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1.
Medicine (Baltimore) ; 101(1): e28487, 2022 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-35029902

RESUMO

ABSTRACT: Studies on the thyroid disease risk in patients with rheumatoid arthritis (RA) associated with comorbidities are limited. This population-based retrospective cohort study investigated the hypothyroidism risk in patients with RA and the role of comorbidities.We used Taiwan National Health Insurance Research Database to identify 16,714 RA patients newly diagnosed in 2000 to 2008 and 66,856 control persons without RA, frequency matched by sex, age, and index year. Incidence and the RA group to controls hazard ratio of hypothyroidism were estimated.The hypothyroidism incidence was 1.74-fold higher in the RA group than in controls (16.6 vs 9.52 per 10,000 person-years), with the Cox method estimated adjusted hazard ratio of 1.67 (95% confidence interval = 1.39-2.00) after controlling for covariates. Near 75% of the study population were women, with the incidence 3.6-time higher than men in both groups. The hypothyroidism incidence increased with age, from 12.1 per 1000 person-years in 20 to 39 years to 20.0 per 1000 person-years in 60+ years in RA patients, higher than that in controls (7.17 vs 10.0 per 1000 person-years, respectively by age). Each comorbidity was related to an increased incidence and higher in the RA group than in controls. Among all comorbidities, stroke exerted the greatest impact in the RA group with an adjusted hazard ratio of 3.85 (95% confidence interval = 1.24-12.0).RA patients have an increased risk of developing hypothyroidism; this risk was pronounced in women and the elderly. RA patients should be closely monitored to prevent the development of hypothyroidism.

2.
Sci Total Environ ; 808: 152054, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34863772

RESUMO

Di-(2-ethylhexyl) phthalate (DEHP) has been used as a plasticizer for decades. Recent research evidence has revealed that environmental factors can alter vascular endothelial cell function through DNA methylation. However, no previous in vitro/vivo study has explored the role of DNA methylation in DEHP exposure and vascular endothelial cell function. In the present study, we enrolled 793 subjects aged 12 to 30 years from a young Taiwanese cohort to investigate the association between mono-2-ethylhexyl phthalate (MEHP) (urine DEHP metabolite), 5mdC/dG (global DNA methylation marker), CD31+/CD42a-, CD31+/CD42a+, and CD14 (apoptotic microparticles of vascular cells). In multiple regression analyses, the levels of mono-2-ethylhexyl phthalate (MEHP) were positively associated with 5mdC/dG and all three apoptotic microparticles. In addition, the regression coefficients between MEHP and the three types of apoptotic microparticles were higher when the 5mdC/dG levels were higher than the 50th percentile. In the structural equation model (SEM), we found that MEHP had a direct correlation with CD31+/CD42a- and an indirect association with CD31+/CD42a- through the effect of 5mdC/dG. Moreover, MEHP only had a direct association with CD31+/CD42a+ and an indirect association with CD14. In conclusion, the results show that global DNA methylation mediates the relationship between MEHP and apoptotic microparticles. These findings indicate that DNA methylation may play a role in the pathogenesis of DEHP-induced endothelial cell apoptosis in humans. Further studies are needed to clarify the causal inference.

3.
Artigo em Inglês | MEDLINE | ID: mdl-34886295

RESUMO

No study has ever investigated how ambient temperature and PM2.5 mediate rotavirus infection (RvI) in children. We used insurance claims data from Taiwan in 2006-2012 to evaluate the RvI characteristics in children aged ≤ 9. The RvI incidence rates were higher in colder months, reaching the highest in March (117.0/100 days), and then declining to the lowest in July (29.2/100 days). The age-sex-specific average incident cases were all higher in boys than in girls. Stratified analysis by temperature (<20, 20-24, and ≥25 °C) and PM2.5 (<17.5, 17.5-31.4, 31.5-41.9, and ≥42.0 µg/m3) showed that the highest incidence was 16.4/100 days at average temperatures of <20 °C and PM2.5 of 31.5-41.9 µg/m3, with Poisson regression analysis estimating an adjusted relative risk (aRR) of 1.26 (95% confidence interval (CI) = 1.11-1.43), compared to the incidence at the reference condition (<20 °C and PM2.5 < 17.5 µg/m3). As the temperature increased, the incident RvI cases reduced to 4.84 cases/100 days (aRR = 0.40, 95% CI = 0.35-0.45) when it was >25 °C with PM2.5 < 17.5 µg/m3, or to 9.84/100 days (aRR = 0.81, 95% CI = 0.77-0.93) when it was >25 °C with PM2.5 > 42 µg/m3. The seasonal RvI is associated with frequent indoor personal contact among children in the cold months. The association with PM2.5 could be an alternative assessment due to temperature inversion.

4.
Ecotoxicol Environ Saf ; 227: 112902, 2021 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-34656858

RESUMO

PURPOSE: Per- and polyfluoroalkyl substances (PFAS) are human-made chemicals used in daily use products. Recent studies have shown that different perfluorooctanoic acid (PFOA) and/or perfluorooctane sulfonate (PFOS) isomers may have different biological effects. In vitro studies have also reported that PFAS exposure can alter the structure of hemoglobin (Hb). In epidemiology, however, few studies have investigated the relationship between PFAS exposure and erythrocytes. Additionally, the correlation between PFOA/PFOS isomers and full erythrograms has never been explored. APPROACH AND RESULTS: In cohorts comprising young and middle-aged Taiwanese populations, we enrolled 1483 participants (aged between 12 and 63 years) to analyze the correlations between the plasma levels of PFOA/PFOS isomers and whole-blood erythrograms. The study comprised 868 men and 615 women with a mean age of 31.2 years. When all PFOA/PFOS isomers were entered into the multiple linear regression model, the linear PFOA (L-PFOA) levels were positively correlated with the Hb, hematocrit (HCT), mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) levels while the branched PFOS (B-PFOS) levels were positively associated with the Hb, HCT, and mean corpuscular hemoglobin concentration (MCHC). The mean value of Hb was the highest (14.66 mg/dL (95% CI =14.52-14.80); P for trend <0.001) when both the L-PFOA and B-PFOS levels were above the 50th percentile. CONCLUSIONS: The results imply that PFOA/PFOS isomers may increase the weight and volume of Hb/RBC and that L-PFOA/B-PFOS may have an additive effect on the Hb levels. However, it is also possible PFAS detected at a higher concentration may due to its binding to higher levels of Hb. Further studies are needed to investigate the effects of PFOA/PFOS isomers on RBCs in humans.


Assuntos
Ácidos Alcanossulfônicos , Poluentes Ambientais , Fluorcarbonetos , Adolescente , Adulto , Ácidos Alcanossulfônicos/toxicidade , Caprilatos/toxicidade , Criança , Feminino , Fluorcarbonetos/toxicidade , Humanos , Isomerismo , Masculino , Pessoa de Meia-Idade , Plasma , Adulto Jovem
5.
Front Public Health ; 9: 699359, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34540785

RESUMO

Objective: This study investigated the medical care costs of stroke type between age-matched cohorts with and without dysmenorrhea using the National Health Insurance Research Database (NHIRD). Methods: We collected all 66,048 women with dysmenorrhea and 66,048 women without dysmenorrhea whose age (15-44-year-old) and index year (from 1997 to 2013) were matched for comparison. We assessed the incidence and compared the risk of stroke and stroke subtype in two cohorts. The proportional distributions of stroke subtypes by age between the two cohorts were compared among the women with stroke, and their hospitalization rate was also estimated. In addition, medical cost, length of stay, and the medical cost within 30 days after stroke were compared between the two cohorts. Results: The stroke risk in dysmenorrhea was greater than comparisons (HR = 1.26, 95% CI = 1.11-1.42). Proportionally, hemorrhagic stroke (HS) significantly decreased with age in both cohorts, whereas ischemic stroke (IS) significantly increased with age when both cohorts were combined. The dysmenorrhea cohort had a higher portion of transient cerebral ischemia (TIA) stroke than comparisons (31.3 vs. 24.2%, p = 0.01) and a lower risk of hospitalization for IS (OR = 0.48, 95% CI = 0.21-0.69). Among the four-stroke subtypes, the cost of care for TIA was the least (US$157 ± 254). The average cost for stroke care was not significantly different between women with and without dysmenorrhea. Conclusion: The hospitalization rate and medical costs of TIA are lower than other types. All women should prevent and treat TIA as soon as possible to avoid recurrence or progression to major stroke events and reduce medical costs, regardless of whether they have dysmenorrhea.


Assuntos
Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Adolescente , Adulto , Dismenorreia/epidemiologia , Feminino , Custos de Cuidados de Saúde , Humanos , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Adulto Jovem
6.
Int J Clin Pract ; : e14776, 2021 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-34510649

RESUMO

BACKGROUND: We aimed to identify associations between the risk of acute respiratory failure (ARF) and types of antihypertensive agents in patients with viral pneumonia. METHODS: In this case-control study, data extracted from the Taiwan National Health Insurance Research Database were analysed. The base population comprised patients with viral pneumonia treated from 2000 to 2013. The case group comprised patients with ARF and the control group comprised participants without ARF. Adjusted odds ratios (ORs) were calculated using a multivariable logistic regression model. RESULTS: In total, 4427 viral pneumonia patients with ARF and 4427 matched control participants without ARF were recruited. Patients with diabetes, alcohol-related disease, asthma, chronic kidney disease or end-stage renal disease, chronic obstructive pulmonary disease, cancer, congestive heart failure, stroke, acute pulmonary oedema and shock had increased odds of developing ARF, especially shock (adjusted OR = 49.3; 95% CI = 27.4, 88.7), cancer (12.6; 8.67, 18.2) and stroke (7.51; 5.32, 10.6). Increasing odds of developing ARF were noted in patients using potassium-sparing diuretics (2.95; 1.54, 5.64), loop diuretics (68.2; 48.1, 96.6), calcium channel blockers (1.64; 1.26, 2.13) and angiotensin-converting enzyme inhibitors (1.70; 1.15, 2.53). Patients with prescriptions of α-blockers (0.44; 0.26, 0.74), ß-blockers (0.37; 0.26, 0.52), thiazides (0.38; 0.25, 0.59) and angiotensin receptor blockers (0.65; 0.51, 0.83) had lower odds of having ARF. CONCLUSION: Patients with viral pneumonia who received α-blockers, ß-blockers, thiazides or angiotensin receptor blockers during hospitalisation had a lower risk of developing ARF.

7.
Sci Rep ; 11(1): 18605, 2021 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-34545155

RESUMO

Increased prevalence of sleep disorders has been found in patients with functional dyspepsia; however, direction of causality remains unclear. Our aim was to compare the risk of incident functional dyspepsia between patients with and without sleep disturbance from a large population-based sample. Utilizing a nation-wide health insurance administrative dataset, we assembled an 11-year historic cohort study to compare subsequent incidence of diagnosed functional dyspepsia between adult patients with any diagnosis of sleep disturbance and age- and gender-matched controls. Hazard ratios adjusted for other relevant comorbidities and medications were calculated using Cox regression models. 45,310 patients with sleep disorder and 90,620 controls were compared. Patients with sleep apnea had a 3.3-fold (95% confidence interval: 2.82 ~ 3.89) increased hazard of functional dyspepsia compared with controls. This increased risk persisted regardless of previously diagnosed depression coexisted. Sleep disturbance was associated with an increased risk of subsequent functional dyspepsia. Potential mechanisms are discussed.


Assuntos
Dispepsia/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Adulto , Fatores Etários , Idoso , Comorbidade , Depressão/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Risco , Fatores Sexuais
8.
Nutrients ; 13(9)2021 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-34578790

RESUMO

(1) Background: In previous research, higher levels of urine heavy metals, especially lead and cadmium, have been associated with increased cardiovascular risk. However, there is no information linking exposure to heavy metal to endothelial and platelet microparticles (EMPs and PMPs), particularly in the younger population, which are novel biomarkers of endothelial dysfunction. (2) Methods: From a nationwide database, which was incepted in 1992-2000, screening for renal health among Taiwanese school children, a total of 789 subjects were recruited. Cross-sectional analysis was performed to evaluate the association between serum EMPs/PMPs and urine iron, nickel, copper, cadmium, lead, chromium, manganese, and zinc levels in the adolescent and young adult population. (3) Results: After we adjusted the conventional cardiovascular risk factors, CD31+/CD42a- and CD31+/CD42a+ counts, in subjects' serum, respective markers of EMP and PMP displayed a significant positive dose-response relationship with urinary lead and cadmium levels. Higher quartiles of urine lead and cadmium levels were associated with an increased risk of higher EMPs/PMPs (≥75th percentile) in a multivariate logistic regression model. (4) Conclusion: Higher urinary lead and cadmium concentrations are strongly associated with endothelium-platelet microparticles in this adolescent and young adult population, which could help explain, in part, the mechanism through which heavy metal exposure results in cardiotoxicity.


Assuntos
Plaquetas/metabolismo , Cádmio/urina , Doenças Cardiovasculares/epidemiologia , Micropartículas Derivadas de Células/metabolismo , Endotélio/metabolismo , Chumbo/urina , Adolescente , Adulto , Biomarcadores/urina , Doenças Cardiovasculares/metabolismo , Criança , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Metais Pesados/urina , Complexo Glicoproteico GPIb-IX de Plaquetas/metabolismo , Fatores de Risco , Taiwan , Adulto Jovem
9.
Postgrad Med ; 133(8): 865-872, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34351833

RESUMO

OBJECTIVES: Studies on the association of estimated glomerular filtration rate (eGFR) levels with hospital discharge disposition after stroke are limited with inconsistent results. This study investigated the odds of home discharge with eGFR levels at admission for patients with stroke using the Taiwan Stroke Registry (TSR) data. METHODS: From the TSR database, a total of 51,338 stroke patients from 2006 to 2015 were categorized into five groups based on eGFR levels at admission. The proportion of home discharge by the eGFR levels was calculated and logistic regression analysis was used to estimate the related odds ratio (OR) and 95% confidence interval. RESULTS: Near 85% of stroke patients were discharged to home. The proportion of home discharges decreased as the eGFR level declined. Compared to patients with eGFR ≥90 mL/min/1.73 m2, the adjusted ORs of home discharge were 0.91, 0.85, 0.63, 0.56 for patients with eGFR 60-89, eGFR 30-59, eGFR 15-29, and eGFR < 15 mL/min/1.73 m2 or on dialysis, respectively, in a graded relationship. The trends were consistent in the ischemic stroke and hemorrhagic stroke patients. The areas under the receiver operating characteristic curve for all stroke patients, ischemic stroke patients, and hemorrhagic stroke patients were 0.801, 0799, 0.815, respectively. CONCLUSION: The odds of home discharge for stroke patients decreased with a significant independent graded association with declining eGFR levels. Renal function could predict home discharge after stroke.

10.
Ecotoxicol Environ Saf ; 224: 112663, 2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34418852

RESUMO

Bisphenol A (BPA) exposure is associated with atherosclerotic cardiovascular diseases. The interactions between BPA, extracellular microparticles (MPs), and atherosclerosis are unknown. A total of 103,756 young students participated in the mass urine-screening program in Taiwan between 1992 and 2000 were analyzed. After exclusion, 886 subjects were recruited to test the relationships between serum level of BPA, endothelial and platelet MPs as well as subclinical atherosclerosis represented by carotid artery intima-media thickness (CIMT). We found that an increment of one unit of log-BPA could lead to significant association between thicker CIMT and concentrations of endothelial microparticles and platelet microparticles in the cohort (odds ratio (OR) 1.23, P < 0.001). CD31 + /CD42a- (> 50%, OR 1.229, P = 0.001) and CD31 + /CD42a+ (≦ 50%, OR 1.262, P = 0.017 and > 50%, OR 1.212, P = 0.006) were significantly associated with thicker CIMT in the presence of elevated BPA. When considering the interactions between CD31 + /CD42a- and CD31 + /CD42a+ , we observed increased OR as CD31 + /CD42a- was greater than 50% (CD31 +/CD42a- > 50% and CD31 +/CD42a+ ≦ 50%, OR 1.356, P = 0.029; CD31 +/CD42a- > 50% and CD31 +/CD42a+ > 50%, OR 1.204, P = 0.014). Our study identified a higher risk of thicker CIMT associated with altered MPs in the presence of elevated BPA levels. BPA exposure is associated with endothelial dysfunction and subclinical atherosclerosis in a young population.

11.
Sci Rep ; 11(1): 17391, 2021 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-34462468

RESUMO

To evaluate birth outcomes in women with hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM), we used insurance data of Taiwan to evaluate 11 adverse neonatal outcomes of infants born to women with HDP (N = 7775) and with both HDP and GDM (HDP/GDM) (N = 1946), comparing to women with neither disorder (N = 19,442), matched by age. The impacts of preeclampsia/eclampsia were also evaluated. Results showed that Caesarean section delivery was near 1.7-fold greater in the HDP/GDM and HDP groups than in comparisons. The preterm delivery rates were more than threefold greater in HDP/GDM group and HDP group than in comparisons with adjusted odds ratios (aORs) of 4.84 (95% confidence interval (CI) 4.34-5.40) and 3.92 (95% CI 3.65-4.21), respectively, followed by jaundice (aORs 2.95 (95% CI 2.63-3.33) and 1.90 (95% CI 1.76-2.06)), and small gestation age (SGA) (aORs 6.57 (95% CI 5.56-7.75) and 5.81 (95% CI 5.15-6.55)). Incidence rates of birth trauma, patent ductus arteriosus, atrial septal defect, respiratory distress syndrome, and neonatal hypoglycemia were also higher in the HDP/GDM and HDP groups than in the comparison group. Most adverse outcomes increased further in women with preeclampsia or eclampsia. In conclusion, women with HDP are at elevated risks of adverse neonatal outcomes. Risks of most adverse outcomes increase further for women with both HDP and GDM. Preeclampsia or eclampsia may also contribute to these outcomes to higher risk levels. Every pregnant woman with these conditions deserves specialized prenatal care.


Assuntos
Diabetes Gestacional/patologia , Pré-Eclâmpsia/patologia , Resultado da Gravidez , Adolescente , Adulto , Estudos de Casos e Controles , Cesárea , Bases de Dados Factuais , Eclampsia/patologia , Feminino , Humanos , Recém-Nascido de Baixo Peso , Icterícia/etiologia , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Nascimento Prematuro , Risco , Taiwan , Adulto Jovem
12.
Artigo em Inglês | MEDLINE | ID: mdl-34444406

RESUMO

Colorectal cancer (CRC) is a common disease and one of the leading causes of cancer deaths worldwide. This retrospective cohort study evaluated the risk of developing CRC in people with hemorrhoids. Using Taiwan's National Health Insurance Research Database, we established three sets of retrospective study cohorts with and without hemorrhoids. The first set of cohorts were matched by sex and age, the second set of cohorts were matched by propensity score without including colonoscopies, and the third set of cohorts were matched by propensity score with colonoscopies, colorectal adenomas, and appendectomies included. In the second set of cohorts, 36,864 persons with hemorrhoids that were diagnosed from 2000 to 2010 and a comparison cohort, with the same size and matched by propensity score, were established and followed up to the end of 2011 to assess the incidence and Cox proportional regression-measured hazard ratio (HR) of CRC. The overall incidence rate of CRC was 2.39 times greater in the hemorrhoid cohort than it was in the comparison cohort (1.29 vs. 0.54 per 1000 person-years), with a multivariable model measured adjusted HR of 2.18 (95% CI = 1.78-2.67) after controlling for sex, age, and comorbidity. Further analysis on the CRC incidence rates among colorectal sites revealed higher incidence rates at the rectum and sigmoid than at other sites, with adjusted HRs 2.20 (95% CI = 1.48-3.28) and 1.79 (95% CI = 1.06-3.02), respectively. The overall incidence rates of both cohorts were similar in the first and second sets of cohorts, whereas the rate was lower in the third set of hemorrhoid cohorts than in the respective comparison cohorts, probably because of overmatching. Our findings suggest that patients with hemorrhoids were at an elevated risk of developing CRC. Colonoscopy may be strongly suggested for identifying CRC among those with hemorrhoids, especially if they have received a positive fecal occult blood test result.


Assuntos
Neoplasias Colorretais , Hemorroidas , Estudos de Coortes , Colonoscopia , Neoplasias Colorretais/epidemiologia , Hemorroidas/epidemiologia , Humanos , Incidência , Estudos Retrospectivos , Fatores de Risco
13.
J Clin Med ; 10(14)2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34300293

RESUMO

We conducted a retrospective cohort study to evaluate the subsequent colorectal cancer (CRC) risk for women with gynecologic malignancy using insurance claims data of Taiwan. We identified patients who survived cervical cancer (N = 25,370), endometrial cancer (N = 8149) and ovarian cancer (N = 7933) newly diagnosed from 1998 to 2010, and randomly selected comparisons (N = 165,808) without cancer, matched by age and diagnosis date. By the end of 2011, the incidence and hazard ratio (HR) of CRC were estimated. We found that CRC incidence rates were 1.26-, 2.20-, and 1.61-fold higher in women with cervical, endometrial and ovarian cancers, respectively, than in comparisons (1.09/1000 person-years). The CRC incidence increased with age. Higher adjusted HRs of CRC appeared within 3 years for women with endometrial and ovarian cancers, but not until the 4th to 7th years of follow up for cervical cancer survivals. Cancer treatments could reduce CRC risks, but not significantly. However, ovarian cancer patients receiving surgery alone had an incidence of 3.33/1000 person-years for CRC with an adjusted HR of 3.79 (95% CI 1.11-12.9) compared to patients without any treatment. In conclusion, gynecologic cancer patients are at an increased risk of developing CRC, sooner for those with endometrial or ovarian cancer than those with cervical cancer.

14.
PLoS One ; 16(7): e0253814, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34228742

RESUMO

BACKGROUND: This study investigated risks of mortality from and morbidity (emergency room visits (ERVs) and outpatient visits) of asthma and chronic obstructive pulmonary disease (COPD) associated with extreme temperatures, fine particulate matter (PM2.5), and ozone (O3) by sex, and age, from 2005 to 2016 in 6 metropolitan cities in Taiwan. METHODS: The distributed lag non-linear model was employed to assess age (0-18, 19-39, 40-64, and 65 years and above), sex-cause-specific deaths, ERVs, and outpatient visits associated with extreme high (99th percentile) and low (5th percentile) temperatures and PM2.5 and O3 concentrations at 90th percentile. Random-effects meta-analysis was adopted to investigate cause-specific pooled relative risk (RR) and 95% confidence intervals (CI) for the whole studied areas. RESULTS: Only the mortality risk of COPD in the elderly men was significantly associated with the extreme low temperatures. Exposure to the 90th percentile PM2.5 was associated with outpatient visits for asthma in 0-18 years old boys [RR = 1.15 (95% CI: 1.09-1.22)]. Meanwhile, significant elevation of ERVs of asthma for females aged 40-64 years was associated with exposure to ozone, with the highest RR of 1.21 (95% CI: 1.05-1.39). CONCLUSIONS: This study identified vulnerable subpopulations who were at risk to extreme events associated with ambient environments deserving further evaluation for adaptation.


Assuntos
Poluição do Ar/efeitos adversos , Asma/epidemiologia , Exposição Ambiental/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Poluição do Ar/estatística & dados numéricos , Asma/etiologia , Criança , Pré-Escolar , Cidades/epidemiologia , Cidades/estatística & dados numéricos , Temperatura Baixa/efeitos adversos , Monitorização de Parâmetros Ecológicos/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Feminino , Temperatura Alta/efeitos adversos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Morbidade , Mortalidade , Material Particulado/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/etiologia , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Fatores Sexuais , Taiwan/epidemiologia , Adulto Jovem
15.
Viruses ; 13(5)2021 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-33925141

RESUMO

Studies evaluating the association between age-related macular degeneration (AMD) risk and HCV infection are scant. In this population-based cohort study, 13,300 patients newly diagnosed as having HCV (HCV cohort) and 26,600 propensity score-matched patients without HCV (non-HCV cohort) were identified from the Taiwan National Health Insurance Research Database between 2000 and 2013. Furthermore, 1,983 patients with HCV who received pegylated interferon and ribavirin treatment (HCV-treated cohort) and propensity score-matched patients with HCV (matched at a ratio of 1:2) who did not receive this treatment (HCV-untreated cohort) were selected from the HCV cohort. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) associated with the risk of AMD in the HCV and non-HCV cohorts. The adjusted HR (aHR) for AMD in the HCV cohort was 1.22 (95% CI = 1.09-1.35). This significant association was observed only for nonexudative AMD (aHR = 1.22, 95% CI = 1.09-1.37). Compared with the HCV-untreated cohort, the HCV-treated cohort showed no significant association with any type of AMD (aHR = 1.07, 95% CI = 0.81-1.43). Age and sex did not modify AMD development after the exposure and treatment of chronic HCV infection. Our findings revealed that patients with chronic HCV infection had an increased risk of AMD.


Assuntos
Hepatite C Crônica/complicações , Hepatite C Crônica/epidemiologia , Degeneração Macular/epidemiologia , Degeneração Macular/etiologia , Estudos de Coortes , Suscetibilidade a Doenças , Feminino , Hepatite C Crônica/virologia , Humanos , Masculino , Vigilância da População , Prognóstico , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco , Taiwan/epidemiologia
16.
Eur J Clin Invest ; 51(6): e13506, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33529347

RESUMO

BACKGROUND: Patients with functional dyspepsia (FD) are more likely to have persistent depression, yet whether depression and antidepressant treatments are associated with subsequent risk of FD remain unclear. METHODS: Using population-based insurance administrative data of Taiwan, an 11-year historic cohort study was assembled, comparing cases aged 18 and above with the diagnosis of depressive disorder, to a propensity score-matched sample of adults without depression. Incident FD as a primary diagnosis was ascertained. Hazard ratios of FD were calculated using Cox regression models by age, gender, other comorbidities, nonsteroidal anti-inflammatory medications, antidepressants and antidiabetic agents. RESULTS: A total of 20,197 people with depressive disorder and 20,197 propensity score-matched comparisons without depression were followed up. The incidence of FD was 1.7-fold greater in the depressive cohort than in comparisons (12.9 versus 7.57 per 1000 person-years), with an adjusted hazard ratio (aHR) of 2.16 (95% confidence interval (CI) 1.93~2.41). Increased risks were significant regardless of comorbidities or medication uses, the highest in the untreated depression group compared to the group without depression, with an aHR of 2.51(95% CI 2.15~2.93). CONCLUSIONS: This population-based study showed that patients with depressive disorder are at elevated risk of FD. Antidepressant treatment could reduce the risk of FD.

17.
Sleep Med ; 80: 9-15, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33545488

RESUMO

BACKGROUND: Restless legs syndrome (RLS) is prevalent in patients with chronic obstructive pulmonary disease (COPD). No large population-based cohort study has assessed the relationship. We evaluated the incidence of RLS among COPD patients by sociodemographic status (SES) and comorbidity using insurance claims data of Taiwan. METHODS: From the database, we established a cohort consisting of 77,831 individuals aged ≥ 20 years newly diagnosed with COPD from 2000 to 2013. We also identified same number of individuals without COPD as the comparison cohort, frequency matched by sex, age and index year. Both cohorts were followed up to the end of 2013 to estimate the incidence and hazard ratio (HR) of developing RLS. RESULTS: The incidence of RLS was 2.2-fold higher in COPD patients than in those free of COPD (6.67 and 3.08 per 10,000 person-years), with an adjusted HR (aHR) 1.68 (95% CI 1.41-2.01) after controlling for covariates. The incidence rates in both cohorts increased with age and higher in low socioeconomic group. The risk of RLS increased further among COPD patients with additional comorbidities. Compared to those without COPD and comorbidity, the aHR was 7.93 (95% CI 1.11-57.8) for those with iron deficiency, 3.95 (96% CI 1.92-8.13) with Parkinson's disease, 2.85 (95% CI 1.05-7.72) with polyneuropathy, or 1.81 (95% CI 1.14-2.87) with diabetes. CONCLUSION: Patients with COPD are at an increased risk of developing RLS regardless of gender, age and occupation. The COPD patients with comorbidities should be particularly cautious about the RLS risk.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Síndrome das Pernas Inquietas , Estudos de Coortes , Comorbidade , Seguimentos , Humanos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Síndrome das Pernas Inquietas/epidemiologia , Fatores de Risco , Taiwan/epidemiologia
18.
J Epidemiol ; 31(12): 628-634, 2021 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-33536376

RESUMO

BACKGROUND: Osteoarthritis (OA) is more prevalent in women with age. Comorbidities are prevalent in OA patients. In this study, we conducted a follow-up study to evaluate whether women with OA are at an increased risk of ischemic stroke using insurance claims data of Taiwan. METHODS: We identified 13,520 women with OA aged 20-99 newly diagnosed in 2000-2006 and 27,033 women without OA for comparison, frequency matched by age and diagnosis date. Women with baseline history of hypertension and other disorders associated with stroke were excluded for this study. Incident ischemic stroke was assessed by the end of 2013. A nested case-control analysis was used to identify factors associated with the stroke in the OA cohort. RESULTS: The incidence rate of ischemic stroke in the OA cohort was 1.5-fold greater than that in comparisons (1.93 versus 1.26 per 1,000 person-years), with an adjusted hazard ratio of 1.34 (95% confidence interval [CI], 1.09-1.66). The nested case-control analysis showed that stroke cases were twice as likely to develop hypertension during the follow-up period than controls without stroke. The ischemic stroke risk was significantly associated with hypertension (odds ratio [OR] 1.84; 95% CI, 1.37-2.46) and atrial fibrillation (OR 2.25; 95% CI, 1.24-4.09). Ischemic stroke was not associated with the use of non-steroidal anti-inflammatory drugs or aspirin. CONCLUSION: Women with OA are at an elevated risk of ischemic stroke. A close monitoring of hypertension, atrial fibrillation, and other stroke related comorbidities is required for stroke prevention for OA patients.

19.
Sci Total Environ ; 765: 142706, 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33071137

RESUMO

There is a dearth of research on the hourly risk of ambulance dispatches with respect to ambient conditions. We evaluated hourly relative risks (RR) and 95% confidence interval (CI) of ambulance dispatches in Taiwan to treat respiratory distress, coma and unconsciousness, and out-of-hospital cardiac arrest (OHCA), from 2006 to 2015. We considered island-wide ambient temperatures, fine particulate matter (PM2.5), and ozone (O3) at lag 0-180 h while using a distributed lag nonlinear model and meta-analysis. Results showed the pooled risks peaked at lag 16-18 h for all ambulance dispatches at 99th percentile of hourly temperature (32 °C, versus reference temperature of 25 °C), with significant excess risk of 0.11% (95% CI; 0.06, 0.17) for coma and unconsciousness, and 0.06% (95% CI; 0.01, 0.11) for OHCA. The risks of exposure to 90th percentile of hourly O3 of 52.3 ppb relative to the Q1 level of 17.3 ppb peaked at lag 14 h, with excess risk of 0.17% (95% CI; 0.11, 0.23) for respiratory distress, 0.11% (95% CI; 0.06, 0.16) for coma and unconsciousness, and 0.07% (95% CI; 0.01, 0.14) for OHCA. The population exposed to reference temperatures of 28 °C, 20 °C, and 26 °C were exposed to the lowest levels of ambulance dispatches risk for respiratory distress, coma and unconsciousness, and OHCA, respectively; the highest cumulative 0-96 h RRs of ambulance dispatches were 1.27 (95% CI; 1.19, 1.35) for OHCA at 5th percentile temperatures and 1.25 (95% CI; 1.11, 1.41) for OHCA at 99th percentile temperatures. Following an accumulating lag of 0-96 h, no significant risk was identified for hourly levels of PM2.5 and O3. In conclusion, the analytical results of hourly data speak to immediate and real-time responses to environmental changes, rather than to short-term relationships. In our analyses, we emphasized health events in extreme heat; thus, we recommend a comparative study of daily versus hourly associations.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Ozônio , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Ambulâncias , Ilhas , Ozônio/efeitos adversos , Material Particulado/efeitos adversos , Material Particulado/análise , Taiwan , Temperatura
20.
Artigo em Inglês | MEDLINE | ID: mdl-35010564

RESUMO

PURPOSE: This retrospective cohort study was conducted to determine the glaucoma risk associated with metabolic disease (MetD) using insurance claims data of Taiwan. METHODS: From the database, we identified patients with newly diagnosed hypertension, diabetes and/or hyperlipidemia from the years 2000 to 2002 as the MetD cohort (N = 42,036) and an age-gender-diagnosis-date matched control cohort without MetD with a two-fold sample size than that of the MetD cohort. Both cohorts were followed until the development of glaucoma, death, or withdrawal, until 31 December 2013. The incidence of glaucoma, and the Cox method estimated hazard ratio (HR) of glaucoma were calculated. Results showed that the incidence of glaucoma was two-fold higher in the MetD cohort than in the controls (1.99 versus 0.99 per 1000 person-years), with an adjusted HR of 1.66 (95% CI: 1.50-1.85). The glaucoma incidence was higher in patients with diabetes than those with hypertension and hyperlipidemia (2.38 versus 1.95 and 1.72 per 1000 person-years, respectively). The incidence increased to 5.67 per 1000 person-years in patients with all three comorbidities, with an aHR of 4.95 (95% CI: 2.35-10.40). We also found higher incidence rates of primary open-angle glaucoma and primary angle-closure glaucoma with aHRs of 2.03 and 1.44, respectively. It was concluded that glaucoma risk increased with the number of MetD. Health providers need to monitor patients with MetD to prevent glaucoma.

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