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Cho CH, Jee HJ, Nam YJ, An H, Kim L, Lee HJ. Temporal association between zolpidem medication and the risk of suicide: A 12-year population-based, retrospective cohort study. Sci Rep 2020; 10:4875. [PMID: 32184423 PMCID: PMC7078307 DOI: 10.1038/s41598-020-61694-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/02/2020] [Indexed: 01/25/2023] Open
Abstract
There have been concerns about abuse and unnecessary chronic administration of zolpidem, and zolpidem's relation to suicide risk. To investigate the temporal association of zolpidem with the risk of suicide, we conducted a 12-year, population-based, retrospective cohort study on the National Health Insurance Service-National Sample Cohort (NHIS-NSC), South Korea. Data were collected from 2002 to 2013 from the NHIS-NSC, and data cleaning was performed for 1,125,691 subjects. Cox proportional hazards regression analysis was used to investigate the correlation over time between zolpidem medication and suicide. Over intervals commencing after 80 months of observation, the adjusted hazard ratio of suicides associated with the use of the zolpidem was 2.01 (95% CI: 1.58-2.56; p < 0.001). The mean cumulative number of days of zolpidem prescription was significantly longer in the suicide group than in the non-suicide group after log-transformation (p = 0.005). Cases of chronic use of zolpidem (over six months or one year) were significantly more common in the suicide group compared to the non-suicide group (p = 0.002 and 0.005, respectively). Subjects who received zolpidem medication had a significantly higher risk of suicide after at least 80 months of observation, suggesting a long-term increased suicide risk associated with insomnia exposed to zolpidem medication.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Psychiatry, School of Medicine, Chungnam National University, Daejeon, South Korea
- Department of Psychiatry, Sejong Chungnam National University Hospital, Sejong, South Korea
- Korea University Chronobiology Institute, Seoul, South Korea
| | - Hee-Jung Jee
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Yoon-Ju Nam
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea
| | - Hyonggin An
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Leen Kim
- Korea University Chronobiology Institute, Seoul, South Korea
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea
| | - Heon-Jeong Lee
- Korea University Chronobiology Institute, Seoul, South Korea.
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea.
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Lai SW, Lin CL, Liao KF. Population-based cohort study investigating the association between weight loss and pyogenic liver abscesses. Biomedicine (Taipei) 2017; 7:26. [PMID: 29130451 PMCID: PMC5682981 DOI: 10.1051/bmdcn/2017070426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/17/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND AIM Few systematic studies focus on the association between weight loss and pyogenic liver abscesses. The objective of the study was to assess the association between weight loss and pyogenic liver abscesses in adults in Taiwan. METHODS This population-based cohort study utilized the database of the Taiwan National Health Insurance Program. Totally, 8453 subjects aged 20 to 84 years with newly diagnosed weight loss between 2000 and 2012 were assigned as the weight loss group, and 33777 randomly selected subjects without weight loss were assigned as the non-weight loss group. Both the weight loss and the non-weight loss groups were matched according to sex, age, and comorbidities. The incidence of pyogenic liver abscesses at the end of 2013 was measured in both groups. RESULTS A multivariable Cox proportional hazards regression model was done and presented evidence that the adjusted HR of pyogenic liver abscess was 2.47 (95 %CI 1.21, 5.02) for those subjects with weight loss and without comorbidities, as compared with those subjects without weight loss and without comorbidities. Among the weight loss group, 5% developed pyogenic liver abscesses within 3 months. CONCLUSION Weight loss is associated with pyogenic liver abscesses in adults. Yet weight loss might not be an early clinical symptom of undiagnosed pyogenic liver abscesses.
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Affiliation(s)
- Shih-Wei Lai
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College of Medicine, China Medical University Taichung 404 Taiwan
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Department of Family Medicine, China Medical University Hospital Taichung 404 Taiwan
| | - Cheng-Li Lin
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College of Medicine, China Medical University Taichung 404 Taiwan
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Management Office for Health Data, China Medical University Hospital Taichung 404 Taiwan
| | - Kuan-Fu Liao
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College of Medicine, Tzu Chi University Hualien 970 Taiwan
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Department of Internal Medicine, Taichung Tzu Chi General Hospital Taichung 427 Taiwan
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Graduate Institute of Integrated Medicine, China Medical University Taichung 404 Taiwan
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Lin HF, Liao KF, Chang CM, Lin CL, Lai SW. Tamoxifen usage correlates with increased risk of Parkinson's disease in older women with breast cancer: a case-control study in Taiwan. Eur J Clin Pharmacol 2017; 74:99-107. [PMID: 28967041 DOI: 10.1007/s00228-017-2341-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 09/22/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Little is known about the association between tamoxifen usage and risk of Parkinson's disease in women with breast cancer. The present study aimed to evaluate the association between tamoxifen usage and Parkinson's disease in older women with breast cancer in Taiwan. METHODS We conducted a retrospective nationwide case-control study using the database of the Taiwan National Health Insurance Program. In total, 293 female subjects with breast cancer, aged 65 years and above, who were newly diagnosed with Parkinson's disease between 2000 and 2011 were included. Additionally, 1053 female subjects with breast cancer aged 65 years and above without Parkinson's disease were randomly selected as controls. Both cases and controls were matched for age and comorbidities. Ever use of tamoxifen was defined as subjects who had at least a prescription for tamoxifen before the index date, whereas never use of tamoxifen was defined as those who never had a prescription for tamoxifen before the index date. We used the unconditional logistic regression model to calculate the odds ratio (OR) and 95% confidence interval (CI) for the association between tamoxifen usage and risk of Parkinson's disease. RESULTS After adjusting for confounding variables, the adjusted OR of Parkinson's disease was 3.32 for subjects with ever use of tamoxifen (95% CI, 2.50-4.43), compared with nonusers. Further analysis showed that the adjusted ORs of Parkinson's disease were 3.21 (95% CI, 2.29-4.49), 3.95 (95% CI, 2.77-5.64), and 11.4 (95% CI, 2.63-49.7) for subjects with < 2, 2-6, and ≥ 6 years of cumulative tamoxifen usage, respectively, when compared with nonusers. CONCLUSIONS Tamoxifen usage was associated with a 3.32-fold increase in the likelihood of having Parkinson's disease among older women with breast cancer in Taiwan.
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Affiliation(s)
- Hsien-Feng Lin
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung City, 404, Taiwan
| | - Kuan-Fu Liao
- Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan.,College of Medicine, Tzu Chi University, Hualien, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Ching-Mei Chang
- Department of Nursing, Tungs' Taichung Metro Habor Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Wei Lai
- Department of Family Medicine, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung City, 404, Taiwan. .,College of Medicine, China Medical University, Taichung, Taiwan.
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Lin HF, Liao KF, Chang CM, Lin CL, Lai SW. Population-based cohort study examining the association between splenectomy and empyema in adults in Taiwan. BMJ Open 2017; 7:e015101. [PMID: 28947439 PMCID: PMC5623461 DOI: 10.1136/bmjopen-2016-015101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 07/05/2017] [Accepted: 08/04/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the association between splenectomy and empyema in Taiwan. METHODS A population-based cohort study was conducted using the hospitalisation dataset of the Taiwan National Health Insurance Program. A total of 13 193 subjects aged 20-84 years who were newly diagnosed with splenectomy from 2000 to 2010 were enrolled in the splenectomy group and 52 464 randomly selected subjects without splenectomy were enrolled in the non-splenectomy group. Both groups were matched by sex, age, comorbidities and the index year of undergoing splenectomy. The incidence of empyema at the end of 2011 was calculated. A multivariable Cox proportional hazards regression model was used to estimate the HR with 95% CI of empyema associated with splenectomy and other comorbidities. RESULTS The overall incidence rate of empyema was 2.56-fold higher in the splenectomy group than in the non-splenectomy group (8.85 vs 3.46 per 1000 person-years). The Kaplan-Meier analysis revealed a higher cumulative incidence of empyema in the splenectomy group than in the non-splenectomy group (6.99% vs 3.37% at the end of follow-up). After adjusting for confounding variables, the adjusted HR of empyema was 2.89 for the splenectomy group compared with that for the non-splenectomy group. Further analysis revealed that HR of empyema was 4.52 for subjects with splenectomy alone. CONCLUSION The incidence rate ratio between the splenectomy and non-splenectomy groups reduced from 2.87 in the first 5 years of follow-up to 1.73 in the period following the 5 years. Future studies are required to confirm whether a longer follow-up period would further reduce this average ratio. For the splenectomy group, the overall HR of developing empyema was 2.89 after adjusting for age, sex and comorbidities, which was identified from previous literature. The risk of empyema following splenectomy remains high despite the absence of these comorbidities.
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Affiliation(s)
- Hsien-Feng Lin
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Fu Liao
- Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan
- College of Medicine, Tzu Chi University, Hualien, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Ching-Mei Chang
- Department of Nursing, Tungs’Taichung Metro Habor Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Wei Lai
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
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Lin HF, Liao KF, Chang CM, Lin CL, Lai SW. Association of use of selective serotonin reuptake inhibitors with risk of acute pancreatitis: a case-control study in Taiwan. Eur J Clin Pharmacol 2017; 73:1615-1621. [PMID: 28856398 DOI: 10.1007/s00228-017-2328-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/22/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Few studies have reported the association of the use of selective serotonin reuptake inhibitors (SSRIs) with acute pancreatitis. We conducted a population-based case-control study to explore this relationship. METHODS In this study, 4631 cases with first attack of acute pancreatitis and 4631 controls without acute pancreatitis were selected using a randomly sampled cohort of one million health insurance enrollees from 2000 to 2013. Both cases and controls were aged 20-84 years and were matched with sex, age, comorbidities, and index year of diagnosis of acute pancreatitis. Patients with current use of SSRIs were defined as those whose last tablet of SSRIs was noted ≤ 7 days before the date of diagnosis of acute pancreatitis; patients with late use of SSRIs were defined as those whose last tablet of SSRIs was noted ≥ 8 days before the date of diagnosis; and patients with no use of SSRIs were defined as those who were never prescribed SSRIs. The odds ratio (OR) and 95% confidence interval (CI) for acute pancreatitis associated with the use of SSRIs were assessed using multivariate unconditional logistic regression analysis. RESULTS After adjusting for covariables, multivariate logistic regression analysis revealed that compared with patients with no use of SSRIs, the adjusted OR of acute pancreatitis for those with current use of SSRIs was 1.7 (95% CI, 1.1-2.5), whereas that for patients with late use of SSRIs was 1.0 (95% CI, 0.9-1.2) without statistical significance. CONCLUSIONS Current use of SSRIs is associated with the diagnosis of acute pancreatitis. Therefore, clinicians should consider the possibility of SSRI-associated acute pancreatitis among patients currently taking SSRIs and those presenting with the diagnosis of acute pancreatitis without a definite cause.
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Affiliation(s)
- Hsien-Feng Lin
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, No 2, Yuh-Der Road, Taichung City, 404, Taiwan
| | - Kuan-Fu Liao
- Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan.,College of Medicine, Tzu Chi University, Hualien, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Ching-Mei Chang
- Department of Nursing, Tungs' Taichung Metro Habor Hospital, Taichung, 435, Taiwan
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Wei Lai
- Department of Family Medicine, China Medical University Hospital, No 2, Yuh-Der Road, Taichung City, 404, Taiwan. .,College of Medicine, China Medical University, Taichung, Taiwan.
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Cheng KC, Liao KF, Lin CL, Lai SW. Correlation of Proton Pump Inhibitors with Pulmonary Tuberculosis: A Case-Control Study in Taiwan. Front Pharmacol 2017; 8:481. [PMID: 28769810 PMCID: PMC5515903 DOI: 10.3389/fphar.2017.00481] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/04/2017] [Indexed: 12/15/2022] Open
Abstract
Background and Objectives: Although the relationship between the use of proton pump inhibitors (PPIs) and pulmonary tuberculosis (TB) in Taiwan published in 2014. Due to just only one article and not enough comprehensively, we explore this issue. Methods: We conducted a population-based case-control study to identify 9,422 subjects aged 20 years or older with newly diagnosed pulmonary TB in 2000–2013 as test cases. We then randomly selected 9,422 subjects aged 20 years or older without pulmonary TB as controls. Both cases and controls were matched in terms of sex, age, and comorbidities. Use of PPIs were defined as subjects who had had at least one prescription for these medications before the index date. No use was defined as subjects who had never had a prescription for PPIs before the index date. The odds ratio (OR) and 95% confidence interval (CI) for pulmonary TB associated with PPI use was estimated using the logistic regression model. Results: The OR of pulmonary TB was 1.31 for subjects who had used PPIs (95% CI 1.22, 1.41) compared with those with no use of the medications. Sub-analysis revealed the OR of pulmonary TB in subjects using PPI per increasing microgram was 1.25 (95% CI 1.19, 1.30). Conclusions: PPI use is associated with a 1.3-fold increase in odds of developing pulmonary TB in Taiwan. There is a dose-related response between PPI use and pulmonary TB.
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Affiliation(s)
- Kao-Chi Cheng
- College of Medicine, China Medical UniversityTaichung, Taiwan.,Department of Family Medicine, China Medical University HospitalTaichung, Taiwan
| | - Kuan-Fu Liao
- Department of Internal Medicine, Taichung Tzu Chi General HospitalTaichung, Taiwan.,College of Medicine, Tzu Chi UniversityHualien, Taiwan.,Graduate Institute of Integrated Medicine, China Medical UniversityTaichung, Taiwan
| | - Cheng-Li Lin
- College of Medicine, China Medical UniversityTaichung, Taiwan.,Management Office for Health Data, China Medical University HospitalTaichung, Taiwan
| | - Shih-Wei Lai
- College of Medicine, China Medical UniversityTaichung, Taiwan.,Department of Family Medicine, China Medical University HospitalTaichung, Taiwan
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Correlation between proton pump inhibitors and risk of pyogenic liver abscess. Eur J Clin Pharmacol 2017; 73:1019-1025. [PMID: 28434021 DOI: 10.1007/s00228-017-2256-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 04/18/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVE Little is known about the relationship between proton pump inhibitors use and pyogenic liver abscess. The objective of this study was to evaluate the correlation between proton pump inhibitors use and pyogenic liver abscess in Taiwan. METHODS This was a population-based case-control study using the database of the Taiwan National Health Insurance Program since 2000 to 2011. Subjects aged 20 to 84 who experienced their first episode of pyogenic liver abscess were enrolled as the case group (n = 1372). Randomly selected subjects aged 20 to 84 without pyogenic liver abscess were enrolled as the control group (n = 1372). Current use, early use, and late use of proton pump inhibitors was defined as subjects whose last one tablet for proton pump inhibitors was noted ≤30 days, between 31 to 90 days and ≥91 days before the date of admission for pyogenic liver abscess. Subjects who never received a prescription for proton pump inhibitors were defined as nonusers of proton pump inhibitors. A multivariable unconditional logistic regression model was used to measure the odds ratio and 95% confidence interval to evaluate the correlation between proton pump inhibitors use and pyogenic liver abscess. RESULTS After adjusting for confounders, the adjusted odds ratio of pyogenic liver abscess was 7.59 for subjects with current use of proton pump inhibitors (95% confidence interval 5.05, 11.4), when compared with nonusers. CONCLUSIONS Current use of proton pump inhibitors is associated with a greater risk of pyogenic liver abscess.
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Cheng KC, Liao KF, Lin CL, Lai SW. Increased Risk of Pulmonary Tuberculosis in Patients with Depression: A Cohort Study in Taiwan. Front Psychiatry 2017; 8:235. [PMID: 29180971 PMCID: PMC5694036 DOI: 10.3389/fpsyt.2017.00235] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 10/31/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/OBJECTIVE Tuberculosis (TB) and depression were major public health issues worldwide and the mutual causative relationships between them were not exhaustive. This study was performed to explore the association between depression, comorbidities, and the risk of pulmonary TB in Taiwan. METHODS The cohort study used the database of the Taiwan National Health Insurance Program. The depression group included 34,765 subjects aged 20-84 years with newly diagnosed depression from 2000 to 2012, and the non-depression group included 138,187 randomly selected subjects without depression. Both depression and non-depression groups were matched with respect to sex, age, and comorbidities. We explored the incidence of pulmonary TB at the end of 2013 in both the groups and used multivariable Cox proportional hazards regression model to explore the hazard ratio (HR) and 95% confidence interval (CI) for the risk of pulmonary TB associated with depression. RESULTS The overall incidence of pulmonary TB was 1.16-fold greater in the depression group than that in the non-depression group (1.52 vs. 1.31 per 1,000 person-years, 95% CI 1.12, 1.21). The multivariable Cox proportional hazards regression analysis revealed that the adjusted HR of pulmonary TB was 1.15 for the depression group (95% CI 1.03, 1.28), compared with the non-depression group. CONCLUSION Depression is associated with 1.15-fold increased hazard of pulmonary TB in Taiwan.
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Affiliation(s)
- Kao-Chi Cheng
- College of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Fu Liao
- Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan.,College of Medicine, Tzu Chi University, Hualien, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Wei Lai
- College of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
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Mei-Ling S, Kuan-Fu L, Sung-Mao T, Cheng-Li LM, Shih-Wei L. Herpes zoster correlates with pyogenic liver abscesses in Taiwan. Biomedicine (Taipei) 2016; 6:22. [PMID: 27854050 PMCID: PMC5112182 DOI: 10.7603/s40681-016-0022-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 08/05/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The purpose of the paper was to explore the relationship between herpes zoster and pyogenic liver abscesses in Taiwan. METHODS This was a nationwide cohort study. Using the database of the Taiwan National Health Insurance Program, there were 33049 subjects aged 20-84 years who were newly diagnosed with herpes zoster from 1998 to 2010 that were selected for our study, and they were our herpes zoster group. 131707 randomly selected subjects without herpes zoster were our non-herpes zoster group. Both groups were matched by sex, age, other comorbidities, and the index year of their herpes zoster diagnosis. The incidence of pyogenic liver abscesses at the end of 2011 was then estimated. The multivariable Cox proportional hazard regression model was used to estimate the hazard ratio and 95% confidence interval for pyogenic liver abscesses associated with herpes zoster and other comorbidities. RESULTS The overall incidence rate was 1.38-fold higher in the herpes zoster group than in the non-herpes zoster group (4.47 vs. 3.25 per 10000 person-years, 95% confidence interval 1.32, 1.44). After controlling for potential confounding factors, the adjusted hazard ratio of pyogenic liver abscesses was 1.34 in the herpes zoster group (95% confidence interval 1.05, 1.72) when compared with the non-herpes zoster group. Sex (in this case male), age, presence of biliary stones, chronic kidney diseases, chronic liver diseases, cancers, and diabetes mellitus were also significantly associated with pyogenic liver abscesses. CONCLUSIONS Patients with herpes zoster are associated with an increased hazard of developing pyogenic liver abscesses.
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Affiliation(s)
- Shen Mei-Ling
- Department of Anesthesiology, Taichung Tzu Chi General Hospital, Taichung, 427, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, 404, Taiwan
| | - Liao Kuan-Fu
- College of Medicine, Tzu Chi University, Hualien, 970, Taiwan.,Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, 427, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, 404, Taiwan
| | - Tsai Sung-Mao
- Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, 427, Taiwan
| | - Lin Ms Cheng-Li
- College of Medicine, China Medical University, Taichung, 404, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, 404, Taiwan
| | - Lai Shih-Wei
- College of Medicine, China Medical University, Taichung, 404, Taiwan. .,Department of Family Medicine, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung, 404, Taiwan.
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