle-aged and older adults in Taiwan: A 16-year population-based study.

AIM: This study aimed to explore the association between multimorbidity patterns with/without frailty and future mortality among Taiwanese middle-aged and older adults through a population-based cohort study design. METHODS: Data were collected from the Taiwan Longitudinal Study on Aging. The data were obtained from Wave 3, with the multimorbidity patterns in the years of 1996 being analyzed through latent class analysis. Frailty was defined using the modified Fried criteria. The association between each disease group with/without frailty and mortality was examined using logistic regression, with the reference group as the Relatively healthy group without frailty. Survival analysis was performed using Cox regression, and the follow-up period of mortality was from 1 January 1996 to 31 December 2012. RESULTS: A total of 4748 middle-aged and older adults with an average age of 66.3 years (SD: 9.07 years) were included. Four disease patterns were identified in 1996, namely the Cardiometabolic (21.0%), Arthritis-cataract (11.9%), Relatively healthy (61.6%), and Multimorbidity (5.5%) groups. After adjusting for all covariates, the Relatively healthy group with frailty showed the highest risk for mortality (odds ratio: 3.66, 95% confidence interval [95% CI]: 2.24-5.95), followed by the Cardiometabolic group with frailty (odds ratio: 3.58, 95% CI: 1.96-6.54), Multimorbidity group with frailty (odds ratio: 2.28, 95% CI: 1.17-4.44), Multimorbidity group without frailty (odds ratio: 1.44, 95% CI: 1.01-2.04), and the Cardiometabolic group without frailty (odds ratio: 1.24, 95% CI: 1.04-1.49). CONCLUSIONS: Frailty plays an important role in mortality among middle-aged and older adults with distinct multimorbidity patterns. Middle-aged and older adults with a relatively healthy multimorbidity pattern or a cardiometabolic multimorbidity pattern with frailty encountered dismal outcomes. Geriatr Gerontol Int 2023; 23: 684-691.

The mediating effect of leisure activities in the relationship between depression and cognitive decline in middle age and older adults in Taiwan.

BACKGROUND: Depression can affect the development of cognitive functions, and there are many people with depressive symptoms and cognitive decline in the aging population. The role of mediators between depressive symptoms and the subsequent cognitive decline remains unclear. We aimed to investigate whether depressive symptoms can slow down cognitive decline through a mediator. METHODS: A total of 3,135 samples were collected in 2003, 2007, and 2011. This study used the CES-D10 and SPMSQ (Short Portable Mental State Questionnaire) to measure depression and cognitive functions. The effect of depression trajectory on the subsequent cognitive dysfunction was analyzed using multivariable logistic regression, and the mediating effect was analyzed using the Sobel test. RESULTS: The results of the multivariable linear regression analysis showed that after including different variables in each model, such as leisure activities and mobility in 2003 and 2007, women had a higher percentage of depressive symptoms in each model, compared to men. The effect of depression in 2003 on cognitive decline in 2011 was mediated by intellectual leisure activities in 2007 in men (Z=-2.01) and physical activity limitation in 2007 in women (Z=-3.02). CONCLUSIONS: The mediation effect of this study shows that people with depressive symptoms will reduce their participation in leisure activities, which will lead to the degeneration of cognitive function. We suggest that if depressive symptoms are addressed as early as possible, people will have the ability and motivation to delay the decline of cognitive function through participation in leisure activities.

Association between multimorbidity patterns and incident depression among older adults in Taiwan: the role of social participation.

BACKGROUND: Previous research has found different multimorbidity patterns that negatively affects health outcomes of older adults. However, there is scarce evidence, especially on the role of social participation in the association between multimorbidity patterns and depression. Our study aimed to explore the relationship between multimorbidity patterns and depression among older adults in Taiwan, including the social participation effect on the different multimorbidity patterns. METHODS: Data were retracted from the Taiwan longitudinal study on ageing (TLSA) for this population-based cohort study. 1,975 older adults (age > 50) were included and were followed up from 1996 to 2011. We used latent class analysis to determine participants' multimorbidity patterns in 1996, whereas their incident depression was determined in 2011 by CES-D. Multivariable logistic regression was used to analyse the relationship between multimorbidity patterns and depression. RESULTS: The participants' average age was 62.1 years in 1996. Four multimorbidity patterns were discovered through latent class analysis, as follows: (1) Cardiometabolic group (n = 93), (2) Arthritis-cataract group (n = 105), (3) Multimorbidity group (n = 128) and (4) Relatively healthy group (n = 1649). Greater risk of incident depression was found among participants in the Multimorbidity group (OR: 1.62; 95% CI: 1.02-2.58) than the Relatively healthy group after the multivariable analysis. Compare to participants in the relatively healthy group with social participation, participants in the arthritis-cataract group without social participation (OR: 2.22, 95% CI: 1.03-4.78) and the multimorbidity group without social participation (OR: 2.21, 95% CI: 1.14-4.30) had significantly increased risk of having depression. CONCLUSION: Distinct multimorbidity patterns among older adults in Taiwan are linked with the incident depression during later life, and social participation functioned as a protective factor.

Association between socioeconomic position trajectories and frailty among elderly people in Taiwan.

This study examined the association between socioeconomic position (SEP) trajectories and frailty in the elderly population in Taiwan. We used data from people aged 53 years and over (n = 1284) collected from wave two of the Social Environment and Biomarkers of Aging Study. Frailty was identified using the modified Fried criteria, with the scores combined to use to categorize participants as frail (score = 3-5), prefrail (score = 1 or 2) and robust (score = 0). We applied a group-based person-centered trajectory model to identify four types of SEP trajectories (low-low, 19.2%; high-low 12.5%; low-high, 35.4%; and high-high, 32.9%) to describe the social mobility patterns in the participants' lives from childhood to older age. The mean age of the study population was 65.30 ± 8.94 years, and 47.39% of the participants were women. The prevalence of frailty was 18.39%. The low-low, high-low, low-high, and high-high SEP trajectory groups were represented by 37.92%, 24.93%, 15.43%, and 7.91%, respectively, of the study population. We used multinomial logistic regression models to evaluate the association between SEP and the risk of frailty. Compared with the low-low SEP trajectory group, the high-high SEP trajectory group was significantly associated with a lower prevalence of frail and pre-frail (odds ratios 0.17 and 0.36; 95% confidence interval 0.08-0.34 and 0.21-0.61). Our results suggest that a disadvantaged life-course SEP is associated with increased risks of frailty in older age. Avoiding that unfavourable SEP trajectories over the life course translate into an increased probability of frailty is key to reducing health inequalities in elderly populations.

Increased risk of psoriasis: An immune sequela of herpes zoster? Evidence from a nationwide population-based cohort study.

BACKGROUND: Several cases of herpes zoster-induced psoriasis have been reported in the literature. OBJECTIVE: Our nationwide retrospective cohort study is designed to examine the risk association between herpes zoster and psoriasis. METHODS: From the Taiwan National Health Insurance Research Database, 26,623 patients from 1999 to 2013 with a diagnosis of herpes zoster and no prior history of psoriasis were selected as the study subjects. The control group was established during the study period from those without a herpes zoster diagnosis and was propensity score matched to minimize confounding factors. Both cohorts were followed for cases of psoriasis development. Data analysis was done via Kaplan-Meier analysis and Cox Proportional-Hazards Models. RESULTS: Comparing the study group to control, the adjusted hazard ratio was 1.66 (95% CI, 1.31-2.13: p < 0.05) after adjusting for covariates (age, gender, urbanization, selected comorbidities and selected medications use). Statistical analysis found no interaction effect among herpes zoster and other covariates for risk modification of psoriasis development. CONCLUSION: This study demonstrated an increased risk of psoriasis in patients diagnosed with herpes zoster.

Transitions of self-management behaviors and frailty status among community-dwelling older adults: a national longitudinal population-based cohort study.

BACKGROUND: Frailty in older adults is a common geriatric syndrome that could be prevented; thus, coping strategies for the aging population are essential. Self-management behaviors may represent cost-effective strategies to prevent physical frailty in community-dwelling older adults. This study aimed to describe the changes in frailty status among community-dwelling older adults in Taiwan and investigate the association between transitions of self-management behaviors and frailty status over 4 years of follow-up (2007 to 2011). METHODS: Data were retrieved from the Taiwan Longitudinal Study of Aging (TLSA), years 2007 and 2011. In this prospective cohort study, 1283 community-dwelling older adults aged 65 years and older without cognitive impairment were recruited. Frailty was defined based on Fried's frailty phenotype. Self-management behaviors (maintaining body weight, quitting smoking or no smoking, drinking less or no drinking, exercising, keeping diet control, and maintaining a regular lifestyle) were assessed using a questionnaire. Multinomial logistic regression analyses were used to investigate the associations between changes in self-management behaviors and in frailty status. The age group was further stratified to examine the moderation effect in the relationship between changes in self-management behaviors and in frailty status among older adults. RESULTS: The prevalence of frailty was 8.7% at baseline and 14.9% after 4 years of follow-up, with 196 (15.3%) deaths. Overall, 514 (40.1%) participants maintained their frailty status, 424 (33.0%) worsened, and only 149 (11.6%) improved. Being aged ≥75 years old, having chronic diseases, and an absence of self-management behaviors were associated with frailty at baseline and after follow-up. Among individuals aged 65-74, compared to those who maintained no self-management behaviors, those who decreased the exercise behaviors (yes-to-no) had a higher risk of worsening (RRR = 2.518), while increasing (no-to-yes) and maintaining (yes-to-yes) frequent physical exercise were associated with a lower risk of worsening (RRR = 0.466 and 0.572, respectively) than stable frailty; those who maintained body weight (yes-to-yes) were associated with a lower risk of worsening (RRR = 0.327) than stable frailty after controlling for individual covariates and chronic diseases. Among individuals over 75 years old, compared to no exerciser, older old who decreased their physical exercise had a higher risk of frailty worsening (RRR = 3.255), and increasing frequent physical exercise (no-to-yes) was associated with an improvement in frailty status (RRR = 3.684). Age was a moderator between the effects of maintaining body weight on frailty worsening. There were no associations between the behavioral transitions of smoking, drinking, diet control, or regular lifestyle on the frailty status changes. CONCLUSIONS: Maintaining body weight and frequent physical exercise increased the ratio of frailty stability among individuals 65-74 years old. Increasing exercise behavior is the only factor to improve their frailty status among older adults aged 75 years and over. Older adults should be encouraged to perform adequate physical exercise and maintain a healthy body weight to maintain the frailty status in younger old aged 65-74 years, and especially perform more frequent exercise to improve frailty status in older old over 75 years.

Depression, Diabetes Mellitus and Mortality in Older Adults: A National Cohort Study in Taiwan.

Purpose: Diabetes mellitus (DM) increases the risk of cardiovascular and all-cause mortality. The coexistence of depression and DM is associated with an increased risk of DM complications and functional morbidity. The independent effect of depression on mortality in patients with DM is unclear, and relevant Asian studies have provided inconsistent results. Accordingly, this study assessed the independent and additive effects of DM and depression on mortality in a nationally representative cohort of older adults in Taiwan over a 10-year observation period. Patients and Methods: A total of 5041 participants aged 50 years or older were observed between 1996 and 2007. We defined depression as a score of ≥8 on the 10-item Center for Epidemiologic Studies Depression (CES-D 10) scale. Additionally, we defined participants as having type 2 DM if they had received a diagnosis of type 2 DM from a health-care provider. Cox proportional hazard models were applied to analyze predictors of mortality in depression and DM comorbidity groups. Results: During the 10-year follow-up period, 1637 deaths were documented. After adjustment for potential confounders, the hazard ratios for mortality in participants with both depression and DM, DM only, and depression only were 2.47 (95% confidence interval [CI]: 2.02-3.03), 1.95 (95% CI: 1.63-2.32), and 1.23 (95% CI: 1.09-1.39), respectively. Conclusion: The co-occurrence of depression with DM in Asian adults increased overall mortality rates. Our results indicate that the increased mortality hazard in individuals with DM and depression was independent of sex.

Mediation Effect of Musculoskeletal Pain on Burnout: Sex-Related Differences.

Burnout occurs when people are exposed to emotionally demanding work situations over an extended period, resulting in physical, emotional, and mental exhaustion. This study adopted the personal burnout (PB) and work-related burnout (WB) scales of the Copenhagen Burnout Inventory to measure burnout levels. Musculoskeletal (MS) pain is one factor influencing burnout. Previous studies have demonstrated that male and female hormones may contribute to sex-related differences in MS pain. This was an observational and cross-sectional study conducted at a medical-university-affiliated hospital in Taichung, Taiwan, in 2021. Data were collected for demographic characteristics, family structure, living habits, occupation, physical health, Nordic Musculoskeletal Questionnaire score, and Copenhagen Burnout Inventory score. Of the 2531 questionnaires that were distributed, 1615 (63.81%) valid questionnaires remained after those with missing data were excluded. The results demonstrated neck and shoulder pain (NBSP) is commonly associated with burnout among healthcare workers, with a higher prevalence among women than among men. With confounders being controlled for, women were found to experience substantially higher levels of personal and work-related burnout than men did. NBSP is a mediating factor; therefore, it is a key reason why women are more likely than men to experience burnout.

Effect of maternal hypertensive disorders during pregnancy on offspring's early childhood body weight: A population-based cohort study.

OBJECTIVE: The prevalence of hypertensive disorder during pregnancy (HDP) and childhood obesity is increasing worldwide. HDP or obesity in mothers can increase the risk of overweight/obesity (OWOB) in their children. Few longitudinal studies have examined the associations of maternal body weight with the growth and risk factors for overweight in infants born to mothers with HDP. This study examined the risk factors for childhood OWOB through the age of 66 months in children born to mothers with HDP. MATERIALS AND METHODS: In total, 24,200 pairs of mothers and their children were selected from the Taiwan Birth Cohort Study. The children's body weights were classified and analyzed to determine infant growth at birth and at the ages of 12, 24, 36, and 66 months. Multiple logistic regression analyses with different model settings were performed to identify the factors affecting growth and childhood OWOB in the children of mothers with HDP. RESULTS: The average birth weight of children was lower in the HDP group than in the non-HDP group. The catch-up phenomenon began at the age of 18 months. The incidence of OWOB was higher in the children in the HDP group than in those in the non-HDP group from the age of 24 months and increased with the children's age. At every age point, maternal overweight before pregnancy was the main risk factor for childhood OWOB, and this effect increased with the children's age (odds ratio [OR]: 1.83 at 66 months). The effect of excessive maternal gestational weight gain on childhood OWOB was significant (OR: 1.26-1.44 for various age points). CONCLUSION: Maternal overweight is the main risk factor for OWOB in children born to mothers with HDP. After adjusting for related confounders, we determined that HDP did not exert a significant effect on the risk of childhood OWOB.

Relationships between Alcohol Use, Musculoskeletal Pain, and Work-Related Burnout.

Background and Objectives: Burnout affects approximately half of all nurses, physicians, and other clinicians. Alcohol use may impair performance in work-related tasks, leading to decreased productivity and morale. The present study's aim was to determine whether a causal relationship existed between alcohol use, work-related burnout (WB), and musculoskeletal pain. Materials and Methods: A total of 1633 members from a hospital affiliated with a medical university in Taichung, Taiwan, completed questionnaires in 2021, where 1615 questionnaires were declared valid. Questionnaires were used to obtain information on basic demographic variables, and the Nordic Musculoskeletal Questionnaire and Copenhagen Burnout Inventory were used. Statistical analyses were performed using SAS Enterprise Guide 6.1 software, and significance was set at p < 0.05. Results: Work experience, being married, parenthood, leisure activities with family and friends, and regular weekly exercise were negatively associated with WB. In addition, overtime work, irregular and regular shift work, the physician and nurse medical profession, chronic disease (heart disease, diabetes, etc.), neck and both shoulders pain (NBSP), both ankles pain (BAP), and alcohol use frequency (AUF) were positively associated with WB. NBSP could explain the residual effect of AUF on WB. AUF was determined to mediate the relationship between NBSP and WB. In addition, NBSP was found to mediate the relationship between AUF and WB. Conclusions: The individuals who used alcohol to cope with NBSP or those with NBSP who often consumed alcohol had worsened WB due to a vicious circle of musculoskeletal pain and alcohol use. Therefore, medical staff should not consider alcohol use as an option to reduce burnout.

The association between visual trajectories and cognitive impairment: insights from the Taiwan Longitudinal Study on Aging.

BACKGROUND: Visual impairment (VI) was associated with cognitive impairment. However, different visual trajectories might contribute to different risks of cognitive decline in the elderly. AIMS: This study aimed to evaluate the association between visual trajectories and cognitive impairment. METHODS: Four thousand two hundred eight community-dwelling elder adults were identified from Waves IV-VII (1999-2011) survey of the Taiwan Longitudinal Study on Aging (TLSA). Cognitive function was determined using the Short Portable Mental Status Questionnaire (SPMSQ) scores. Visual impairment was self-reported and visual trajectories were assessed in at least two waves of the survey. Ordinal logistic regression was performed to estimate adjusted odds ratios (adjORs) and 95% confidence intervals (CIs). RESULTS: Participants with visual trajectory from no VI to VI had significantly higher risk of cognitive impairment with an adjOR of 1.69 (95% CI 1.12-2.57) than participants without VI. Compared to participants without VI, participants with persistent VI (adjOR 1.32; 95% CI 0.89-1.96) and with visual trajectory from VI to no VI (adjOR 1.25; 95% CI 0.83-1.88) were not associated with cognitive impairment. A protective association between eyeglasses use and cognitive impairment (adjOR 0.69; 95% CI 0.55-0.87) was found in this study. Importantly, cataract was associated with higher risk of cognitive impairment (adjOR 1.34; 95% CI 1.10-1.62). However, nonsurgical cataract treatment did not show protective effect on cognitive impairment in patients with cataract. CONCLUSIONS AND DISCUSSION: Visual trajectory from no VI to VI is a significant risk factor for cognitive impairment that physicians should pay special attention during community screening.

Factors Associated with Attitudes toward Aging among Taiwanese Middle-Aged and Older Adults: Based on Population-Representative National Data.

In middle-aged and older adults, attitude toward aging (ATA) exerts significant influences on their current and future health. For health promotion to be successful, participants' ATA requires health care providers' attention. Knowing the factors associated with ATA can facilitate future studies to investigate effective interventions. The aim of this study was to identify the factors associated with ATA in middle-aged and older adults. This cross-sectional study analyzed data of a nationally representative sample of adults aged 58 years and older collected in a population-based longitudinal study: the Taiwan Longitudinal Study on Aging (TLSA). To identify the factors associated with ATA, we investigated demographic factors (age, gender, education, marital and cohabitation status, and financial satisfaction status) and health-related factors (number of co-morbidities, depression, physical function dependency) with bivariate analysis and multiple regression analysis. To identify the activities beneficial to ATA over and above demographic and health-related factors, various activities (exercise, volunteer service, and leisure activities) were each examined individually by multiple regression analysis. The factors detrimental to ATA were advanced age, a higher number of co-morbidities, living alone, depression, and dependence on physical function. Those beneficial to ATA were higher education, financial satisfaction, physical exercise, volunteer service, and six leisure activities.

Multimorbidity patterns and their relationships with incident disability and frailty among older adults in Taiwan: A 16-year, population-based cohort study.

BACKGROUND: Multimorbidity has negative impacts on the health outcomes of older adults. Previous research has discovered different patterns of multimorbidity. However, evidence is scarce for associations between multimorbidity patterns and disability/frailty, especially evidence from longitudinal studies. This study aimed to explore the relationship between multimorbidity patterns and disability/frailty among older adults in Taiwan. METHODS: This population-based cohort study used data from the Taiwan Longitudinal Study on Aging. It included 2,194 older adults (age >50 years) who were followed from 1996 to 2011. The participants' multimorbidity patterns in 1996 were determined by latent class analysis; their incident disability and frailty were ascertained in 2011. Multivariate logistic regression was used to analyze the relationship between multimorbidity patterns and disability/frailty. RESULTS: In 1996, the participants' average age was 62 years. Four multimorbidity patterns were discovered through latent class analysis, as follows: (1) Cardiometabolic group (n = 222), (2) Arthritis-cataract group (n = 112), (3) Multimorbidity group (n = 189), and (4) Relatively healthy group (n = 1671). After adjusting for age, sex, social participation, alcohol consumption, self-rated health, admission in the past year, and depression, participants in the Cardiometabolic group had a greater risk of incident disability (odds ratio: 1.78; 95% confidence interval: 1.26-2.52), compared with the Relatively healthy group. No statistically significant relationships were found between multimorbidity patterns and frailty. Subgroup analysis showed that females in the Cardiometabolic and Multimorbidity groups had greater risks of developing disability. CONCLUSION: This 16-year, population-based cohort study showed that distinct multimorbidity patterns among older adults in Taiwan were associated with incident disability during later life but were not related to frailty.

The Risk of Gout in Patients with Psoriasis: A Population-Based Cohort Study in Taiwan.

Background: Previous research has pointed to the relationship between psoriasis and the development of gout. However, most previous studies had either small sample sizes or short study durations. Therefore, in this nationwide cohort study, we investigated the effect of psoriasis on the risk of gout development. Methods: The study group included one million patients from Taiwan, whom we followed for 14 years. The participants were divided into two cohorts designated as psoriasis and non-psoriasis. A 1:4 propensity score matching test was used to compare age, sex, and index year between the two cohorts. Cox proportional hazard regression was used to determine the hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of gout. Sensitivity analyses were conducted to evaluate the HR for gout after the occurrence of psoriasis. Results: The incidence densities of gout in the psoriasis and non-psoriasis cohorts were 6.96 and 5.09 per 1000 person-years, respectively. After adjusting for age, sex, urbanization, comorbidities, and nonsteroidal anti-inflammatory drug (NSAID) use, the adjusted hazard ratio (aHR) with 95% CI for incidental gout in the psoriasis group was 1.38 (1.2-1.6). Moreover, the aHR (95% CI) values for gout risk in patients with psoriasis using NSAIDs and those who did not were 1.21 (1.0-1.47) and 1.65 (1.33-2.05), respectively. Conclusion: This study demonstrated an association between psoriasis and risk of developing gout. Clinically, patients with psoriasis should be evaluated for incidental gout.

Trends of Multimorbidity Patterns over 16 Years in Older Taiwanese People and Their Relationship to Mortality.

Understanding multimorbidity patterns is important in finding a common etiology and developing prevention strategies. Our aim was to identify the multimorbidity patterns of Taiwanese people aged over 50 years and to explore their relationship with health outcomes. This longitudinal cohort study used data from the Taiwan Longitudinal Study on Aging. The data were obtained from wave 3, and the multimorbidity patterns in 1996, 1999, 2003, 2007, and 2011 were analyzed separately by latent class analysis (LCA). The association between each disease group and mortality was examined using logistic regression. Four disease patterns were identified in 1996, namely, the cardiometabolic (18.57%), arthritis-cataract (15.61%), relatively healthy (58.92%), and multimorbidity (6.9%) groups. These disease groups remained similar in the following years. After adjusting all the confounders, the cardiometabolic group showed the highest risk for mortality (odds ratio: 1.237, 95% confidence interval: 1.040-1.472). This longitudinal study reveals the trend of multimorbidity among older adults in Taiwan for 16 years. Older adults with a cardiometabolic multimorbidity pattern had a dismal outcome. Thus, healthcare professionals should put more emphasis on the prevention and identification of cardiometabolic multimorbidity.