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The Association between Comorbidities and Comorbid Injuries on Treatment Outcome in Pediatric and Elderly Patients with Injuries in Korea: An Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106277. [PMID: 35627814 PMCID: PMC9141990 DOI: 10.3390/ijerph19106277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022]
Abstract
We aimed to compare the characteristics and types of injuries affecting pediatric and elderly patients and to identify factors associated with treatment outcomes. We used data from the 2006−2017 Korea National Hospital Discharge Survey. The patients were divided into two groups, children (0−12 years) and elderly (≥65 years), based on their age at discharge. In total, 47,528 (11,842 children and 35,686 older adults) patients with injuries were identified. The number of deaths and the LOS were 36 (0.3%) and 7.6 days (±10.1), respectively, in the children group, and 861 (2.4%) and 18.5 days (±27.3), respectively, in the elderly group (p < 0.001). In the children group, there were increased odds for surgery among boys, Medicaid and health insurance subscribers, patients with multiple injuries, patients without a subdiagnosis, and an increasing number of hospital beds. In the elderly group, there were increased odds for surgery among women, Medicaid and health insurance subscribers, patients who died, patients with a single injury, patients with a subdiagnosis, and increasing numbers of hospital beds. Treatment outcomes could be improved by providing early diagnosis and prompt treatment in pediatric patients and by taking multilateral approaches for multiple injuries and comorbidities in elderly patients.
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Effect of Obstructive Sleep Apnea on the Risk of Injuries-A Nationwide Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413416. [PMID: 34949031 PMCID: PMC8707297 DOI: 10.3390/ijerph182413416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 11/17/2022]
Abstract
Obstructive sleep apnea (OSA) has been reported to increase the risk of motor vehicle accidents. However, only few studies have investigated the effects of OSA on overall risk injury. The aim of study is to investigate whether OSA increases the risk of overall injury. The data were collected during 2000–2015 from Taiwan’s National Health Insurance Research Database. A total of 8901 individuals diagnosed with OSA were inpatients, or outpatients at least three times were enrolled. Finally, 6915 participants with OSA were included as the study cohort. We matched the study cohort with a comparison cohort, at a ratio of 1:4. Cox proportional hazards regression was used to analyse the association between OSA and overall injury. Patients with OSA had 83.1% increased risk of overall injury, compared to non-OSA individuals [adjusted hazards ratio (HR) = 1.831, confidence interval (CI) = 1.674–2.020, p < 0.001]. In the stratified age group, patients aged ≧65 years had the highest risk of injury (adjusted HR= 2.014; CI = 1.842–2.222, p < 0.001). Patients with OSA were at a higher risk of falls, traffic injury, poisoning, suffocation, suicide, and abuse or homicide than non-OSA individuals, with falls and traffic injury as the leading causes of injuries. The data demonstrated that patients with OSA have a higher risk of overall injury. The study results can be a reference for developing injury prevention strategies in the future. The general population and clinicians should have more awareness regarding OSA and its negative effects on injury development.
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Yeh TC, Chien WC, Chung CH, Liang CS, Chang HA, Kao YC, Yeh HW, Yang YJ, Tzeng NS. Psychiatric Disorders After Traumatic Brain Injury: A Nationwide Population-Based Cohort Study and the Effects of Rehabilitation Therapies. Arch Phys Med Rehabil 2020; 101:822-831. [PMID: 31917196 DOI: 10.1016/j.apmr.2019.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/16/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the risk of psychiatric disorders after traumatic brain injury (TBI), and to clarify whether the post-TBI rehabilitation was associated with a lower risk of developing psychiatric disorders. DESIGN A register-based, retrospective cohort design. SETTING Using data from the National Health Insurance Research Database of Taiwan, we established an exposed cohort with TBI and a nonexposed group without TBI matched by age and year of diagnosis between 2000 and 2015. PARTICIPANTS This study included 231,894 patients with TBI and 695,682 patients without TBI (N=927,576). INTERVENTIONS Rehabilitation therapies in TBI patients. MAIN OUTCOME MEASURES A multivariable Cox proportional hazards regression model was used to compare the risk of developing psychiatric disorders. RESULTS The incidence rate of psychiatric disorders was higher in the TBI group than the control group. Compared with the control group, the risk of psychiatric disorders in the TBI group was twofold (hazard ratio [HR]=2.072; 95% confidence interval [95% CI], 1.955-2.189; P<.001). Among the participants with TBI, 49,270 (21.25%) had received rehabilitation therapy and had a lower risk of psychiatric disorders (HR=0.691; 95% CI, 0.679-0.703; P<.001). In the subgroup analysis, the medium- to high-level intensity rehabilitation therapy was associated with lower risks of psychiatric disorder (HR=0.712 and 0.568, respectively), but there was no significant finding in the low-intensity group. CONCLUSIONS We found that TBI was associated with a high risk for developing psychiatric disorders, and that the post-TBI rehabilitation significantly reduced the risk of psychiatric disorders in a dose-dependent manner.
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Affiliation(s)
- Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Department of Psychiatry, Tri-Service General Hospital, Penghu Branch, Penghu, Taiwan, Republic of China
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China; School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China; School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, Republic of China
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Hui-Wen Yeh
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Institute of Bioinformatics and System Biology, National Chiao Tung University, Hsin-Chu, Taiwan, Republic of China; Department of Nursing, Tri-Service General Hospital, School of Nursing, National Defense Medical Center, Taipei, Taiwan, Republic of China; Department of Nursing, Kang Ning University (Taipei Campus), Taipei, Taiwan, Republic of China
| | - Yun-Ju Yang
- Department of Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, Republic of China.
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Perng HJ, Chiu YL, Chung CH, Kao S, Chien WC. Fall and risk factors for veterans and non-veterans inpatients over the age of 65 years: 14 years of long-term data analysis. BMJ Open 2019; 9:e030650. [PMID: 31481377 PMCID: PMC6731917 DOI: 10.1136/bmjopen-2019-030650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Falls are one of the most important causes of injuries and accidental deaths among this segment of over the age of 65 years.The long-term follow-up study of fall-related injuries was conducted in elderly veterans over the age of 65 years, and the risk of falls in veterans and non-veterans was compared. METHODS This study used the National Health Insurance Research Database for the period from 2000 to 2013 in Taiwan. This longitudinal study tracked falls in veterans over the age of 65 years, designated a control group (non-veterans), using 1:2 pairing on the basis of sex and time receiving medical care, and used Cox regression to analyse and compare the risk of falls among veterans and non-veterans. RESULTS This study subjects consisted of 35 454 of the veterans had suffered falls (9.5%), as had 55 037 of the non-veterans (7.4%). After controlling for factors such as comorbidities/complications, the veterans had 1.252 times the risk of falls of the non-veterans. Furthermore, among persons in the 75-84 years old age group, veterans had 1.313 times the risk of falls of non-veterans, and among persons with mental illnesses and diseases of the eyes, veterans had 1.300 and 1.362 times the risk of falls of non-veterans. In addition, each veteran had an average of 4.07 falls during the 2000-2013 period, which was significantly higher than in the case of non-veterans (3.88 falls). CONCLUSIONS Veterans' risk of falls and recurrent falls were both higher than those of non-veterans, and age level, comorbidities/complications and level of low urbanisation were all important factors affecting veterans' falls. The responsible authorities should, therefore, use appropriate protective measures to reduce the risk of falls and medical expenses in high-risk groups.
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Affiliation(s)
- Huey-Jen Perng
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Lung Chiu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital Taipei, National Defense Medical Center, Taipei, Taiwan
| | - Senyeong Kao
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- Department of Medical Research, Tri-Service General Hospital Taipei, National Defense Medical Center, Taipei, Taiwan
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Kuo YL, Chung CH, Huang TW, Tsao CH, Chang SY, Peng CK, Cheng WE, Chien WC, Shen CH. Association between spinal curvature disorders and injury: a nationwide population-based retrospective cohort study. BMJ Open 2019; 9:e023604. [PMID: 30782710 PMCID: PMC6340633 DOI: 10.1136/bmjopen-2018-023604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Injury is an important issue in public health. Spinal curvature disorders are deformities characterised by excessive curves of the spine. The prevalence of spinal curvature disorders is not low, but its relationship with injury has not been studied. The aim of this study is to investigate whether spinal curvature disorders increase the risk of injury. DESIGN Population-based retrospective cohort study. SETTING Using data from the Taiwan National Health Insurance Research Database from 2000 to 2010. PARTICIPANTS AND EXPOSURE Patients with spinal curvature disorders were selected using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. A cohort without spinal curvature was randomly frequency-matched to the spinal curvature disorders cohort at a ratio of 2:1 according to age, sex and index year. PRIMARY OUTCOME MEASURES The risk of injury was analysed using Cox's proportional hazards regression models adjusting for age, sex, comorbidities, urbanisation level and socioeconomic status. RESULTS A total of 20 566 patients with spinal curvature disorders and 41 132 controls were enrolled in this study. The risk of injury was 2.209 times higher (95% CI 2.118 to 2.303) in patients with spinal curvature disorders than in the control group. The spinal curvature disorders cohort exhibited higher risk of developing injury compared with the control group, regardless of age, sex, comorbidities, urbanisation level and subgroup of spinal curvature disorders. Based on the subgroup analysis, the spinal curvature disorders cohort had higher risks of unintentional injury and injury diagnoses such as fracture, dislocation, open wound, superficial injury/contusion, crushing and injury to nerves and spinal cord compared with the control cohort. CONCLUSIONS Patients with spinal curvature disorders have a significantly higher risk of developing injury than patients without spinal curvature disorders. Aggressive detection and management of spinal curvature disorders may be beneficial for injury prevention.
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Affiliation(s)
- Yen-Liang Kuo
- Division of Chest Medicine, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Division of Pulmonary and Critical Care, Department of Internal Medicine, National Defense Medical Center Tri-Service General Hospital, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Tsai-Wang Huang
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chang-Huei Tsao
- Department of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
- Department of Medical Research, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Shan-Yueh Chang
- Division of Pulmonary and Critical Care, Department of Internal Medicine, National Defense Medical Center Tri-Service General Hospital, Taipei, Taiwan
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care, Department of Internal Medicine, National Defense Medical Center Tri-Service General Hospital, Taipei, Taiwan
| | - Wei-Erh Cheng
- Division of Chest Medicine, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Department of Medical Research, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Chih-Hao Shen
- Division of Pulmonary and Critical Care, Department of Internal Medicine, National Defense Medical Center Tri-Service General Hospital, Taipei, Taiwan
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Yang YJ, Chien WC, Chung CH, Hong KT, Yu YL, Hueng DY, Chen YH, Ma HI, Chang HA, Kao YC, Yeh HW, Tzeng NS. Risk of Erectile Dysfunction After Traumatic Brain Injury: A Nationwide Population-Based Cohort study in Taiwan. Am J Mens Health 2018; 12:913-925. [PMID: 29325484 PMCID: PMC6131467 DOI: 10.1177/1557988317750970] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Introduction: In our study, we aimed to investigate the association between a traumatic
brain injury (TBI) and subsequent erectile dysfunction (ED). This is a
population-based study using the claims dataset from The National Health
Insurance Research Database. Methods: We included 72,642 patients with TBI aged over 20 years, retrospectively,
selected from the longitudinal health insurance database during 2000–2010,
according to the ICD-9-CM. The control group consisted of 217,872 patients
without TBI that were randomly chosen from the database at a ratio of 1:3,
with age- and index year matched. Cox proportional hazards analysis was used
to estimate the association between the TBI and subsequent ED. Results: After a 10-year follow-up, the incidence rate of ED was higher in the TBI
patients when compared with the non-TBI control group (24.66 and 19.07 per
100,000, respectively). Patients with TBI had a higher risk of developing ED
than the non-TBI cohort after the adjustment of the confounding factors,
such as age, comorbidity, residence of urbanization and locations, seasons,
level of care, and insured premiums (adjusted hazard ratio (HR) = 2.569, 95%
CI [1.890, 3.492], p < .001). Conclusion: This is the first study using a comprehensive nationwide database to analyze
the association of ED and TBI in the Asian population. After adjusted the
confounding factors, patients with TBI have a significantly higher risk of
developing ED, especially organic ED, than the general population. This
finding might remind clinicians that it’s crucial in early identification
and treatment of ED in post-TBI patients.
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Affiliation(s)
- Yun-Ju Yang
- 1 Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wu-Chien Chien
- 2 Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,3 School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chi-Hsiang Chung
- 2 Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,3 School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.,4 Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, ROC
| | - Kun-Ting Hong
- 1 Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yi-Lin Yu
- 1 Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Dueng-Yuan Hueng
- 1 Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yuan-Hao Chen
- 1 Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hsin-I Ma
- 1 Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hsin-An Chang
- 5 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,6 Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yu-Chen Kao
- 5 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,7 Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hui-Wen Yeh
- 5 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,8 Institute of Bioinformatics and System Biology, National Chiao Tung University, Hsin-Chu, Taiwan, ROC.,9 Department of Nursing, Tri-Service General Hospital, and School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC.,10 Department of Nursing, Kang Ning University (Taipei Campus), Taipei, Taiwan, ROC
| | - Nian-Sheng Tzeng
- 5 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,6 Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, ROC
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Affiliation(s)
- Samuel N Forjuoh
- a Department of Family and Community Medicine, Scott & White Healthcare , Texas A&M HSC College of Medicine , 1402 West Ave H , Temple , TX , 76504 , USA
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