Chien-Chang Liao

Does Hepatitis C Virus Infection Increase Risk for Stroke? A Population-Based Cohort Study

Background The relationship between hepatitis C virus infection and risk of stroke remains inconsistent. This study evaluates the risk of stroke in association with chronic hepatitis C infection in a longitudinal population-based cohort. Methods We identified 4,094 adults newly diagnosed with hepatitis C infection in 2002–2004 from the Taiwan National Health Insurance Research Database. Comparison group consisted of 16,376 adults without hepatitis C infection randomly selected from the same dataset, frequency matched by age and sex. Events of stroke from 2002–2008 were ascertained from medical claims (International Classification of Diseases, Ninth Revision, Clinical Modification, ICD-9-CM, codes 430–438). Multivariate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for potential associated factors including HCV infection, age, sex, low-income status, urbanization, cessation of cigarette smoking, alcohol-related illness, obesity, history of chronic diseases and medication use. Findings During 96,752 person-years of follow-up, there were 1981 newly diagnosed stroke cases. The HRs of stroke associated with medical conditions such as hypertension, diabetes and heart disease were 1.48 (95% CI 1.33 to 1.65), 1.23 (95% CI 1.11 to 1.36) and 1.17 (95% CI 1.06 to 1.30), respectively, after adjustment for covariates. The cumulative risk of stroke for people with hepatitis C and without hepatitis C infections was 2.5% and 1.9%, respectively (p<0.0001). Compared with people without hepatitis C infection, the adjusted HR of stroke was 1.27 (95% CI 1.14 to 1.41) for people with hepatitis C infection. Conclusion Chronic hepatitis C infection increases stroke risk and should be considered an important and independent risk factor.

Surgical adverse outcomes in patients with schizophrenia: a population-based study.

Objective: To validate the global features of postoperative adverse outcomes for surgical patients with schizophrenia. Background: Patients with schizophrenia were known to have a higher risk of complications during hospitalization. Quality of care has become the key factor in reducing their potential mortality afterwards. Methods: We present a population-based study of 8967 schizophrenic patients receiving major surgery from the Taiwan National Health Insurance Research Database within the years 2004 and 2007 compared with 35,868 surgical patients without mental disorders. Eight major postoperative complications and mortality after complications were evaluated among schizophrenic patients with different severity. Results: Schizophrenic patients had significantly higher risk for postoperative complications, including acute renal failure, pneumonia, bleeding, septicemia, stroke, and 30-day postoperative mortality (adjusted OR = 2.70; 95% CI: 2.08–3.49), than surgical patients without mental disorders. Among surgical patients with 1 to 2, 3 to 18, 19 to 48, and more than 49 schizophrenia-related outpatient visits within 24-month period preoperatively, the adjusted ORs of 30-day mortality ranged from 1.95 (95% CI: 1.25–3.02) to 3.97 (95% CI: 2.66–5.92) in a frequency-dependent pattern when compared with controls. When compared with surgical patients with schizophrenia-related outpatient services only, OR of 30-day postoperative mortality increased from 2.54 (95% CI: 1.93–3.34) to 3.69 (95% CI: 2.25–6.03) in surgical patients with preoperative hospitalization or emergency visit because of schizophrenia. Conclusions: Surgical patients with schizophrenia showed significantly higher postoperative adverse outcome rates with risk of 30-day mortality nearly threefold when compared with patients without mental disorders. Our findings suggest the urgency revising the protocol of postoperative care for this specific population.

Increased risk of fracture and postfracture adverse events in patients with diabetes: two nationwide population-based retrospective cohort studies.

OBJECTIVE The relationship between diabetes and fracture is not completely understood. This study evaluated fracture risk and postfracture mortality in patients with diabetes. RESEARCH DESIGN AND METHODS We identified 32,471 adults newly diagnosed with diabetes in 2000–2003 using Taiwan’s National Health Insurance Research Database. A comparison cohort of 64,942 adults without diabetes was randomly selected from the same dataset, with frequency matched by age and sex. Fracture events in 2000–2008 were ascertained from medical claims. Adjusted hazard ratios (HRs) and 95% CIs of fracture associated with diabetes were calculated. A nested cohort study of 17,002 patients with fracture receiving repair surgeries between 2004 and 2010 calculated adjusted odds ratios (ORs) and 95% CIs of adverse events after fracture in patients with and without diabetes. RESULTS During 652,530 person-years of follow-up, there were 12,772 newly diagnosed fracture cases. The incidences of fracture for people with diabetes and without were 24.2 and 17.1 per 1,000 person-years, respectively (P < 0.0001). Compared with people without diabetes, the adjusted HR of fracture was 1.66 (95% CI 1.60–1.72) for people with diabetes. The ORs of postfracture deep wound infection, septicemia, and mortality associated with diabetes were 1.34 (95% CI 1.06–1.71), 1.42 (95% CI 1.23–1.64), and 1.27 (95% CI 1.02–1.60), respectively. CONCLUSIONS Diabetes was associated with fracture. Patients with diabetes had more adverse events and subsequent mortality after fracture. Prevention of fracture and postfracture adverse events is needed in this susceptible population.

Medical and non-medical correlates of carpal tunnel syndrome in a Taiwan cohort of one million

Background:  Carpal tunnel syndrome (CTS), with unclear etiology, is the most common entrapment neuropathy. Its occurrence is related to lots of medical and non‐medical conditions with uncertain causality. With a large population, we characterized selected demographical and clinical factors to add more information on CTS‐correlated factors and new insight into future CTS prevention.

Elevated Blood Pressure, Obesity, and Hyperlipidemia

OBJECTIVES To investigate the association of blood pressure elevation with body mass index (BMI) and total cholesterol levels in children who screened positive for proteinuria, glucosuria, and/or hamaturia. STUDY DESIGN From 1992 to 2000, a mass urine screening program was conducted annually for nearly 3,000,000 students aged 6 to 18 years. Of 99,350 students with positive results on urine tests, further examination found 17,548 students (17.7%) had blood pressure elevation. A case-control analysis was performed with randomly selected subjects with normal blood pressure who were frequency matched by sex and age. RESULTS The adjusted odds ratio for blood pressure elevation in obese students was 3.45 (95% CI, 3.20-3.72), compared with students of normal weight. The odds ratio for blood pressure elevation increased to 6.15 (95% CI, 4.12-9.18) for students with a total cholesterol level > or =250 mg/dL and obesity, compared with students with a total cholesterol level <200 mg/dL and normal weight. CONCLUSION This study found a high prevalence of elevated blood pressure in children with abnormal urinalysis results, with a strong association with BMI and total cholesterol level.

LOW BACK PAIN ASSOCIATED WITH SOCIODEMOGRAPHIC FACTORS, LIFESTYLE AND OSTEOPOROSIS: A POPULATION-BASED STUDY

OBJECTIVE To investigate the prevalence and factors associated with low back pain among adults in Taiwan. METHODS The National Health Interview Survey, a cross-sectional study, was conducted from October 2002 to March 2003 to gather data from 24,435 adults aged 20 years and older selected randomly from Taiwans general population. Participants with history of low back pain were assessed using a comprehensive questionnaire. Additional assessment of osteoporosis diagnosed by physician was also evaluated. RESULTS Among the 24,435 adults, 25.7% had reported low back pain within the past 3 months. Factors associated with low back pain included female gender (odds ratio (OR) = 1.67, 95% confidence interval (CI) = 1.43-1.95), low education (OR = 1.38, 95% CI = 1.23-1.55), and blue-collar work (OR = 1.16, 95% CI = 1.07-1.26). Patients with osteoporosis were more likely than those without osteoporosis to have low back pain (OR = 2.55, 95% CI = 2.33-2.78) or frequent low back pain (OR = 4.15, 95% CI = 3.66-4.70). The ORs of frequent low back pain in association with osteoporosis in men and women were 5.77 (95% CI = 4.66-7.15) and 3.49 (95% CI = 2.99-4.07), respectively. CONCLUSION Low back pain is prevalent among Taiwanese adults and is associated with osteoporosis.

Adverse outcomes after major surgery in patients with systemic lupus erythematosus: a nationwide population-based study

Objectives To investigate the postoperative adverse outcomes among surgical patients with preoperative systemic lupus erythematosus (SLE) in a nationwide population-based study. Methods We used Taiwans National Health Insurance Research Database to identify 4321 surgical inpatients with SLE and 17 284 sex- and age-matched controls receiving major surgery. Sociodemographic characteristics, preoperative comorbidities, postoperative 30-day in-hospital major complications and mortality were analysed among surgical patients with and without SLE. Results Surgical patients with SLE had a higher prevalence of preoperative coexisting medical conditions and postoperative major complications. The OR of 30-day postoperative mortality for surgical patients with SLE was 1.71 (95% CI 1.09 to 2.67) after adjustment. Surgical patients who had received more recent (within 6 months) preoperative SLE-related inpatient care had higher risks of 30-day postoperative acute renal failure (OR=7.23, 95% CI 4.52 to 11.6), pneumonia (OR=2.60, 95% CI 1.82 to 3.72), pulmonary embolism (OR=4.86, 95% CI 1.20 to 19.7), septicaemia (OR=3.43, 95% CI 2.48 to 4.74), stroke (OR=2.01, 95% CI 1.38 to 2.92), overall complications (OR=2.30, 95% CI 1.89 to 2.80) and 30-day postoperative mortality (OR=2.39, 95% CI 1.28 to 4.45) than surgical patients without SLE. SLE-related preoperative steroid injections showed a dose-dependent relationship with postoperative complications and mortality. Conclusions SLE significantly increased the risks of surgical patients for overall major complications and mortality after major surgery. Our findings demonstrated the need for integrated care and revised protocols for perioperative management to improve outcomes for surgical patients with SLE.

Postoperative adverse outcomes after non-hepatic surgery in patients with liver cirrhosis.

Postoperative adverse outcomes in patients with liver cirrhosis are not completely understood. This study evaluated the association between liver cirrhosis and adverse outcomes after non‐hepatic surgery.

Increased risk of acute myocardial infarction and mortality in patients with systemic lupus erythematosus: Two nationwide retrospective cohort studies

BACKGROUND This study evaluated the risk of acute myocardial infarction (AMI) and mortality among patients with systemic lupus erythematosus (SLE) in two nationwide retrospective cohort studies. METHODS Using Taiwans National Health Insurance Research Database, we conducted a retrospective cohort study and identified 1207 adults newly diagnosed with SLE in 2000-2004. Non-SLE cohort consisted of 9656 adults without SLE, frequency-matched for age and sex and randomly selected from the same data set. Events of AMI were considered as outcome during the follow-up period between 2000 and 2008. Another nested cohort study of 6900 patients with AMI receiving cardiac surgeries was conducted to analyze the impact of SLE on post-AMI mortality. RESULTS During the follow-up period, there were 52 newly diagnosed AMI cases. The incidences of AMI for SLE cohort and non-SLE cohort were 2.10 and 0.49 per 1000 person-years, respectively, with an adjusted hazard ratio (HR) of 5.11 (95% confidence interval [CI] 2.63-9.92). For females, the adjusted HR of AMI associated with SLE was as high as 6.28 (95% CI 2.67-14.7). Further analyses in the nested cohort showed that SLE was significantly associated with post-AMI mortality (odds ratio, 2.60; 95% CI 1.09-6.19). CONCLUSION Patients with SLE had higher risk of AMI compared with non-SLE control, and this risk was more significant in females. In addition, SLE is an independent risk factor for post-AMI mortality.

Waist circumference and risk of elevated blood pressure in children: a cross-sectional study

BackgroundIncreasing childhood obesity has become a major health threat. This cross-sectional study reports associations between schoolchildrens waist circumference (WC) and risk of elevated blood pressure.MethodsWe measured height, weight, neck and waist circumference, and blood pressure in regular health examinations among children in grade 1 (ages 6-7 years) at six elementary schools in Taipei County, Taiwan. Elevated blood pressure was defined in children found to have mean systolic or diastolic blood pressure greater than or equal to the gender-, age-, and height-percentile-specific 95th-percentile blood pressure value.ResultsAll 2,334 schoolchildren were examined (response rate was 100% in the six schools). The mean of systolic and diastolic blood pressure increased as WC quartiles increased (p < 0.0001). The prevalence of elevated blood pressure for boys and girls within the fourth quartile of waist circumference was 38.9% and 26.8%, respectively. In the multivariate logistic regression analyses, the adjusted odds ratios of elevated blood pressure were 1.78 (95% confidence interval [CI] = 1.13-2.80), 2.45 (95% CI = 1.56-3.85), and 6.03 (95% CI = 3.59-10.1) for children in the second, third, and fourth waist circumference quartiles compared with the first quartile. The odds ratios for per-unit increase and per increase of standard deviation associated with elevated blood pressure were 1.14 (95% CI = 1.10-1.18) and 2.22 (95% CI = 1.76-2.78), respectively.ConclusionsElevated blood pressure in children was associated with waist circumference. Not only is waist circumference easier to measure than blood pressure, but it also provides important information on metabolic risk. Further research is needed on effective interventions to identify and monitor children with increased waist circumference to reduce metabolic and blood pressure risks.