Chao-Hsiun Tang

Migraine is associated with a higher risk of transient global amnesia: a nationwide cohort study.

The association between migraine and transient global amnesia (TGA) is not determined. Only two clinic‐based studies showed that TGA patients had a higher frequency of migraine history. Our population‐based study aimed to investigate whether migraine patients were associated with a higher risk of developing TGA.

The distribution of different surgical types for female stress urinary incontinence among patients' age, surgeons' specialties and hospital accreditations in Taiwan: a descriptive 10-year nationwide study

This study aims to identify the changing trends of different surgical types for female stress urinary incontinence (SUI) and the distribution amongst various providers’ characteristics. A total of 17,532 women who had undergone surgery for SUI during 1996–2005 were identified from the National Health Insurance Research Database for analysis. Retropubic urethropexy (RPU) was the most common surgical type (43%), followed by tension-free mid-urethral sling (MUS; 24%), and traditional pubovaginal sling (15%). MUS had an annual growth rate of 20.5%, whilst traditional pubovaginal sling was reduced by 11.3% annually after 2002. RPU was the most common procedure by both gynecologists and urologists. Gynecologists performed more Kelly plications, whereas urologists performed more traditional pubovaginal sling. MUS was more commonly performed in medical centers than in regional and local hospitals. There has been a notable growth and changing trend in various surgical types for female SUI in Taiwan.

Major Adverse Cardiovascular Events and Mortality in Systemic Lupus Erythematosus Patients After Successful Delivery: A Population-based Study

Background:Limited data exist regarding the incidence rate and hazard ratios (HRs) of major adverse cardiovascular events and mortality in the successful-delivery women with or without systemic lupus erythematosus. Methods:A retrospective, population-based cohort study was performed on 1,132,089 parturients from 1999 to 2003. The Kaplan-Meier method and the log-rank test were used to examine the effect of systemic lupus erythematosus on the incidence of major adverse cardiovascular events and mortality. Cox-proportional hazard regression modeling was used to determine the adjusted HRs of systemic lupus erythematosus on the risk of major adverse cardiovascular events and mortality among successful-delivery women. Results:Systemic lupus erythematosus group has the highest risk for major adverse cardiovascular events and mortality. The incidence rate of major adverse cardiovascular events and all-causes mortality among lupus women was 194.67 and 438.82 per 100,000 patients per year, respectively. Lupus women had higher incidence rates of major adverse cardiovascular events, including myocardial infarction, (HR, 54.43; confidence interval [CI], 16.04–184.78; P < 0.0001), heart failure (HR, 11.10; CI, 2.71–45.52; P < 0.0001), percutaneous coronary intervention (HR, 228.32; CI, 43.34–1203.00; P < 0.0001), stroke (HR, 8.02; CI, 3.79–16.99; P < 0.0001) and maternal death (HR, 11.68; CI, 7.97–17.10; P < 0.0001). Conclusions:Although major adverse cardiovascular events and mortality are rare events in women of reproductive age, the incidence rates have increased approximately 10-fold among lupus women with successful delivery. Clinicians should note the possibility of persisting major adverse cardiovascular events and death in young women with lupus and successful delivery.

Prognostic Benefits of Carvedilol, Bisoprolol, and Metoprolol Controlled Release/Extended Release in Hemodialysis Patients with Heart Failure: A 10‐Year Cohort

Background Heart failure is a highly prevalent cardiovascular complication among patients receiving long‐term hemodialysis, but the benefits of carvedilol, bisoprolol, and metoprolol controlled release/extended release on the outcomes of these patients remain unclear. In this study, we address the use of these 3 β‐blockers and their associations with mortality. Methods and Results Long‐term hemodialysis patients, aged ≥35 years, with new‐onset heart failure and receiving various medications were identified through the use of 1999–2010 data from the Taiwan National Health Insurance Research Database. From the total of 4435 heart failure patients, we selected 1700 new users of the 3 β‐blockers (study group) and 1700 nonusers (control group), by using matched cohorts according to their propensity scores, and then compared the 5‐year all‐cause mortality rates by using Cox proportional hazard regressions and time‐dependent covariate adjustment. During 3944 person‐years of follow‐up, 666 (39.2%) deaths occurred within the study group, compared with 918 (54%) deaths during 2893 person‐years of follow‐up in the control group. The 5‐year mortality rate for the study (control) group was 54.5% (70.3%); P<0.001. Adjusted hazard regression analyses revealed that the therapeutic effects of β‐blockers remained significant for all‐cause mortality (hazard ratio 0.80, 95% CI 0.72 to 0.90). Subgroup analyses revealed that patients in the study group receiving β‐blockers plus renin‐angiotensin system antagonists exhibited the lowest mortality rate, while the highest mortality rate was found among patients in the control group receiving neither β‐blockers nor renin‐angiotensin system antagonists. Conclusions This study demonstrates that the 3 β‐blockers were associated with improved survival in long‐term hemodialysis patients with heart failure.

Temperature variation and the incidence of cluster headache periods: A nationwide population study

Background Cluster headache (CH) is well known to show a seasonal predilection; however, the impact of temperature and other meteorological factors on cluster periods (or bouts) has not been established. Methods This nationwide survey included 758 patients with episodic CH retrieved from the Taiwan National Health Insurance Research Database from 2005 to 2009. Corresponding meteorological recordings were obtained from the Central Weather Bureau. A case-crossover study design was used to investigate the association between cluster periods and meteorological factors. Results A total of 2452 episodes of cluster periods were recorded. The cluster periods were most frequent in the autumn and least frequent in the winter. Seasonal changes from winter to spring and from autumn to winter also increased the frequency of cluster periods. The risk of cluster periods increased when there was a higher mean temperature on event days (odds ratio (OR), 1.014, 95% confidence interval (CI), 1.005–1.023, p = 0.003) or within seven to 56 days. Either an increase or a decrease in temperature (0.05℃/day) following a warm period (mean temperature ≥26℃) was associated with the onset of cluster periods. In contrast, a greater increase in temperature (0.15℃/day) following a cold period (mean temperature < 21℃) was needed to evoke cluster periods. No such associations were found following moderate periods (21℃ ≤mean temperature <26℃). Discussion Our study shows that temperature is associated with precipitating or priming cluster periods. The influence depends on the temperature of the preceding periods.

A real-world risk analysis of biological treatment (adalimumab and etanercept) in a country with a high prevalence of tuberculosis and chronic liver disease: a nationwide population-based study.

Objectives: Few studies on tumour necrosis factor (TNF) inhibitor-associated tuberculosis (TB) and hepatic events have been performed in regions where these risks are elevated. This study aimed to provide a direct comparison between adalimumab and etanercept in a high-risk population and to address the implications for physicians working with patients in such an environment. Method: Data collected from the National Health Insurance Research Database (NHIRD) in Taiwan between 2007 and 2011 were analysed retrospectively for incidences of eight adverse events associated with TNF-α inhibitors. Hazard ratios (HRs) of adalimumab vs. etanercept were calculated using a Cox proportional hazards model. Results: During this 5-year period, 86 events of TB were reported after 5317 person-years of exposure to adalimumab (1.62 events per 100 person-years), compared to 44 events after 7690 person-years of exposure to etanercept (0.57 events per 100 person-years). For serious hepatic events that led to hospitalization, 0.75 events were reported per 100 person-years of exposure to adalimumab compared to 0.39 events per 100 person-years of exposure to etanercept. Adjusted HRs for TB [aHR 3.06, 95% confidence interval (CI) 2.09–4.49, p < 0.0001], hospitalization due to a hepatic event (aHR 2.05, 95% CI 1.27–3.30, p = 0.0035), and serious infection (aHR 1.48, 95% CI 1.19–1.84, p = 0.0005) attained significance. Conclusions: TNF-α-targeting therapies with the monoclonal antibody adalimumab confers significant added risk of TB and serious hepatic events compared to therapies with the soluble fusion protein etanercept. Tailored strategies to attenuate these risks are warranted in high-risk regions such as Taiwan.

Estimating the Economic Burden of Rheumatoid Arthritis in Taiwan Using the National Health Insurance Database

Background Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation and destruction of the joints. Objectives This research aims to estimate the economic burden of RA in Taiwan. Methods The National Health Insurance Research Database (NHIRD), a claims-based dataset encompassing 99 % of Taiwan’s population, was applied. We used a micro-costing approach for direct healthcare costs and indirect social costs by estimating the quantities and prices of cost categories. Direct costs included surgeries, hospitalizations, medical devices and materials, laboratory tests, and drugs. The costs and quantities of the direct economic burden were calculated based on 2011 data of NHIRD. We identified RA patients and a control cohort matched 1:4 on demographic and clinical covariates to calculate the incremental cost related to RA. Indirect costs were evaluated by missed work (absenteeism) and worker productivity (presenteeism). For the indirect burden, we estimated the rate of absenteeism and presenteeism from a patient survey. Costs were presented in US dollars (US

Effect of glucocorticoid use on survival in patients with stage I–III breast cancer

1 = 30 TWD). Results A total of 41,269 RA patients were included in the database with incremental total direct cost of US

Risk of skin cancer in patients on chronic haemodialysis: a nationwide, population-based study in Taiwan†

86,413,971 and indirect cost of US

Increased risk of incident psoriasis in end-stage renal disease patients on chronic hemodialysis: A nationwide population-based cohort study

138,492,987. This resulted in an average incremental direct cost of US