Chung-Yu Chen

Areca Nut Chewing and Risk of Atrial Fibrillation in Taiwanese Men: A Nationwide Ecological Study

Background: Areca nut chewing is associated with the risk of obesity, metabolic syndrome, hypertension, and cardiovascular mortality. Although a few case reports or case series have suggested the link between areca nut chewing and cardiac arrhythmias, information about the relationship between areca nut chewing and atrial fibrillation (AF) is lacking. Thus, a nationwide ecological study was conducted to investigate this. Methods: Two national datasets, the nationwide population-based 2005 Taiwan National Health Insurance Research dataset (NHIRD) and the 2005 National Health Interview Survey (NHIS), were used for analyses. The clinical characteristics, inhabited area and medical histories for 375,360 eligible males were retrieved from the 2005 NHIRD. Health related behaviors including areca nut chewing, cigarette smoking, infrequent vegetable eating, and exercise habit were collected from the 2005 NHIS. The prevalence of AF and the areca nut chewing rate were evaluated by multivariate analysis. Results: Of the 375,360 males (mean age, 44 years old), 1,326 (0.35%) were diagnosed with AF. The higher areca nut chewing rate, the higher prevalence rate of AF in Taiwan (Spearman correlation coefficient r = 0.558, p = 0.007). After adjusting for other covariates, the current areca nut chewing rate was found to be independently associated with the prevalence of AF. The adjusted odd ratio for areca nut chewing was 1.02 (95% CI = 1.00-1.04) in risk of AF prevalence. Conclusions: Areca nut chewing is independently associated with the prevalence of AF in Taiwanese men. However, further exploration of the underlying mechanisms is necessary.

Effectiveness and safety of antiplatelet in stroke patients with end-stage renal disease undergoing dialysis

Background Antiplatelet therapy is known to decrease the risk of secondary ischemic stroke. However, the effectiveness and safety of antiplatelet therapy in patients with end-stage renal disease are uncertain, especially in dialysis. Aims and/or hypothesis We estimated the effectiveness and safety of antiplatelet drugs (aspirin and clopidogrel) for the prevention of recurrent ischemic stroke in end-stage renal disease patients undergoing dialysis during long-term follow-up after first-time ischemic stroke. Methods The cases were identified from the National Health Insurance Research Database. Antiplatelet therapy was administered for 11 years to patients experiencing a first ischemic stroke between 1998 and 2006. Primary outcomes, including death and readmission to hospital for stroke, and secondary outcomes, including death, stroke, and acute myocardial infarction or bleeding, were examined. Results In total, 1936 patients experienced a first ischemic stroke during the follow-up. In a time-dependent analysis, the hazard ratio for primary outcomes in patients treated with aspirin was 0·671 (P < 0·001) and that for clopidogrel was 0·933 (P = 0·497). At secondary outcomes, patients treated with aspirin, hazard ratio for readmission for stroke was 0·715 (P = 0·002) and that for bleeding was 0·885 (P = 0·291). Independent risk factors for mortality and readmission due to ischemic stroke included age, diabetes mellitus, and administration of proton pump inhibitors. Conclusions Antiplatelet therapy, especially aspirin, still offers safe and effective treatment for ischemic stroke prevention in patients with end-stage renal disease undergoing dialysis.

Epidemiology and disease burden of ischemic stroke in Taiwan.

Background: The incidence and prevalence of ischemic stroke (IS) are increasing in Asian countries. We conducted this retrospective database research to investigate epidemiology and disease burden of IS in Taiwan. Methods: We identified cases from the National Health Insurance Research Database during period from 2000 to 2005 to calculate prevalence and mortality. We analyzed the relationship between disease burden and gender in Taiwan during the period from 2000 to 2005 using Dismod II. Results: From study period, stroke mortality increased from 50 to 2300 per 100 000 among individuals aged 50–90 years, with a higher prevalence among females than males. The highest prevalence was observed among men aged 80–84 years, but prevalence among women was highest in patients aged >85 years. The burden of stroke during the period per 1000 population was estimated as follows: the sum of the years of life lost as a result of premature mortality of 55–80 years, years lost as a result of disability of 11–19 years, and disability-adjusted life years (DALYs) of 70–80 years. Most of the DALYs of stroke occurred among those aged 65–69 years. The DALY value was higher among women than among men before 2005; there was no clear trend in 2005. Conclusions: Stroke is a significant health concern in Taiwan. The associated disease burden was found to increase each year, especially among individuals aged 65–69 years. Overall, the DALY value increased from 2000 to 2005, which suggests that the associated disease burden will continue to increase over time.

Hormone replacement therapy and risk of atrial fibrillation in Taiwanese menopause women: A nationwide cohort study.

Hormone replacement therapy (HRT) is associated with risk of vascular disease. The association between atrial fibrillation (AF), vascular events, and different HRTs, including estradiol and conjugated equine estrogens (CEE), has been controversial in previous studies. Thus, we conducted a retrospective cohort study to investigate these associations. Female patients (>45 years old) first diagnosed with menopause were enrolled from National Health Insurance Research Dataset (1998–2008). Cox regression analysis estimated risk of new-onset AF, stroke, and major adverse cardiac events (MACE) after exposure to estradiol or CEE. Of 5489 females (mean age = 55 years) enrolled, 1815 treated with estradiol and 3674 treated with CEE. Incidence per 103 person-years of AF, stroke, and MACE in CEE vs estradiol patients was 2.23 vs. 0.92, 14.0 vs. 9.09, and 15.55 vs. 10.47. As compared with patients treated with estradiol, those treated with CEE had a significantly higher incidence of AF, stroke, and MACE. The adjusted hazard ratios for each category were 1.96, 1.30, and 1.26, respectively. The significant results remained similar, even after use of propensity-score-matched strategy. In conclusion, CEE was associated with a higher risk of AF, stroke, and MACE than estradiol in menopausal females. Further exploration of underlying mechanisms is necessary.

Effectiveness and safety of antiplatelet therapy in stroke recurrence prevention in patients with liver cirrhosis: a 2-year follow-up study

Data are limited on antiplatelet therapy for ischemic stroke prevention in liver cirrhosis patients.

Epidemiology, Clinical Features, and Prescribing Patterns of Aortic Aneurysm in Asian Population From 2005 to 2011.

AbstractAortic aneurysm (AA) is a leading cause of death in Asia and the world. The prevalence in Western countries is around 1.3% to 8%. However, it is still unclear about the incidence, prevalence, and mortality of AA in Asian population. The aim of this study is to investigate the epidemiology of AA for all subtypes in Taiwan, and describe the clinical features and prescribing patterns for AA population.A population-based study was conducted using information from National Health Insurance Research Database (NHIRD) in Taiwan. Patients who were diagnosed with AA and also received computed tomography (CT) were included in this study. Incidence, prevalence, and mortality were calculated in each year during 2005 to 2011. Prevalent comorbidities and prescribing patterns were both evaluated among study population.The average annual incidence of AA in Taiwan was 7.35 per 100,000 population, and the prevalence was 29.04 per 100,000 population. It showed an increased trend of incidence from 2005 to 2011, so as prevalence and mortality. The incidence was associated with age and sex difference. It was much higher in those older than 65 years, especially for male. Hypertension, coronary artery disease (CAD), and chronic obstructive pulmonary disease (COPD) were prevalent comorbidities. Eighty-eight percentages of patients were prescribed antihypertensive agents in acute phase, where 61.4% of calcium channel blocker (CCB) was the most one.Our study found that incidence of AA was lower in Taiwan than in other countries. Nevertheless, it showed an increased trend of AA disease for incidence, prevalence, and also mortality during 2005 to 2011.

Epidemiology and Medication Utilization Pattern of Aortic Dissection in Taiwan: A Population-Based Study.

AbstractAcute aortic dissection (AD) is a catastrophic condition associated with a high rate of mortality. However, current epidemiological information regarding AD remains sparse. The objective of the present study was to investigate the current epidemiological profile and medication utilization patterns associated with aortic dissection in Taiwan.In this population-based study, we identified cases of AD diagnosed during 2005 to 2012 in the complete Taiwan National Health Insurance (NHI) Research Database. Patients with AD were identified using the International Classification of Disease, Ninth Revision (ICD-9) code 441.0, and surgical interventions were defined using NHI procedure codes.A total of 9092 individuals with a mean age of 64.4 ± 15.1 years were identified. The cases were divided into 3 groups: Group A included 2340 patients (25.74%) treated surgically for type A AD; Group B included 1144 patients (12.58%) treated surgically for type B AD, and Group C included 5608 patients (61.68%) with any type of AD treated with medical therapy only. The average annual incidence of AD was 5.6 per 100,000 persons, and the average prevalence was 19.9 per 100,000 persons. Hypertension was the most common risk factor, followed by coronary artery disease and chronic obstructive pulmonary disease. Within 1 year of AD diagnosis, 92% of patients were taking antihypertensive medication. Calcium channel blockers were the most frequently prescribed antihypertensive medication for long-term observation in Taiwan.The annual trends revealed statistically significant increases in the numbers and percentages of prevalence, incidence, and mortality. Changes in patients’ drug utilization in patterns were observed after AD diagnosis. Our study provides a local profile that supports further in-depth analyses in AD-affected populations.

Epidemiology and Disease Burden of Ulcerative Colitis in Taiwan: A Nationwide Population-Based Study

OBJECTIVES A rising trend of incidence and prevalence of ulcerative colitis (UC) had been noticed in Asian countries. We conducted this study to investigate the epidemiology and medical burden of UC in Taiwan. METHODS In this 10-year retrospective database study, we identified cases of patients with UC during 1998 to 2008 from the Taiwan National Health Insurance Research Database. Patients who had a catastrophic illness certificate were included in epidemiology and medical burden calculation. RESULTS There were 1522 cases identified in our study period. The incidence increased twofold from 0.37 per 100,000 in 1998 to 0.78 per 100,000 in 2008. The incidence and prevalence had an increasing trend in our population. The cases onset age was 45.0 years on average. In our survey, most of the top 20 coexisting diseases were gastrointestinally relevant diseases, anemia (9.99%), and hypertension (7.69%). There were more than 70% patients using mesalamine, and the medical expenditure on mesalamine occupied the highest position in patients with UC. The average medical expenditure of patients with UC had a decreasing trend after 2001. CONCLUSIONS This study had the largest sample and the longest study period for the epidemiology and medical burden estimation of UC in Taiwan. The incidence rates and medicine use of patients with UC had a definite rising trend across the years in Taiwan. Patients with anemia or choric diseases were observed in our population. More surveillance of UC-related diseases and health care costs need to be conducted in the future.

Increasing risks of ischemic stroke in oral cancer patients treated with radiotherapy or chemotherapy: a nationwide cohort study

Background: Several studies have identified correlations between cancer and increased risks of ischemic stroke (IS), particularly following radiotherapy (RT) or chemotherapy (CT). However, data regarding relative risks of IS in oral cancer are limited. The aim of this study was to compare hazard ratios (HR) of IS among oral cancer patients treated with and without RT, CT, or both (CCRT). Methods: We analyzed data collected by the Taiwan National Health Insurance Research Database (NHIRD) from 1996 to 2009, which covered approximately 99.5% of the medical claims submitted nationally. A total of 21,853 patients diagnosed with oral cancer from 2000 to 2008 were included. The Cox proportional hazard model was used to estimate the HRs of IS among different treatment modalities and a matched cohort. Results: The overall risk of IS was1.24-fold greater in patients treated with RT/CT/CCRT than those treated with surgery alone and 1.08-fold greater for surgery with adjuvant therapy (radiotherapy or chemotherapy after surgery) after adjusting for confounding factors. The incidence of IS was 0.23-fold lower in matched control group than in the oral cancer cohort. In subgroup analysis, patients who received RT/CT/CCRT and aged <40 years old were at a 2.77-fold greater risk for IS than age-matched patients who underwent surgery alone, although this difference decreased with patient age. Conclusions: Oral cancer patients, particularly those aged <40 years, who underwent RT or CT are at increased risks for IS. Other significant risk factors for IS included Charlson comorbidity index (CCI) >1, hypertension, coronary artery disease, and atrial fibrillation.

Long-Term Outcome of Patients With Aortic Aneurysms Taking Low-Dose Aspirin: A Population-Based Cohort Study

Background Limited studies evaluated the association between low-dose aspirin use and abdominal aortic aneurysm (AAA), thoracoabdominal aortic aneurysm (TAAA), and thoracic aortic aneurysm (TAA) treatment. We conducted this study to investigative the association of low-dose aspirin in terms of preventing death and exacerbation of different aortic aneurysms. Methods This retrospective study identified aortic aneurysm cases between 1999 and 2006 from the National Health Insurance Research Database and used time-dependent methods to determine whether the use of low-dose aspirin reduced the risk of outcomes. Primary outcomes, including a composite outcome of death, aortic dissection, a rupture event, an unruptured event, or surgical repair, and secondary outcomes, the composite end point of death and readmission for aortic aneurysm events, were estimated separately. Results Two hundred eighty-seven cases were identified. The hazard ratio for the primary outcome in patients taking low-dose aspirin in AAA/TAAA patients at each 90-day interval based on the time-dependent analysis was 1.000 (95% confidence interval [CI], 0.994–1.005), and in TAA patients 1.010 (95% CI, 0.994–1.026) compared with those with no exposure. In terms of the secondary outcomes, the hazard ratio for all-cause mortality was 0.995 (95% CI, 0.988–1.003) for AAA/TAAA patients and 1.008 (95% CI, 0.991–1.026) for TAA patients. Conclusions From a national population database, we did not find an association between low-dose aspirin exposure and mortality or exacerbation in different aortic aneurysms by using time-dependent analysis. However, adjustments for aneurysms size and smoking status could not be made, which may limit the validity of the study.