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Wang YC, Chen YC, Ko CY, Guo YLL, Sung FC. Pre-existing comorbidity modify emergency room visit for out-of-hospital cardiac arrest in association with ambient environments. PLoS One 2018; 13:e0204593. [PMID: 30256842 PMCID: PMC6157874 DOI: 10.1371/journal.pone.0204593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 09/11/2018] [Indexed: 11/19/2022] Open
Abstract
Background This study evaluated risks of emergency room visit (ERV) for out-of-hospital cardiac arrest (OHCA) in 2005–2011, among patients with cardiologic and metabolic syndromes (CMS), in association with ambient environments. Methods Pooled and area-specific weather related cumulative six-day (lags 0 to 5) relative risks (RRs) and confidence intervals (CIs) of ERV for OHCA were evaluated for CMS cases, using distributed lag nonlinear models and multivariate meta-analytical second-stage model in association with the daily average temperatures and daily concentrations of air pollutants. Results ERV risk increased as average temperature dropped to <27°C. At the mean temperature of 14°C, the cumulative six-day RRs of ERV were 1.73 (95% CI: 1.22, 2.46) for all OHCA patients, 1.74 (95% CI: 1.06, 2.84) for OHCA patients younger than 65 years old, and 1.99 (95% CI: 1.03, 3.81) for subjects with pre-existing hypertension. High temperature was also associated with elevated ERV of OHCA. Increased ERV risks in cases with pre-existing hypertension and diabetes mellitus were also associated with concentrations of air pollutants in northern Taiwan. Conclusions Our data provided evidences to clinicians, emerging medical services and public health that the ERV risk for OHCA patients is greater at low temperature than at high temperature. Patients with cardio and metabolic disorders need to pay greater attention to low temperature and avoid heat wave.
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Affiliation(s)
- Yu-Chun Wang
- Department of Environmental Engineering, College of Engineering, Zhongli, Taiwan
- Research Center for Environmental Risk Management, Chung Yuan Christian University, Zhongli, Taiwan
| | - Yi-Chun Chen
- Department of Health Management, I-Shou University, Kaohsiung, Taiwan
| | - Chun-Yu Ko
- Department of Environmental Engineering, College of Engineering, Zhongli, Taiwan
| | - Yue-Liang Leon Guo
- Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Fung-Chang Sung
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- * E-mail: ,
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Pan CS, Ju TR, Lee CC, Chen YP, Hsu CY, Hung DZ, Chen WK, Wang IK. Alcohol use disorder tied to development of chronic kidney disease: A nationwide database analysis. PLoS One 2018; 13:e0203410. [PMID: 30188943 PMCID: PMC6126842 DOI: 10.1371/journal.pone.0203410] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/20/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Alcohol use disorder (AUD) is a spectrum of high risk behaviors including alcohol abuse and dependence. Chronic kidney disease (CKD) is progressive loss of renal function for more or equal to 3 months or presence of any irreversible kidney damage. Common risk factors of CKD have been identified, but the impact of alcohol consumption on kidney function is controversial. The study aims to investigate the relationship between alcohol use disorder and CKD on a national scale. METHODS This retrospective cohort study was conducted using Taiwan's National Health Insurance research database. Patients aged 20 years or older, without CKD and with the diagnosis of AUD (ICD-9-CM codes 303.X; 305.0, V113) from years 2000 to 2013 were enrolled. Control cohort was selected to match the demographics of the target population. Patients were followed until the end of 2013 or earlier if they developed CKD, died, or lost follow up. Baseline characteristics and comorbidities were identified for risk stratification. RESULTS We identified 11639 patients in the AUD cohort and 46556 patients in the control cohort. Compared to patients in the control cohort, those in the AUD group were more likely to have multiple comorbidities (p < 0.001 for all comorbidities). After adjustment of age, gender, baseline comorbidities, and nonsteroidal anti-inflammatory drug use, the diagnosis of AUD was associated with an increased risk of CKD development (aHR = 1.62, 95% CI, 1.46-1.81). During the mean follow up periods of 6.47 (standard deviation (SD) = 3.80) years for the AUD cohort and 7.23 (SD = 3.75) years for the control cohort, the overall incidence density of CKD was significantly higher in patients with AUD than those in the control cohort (3.48 vs 6.51 per 1000 person-years, aHR = 1.68, 95% CI, 1.50-1.87). Kaplan-Meier analysis showed that the AUD cohort had a higher cumulative incidence of CKD than the control cohort (log-rank test, p value < 0.001). Patients with AUD had higher risks of CKD in all the stratified groups, except for the subgroup with age over 65 years old. CONCLUSION Our study suggested that AUD was associated with an increased incidence of newly diagnosed CKD by nearly two folds. Young age, in particular, had a higher association between AUD and CKD. Considering the preventable nature of AUD, establishing effective health policies is imperative to reduce high-risk alcohol behaviors and thereby prevent alcohol-related kidney disease. Further prospective studies are warranted to further elucidate the causation of AUD on kidney function.
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Affiliation(s)
- Chi-syuan Pan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | | | - Chi Chan Lee
- Department of Critical Care, Oregon Health Science University Hospital, Portland, OR, United States of America
| | - Yu-Pei Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chung-Y. Hsu
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Dong-Zong Hung
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Kung Chen
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - I-Kuan Wang
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Department of Nephrology, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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Lo C, Sung FC, Mou CH, Lin TC, Tseng CH, Tzeng YL. Population study evaluating fracture risk among patients with chronic osteomyelitis. PLoS One 2017; 12:e0189743. [PMID: 29267371 PMCID: PMC5739410 DOI: 10.1371/journal.pone.0189743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/30/2017] [Indexed: 11/18/2022] Open
Abstract
Background Studies investigating the fracture risk in patients with chronic osteomyelitis (COM) limited to case reports. This study evaluated the association between COM and subsequent fracture risk using population-based data. Methods A subset claims data of the Taiwan National Health Insurance was used to identify 7,147 patients with COM newly diagnosed in 1999–2005 without fracture history and 28,588 general population controls, frequency matched by sex, age and diagnosis date. The incident fractures was measured by the end of 2013. Results The incidence density of fracture was 1.94-fold greater in the COM cohort than in controls (21.5 vs. 11.1 per 1000 person-years), with the adjusted hazard ratio (HR) of 1.81 (95% CI: 1.67–1.95) for COM patients compared to controls after controlling for sex, age, and comorbidities of diabetes, osteoporosis, depression and end-stage renal disease in Cox proportional hazards regression. The fracture risk increased with age and women were at greater risk than men. The fracture incidence increased substantially in those with osteoporosis, 40.2 per 1000 person-years in COM patients. Site specific analysis showed a higher portion of incident fractures for lower limbs, 52.7% in COM cohort and 46.3% in controls. Conclusion Findings in this 15-year follow-up observation support our hypothesis that patients with COM are at an elevated risk of subsequent fracture. COM patients and the elderly deserve adequate consultation and awareness for fracture prevention.
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Affiliation(s)
- Chyi Lo
- School of Nursing, College of Health Care, China Medical University, Taichung, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Chih-Hsin Mou
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Tzu-Chieh Lin
- Division of Traumatology, Emergency Department, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chun-Huang Tseng
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Ya-Ling Tzeng
- School of Nursing, College of Health Care, China Medical University, Taichung, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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Peng YH, Huang CW, Liao WC, Chen HJ, Yin MC, Huang YM, Wu TN, Ho WC. Association between chronic obstructive pulmonary disease and increased risk of benign prostatic hyperplasia: a retrospective nationwide cohort study. BMJ Open 2017; 7:e015581. [PMID: 28645971 PMCID: PMC5734354 DOI: 10.1136/bmjopen-2016-015581] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) and benign prostatic hyperplasia (BPH) are common disorders in ageing male populations. Nevertheless, the relationship between the two diseases has rarely been explored. The objective of this study was to examine whether patients with COPD are at an increased risk of BPH. DESIGN Retrospective nationwide cohort study. SETTING Data retrieved from the Taiwan National Health Insurance Research Database. PARTICIPANTS Overall, 19 959 male patients aged 40 years and over with newly diagnosed COPD between 2000 and 2006 were included as the COPD group, and 19 959 sex-matched and age-matched enrollees without COPD were included as the non-COPD group. Both groups were followed-up until the end of 2011. OUTCOME MEASURES A Cox proportional hazards regression model was used to compute the risk of BPH in patients with COPD compared with enrollees without COPD. RESULTS The overall incidence rate of BPH was 1.53 times higher in the COPD group than that in the non-COPD group (44.7 vs 25.7 per 1000 person-years, 95% CI 1.46 to 1.60) after adjusting for covariates. An additional stratified analysis revealed that this increased risk of BPH in patients with COPD remained significantly higher than that in enrollees without COPD in all men aged 40 years and over. CONCLUSION After adjustment for covariates, male patients with COPD were found to be at a higher risk of BPH. We suggest that clinicians should be cautious about the increased risk of BPH in male patients with COPD.
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Affiliation(s)
- Yi-Hao Peng
- Department of Public Health, China Medical University, Taichung, Taiwan
- Division of Respiratory Therapy, Asia University Hospital, Asia University, Taichung, Taiwan
- Department of Respiratory Therapy, China Medical University, Taichung, Taiwan
| | - Chien-Wen Huang
- Division of Chest Medicine, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan
- Department of Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Institute of Molecular Biology, College of Life Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Wei-Chih Liao
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsuan-Ju Chen
- College of Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Chien Yin
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Respiratory Therapy, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yu-Ming Huang
- Division of Respiratory Therapy, Asia University Hospital, Asia University, Taichung, Taiwan
| | - Trong-Neng Wu
- Department of Health Care Administration, Asia University, Taichung, Taiwan
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung, Taiwan
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Chen YW, Li CH, Yang CD, Liu CH, Chen CH, Sheu JJ, Lin SK, Chen AC, Chen PK, Chen PL, Yeh CH, Chen JR, Hsiao YJ, Lin CH, Hsu SP, Chen TS, Sung SF, Yu SC, Muo CH, Wen CP, Sung FC, Jeng JS, Hsu CY. Low cholesterol level associated with severity and outcome of spontaneous intracerebral hemorrhage: Results from Taiwan Stroke Registry. PLoS One 2017; 12:e0171379. [PMID: 28422955 PMCID: PMC5396870 DOI: 10.1371/journal.pone.0171379] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/18/2017] [Indexed: 01/14/2023] Open
Abstract
The relationship between cholesterol level and hemorrhagic stroke is inconclusive. We hypothesized that low cholesterol levels may have association with intracerebral hemorrhage (ICH) severity at admission and 3-month outcomes. This study used data obtained from a multi-center stroke registry program in Taiwan. We categorized acute spontaneous ICH patients, based on their baseline levels of total cholesterol (TC) measured at admission, into 3 groups with <160, 160–200 and >200 mg/dL of TC. We evaluated risk of having initial stroke severity, with National Institutes of Health Stroke Scale (NIHSS) >15 and unfavorable outcomes (modified Rankin Scale [mRS] score >2, 3-month mortality) after ICH by the TC group. A total of 2444 ICH patients (mean age 62.5±14.2 years; 64.2% men) were included in this study and 854 (34.9%) of them had baseline TC <160 mg/dL. Patients with TC <160 mg/dL presented more often severe neurological deficit (NIHSS >15), with an adjusted odds ratio [aOR] of 1.80; 95% confidence interval [CI], 1.41–2.30), and 3-month mRS >2 (aOR, 1.41; 95% CI, 1.11–1.78) using patients with TC >200 mg/dL as reference. Those with TC >160 mg/dL and body mass index (BMI) <22 kg/m2 had higher risk of 3-month mortality (aOR 3.94, 95% CI 1.76–8.80). Prior use of lipid-lowering drugs (2.8% of the ICH population) was not associated with initial severity and 3-month outcomes. A total cholesterol level lower than 160 mg/dL was common in patients with acute ICH and was associated with greater neurological severity on presentation and poor 3-month outcomes, especially with lower BMI.
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Affiliation(s)
- Yu-Wei Chen
- Department of Neurology, Taiwan Landseed Hospital, Taoyuan, Taiwan
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Hua Li
- Department of Neurology, Taiwan Landseed Hospital, Taoyuan, Taiwan
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Dong Yang
- Department of Neurosurgery, Taiwan Landseed Hospital, Taoyuan, Taiwan
| | - Chung-Hsiang Liu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hung Chen
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jau-Jiuan Sheu
- Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shinn-Kuang Lin
- Department of Neurology, Taipei Tzu Chi Hospital, and School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - An-Chih Chen
- Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ping-Kun Chen
- Department of Neurology, Lin Shin Hospital, Taichung, Taiwan
| | - Po-Lin Chen
- Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Hsin Yeh
- Department of Neurology, Yuan Rung Hospital, Changhua, Taiwan
- Department of Sport and Health Management, Da-Yeh University, Changhua, Taiwan
- Department of Nursing, College of Medicine & Nursing, Hung-Kuang University, Taichung, Taiwan
| | - Jiunn-Rong Chen
- Department of Neurology, Yunlin Christian Hospital, Yunlin, Taiwan
| | - Yu-Jen Hsiao
- Department of Neurology, National Taiwan University Hospital—Yunlin Branch, Yunlin, Taiwan
| | - Ching-Huang Lin
- Department of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shih-Pin Hsu
- Department of Neurology, E-Da Hospital, Kaohsiung, Taiwan
| | | | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Shih-Chieh Yu
- Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chi Pang Wen
- National Health Research Institutes, Miaoli, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Fung-Chang Sung
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- * E-mail: (JSJ); (FCS)
| | - Jiann-Shing Jeng
- Department of Neurology, Taiwan Landseed Hospital, Taoyuan, Taiwan
- Stroke Center, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail: (JSJ); (FCS)
| | - Chung Y. Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
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