Chien-Hua Chen

Irritable Bowel Syndrome Is Associated with an Increased Risk of Dementia: A Nationwide Population-Based Study.

Purpose Abnormal interaction in the brain–gut axis has emerged as one of the relevant pathophysiological mechanisms for the development of irritable bowel syndrome (IBS). Moreover, the brain–gut axis has recently been demonstrated to be crucial for the maintenance of cognitive performance. Therefore, we assessed the risk of dementia following diagnosis of IBS. Methods Using the Taiwan National Health Insurance Research Database (NHIRD) to obtain medical claims data from 2000 to 2011, we employed a random sampling method to enroll32 298 adult patients with IBS and frequency-matched them according to sex, age, and baseline year with 129 192 patients without IBS. Results The patients with IBS exhibited an increased risk of dementia [adjusted hazard ratio (aHR) = 1.26, 95% confidence interval (CI) = 1.17–1.35]after adjustment for age, sex, diabetes, hypertension, stroke, coronary artery disease (CAD), head injury, depression, and epilepsy, and the overall incidence of dementia for the cohorts with and without IBS was 4.86 and 3.41 per 1000 person-years, respectively. IBS was associated with an increased risk of dementia in patients older than 50 years in both male and female, and in those with comorbidity or without comorbidity. After adjustment for age, sex, and comorbidity, patients with IBS were also more likely to develop either non- Alzheimer’s disease (AD) dementia (aHR = 1.24, 95% CI = 1.15–1.33) or AD (aHR = 1.76, 95% CI = 1.28–2.43). Conclusions IBS is associated with an increased risk of dementia, and this effect is obvious only in patients who are ≥50 years old.

Association between gallbladder stone disease and prostate cancer: A nationwide population-based study

Objectives Chronic inflammation and abnormal cholesterol metabolism are involved in the pathogenesis of gallbladder stone disease (GSD) and that of prostate cancer in experimental studies. We assessed the association between GSD and prostate cancer in this population-based study. Results The cumulative incidence of prostate cancer (log-rank test: P <.001) and the risk of prostate cancer (1.64 vs 1.14 per 10 000 person-y, adjusted hazard ratio [aHR] = 1.30, 95% confidence interval [CI] = 1.22-1.39) were greater in the patients with GSD than in those without GSD. Furthermore, the risk of prostate cancer increased with the time of follow-up after a diagnosis of GSD, particularly after 9 years of follow-up (aHR = 1.95, 95% CI = 1.74-2.19). Materials and Methods We identified 9496 patients who were diagnosed with GSD between 1998 and 2011 from Taiwans Longitudinal Health Insurance Database 2000 as the study cohort. We randomly selected 37 983 controls from the non-GSD population and used frequency matching by age, sex, and index year for the control cohort. All patient cases were followed until the end of 2011 to measure the incidence of prostate cancer. Conclusion GSD is associated with an increased risk of prostate cancer, and the risk increases with the time of follow-up after a diagnosis of GSD.

Relation Between Hepatitis C Virus Exposure and Risk of Osteoporosis: A Nationwide Population-Based Study.

AbstractThe effect of hepatitis C virus (HCV) exposure on bone mineral density without advanced liver disease remains debated. Thus, we assessed the relation between HCV exposure and the risk of osteoporosis.From 2000 to 2011, patients aged >20 years with HCV exposure were identified from the Longitudinal Health Insurance Database 2000. Of the 51,535 sampled patients, 41,228 and 10,307 patients were categorized as the comparison and the HCV exposure cohorts, respectively.The overall incidence of osteoporosis in the HCV exposure cohort was higher than in the comparison cohort (8.27 vs 6.19 per 1000 person-years; crude hazard ratiou200a=u200a1.33, 95% confidence intervalu200a=u200a1.20–1.47). The incidence of osteoporosis, higher in women than in men, increased with age and comorbidity of hypertension, hyperlipidemia, and heart failure. The risk of developing osteoporosis was significantly higher in the HCV exposure cohort than in the comparison cohort after adjusting for age, sex, diabetes, hypertension, hyperlipidemia, heart failure, stroke, and cirrhosis. However, the risk of osteoporosis contributed by HCV decreased with age and the presence of comorbidity. Furthermore, the risk of osteoporotic fracture did not differ significantly between patients exposed to HCV and the comparison cohorts.HCV increases the risk of osteoporosis, but no detrimental effect on osteoporotic fracture was observed in this study. Furthermore, HCV may be less influential than other risk factors, such as hypertension, hyperlipidemia, and heart failure, in contributing to the development of osteoporosis.

Association Between Chronic Hepatitis B Virus Infection and Risk of Osteoporosis: A Nationwide Population-Based Study.

AbstractThe effect of hepatitis B virus (HBV) infection on bone mineral density in patients without advanced liver disease remains unclear. Hence, we assessed the association between HBV infection and the risk of osteoporosis.From 2000 to 2011, patients older than 20 years with HBV infection were identified from the Longitudinal Health Insurance Database 2000. Of the 180,730 sampled patients, 36,146 and 144,584 patients were categorized into HBV infection and comparison cohorts, respectively.Compared with the comparison cohort, the HBV infection patients had a higher risk of osteoporosis (adjusted hazard ratio [aHR]: 1.14, 95% confidence interval [CI]: 1.03–1.25) after adjusting for age, sex, frequency of medical visits, and comorbidities of diabetes, hypertension, hyperlipidemia, heart failure, cirrhosis, chronic kidney disease, thyroid diseases, medication of steroid, PPI, warfarin, aspirin, and estrogen replacement therapy. The patients with HBV infection exhibited a 1.13-fold (95% CIu200a=u200a1.03–1.25) higher risk of developing osteoporosis, but the risk of osteoporotic fracture was comparable between patients with HBV infection and the comparison cohort (aHRu200a=u200a1.20, 95% CIu200a=u200a0.77–1.86). The incidence of osteoporosis increased with the increment of age (ageu200a⩽u200a49: aHRu200a=u200a1; age 50–64: aHRu200a=u200a5.67, 95% CIu200a=u200a5.09–6.32; ageu200a≧u200a65: aHRu200a=u200a13.3, 95% CIu200a=u200a11.8–14.9) and coexisting cirrhosis (aHRu200a=u200a1.62, 95% CIu200a=u200a1.24–2.12). However, the osteoporosis risk contributed by HBV infection decreased with age and the age-specific risk analyses showed that patients with HBV infection exhibited the highest risk of osteoporosis than patients without HBV infection for the patients aged ⩽49 (aHRu200a=u200a1.42, 95% CIu200a=u200a1.19–1.70). Furthermore, the osteoporosis risk contributed by HBV infection has decreased with the presence of comorbidity (aHRu200a=u200a1.27, 95% CIu200a=u200a1.09–1.48 vs aHRu200a=u200a1.04, 95% CIu200a=u200a0.91–1.15).HBV increases the risk of osteoporosis, but HBV infection may be less influential than other risk factors. Moreover, HBV has no detrimental effect on osteoporotic fracture in this study.

Irritable Bowel Syndrome Increases the Risk of Epilepsy: A Population-Based Study.

AbstractAn abnormal interaction in the brain–gut axis is regarded as the cause of irritable bowel syndrome (IBS). We attempted to determine the association between IBS and subsequent development of epilepsy.A total of 32,122 patients diagnosed with IBS between 2000 and 2011 were identified from the Longitudinal Health Insurance Database as the study cohort, and 63,295 controls were randomly selected from the insurants without IBS and frequency-matched according to age, sex, and index year as the comparison cohort. Both cohorts were followed up until the end of 2011 to measure the incidence of epilepsy. We analyzed the risks of epilepsy using Cox proportional hazards regression models.The IBS patients had greater cumulative incidence of epilepsy than the cohort without IBS (log-rank test, Pu200a<u200a0.001 and 2.54 versus 1.86 per 1000 person-years). The IBS cohort had a higher risk of epilepsy after adjusting for age, sex, diabetes, hypertension, stroke, coronary artery disease, head injury, depression, systemic lupus erythematosus, brain tumor, and antidepressants usage (adjusted hazard ratio [aHR]: 1.30, 95% confidence interval [CI]: 1.17–1.45). Stratified by the presence of other risk factors, the relative risk was also greater for patients with (aHR: 1.25, 95% CI: 1.10–1.41) or without other risk factors (aHR: 1.68, 95% CI: 1.35–2.10) in the IBS cohort than for those in the non-IBS cohort. The age-specific relative risk of epilepsy in the IBS cohort was greater than that in the non-IBS cohort for both 35 to 49 age group and 50 to 64 age group (age ⩽ 34, aHR:1.31, 95% CI: 0.93–1.85; age 35–49, aHR: 1.43, 95% CI: 1.12–1.83; age 50–64, aHR: 1.56, 95% CI: 1.27–1.91). However, there was no difference between patients > 65 years with IBS and those without IBS (aHR: 1.11, 95% CI: 0.94–1.31).This population-based cohort study revealed that IBS increases the risk of developing epilepsy. However, IBS may be less influential than other risk factors. Further study is necessary to clarify whether IBS is a risk factor or an epiphenomenon for epilepsy development.

Association between gastroesophageal reflux disease and coronary heart disease: A nationwide population-based analysis.

AbstractIn this study, we aimed to determine the association between gastroesophageal reflux disease (GERD) and subsequent coronary heart disease (CHD) development, if any, and to evaluate whether longer use of proton pump inhibitors (PPIs) increases the risk of CHD.Patients diagnosed with GERD between 2000 and 2011 were identified as the study cohort (n = 12,960). Patients without GERD were randomly selected from the general population, frequency-matched with the study group according to age, sex, and index year, and evaluated as the comparison cohort (n = 51,840). Both cohorts were followed up until the end of 2011 to determine the incidence of CHD. The risk of CHD was evaluated in both groups by using Cox proportional hazards regression models.The GERD patients had a greater probability of CHD than the cohort without GERD did (log-rank test, Pu200a<u200a0.001 and 11.8 vs 6.5 per 1000 person-years). The GERD cohort had a higher risk of CHD than the comparison cohort did after adjustment for age, sex, hypertension, diabetes, hyperlipidemia, alcohol-related illness, stroke, chronic obstructive pulmonary disease, asthma, biliary stone, anxiety, depression, chronic kidney disease, and cirrhosis (adjusted hazard ratio [aHR]: 1.49, 95% confidence interval [CI]: 1.34–1.66). The risk of CHD was greater for the patients treated with PPIs for more than 1 year (aHR = 1.67, 95% CI = 1.34–2.08) than for those treated with PPIs for <1 year (aHR = 1.56, 95% CI = 1.39–1.74).Our population-based cohort study results indicate that GERD was associated with an increased risk of developing CHD, and that PPI use for more than 1 year might increase the risk of CHD.

Subtotal Gastrectomy With Billroth II Anastomosis Is Associated With a Low Risk of Ischemic Stroke in Peptic Ulcer Disease Patients: A Nationwide Population-Based Study.

AbstractDuodenal diversion can ameliorate lipid and glucose metabolism. We assessed the risk of stroke after subtotal gastrectomy with Billroth II anastomosis (SGBIIA) in peptic ulcer disease (PUD).We identified 6425 patients who received SGBIIA for PUD between 1998 and 2010 from the Taiwan National Health Insurance Research Database as the study cohort; we frequency-matched them with 25,602 randomly selected controls from the PUD population who did not receive SGBIIA according to age, sex, index year, and comorbidities including hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease (COPD), and obesity. All patients were followed until the end of 2011 to determine the incidence of stroke.The incidence of stroke was lower in patients in the SGBIIA cohort than in those in the non-SGBIIA cohort (18.9 vs 22.9 per 1000 person-years, adjusted hazard ratio [aHR] 0.80, 95% confidence interval [CI] 0.72–0.89, Pu200a<u200a0.001). The risk of ischemic stroke (aHR 0.77, 95% CI 0.69–0.86, Pu200a<u200a0.001), rather than hemorrhagic stroke (aHR 1.00, 95% CI 0.78–1.28), was lower for the SGBIIA cohort than for the non-SGBIIA cohort according to the multivariable Cox proportional hazard regression analysis. The relative risk of ischemic stroke after SGBIIA was lower in men (aHR 0.77, 95% CI 0.69–0.86) than in women (aHR 0.80, 95% CI 0.65–0.99) and in patients aged ≥65 years (aHR 0.72, 95% CI 0.63–0.81) than in those of other age groups (⩽49 years, aHR 0.82, 95% CI 0.48–1.39; 50–64 years, aHR 1.01, 95% CI 0.79–1.28). The relative risk of ischemic stroke after SGBIIA was also reduced in patients with comorbidities (aHR 0.84, 5% CI 0.75–0.95) rather than in those without comorbidities (aHR 0.81, 95% CI 0.59–1.12).SGBIIA is associated with a low risk of ischemic stroke for PUD patients, and its protective effect is prominent in men, patients aged ≥65 years, and those with comorbidities.

Association of Gallbladder Polyp and Stroke: A Nationwide, Population-Based Study

AbstractGallbladder polyp (GP) and stroke share several metabolic disorders as risk factors. We assessed the association between GP and subsequent stroke risk.From 2000 to 2011, patients with GP aged >20 years were identified from the Longitudinal Health Insurance Database 2000. Of the 15,975 examined patients, 12,780 and 3195 were categorized into the non-GP and GP cohorts, respectively. The relative risks of stroke were estimated using the Cox proportional hazard model after adjusting for age, sex, and comorbidities.The overall incidence of stroke was higher in the GP cohort than in the non-GP cohort (6.66 vs 5.20/1000 person-yr), with an incidence rate ratio (IRR) of 1.28 (95% confidence interval [CI]u200a=u200a1.15–1.42). The risk of stroke was 1.32-fold (95% CIu200a=u200a1.06–1.63) in patients with GP compared with patients without GP after adjusting for age, sex, income level, urbanization level, occupation and comorbidities of gallstone, alcohol-related illness, diabetes, hyperlipidemia, hypertension, obesity, COPD, coronary heart disease, and asthma. Furthermore, the stroke risk was higher among elderly patients (with 1-yr intervals; adjusted HR [aHR]u200a=u200a1.06, 95% CIu200a=u200a1.05–1.07), the male sex (aHRu200a=u200a1.62, 95% CIu200a=u200a1.35–1.96), lower income level (aHRu200a=u200a1.37, 95% CIu200a=u200a1.02–1.85 for level I; aHRu200a=u200a1.62, 95% CIu200a=u200a1.25–2.10 for level II), living in second urbanized areas (aHRu200a=u200a1.28, 95% CIu200a=u200a1.00–1.63), alcohol-related illness (aHRu200a=u200a1.56, 95% CIu200a=u200a1.07–2.28), diabetes (aHRu200a=u200a1.78, 95% CIu200a=u200a1.41–2.24), and hypertension (aHRu200a=u200a2.74, 95% CIu200a=u200a2.19–3.42).GP is associated with stroke; however, GP may be less influential than other risk factors are, such as male sex, lower income level, alcohol-related illness, diabetes, and hypertension, on stroke development. Additional studies are required to clarify whether GP is a risk factor for or an epiphenomenon of stroke development.

Risk of gallstones in patients with obstructive sleep apnea: a nationwide observational cohort study

PurposeTo assess the association between obstructive sleep apnea (OSA) and gallstones.MethodsWe identified 3827 patients aged ≥u200920xa0years with OSA between 2000 and 2010 from the Longitudinal Health Insurance Research Database 2000 (LHID2000) as the study cohort. The beneficiaries without OSA were randomly selected and propensity-matched with the study cohort in a 1:1 ratio according to age; sex; occupation; urbanization; comorbidities of hypothyroidism, hyperlipidemia, diabetes, liver cirrhosis, alcohol-related illness, hypertension, chronic obstructive pulmonary disease (COPD), obesity, inflammatory bowel disease, stroke, coronary artery disease (CAD), hepatitis B virus, and hepatitis C virus; and the index year. All patients were followed until the end of 2011 or withdrawal from the National Health Insurance program to determine the incidence of gallstones.ResultsThe prevalence of OSA was higher in men (67.3%) and in patients younger than 49xa0years (57.0%; mean age 47.8u2009±u200915.1xa0years). The cumulative incidence of gallstones was higher in the OSA cohort than in the non-OSA cohort (log-rank test, Pu2009<u20090.001). Compared with patients without OSA, those with OSA had an increased risk of gallstones (adjusted hazard ratiou2009=u20091.53, 95% confidence intervalu2009=u20091.16–2.03) after adjustment for age, sex, hyperlipidemia, diabetes, hypertension, COPD, stroke, and CAD.ConclusionThe study shows a strong association between OSA and gallstones. Moreover, our findings suggest the requirement for survey and health education for gallstones in OSA and further studies to verify whether the treatment of OSA can reduce the risk of gallstones.

Association between Inflammatory Bowel Disease and Cholelithiasis: A Nationwide Population-Based Cohort Study

We assessed the subsequent risk of cholelithiasis development in patients with inflammatory bowel diseases (IBDs) such as Crohn’s disease (CD) or ulcerative colitis (UC). We identified 8186 patients who aged ≥20 years and were diagnosed with IBD between 2000 and 2010 as the study cohort. A total of 8186 patients without IBD were selected by frequency-matching according to age, sex, comorbidities, and the index date of diagnosis, and they were identified as the control cohort. To measure the incidence of cholelithiasis, all patients were followed up until the end of 2011. The risk of developing cholelithiasis, either gallbladder stone disease (GSD; adjusted hazard ratio (aHR) = 1.76, 95% CI = 1.34–2.61) or common bile duct (CBD) stones and intrahepatic stones (IHSs; aHR = 2.78, 95% CI = 1.18–6.51), was higher for the CD cohort than for the non-IBD cohort after adjusting for age, sex, and comorbidities of hyperlipidemia, diabetes, liver cirrhosis, hypertension, chronic obstructive pulmonary disease, stroke, coronary artery disease, and hepatitis C virus infection. However, UC was related to the development of GSD (aHR = 1.44, 95% CI = 1.19–1.75) but not to CBD stones and IHSs (aHR = 1.70, 95% CI = 0.99–2.91). Our population-based cohort study demonstrated that CD is related to the development of cholelithiasis, including GSD alone and non-GSD-associated cholelithiasis. However, UC is only related to the development of GSD alone.