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Huang YT, Wei T, Huang YL, Wu YP, Chan KA. Validation of diagnosis codes in healthcare databases in Taiwan, a literature review. Pharmacoepidemiol Drug Saf 2023; 32:795-811. [PMID: 36890603 DOI: 10.1002/pds.5608] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 02/02/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE To compile validation findings of diagnosis codes and related algorithms for health outcomes of interest from National Health Insurance (NHI) or electronic medical records in Taiwan. METHODS We carried out a literature review of English articles in PubMed® and Embase from 2000 through July 2022 with appropriate search terms. Potentially relevant articles were identified through review of article titles and abstracts, full text search of methodology terms "validation", "positive predictive value", and "algorithm" in Subjects & Methods (or Methods) and Results sections of articles, followed by full text review of potentially eligible articles. RESULTS We identified 50 published reports with validation findings of diagnosis codes and related algorithms for a wide range of health outcomes of interest in Taiwan, including cardiovascular diseases, stroke, renal impairment, malignancy, diabetes, mental health diseases, respiratory diseases, viral (B and C) hepatitis, and tuberculosis. Most of the reported PPVs were in the 80% ~ 99% range. Assessment of algorithms based on ICD-10 systems were reported in 8 articles, all published in 2020 or later. CONCLUSIONS Investigators have published validation reports that may serve as empirical evidence to evaluate the utility of secondary health data environment in Taiwan for research and regulatory purpose.
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Affiliation(s)
- Yue-Ton Huang
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Tiffaney Wei
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
- Epidemiology and Biostatistics, Master of Public Health (MPH), Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ya-Ling Huang
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Yu-Pu Wu
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - K Arnold Chan
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
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Cho EJ, Chung GE, Yoo JJ, Cho Y, Shin DW, Kim YJ, Yoon JH, Han K, Yu SJ. The association between alcohol consumption and the risk of hepatocellular carcinoma according to glycemic status in Korea: A nationwide population-based study. PLoS Med 2023; 20:e1004244. [PMID: 37307271 PMCID: PMC10259796 DOI: 10.1371/journal.pmed.1004244] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/19/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Alcohol and diabetes are known risk factors for hepatocellular carcinoma (HCC); however, it is unclear whether the association between alcohol consumption and HCC risk differs by fasting serum glucose level and diabetes. We investigated the dose-response relationship between alcohol consumption and the risk of HCC according to glycemic status. METHODS AND FINDINGS This population-based observational cohort study included patients who underwent general health checkups in 2009 using the Korean National Health Insurance Service Database. The primary outcome was HCC incidence, and Cox proportional hazard regression analysis was performed to estimate the relationship between alcohol consumption and HCC risk according to glycemic status. A total of 34,321 patients newly diagnosed with HCC were observed in the median follow-up period of 8.3 years. In the multivariable model, we adjusted for age, sex, smoking, regular exercise, income, hypertension, dyslipidemia, and body mass index. Mild-to-moderate alcohol consumption increased the risk of HCC in all glycemic statuses (normoglycemia: hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.02 to 1.10; prediabetes: HR, 1.19; 95% CI, 1.14 to 1.24; and diabetes: HR, 2.02; 95% CI, 1.93 to 2.11) compared to normoglycemic nondrinking. Heavy alcohol consumption also increased the risk of HCC in all glycemic statuses (normoglycemia: HR, 1.39; 95% CI, 1.32 to 1.46; prediabetes: HR, 1.67; 95% CI, 1.58 to 1.77; and diabetes: HR, 3.29; 95% CI, 3.11 to 3.49) compared to normoglycemic nondrinking. Since alcohol consumption information in this study was based on a self-administered questionnaire, there may be a possibility of underestimation. Although we excluded patients with a history of viral hepatitis using diagnosis codes, we could not obtain information on hepatitis B or hepatitis C serum markers. CONCLUSIONS Both mild-to-moderate and heavy alcohol consumption was associated with an increased risk of HCC in all glycemic statuses. The increased risk of HCC according to alcohol consumption was the highest in the diabetes group, suggesting that more intensive alcohol abstinence is required for patients with diabetes.
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Affiliation(s)
- Eun Ju Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Goh Eun Chung
- Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Jeong-Ju Yoo
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Soonchunhyang University Bucheon Hospital, Gyeonggi-do, Republic of Korea
| | - Yuri Cho
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation/Department of Digital Health, Samsung Advanced Institute for Health Science, Seoul, Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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Lam L, Fontaine H, Lapidus N, Bellet J, Lusivika-Nzinga C, Nicol J, Dorival C, Cagnot C, Hejblum G, Pol S, Bourlière M, Carrat F. Performance of algorithms for identifying patients with chronic hepatitis B or C infection in the french health insurance claims databases using the ANRS CO22 HEPATHER cohort. J Viral Hepat 2023; 30:232-241. [PMID: 36529681 DOI: 10.1111/jvh.13788] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 02/16/2023]
Abstract
The validity of algorithms for identifying patients with chronic hepatitis B or C virus (HBV or HCV) infection in claims databases has been little explored. The performance of 15 algorithms was evaluated. Data from HBV- or HCV-infected patients enrolled between August 2012 and December 2015 in French hepatology centres (ANRS CO22 HEPATHER cohort) were individually linked to the French national health insurance system (SNDS). The SNDS covers 99% of the French population and contains healthcare reimbursement data. Performance metrics were calculated by comparing the viral status established by clinicians with those obtained with the algorithms identifying chronic HBV- and HCV-infected patients. A total of 14 751 patients (29% with chronic HBV and 63% with chronic HCV infection) followed-up until December 2018 were selected. Despite good specificity, the algorithms relying on ICD-10 codes performed poorly. By contrast, the multi-criteria algorithms combining ICD-10 codes, antiviral dispensing, laboratory diagnostic tests (HBV DNA or HCV RNA detection and quantification, HCV genotyping), examinations for the assessment of liver fibrosis and long-term disease registrations were the most effective (sensitivity 0.92, 95% CI, 0.91-0.93 and specificity 0.96, 95% CI, 0.95-0.96 for identifying chronic HBV-infected patients; sensitivity 0.94, 95% CI, 0.94-0.94 and specificity 0.85, 95% CI, 0.84-0.86 for identifying chronic HCV-infected patients). In conclusion, the multi-criteria algorithms perform well in identifying patients with chronic hepatitis B or C infection and can be used to estimate the magnitude of the public health burden associated with hepatitis B and C in France.
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Affiliation(s)
- Laurent Lam
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, France
| | - Hélène Fontaine
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Nathanael Lapidus
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, France.,Department of Public Health, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Jonathan Bellet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, France
| | - Clovis Lusivika-Nzinga
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, France
| | - Jérôme Nicol
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, France
| | - Céline Dorival
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, France
| | | | - Gilles Hejblum
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, France
| | - Stanislas Pol
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France.,Université de Paris Cité, Paris, France
| | - Marc Bourlière
- Department of Hepatology and Gastroenterology, Hôpital Saint Joseph, Marseille, France.,INSERM, UMR 1252 IRD SESSTIM, Aix Marseille Université, Marseille, France
| | - Fabrice Carrat
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, France.,Department of Public Health, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
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Association of Dipeptidyl Peptidase-4 Inhibitors Use with Reduced Risk of Hepatocellular Carcinoma in Type 2 Diabetes Patients with Chronic HBV Infection. Cancers (Basel) 2023; 15:cancers15041148. [PMID: 36831491 PMCID: PMC9954498 DOI: 10.3390/cancers15041148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
Previous studies have indicated that HBV infection and T2DM are the factors that increase the risk of developing HCC. The experimental evidence has shown that antiglycemic agents may reduce the risk of HCC. However, the effect of dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) on the risk of HCC in T2DM patients with chronic HBV infection remains unclear. In this retrospective cohort study, we extracted patients with T2DM and chronic HBV infection from the National Health Insurance Research Database (NHIRD) in Taiwan. The cases were divided into DPP-4 inhibitors use and non-use groups, according to whether they received DPP-4 inhibitors treatment, and the risk of HCC was compared between the two groups. At the end of the follow-up, approximately 2.33% of DPP-4 inhibitors users had received an HCC diagnosis compared with 3.33% of non-DPP-4 inhibitors users (p < 0.0001). After multivariate adjustment, DPP-4 inhibitors users showed a significant reduction in HCC risk (adjusted hazard ratios (aHRs): 0.53; 95% confidence intervals (CIs): 0.44-0.65). In conclusion, this population-based retrospective cohort study indicated that, in T2DM patients with chronic HBV infection, the use of DPP-4 inhibitors significantly reduced the risk of developing HCC compared with non-DPP-4 inhibitors use.
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Lee MH, Wu PF, Chen TI, Chan C, Lin HH, Huang YH, Chen HY, Lin YT, Chen CJ. Tenofovir use is associated with a decreased risk of hepatocellular carcinoma among men with HIV irrespective of coinfection status. JHEP Rep 2022; 5:100634. [PMID: 36686591 PMCID: PMC9852951 DOI: 10.1016/j.jhepr.2022.100634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/26/2022] Open
Abstract
Background & Aims Tenofovir is recommended as part of the first-line antiretroviral therapy (ART) to treat people living with HIV (PLWH) with HBV coinfection. However, the effects of tenofovir-containing ART on hepatocellular carcinoma (HCC) risk among PLWH with/without chronic hepatitis virus infections remain unclear. Methods This study included 23,838 PLWH. All of them were males aged ≥20 years and followed prospectively during 2000-2017. Four major nationwide registries - the Human Immunodeficiency Virus surveillance database, Taiwan Cancer Registry, Death Certification System, and National Health Insurance Database - were applied to define ART and comorbidities and ascertain newly diagnosed HCC. Tenofovir-containing ART was identified through prescription records. Cox proportional hazards models were used to determine the association of tenofovir use with HCC incidence. Results HCC incidence was lower among ever users of tenofovir than among never users (24.2 and 85.7 per 100,000 person-years, respectively). Ever users had significantly reduced HCC risk (adjusted hazard ratio 0.20, 95% CI 0.13-0.31). The effect of tenofovir use on reduced risk for HCC consistently favored never users across many prespecified subgroups, including HBV or HCV coinfection (p <0.05). The findings were consistent in subgroups of PLWH diagnosed with HIV before tenofovir's approval and in those born before the nationwide roll-out of neonatal HBV vaccination. Conclusions Our findings underscore the need for randomized controlled trials of tenofovir in combination with long-acting injectable ART regimens to assess its safety and efficacy in PLWH, particularly in those with HBV or HCV coinfection. Impact and implications Tenofovir's effect on the risk of hepatocellular carcinoma (HCC) among people living with HIV with hepatitis B or C coinfection remains under investigated. This nationwide prospective cohort study, comprising 23,838 men living with HIV, showed that tenofovir-containing antiretroviral therapy was associated with reduced risk of HCC (adjusted relative risk: 0.20, 95% CI 0.13-0.31), which was consistently observed across many prespecified subgroups. The effect of tenofovir use on HCC risk should be further investigated in PLWH, particularly following the development of long-acting injectable ART regimens.
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Affiliation(s)
- Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Corresponding author. Address: Institute of Clinical Medicine, National Yang Ming Chiao Tung University, 155 Li-Nong Street, Section 2, Peitou, Taipei 112, Taiwan; Tel.: +886-2-2826-7248, fax: +886-2-2820-5699
| | - Ping-Feng Wu
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Faculty of Medicine, Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzu-I Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chi Chan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsi-Hsun Lin
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Yi-Hsiang Huang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsuan-Yu Chen
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Yi-Tsung Lin
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
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Wu HY, Chang CC, Yeh CC, Chen MY, Cherng YG, Chen TL, Liao CC. Adverse outcomes after non-hepatic surgeries in patients with alcoholic liver diseases: a propensity-score matched study. BMC Gastroenterol 2022; 22:475. [PMID: 36404314 PMCID: PMC9677632 DOI: 10.1186/s12876-022-02558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 10/28/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The influence of alcoholic liver disease (ALD) on the postoperative outcomes is not completely understood. Our purpose is to evaluate the complications and mortality after nonhepatic surgeries in patients with ALD. METHODS We conducted a retrospective cohort study included adults aged 20 years and older who underwent nonhepatic elective surgeries using data of Taiwan's National Health Insurance, 2008-2013. Using a propensity-score matching procedure, we selected surgical patients with ALD (n = 26,802); or surgical patients without ALD (n = 26,802) for comparison. Logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of postoperative complications and in-hospital mortality associated with ALD. RESULTS Patients with ALD had higher risks of acute renal failure (OR 2.74, 95% CI 2.28-3.28), postoperative bleeding (OR 1.64, 95% CI 1.34-2.01), stroke (OR 1.51, 95% CI 1.34-1.70) septicemia (OR 1.47, 95% CI 1.36-1.58), pneumonia (OR 1.43, 95% CI 1.29-1.58), and in-hospital mortality (OR 2.64, 95% CI 2.24-3.11) than non-ALD patients. Patients with ALD also had longer hospital stays and higher medical expenditures after nonhepatic surgical procedures than the non-ALD patients. Compared with patients without ALD, patients with ALD who had jaundice (OR 4.82, 95% CI 3.68-6.32), ascites (OR 4.57, 95% CI 3.64-5.74), hepatic coma (OR 4.41, 95% CI 3.44-5.67), gastrointestinal hemorrhage (OR 3.84, 95% CI 3.09-4.79), and alcohol dependence syndrome (OR 3.07, 95% CI 2.39-3.94) were more likely to have increased postoperative mortality. CONCLUSION Surgical patients with ALD had more adverse events and a risk of in-hospital mortality after nonhepatic surgeries that was approximately 2.6-fold higher than that for non-ALD patients. These findings suggest the urgent need to revise the protocols for peri-operative care for this population.
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Affiliation(s)
- Hsin-Yun Wu
- grid.412896.00000 0000 9337 0481Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan ,grid.412896.00000 0000 9337 0481Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chuen-Chau Chang
- grid.412896.00000 0000 9337 0481Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan ,grid.412897.10000 0004 0639 0994Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan ,grid.412897.10000 0004 0639 0994Department of Anesthesiology, Taipei Medical University Hospital, 252 Wuxing St., Taipei, 11031 Taiwan
| | - Chun-Chieh Yeh
- grid.411508.90000 0004 0572 9415Team of Liver Transplantation, Department of Surgery, China Medical University Hospital, Taichung, Taiwan ,grid.185648.60000 0001 2175 0319Department of Surgery, University of Illinois, Chicago, USA
| | - Ming-Yao Chen
- grid.412896.00000 0000 9337 0481Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yih-Giun Cherng
- grid.412896.00000 0000 9337 0481Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan ,grid.412896.00000 0000 9337 0481Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ta-Liang Chen
- grid.412896.00000 0000 9337 0481Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan ,grid.412897.10000 0004 0639 0994Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan ,grid.412896.00000 0000 9337 0481Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Chang Liao
- grid.412896.00000 0000 9337 0481Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan ,grid.412897.10000 0004 0639 0994Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan ,grid.412897.10000 0004 0639 0994Department of Anesthesiology, Taipei Medical University Hospital, 252 Wuxing St., Taipei, 11031 Taiwan ,grid.412896.00000 0000 9337 0481Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan ,grid.412896.00000 0000 9337 0481Centers of Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan ,grid.254145.30000 0001 0083 6092School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
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Guo C, Yu T, Lin C, Chang LY, Bo Y, Wong MCS, Tam T, Lau AKH, Lao XQ. Habitual Exercise, Air Pollution, and Pneumonia Mortality: A Longitudinal Cohort Study of Approximately 0.4 Million Adults. Am J Epidemiol 2022; 191:1732-1741. [PMID: 35773998 DOI: 10.1093/aje/kwac113] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 06/15/2022] [Accepted: 06/23/2022] [Indexed: 01/29/2023] Open
Abstract
In this study, we aimed to examine the combined associations of particulate matter with an aerodynamic diameter less than or equal to 2.5 μm (PM2.5) and habitual exercise with pneumonia mortality. We included 384,130 persons aged ≥18 years from Taiwan, Republic of China, during 2001-2016. We followed participants until May 31, 2019, to obtain information on vital status. A time-dependent Cox regression model was used for statistical analysis. We found that risks of pneumonia mortality were reduced by 55% (hazard ratio (HR) = 0.45, 95% confidence interval (CI): 0.36, 0.55) and 36% (HR = 0.64, 95% CI: 0.52, 0.80) in participants who engaged in high and moderate levels of exercise, respectively, as compared with inactive persons. By contrast, each 10-μg/m3 increase in chronic PM2.5 exposure was associated with a 30% (HR = 1.30, 95% CI: 1.17, 1.45) higher risk of pneumonia mortality. Risk of pneumonia death was 72% lower (HR = 0.28, 95% CI: 0.20, 0.41) for persons with a high exercise level and a low PM2.5 level. Lower risk of pneumonia mortality was associated with both higher exercise and lower PM2.5 air pollution levels. For adults exposed to different levels of PM2.5, exercise benefits remained. Our findings suggest that engaging in exercise is a safe and effective strategy for alleviating the burden of pneumonia mortality, even for people who reside in a moderately polluted area.
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Sheu MJ, Chin TW, Ku FP, Li CY, Li ST, Lu TH. Validation of coding algorithms for identifying people with viral hepatitis using claims data according to different standard references. BMC Infect Dis 2022; 22:222. [PMID: 35246067 PMCID: PMC8897839 DOI: 10.1186/s12879-022-07212-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/23/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To assess the performance of various coding algorithms for identifying people with hepatitis B virus (HBV) and hepatitis C virus (HCV) using claims data according to different reference standards (RSs) and study periods (SPs). METHODS A proportional random sampling of 10,000 patients aged ≥ 20 years in a health care system in Southern Taiwan were enrolled as study participants. We used three hierarchical RSs (RS1: having positive results of laboratory tests; R2: having RS1 or having prescriptions of anti-HBV or anti-HCV medications; R3: having R1 or R2 or having textual diagnosis recorded in electrical medical records) with three SPs (4-, 8-, and 12-years) to calculate positive predictive value (PPV) and sensitivity (Sen) of 6 coding algorithms using HBV- and HCV-related International Classification of Disease Tenth Revision Clinical Modification (ICD-10-CM) codes in Taiwan National Health Insurance claims data for years 2016-2019. RESULTS Of 10,000 enrolled participants, the number of participants had confirmed HBV and HCV was 146 and 165, respectively according to RS1 with 4-years SP and increased to 729 and 525, respectively according to RS3 with 12-years SP. For both HBV and HCV, the PPV was lowest according to RS1 and highest according to RS3. The longer the SP, the higher the PPV. However, the Sen was highest according to RS2 with 4-years SP. For both HBV and HCV, the coding algorithm with highest PPV and Sen was " ≥ 3 outpatient codes" and " ≥ 2 outpatient or ≥ 1 inpatients codes," respectively. CONCLUSIONS In conclusion, using different RSs with different SPs would result in different estimation of PPV and Sen. To achieve the best yield of both PPV and Sen, the optimal coding algorithm is " ≥ 2 outpatients or ≥ 1 inpatients codes" for identifying people with HBV or HCV.
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Affiliation(s)
- Ming-Jen Sheu
- Division of Gastroenterology and Hepatology, Chi Mei Medical Center, Tainan, Taiwan
| | - Tsung-Wei Chin
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, Dah Hsueh Road, East District, Tainan, 701, Taiwan
| | - Fang-Ping Ku
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, Dah Hsueh Road, East District, Tainan, 701, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, Dah Hsueh Road, East District, Tainan, 701, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Sheng-Tun Li
- Department of Industrial and Information Management, College of Management, National Cheng Kung University, Tainan, Taiwan
- Center for Innovative FinTech Business Models, National Cheng Kung University, Tainan, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, Dah Hsueh Road, East District, Tainan, 701, Taiwan.
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9
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Zhang Y, Li L, Jia L, Chong W, Hai Y, Lunsford LD, You C, Cheng Y, Fang F. Association of Chronic Liver Disease and Mortality in Patients With Aneurysmal Subarachnoid Hemorrhage. Stroke 2021; 52:e614-e617. [PMID: 34281381 DOI: 10.1161/strokeaha.121.034136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Chronic liver disease (CLD) is a risk factor for increased morbidity and mortality in acutely ill patients. For patients with aneurysmal subarachnoid hemorrhage (aSAH), the association between CLD and mortality remains unknown. METHODS In this retrospective cohort study, we analyzed consecutive aSAH patients admitted to the West China Hospital between 2009 and 2019. The primary outcome was in-hospital all-cause mortality. RESULTS This study included 6228 cases of aSAH, 489 (7.9%) of whom also had CLD. In a propensity-matched analysis, CLD was associated with increased mortality in patients with aSAH compared with non-CLD (odds ratio, 2.04 [95% CI, 1.43-2.92]). In aSAH patients with CLD, a high Model for End-Stage Liver Disease score was still associated with an increased odds of mortality. CONCLUSIONS Among aSAH patients, CLD was associated with increased mortality compared with non-CLD. Among aSAH patients with CLD, a higher Model for End-Stage Liver Disease score was associated with an increased odds of mortality.
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Affiliation(s)
- Yu Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China (Y.Z., L.L., L.J., C.Y., Y.C., F.F.)
| | - Linjie Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China (Y.Z., L.L., L.J., C.Y., Y.C., F.F.)
| | - Lu Jia
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China (Y.Z., L.L., L.J., C.Y., Y.C., F.F.)
| | - Weelic Chong
- Thomas Jefferson University, Philadelphia, PA (W.C., Y.H.)
| | - Yang Hai
- Thomas Jefferson University, Philadelphia, PA (W.C., Y.H.)
| | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh Medical Center, PA (L.D.L.)
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China (Y.Z., L.L., L.J., C.Y., Y.C., F.F.)
| | - Yongzhong Cheng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China (Y.Z., L.L., L.J., C.Y., Y.C., F.F.)
| | - Fang Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China (Y.Z., L.L., L.J., C.Y., Y.C., F.F.)
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10
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Lee PC, Kao FY, Liang FW, Lee YC, Li ST, Lu TH. Existing Data Sources in Clinical Epidemiology: The Taiwan National Health Insurance Laboratory Databases. Clin Epidemiol 2021; 13:175-181. [PMID: 33688263 PMCID: PMC7935352 DOI: 10.2147/clep.s286572] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/30/2021] [Indexed: 01/28/2023] Open
Abstract
This paper provides an introduction to laboratory databases established by Taiwan National Health Insurance Administration (NHIA) since 2015 and released for research since June 2017. The National Health Insurance (NHI) is a government-run single-payer program introduced in 1995 that now covers more than 99% of 23 million Taiwanese citizens. To prevent duplication of medication prescriptions and laboratory test and examination prescriptions, contracted health care providers are required to upload the results of laboratory tests and reports of examinations to the NHIA. The cumulative number of laboratory test results was 5.64 billion from January 2015 to the end of August 2020 for 602 types of test. There are 35 variables for each laboratory test result stored in the databases that can be used for research. However, different hospitals might use different format in reporting the results. The researchers therefore have to develop algorithms to include and exclude incompatible records and to determine whether the results are positive or negative (normal or abnormal). The NHIA suggests that researchers release their source codes of algorithms so that other researchers can modify the codes to improve inter-study comparability. Through the unique personal identification number, the laboratory data can be linked to NHI inpatient and outpatient claims data for further value-added analyses. Non-Taiwanese researchers can collaborate with Taiwan researchers to access the NHI laboratory databases.
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Affiliation(s)
- Po-Chang Lee
- National Health Insurance Administration, Ministry of Health & Welfare, Taipei, Taiwan
| | - Feng-Yu Kao
- National Health Insurance Administration, Ministry of Health & Welfare, Taipei, Taiwan
| | - Fu-Wen Liang
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chan Lee
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Tun Li
- Department of Industrial and Information Management, College of Management, National Cheng Kung University, Tainan, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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11
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The Use of Administrative Data to Investigate the Population Burden of Hepatic Encephalopathy. J Clin Med 2020; 9:jcm9113620. [PMID: 33182743 PMCID: PMC7696713 DOI: 10.3390/jcm9113620] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 12/13/2022] Open
Abstract
Hepatic encephalopathy (HE) is a devastating complication of cirrhosis with an increasing footprint in global public health. Although the condition is defined using a careful history and examination, we cannot accurately measure the true impact of HE relying on data collected exclusively from clinical studies. For this reason, administrative data sources are necessary to study the population burden of HE. Administrative data is generated with each health care encounter to account for health care resource utilization and is extracted into a dataset for the secondary purpose of research. In order to utilize such data for valid analysis, several pitfalls must be avoided—specifically, selecting the particular database capable of meeting the needs of the study’s aims, paying careful attention to the limits of each given database, and ensuring validity of case definition for HE specific to the dataset. In this review, we summarize the types of data available for and the results of administrative data studies of HE.
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12
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Nguyen PA, Chang CC, Galvin CJ, Wang YC, An SY, Huang CW, Wang YH, Hsu MH, Li YCJ, Yang HC. Statins use and its impact in EGFR-TKIs resistance to prolong the survival of lung cancer patients: A Cancer registry cohort study in Taiwan. Cancer Sci 2020; 111:2965-2973. [PMID: 32441434 PMCID: PMC7419042 DOI: 10.1111/cas.14493] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 12/12/2022] Open
Abstract
Statins have been shown to be a beneficial treatment as chemotherapy and target therapy for lung cancer. This study aimed to investigate the effectiveness of statins in combination with epidermal growth factor receptor-tyrosine kinase inhibitor therapy for the resistance and mortality of lung cancer patients. A population-based cohort study was conducted using the Taiwan Cancer Registry database. From January 1, 2007, to December 31, 2012, in total 792 non-statins and 41 statins users who had undergone EGFR-TKIs treatment were included in this study. All patients were monitored until the event of death or when changed to another therapy. Kaplan-Meier estimators and Cox proportional hazards regression models were used to calculate overall survival. We found that the mortality was significantly lower in patients in the statins group compared with patients in the non-statins group (4-y cumulative mortality, 77.3%; 95% confidence interval (CI), 36.6%-81.4% vs. 85.5%; 95% CI, 78.5%-98%; P = .004). Statin use was associated with a reduced risk of death in patients the group who had tumor sizes <3 cm (hazard ratio [HR], 0.51, 95% CI, 0.29-0.89) and for patients in the group who had CCI scores <3 (HR, 0.6; 95% CI, 0.41-0.88; P = .009). In our study, statins were found to be associated with prolonged survival time in patients with lung cancer who were treated with EGFR-TKIs and played a synergistic anticancer role.
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Affiliation(s)
- Phung-Anh Nguyen
- International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan
| | - Chih-Cheng Chang
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Pulmonary, Department of Internal Medicine, Shuang-Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Cooper J Galvin
- Biophysics Program, Stanford Medical School, Stanford, CA, USA
| | - Yao-Chin Wang
- Department of Emergency, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Soo Yeon An
- Department of Cardiology, Chungnam National University Hospital, Daejeon, South Korea
| | - Chih-Wei Huang
- International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan
| | - Yu-Hsiang Wang
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Min-Huei Hsu
- Graduate Institute of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chuan Jack Li
- International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan.,Department of Dermatology, Wan-Fang Hospital, Taipei, Taiwan
| | - Hsuan-Chia Yang
- International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
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13
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Kache PA, Person MK, Seeman SM, McQuiston JR, McCollum J, Traxler RM. Rat-Bite Fever in the United States: An Analysis Using Multiple National Data Sources, 2001-2015. Open Forum Infect Dis 2020; 7:ofaa197. [PMID: 32617373 PMCID: PMC7320832 DOI: 10.1093/ofid/ofaa197] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/20/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Rat-bite fever is a rare disease associated with rat bites or direct/indirect rodent contact. METHODS We examined rat-bite fever and rat-bite injury diagnoses in the United States during 2001-2015. We analyzed national, state, and Indian Health Service healthcare encounter datasets for rat-bite fever and rat-bite injury diagnoses. We calculated average-annual encounter rates per 1 000 000 persons. RESULTS Nationally, the rat-bite fever Emergency Department visit rate was 0.33 (95% confidence interval [CI], 0.19-0.47) and the hospitalization rate was 0.20 (95% CI, 0.17-0.24). The rat-bite injury Emergency Department visit rate was 10.51 (95% CI, 10.13-10.88) and the hospitalization rate was 0.27 (95% CI, 0.23-0.30). The Indian Health Service Emergency Department/outpatient visit rate was 3.00 for rat-bite fever and 18.89 for rat-bite injury. The majority of rat-bite fever encounters were among individuals 0-19 years of age. CONCLUSIONS Our results support the literature that rat-bite fever is rare and affects children and young adults. Targeted education could benefit specific risk groups.
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Affiliation(s)
- Pallavi A Kache
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marissa K Person
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sara M Seeman
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John R McQuiston
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Rita M Traxler
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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