Chung-Te Hsu

Clinical predictors of incident gallstone disease in a Chinese population in Taipei, Taiwan

BackgroundGallstone disease (GSD) is a common gastrointestinal disorder throughout the world. The authors explored the incidence of GSD in Taiwan and its condition-associated predictive factors.MethodsThe initial study cohort comprised 2386 healthy adult participants, who were voluntarily admitted to a teaching hospital for a physical check-up in 2002 in Taipei, Taiwan. After excluding 126 patients who exhibited prevalent GSD, 2260 non-GSD participants received annual follow-up screenings for GSD until 31 December, 2007. Of those, 1296 (57.3%) patients were re-examined to collect blood samples and conduct ultrasound sonography.ResultsAmong the 1296 participants who exhibited no GSD at the first screening, 23 patients developed GSD during 3640 person-years of follow-up. The incidence was 0.632% per year (95% CI: 0.292%–2.009%). After conducting a Cox regression, increased age (50–59 years versusu2009<u200940xa0years, RRu2009=u20092.16 [95% CI: 1.09–5.97], 60+ years versusu2009<u200940xa0years, RRu2009=u20093.81 [95% CI: 2.77–8.63]), high body mass index (≥27xa0kg/m2 versusu2009<u200924xa0kg/m2, RRu2009=u20091.64 [95% CI: 1.07–2.98]), high fasting plasma glucose levels (≥126xa0mg/dL versusu2009<u2009110xa0mg/dL, RRu2009=u20091.68, 95% CI: 1.10–3.87), and nonalcoholic fatty liver disease (yes versus no, RRu2009=u20091.44, 95% CI: 1.21–1.90) appeared to be significantly related to developing GSD.ConclusionIncreased age is a well-established risk factor for developing GSD. The current findings indicated that high body mass index, elevated fasting plasma glucose levels, and nonalcoholic fatty liver disease were also associated with GSD.

A population-based cohort study of symptomatic gallstone disease in diabetic patients

AIMnTo investigate the prevalence of gallstone disease (GSD) and to evaluate the risk of symptomatic GSD among diabetic patients.nnnMETHODSnThe study was conducted by analyzing the National Health Research Institutes (NHRI) dataset of ambulatory care patients, inpatient claims, and the updated registry of beneficiaries from 2000 to 2008. A total of 615,532 diabetic patients without a prior history of hospital treatment or ambulatory care visits for symptomatic GSD were identified in the year 2000. Age- and gender-matched control individuals free from both GSD and diabetes from 1997 to 1999 were randomly selected from the NHIR database (n = 614,871). The incidence densities of symptomatic GSD were estimated according to the subjects diabetic status. The distributions of age, gender, occupation, income, and residential area urbanization were compared between diabetic patients and control subjects using Cox proportion hazards models. Differences between the rates of selected comorbidities were also assessed in the two groups.nnnRESULTSnOverall, 60,734 diabetic patients and 48,116 control patients developed symptomatic GSD and underwent operations, resulting in cumulative operation rates of 9.87% and 7.83%, respectively. The age and gender distributions of both groups were similar, with a mean age of 60 years and a predominance of females. The diabetic group had a significantly higher prevalence of all comorbidities of interest. A higher incidence of symptomatic GSD was observed in females than in males in both groups. In the control group, females under the age of 64 had a significantly higher incidence of GSD than the corresponding males, but this difference was reduced with increasing age. The cumulative incidences of operations for symptomatic GSD in the diabetic and control groups were 13.06 and 9.52 cases per 1000 person-years, respectively. Diabetic men exhibited a higher incidence of operations for symptomatic GSD than did their counterparts in the control group (12.35 vs 8.75 cases per 1000 person-years).nnnCONCLUSIONnThe association of diabetes with increased symptomatic GSD may provide insight to the treatment or management of diabetes in clinical settings.

Cost-Benefit Analysis of Screening for Gallstone Disease among Chinese Population in Taiwan

Purpose: To explore whether it is worthwhile to launch a nroutine gallstone disease screening for cholecystectomy prevention namong Chinese population from different perspective in Taiwan. n Methods: The study cohort was conducted with a total of n2,386 healthy adults voluntarily admitted to a teaching hospital nfor a physical check-up in 2002 in Taiwan. Annual follow-up nscreenings of gallstone disease then were until 31 December, 2007. nThe cost-benefit analysis tool of screening for gallstone disease nis based on TreeAge software for medical decision analysis. A ndecision analysis using the Markov Decision Model was constructed nto compare different screening regimes for gallstone disease. n Results: In terms of benefit-cost ratio, the different nscreening programs for gallstone disease could save New Taiwan nDollars (NTD) from 19.61 to 63.41 in discounted costs for each ndollar incurred in different screening years from the societal nviewpoint for Taiwan and save NTD from 2.89 to 4.71 in different nscreening years from health care payers perspective. The average nestimate of willingness-to-pay to translate into benefit yields nNTD from 807.8 to 4,039 benefits per case due to gallstone disease nscreening in different screening years during 10-year follow-up. nThe net present value of the gallstone disease screening were NTD nfrom −133,736 to −217,689.2 in different screening years. n Conclusion: It is worthwhile to initial a routine ngallstone disease screening of Chinese population for ncholecystectomy prevention from the societal perspective but not nfrom consumer decision based on the willingness-to-pay nperspective.

The Clinical Investigation of Disparity of Utility Values Associated with Gallstone Disease: A Pilot Study

Purpose. The utility evaluation was an effective method to incorporate all of the contributing variables for multiple diseases into one outcome measure. A cross-sectional study was conducted to assess the utility values associated with varying states of gallstone disease among outpatient clinics participants at a teaching hospital in Taipei, Taiwan. Methods. The utility values were measured by using time trade-off method. A total of 120 outpatient clinics participants (30 subjects with no gallstone disease, 30 subjects with single stone, 30 subjects with multiple stones, and 30 subjects with cholecystectomy) evaluated utility values from January 1, 2006 to December 31, 2006. The diagnosis of gallstone disease was performed by a panel of specialists using ultrasound sonography. Results. The overall mean utility value was 0.89 ± 0.13 (95% CI: 0.87–0.91) indicating that study participants were willing to trade about 11% (95% CI: 9–13%) of their remaining life in return for being free of gallstone disease perpetually. The significant associated factors of utility values based on the multiple linear regression analysis were older age and different degrees of gallstone disease. Conclusion. Our results found that in addition to older age, multiple stones and cholecystectomy could influence utility values from the patients preference-based viewpoint.

The Correlation between Cholecystectomy and Seasonal Impact in Taiwan

Many diseases and illnesses are known to be induced by changes in season and have seasonal fluctuations, and are affected by meteorological factors. Cholecystectomy is a very common surgical procedure used to treat gallstone disease and related complications. This study aimed to examine possible impacts of the seasons on the incidence of cholecystectomy with respect to gender and age as well as whether meteorological variables showed an association with incidences of cholecystectomy. The study was retrospectively conducted using the nationwide population-based datasets of National Health Insurance System in Taiwan. Patients who had undergone cholecystectomy were identified according to the International Classification of Diseases version 9 codes and categorized in terms of age and gender. Autoregression integrated moving average (ARIMA) multivariate models were applied to investigate the association of cholecystectomy incidence rates, time and meteorological variables. A total of 192,833 patients who underwent cholecystectomy between 1996 and 2008 were identified for the analysis. A trend indicating an overall increase was observed for the incidence rate of cholecystectomy over the study period. There were more females who underwent cholecystectomy than males. The highest incidence was found to occur during the summer and the lowest during the winter correlating with the cyclic pattern of temperature in Taiwan. Overall, the cholecystectomy incidence rate increased steadily over the 13-year study period for all age groups. In conclusion, the incidence of cholecystectomy was found to be correlated with the seasons. Temperature is the most notable variable among the relevant meteorological factors. Culture may also play a role in these correlations.

An epidemiologic study of prevalence and associated factors of non-alcoholic fatty liver disease in the Taiwanese police service

Objectives To explore any gender-related differences in prevalence of and condition-associated factors related to non-alcoholic fatty liver disease (NAFLD) amongst police population in Taipei, Taiwan. Methods We studied a total of 1016 healthy adults with police work (972 males and 44 females) voluntarily admitted to physical check-up between January 2006 and December 2006. Blood samples and ultrasound-proved fatty liver sonography results were collected. Results The prevalence of NAFLD for this subpopulation was found to be 52.2%, the prevalence revealing a statistically significant decrease with increasing population age (p<0.001). Males exhibited a greater prevalence of NAFLD than did females (53.6% vs 20.5%, p<0.0001). Using multiple logistic regression analysis, in addition to male gender, an older age, higher BMI, higher ALT, presence of hyperuricaemia, hypercholesterolemia, and hypertriglyceridaemia were the significant factors associated with NAFLD. Gender-related differences as regards associated factors were also revealed. For males, hyperuricaemia (OR=1.35, 95% CI: 1.07 to 1.86), higher ALT (OR=2.31, 95% CI: 1.50 to 3.56), hypercholesterolemia (OR=1.33, 95% CI: 1.01 to 1.82), and hypertriglyceridaemia (OR=1.55, 95% CI: 1.01 to 2.37) were significantly related to NAFLD but these were not so for females. Conclusions Several gender-related differences were noted pertaining to the prevalence of and relationship between hyperuricaemia, higher ALT, hypercholesterolemia, and hypertriglyceridaemia and NAFLD in the present study.