Chien Chin Hsu

Long-term Mortality Risk After Hyperglycemic Crisis Episodes in Geriatric Patients With Diabetes: A National Population-Based Cohort Study

OBJECTIVE Hyperglycemic crisis is one of the most serious diabetes-related complications. The increase in the prevalence of diabetes in the geriatric population leads to a large disease burden, but previous studies of geriatric hyperglycemic crisis were focused on acute hyperglycemic crisis episode (HCE). This study aimed to delineate the long-term mortality risk after HCE. RESEARCH DESIGN AND METHODS This retrospective national population-based cohort study reviewed, in Taiwan’s National Health Insurance Research Database, data from 13,551 geriatric patients with new-onset diabetes between 2000 and 2002, including 4,517 with HCE (case subjects) (ICD-9 code 250.1 or 250.2) and 9,034 without HCE (control subjects). The groups were compared and followed until 2011. RESULTS One thousand six hundred thirty-four (36.17%) case and 1,692 (18.73%) control subjects died (P < 0.0001) during follow-up. Incidence rate ratios (IRRs) of death were 2.82 times higher in case subjects (P < 0.0001). The mortality risk was highest in the first month (IRR 26.56; 95% CI 17.97–39.27) and remained higher until 4–6 years after the HCE (IRR 1.49; 95% CI 1.23–1.81). After adjustment for age, sex, selected comorbidities, and monthly income, the mortality hazard ratio was still 2.848 and 4.525 times higher in case subjects with one episode and two or more episodes of hyperglycemic crisis, respectively. Older age, male sex, renal disease, stroke, cancer, chronic obstructive pulmonary disease, and congestive heart failure were independent mortality predictors. CONCLUSIONS Patients with diabetes had a higher mortality risk after HCE during the first 6 years of follow-up. Referral for proper education, better access to medical care, effective communication with a health care provider, and control of comorbidities should be done immediately after HCE.

Subsequent mortality after hyperglycemic crisis episode in the non-elderly: a national population-based cohort study

AbstractnHyperglycemic crisis episodes (HCEs)—diabetic ketoacidosis and the hyperosmolar hyperglycemic state—are the most serious acute metabolic complications of diabetes. We aimed to investigate the subsequent mortality after HCE in the non-elderly diabetic which is still unclear. This retrospective national population-based cohort study reviewed, in Taiwan’s National Health Insurance Research Database, data from 23,079 non-elder patients (≤65xa0years) with new-onset diabetes between 2000 and 2002: 7693 patients with HCE and 15,386 patients without HCE (1:2). Both groups were compared, and follow-up prognoses were done until 2011. One thousand eighty-five (14.1xa0%) patients with HCE and 725 (4.71xa0%) patients without HCE died (Pxa0<xa00.0001) during follow-up. Incidence rate ratios (IRR) of mortality were 3.24 times higher in patients with HCE than in patients without HCE (Pxa0<xa00.0001). Individual analysis of diabetic ketoacidosis and hyperosmolar hyperglycemic state also showed the similar result with combination of both. After stratification by age, mortality was significant higher in the middle age (40–64xa0years) [IRR 3.29; 95xa0% confidence interval (CI) 2.98–3.64] and young adult (18–39xa0years) (IRR 3.91; 95xa0% CI 3.28–4.66), but not in the pediatric subgroup (<18xa0years) (IRR 1.28; 95xa0% CI 0.21–7.64). The mortality risk was highest in the first month (IRR 54.43; 95xa0% CI 27.98–105.89), and still high after 8xa0years (IRR 2.05; 95xa0% CI 1.55–2.71). After adjusting for age, gender, and selected comorbidities, the mortality hazard ratio for patients with HCE was still four times higher than for patients without HCE. Moreover, older age, male gender, stroke, cancer, chronic obstructive pulmonary disease, congestive heart failure, and liver disease were independent mortality predictors. HCE significantly increases the subsequent mortality risk in the non-elderly with diabetes. Strategies for prevention and control of comorbidities are needed as soon as possible.

Acute Anticholinesterase Pesticide Poisoning Caused a Long-term Mortality Increase: A Nationwide Population-based Cohort Study

Abstract Acute anticholinesterase pesticide (organophosphate and carbamate) poisoning (ACPP) often produces severe complications, and sometimes death. We investigated the long-term mortality of patients with ACPP because it is not sufficiently understood. In this retrospective nationwide population-based cohort study, 818 patients with ACPP and 16,360 healthy comparisons from 1999 to 2010 were selected from Taiwans National Health Insurance Research Database. They were followed until 2011. Ninety-four (11.5%) ACPP patients and 793 (4.9%) comparisons died (Pu200a<u200a0.01) during follow-up. The incidence rate ratios (IRRs) of death were 2.5 times higher in ACPP patients than in comparisons (Pu200a<u200a0.01). The risk of death was particularly high in the first month after ACPP (IRR: 92.7; 95% confidence interval [CI]: 45.0–191.0) and still high for ∼6 months (IRR: 3.8; 95% CI: 1.9–7.4). After adjusting for age, gender, selected comorbidities, geographic area, and monthly income, the hazard ratio of death for ACPP patients was still 2.4 times higher than for comparisons. Older age (≥35 years), male gender, diabetes mellitus, coronary artery disease, hypertension, stroke, mental disorder, and lower monthly income also predicted death. ACPP significantly increased long-term mortality. In addition to early follow-up after acute treatment, comorbidity control and socioeconomic assistance are needed for patients with ACPP.

Chronic osteomyelitis increases long-term mortality risk in the elderly: a nationwide population-based cohort study

BackgroundThe elderly are predisposed to chronic osteomyelitis because of the immunocompromised nature of aging and increasing number of chronic comorbidities. Chronic osteomyelitis may significantly affect the health of the elderly; however, its impact on long-term mortality remains unclear. We conceived this retrospective nationwide population-based cohort study to address this issue.MethodsWe identified 10,615 elderly patients (≥65xa0years) comprising 965 patients with chronic osteomyelitis and 9650 without chronic osteomyelitis matched at a ratio of 1:10 by age and gender between 1999 and 2010 from the Taiwan National Health Insurance Research Database. The risk of chronic osteomyelitis between the two cohorts was compared by a following-up until 2011.ResultsPatients with chronic osteomyelitis had a significantly higher mortality risk than those without chronic osteomyelitis [incidence rate ratio (IRR): 2.29; 95xa0% confidence interval (CI): 2.01–2.59], particularly the old elderly (≥85xa0years; IRR: 3.27; 95xa0% CI: 2.22–4.82) and males (IRR: 2.7; 95xa0% CI: 2.31–3.16). The highest mortality risk was observed in the first month (IRR: 5.01; 95xa0% CI: 2.02–12.42), and it remained persistently higher even after 6xa0years (IRR: 1.53; 95xa0% CI: 1.13–2.06) of follow-up. Cox proportional hazard regression analysis showed that chronic osteomyelitis [adjusted hazard ratio (AHR): 1.89; 95xa0% CI: 1.66–2.15], advanced age (≥85xa0years; AHR: 2.02; 95xa0% CI: 1.70–2.41), male (AHR: 1.34; 95xa0% CI: 1.22–1.48), and chronic comorbidities were independent predictors of mortality.ConclusionsThis study demonstrated that chronic osteomyelitis significantly increased the long-term mortality risk in the elderly. Therefore, strategies for prevention and treatment of chronic osteomyelitis and concomitant control of chronic comorbidities are very important for the management of the elderly, particularly for a future with an increasingly aged population worldwide.

Hypotension, bedridden, leukocytosis, thrombocytopenia and elevated serum creatinine predict mortality in geriatric patients with fever

The geriatric population (aged ≥65 years) accounts for 12–24% of all emergency department (ED) visits. Of them, 10% have a fever, 70–90% will be admitted and 7–10% of will die within a month. Therefore, mortality prediction and appropriate disposition after ED treatment are of great concern for geriatric patients with fever. We tried to identify independent mortality predictors of geriatric patients with fever, and combine these predictors to predict their mortality.

Urolithiasis risk: a comparison between healthcare providers and the general population

BackgroundHealthcare providers have many health-related risk factors that might contribute to urolithiasis: a heavy workload, a stressful workplace, and an unhealthy quality of life. However, the urolithiasis risk in healthcare providers is not clear.MethodsUsing Taiwan’s National Health Insurance Research Database, we identified 50,226 physicians, 20,677 pharmacists, 122,357 nurses, and 25,059 other healthcare providers as the study cohort and then randomly selected an identical number of patients who are not healthcare providers (general population) as the comparison cohort for this study. Conditional logistical regression analysis was used to compare the urolithiasis risk between healthcare providers and comparisons. Physician specialty subgroups were also analyzed.ResultsPhysicians had a lower urolithiasis risk than did the general population (adjusted odds ratio [AOR]: 0.682; 95xa0% confidence interval [CI]: 0.634–0.732) and other healthcare providers (AOR: 0.661; 95xa0% CI 0.588–0.742) after adjusting for hypertension, diabetes, hyperlipidemia, coronary artery disease, and residence location. For pharmacists, nurses, and other healthcare providers, the urolithiasis risk was not significantly different than that for general population. Subgroup analysis showed that surgeons and family medicine physicians had a lower urolithiasis risk than did physician comparisons (AOR: 0.778; 95xa0% CI: 0.630–0.962 and AOR: 0.737; 95xa0% CI: 0.564–0.962, respectively).ConclusionsAlthough job stress and heavy workloads affect physicians’ health, physicians had a lower urolithiasis risk than did the general population and other healthcare providers. This might be attributable to their greater medical knowledge and access to healthcare. Our findings provide useful information for public health policy makers about the disease risks of healthcare providers.

Peptic Ulcer Disease in Healthcare Workers: A Nationwide Population-Based Cohort Study

Health care workers (HCWs) in Taiwan have heavy, stressful workloads, are on-call, and have rotating nightshifts, all of which might contribute to peptic ulcer disease (PUD). We wanted to evaluate the PUD risk in HCWs, which is not clear. Using Taiwan’s National Health Insurance Research Database, we identified 50,226 physicians, 122,357 nurses, 20,677 pharmacists, and 25,059 other HCWs (dieticians, technicians, rehabilitation therapists, and social workers) as the study cohort, and randomly selected an identical number of non-HCW patients (i.e., general population) as the comparison cohort. Conditional logistical regression analysis was used to compare the PUD risk between them. Subgroup analysis for physician specialties was also done. Nurses and other HCWs had a significantly higher PUD risk than did the general population (odds ratio [OR]: 1.477; 95% confidence interval [CI]: 1.433–1.521 and OR: 1.328; 95% CI: 1.245–1.418, respectively); pharmacists had a lower risk (OR: 0.884; 95% CI: 0.828–0.945); physicians had a nonsignificantly different risk (OR: 1.029; 95% CI: 0.987–1.072). In the physician specialty subgroup analysis, internal medicine, surgery, Ob/Gyn, and family medicine specialists had a higher PUD risk than other physicians (OR: 1.579; 95% CI: 1.441–1.731, OR: 1.734; 95% CI: 1.565–1.922, OR: 1.336; 95% CI: 1.151–1.550, and OR: 1.615; 95% CI: 1.425–1.831, respectively). In contrast, emergency physicians had a lower risk (OR: 0.544; 95% CI: 0.359–0.822). Heavy workloads, long working hours, workplace stress, rotating nightshifts, and coping skills may explain our epidemiological findings of higher risks for PUD in some HCWs, which might help us improve our health policies for HCWs.

Dengue fever mortality score: A novel decision rule to predict death from dengue fever

OBJECTIVESnDengue fever (DF) is still a major challenge for public health, especially during massive outbreaks. We developed a novel prediction score to help decision making, which has not been performed till date.nnnMETHODSnWe conducted a retrospective case-control study to recruit all the DF patients who visited a medical center during the 2015 DF outbreak. Demographic data, vital signs, symptoms/signs, chronic comorbidities, laboratory data, and 30-day mortality rates were included in the study. Univariate analysis and multivariate logistic regression analysis were used to identify the independent mortality predictors, which further formed the components of a DF mortality (DFM) score. Bootstrapping method was used to validate the DFM score.nnnRESULTSnIn total, a sample of 2358 DF patients was included in this study, which also consisted of 34 deaths (1.44%). Five independent mortality predictors were identified: elderly age (≥65 years), hypotension (systolic blood pressure <90xa0mmHg), hemoptysis, diabetes mellitus, and chronic bedridden. After assigning each predictor a score of 1, we developed a DFM score (range: 0-5), which showed that the mortality risk ratios for scores 0, 1, 2, and ≥3 were 0.2%, 2.3%, 6.0%, and 45.5%, respectively. The area under the curve was 0.849 (95% confidence interval [CI]: 0.785-0.914), and Hosmer-Lemeshow goodness-of-fit was 0.642. Compared with score 0, the odds ratios for mortality were 12.73 (95% CI: 3.58-45.30) for score 1, 34.21 (95% CI: 9.75-119.99) for score 2, and 443.89 (95% CI: 86.06-2289.60) for score ≥3, with significant differences (all p values <0.001). The score ≥1 had a sensitivity of 91.2% for mortality and score ≥3 had a specificity of 99.7% for mortality.nnnCONCLUSIONSnDFM score was a simple and easy method to help decision making, especially in the massive outbreak. Further studies in other hospitals or nations are warranted to validate this score.

Cancer Incidence in Physicians: A Taiwan National Population-based Cohort Study.

AbstractCancer has been the leading cause of death in Taiwan since 1982. Physicians have many health-related risk factors which may contribute to cancer, such as rotating night shift, radiation, poor lifestyle, and higher exposure risk to infection and potential carcinogenic drugs. However, the cancer risk in physicians is not clear. In Taiwans National Health Insurance Research Database, we identified 14,889 physicians as the study cohort and randomly selected 29,778 nonmedical staff patients as the comparison cohort for this national population-based cohort study. Cox proportional-hazard regression was used to compare the cancer risk between physicians and comparisons. Physician subgroups were also analyzed. Physicians had a lower all-cancer risk than did the comparisons (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.76–0.97). In the sex-based analysis, male physicians had a lower all-cancer risk than did male comparisons (HR 0.82, 95% CI 0.73–0.94); and female physicians did not (HR 1.29, 95% CI 0.88–1.91). In the cancer-type analysis, male physicians had a higher risk of prostate cancer (HR 1.72, 95% CI 1.12–2.65) and female physicians had twice the risk of breast cancer (HR 2.00, 95% CI 1.11–3.62) than did comparisons. Cancer risk was not significantly associated with physician specialties. Physicians in Taiwan had a lower all-cancer risk but higher risks for prostate and breast cancer than did the general population. These new epidemiological findings require additional study to clarify possible mechanisms.

Higher migraine risk in healthcare professionals than in general population: a nationwide population-based cohort study in Taiwan

BackgroundHigh stress levels and shift work probably trigger migraine in healthcare professionals (HCPs). However, the migraine risk differences between HCPs and the general population is unknown.MethodsThis nationwide population-based cohort study used Taiwan’s National Health Insurance Research Database. Physicians (50,226), nurses (122,357), and other HCPs (pharmacists, technicians, dietitians, rehabilitation therapists, social workers, etc.) (45,736) were enrolled for the study cohort, and randomly selected non-HCPs (218,319) were enrolled for the comparison cohort. Conditional logistical regression analysis was used to compare the migraine risks. Comparisons between HCPs and between physician specialties were also done.ResultsPhysicians, nurses, and other HCPs had higher migraine risks than did the general population (adjusted odds ratio [AOR]: 1.672; 95xa0% confidence interval [CI]: 1.468–1.905, AOR: 1.621; 95xa0% CI: 1.532–1.714, and AOR: 1.254; 95xa0% CI: 1.124–1.399, respectively) after stroke, hypertension, epilepsy, anxiety, depression, and insomnia had been adjusted for. Nurses and physicians had higher migraine risks than did other HCPs (AOR: 1.303; 95xa0% CI: 1.206–1.408, and AOR: 1.193; 95xa0% CI: 1.069–1.332, respectively). Obstetricians and gynecologists had a lower migraine risk than did other physician specialists (AOR: 0.550; 95xa0% CI: 0.323–0.937).ConclusionHCPs in Taiwan had a higher migraine risk than did the general population. Heavy workloads, emotional stress, and rotating night shift sleep disturbances appear to be the most important risk factors. These findings should provide an important reference for promoting occupational health in HCPs in Taiwan.