Herng Ching Lin

Comorbidity profiles among patients with ankylosing spondylitis: a nationwide population-based study

Objective Ankylosing spondylitis (AS) is a systemic inflammatory disease that can result in chronic pain and disability. This study aimed to analyse the prevalence and risk of medical comorbidities in patients with AS compared with the general population. Methods 11 701 patients with AS and 58 505 matching controls were selected for analysis from the National Health Insurance Research Dataset (NHIRD) in Taiwan. The Elixhauser comorbidity index was used for selecting medical comorbidities. Pearson χ2 tests and conditional logistic regression a nalyses were performed to examine the prevalence and risk of comorbidities between these two groups. Results Patients with AS were at increased risk for multiple systemic comorbidities including cardiovascular, neurological, pulmonary, gastrointestinal, endocrine, haematological and mental illness. The most prevalent comorbidities in patients with AS were hypertension (16.4%), peptic ulcers (13.9%) and headaches (10.2%). Conclusion The results show that patients with AS have a higher prevalence of multiple comorbidities than the general population in Taiwan. These findings are consistent with previous studies done in Western populations. The results could be useful for both the clinical management of patients with AS and for researching the underlying pathological mechanisms.

Increased Risk of Stroke After a Herpes Zoster Attack A Population-Based Follow-Up Study

Background and Purpose— Varicella zoster virus-induced vasculopathy and postherpes zoster attack stroke syndromes have been reported previously; nevertheless, data regarding the exact prevalence and risk of stroke occurring postherpes zoster attack are still lacking. This study aims to investigate the frequency and risk of stroke after a herpes zoster attack using a nationwide, population-based study of a retrospective cohort design. Method— A total of 7760 patients who had received treatment for herpes zoster between 1997 and 2001 were included and matched with 23 280 randomly selected subjects. A 1-year stroke-free survival rate was then estimated using the Kaplan-Meier method. After adjusting for potential confounders, Cox proportional hazard regressions were carried out to compute the adjusted 1-year survival rate. Results— Of the sampled patients, 439 patients (1.41%) developed strokes within the 1-year follow-up period, that is, 133 individuals (1.71% of the patients with herpes zoster) from the study cohort and 306 individuals (1.31% of patients in the comparison cohort) from the comparison cohort. The log rank test indicated that patients with herpes zoster had significantly lower 1-year stroke-free survival rates than the control (P<0.001). The adjusted hazard ratios of stroke after herpes zoster and herpes zoster ophthalmicus during the 1-year follow-up period were 1.31 and 4.28, respectively. Conclusion— The risk for stroke increased after a zoster attack. Although varicella zoster virus vasculopathy is a well-documented complication that may induce a stroke postherpes zoster attack, it does not fully account for the unexpectedly high risk of stroke in these patients.

Medical comorbidity associated with psoriasis in adults: A population-based study

Background  Most publications to date on comorbidities associated with psoriasis have focused on cardiovascular and metabolic diseases. Few comprehensive investigations of medical comorbidities in a cohort of patients with psoriasis appear in the literature.

Increased risk of adverse pregnancy outcomes in women with rheumatoid arthritis: a nationwide population-based study

Objective Using a 3-year nationwide population-based database (2001–3), this study aims to examine the relationship between rheumatoid arthritis (RA) and adverse pregnancy outcomes. Methods The study used the Taiwan National Health Insurance Research Dataset and birth certificate registry. In total, 1912 mothers with RA and 9560 matched comparison mothers were included. Separate conditional logistic regression analyses were carried out to explore the risk of low birthweight (LBW), preterm births, small for gestational age (SGA) infants, preeclampsia and delivery mode (vaginal vs caesarean section (CS)) for the study and comparison groups. Results Regression analyses showed that the adjusted odds of LBW, SGA infants, preeclampsia and CS for women with RA were 1.47 (95% CI 1.22 to 1.78), 1.20 (95% CI 1.05 to 1.38), 2.22 (95% CI 1.59 to 3.11) and 1.19 (95% CI 1.07 to 1.31) times, respectively, that of comparison mothers. Conclusion Women with RA had an increased risk of LBW, SGA babies, preeclampsia and CS compared with unaffected women.

Seasonality in Adult Asthma Admissions, Air Pollutant Levels, and Climate: A Population-based Study

Objective and Background. Most studies of asthma seasonal variations have not examined associations of environmental risk factors and climatic changes associated with seasonality in asthma hospitalizations. This study used population-based data to examine seasonality in asthma admissions and the associated seasonality in levels of air pollutants and climatic factors during a 4-year period in Taiwan. Methods. A total of 126,671 asthma hospitalizations in Taiwan during 1998–2001 operationalized as monthly admissions per 100,000 population and monthly mean levels of criterion air pollutants and meteorological factors were subjected to Auto-Regressive Integrated Moving Average to test for seasonality and association between asthma admission rates and the pollutant and climatic factor levels. Owing to significant differences in seasonality between pediatric and adult age groups, this study was limited to 99,591 adult asthma cases to examine the seasonality issue as related to the criterion air pollutants and climatic factors using Spearman rank correlations. Results. Seasonal trends showed a hospitalization peak in January through March and a sharp decline beginning in April to a trough in June for both sexes. Seasonal variations in adult asthma admissions were significantly positively correlated with levels of PM10, SO2, CO, NO2, and atmospheric pressure and negatively correlated with temperature and hours of sunshine. Conclusions. Adult asthma hospitalization propensity is highest in spring and is significantly correlated with air pollution and climate. Air quality control programs and early public warning systems on pollution and atmospheric factors are needed to enable predisposed individuals and their physicians to preempt attacks through primary and secondary preventive measures.

Affect of Seizures During Gestation on Pregnancy Outcomes in Women With Epilepsy

OBJECTIVE To assess whether seizures in women with epilepsy during pregnancy contribute to adverse pregnancy outcomes. DESIGN A retrospective cross-sectional study. SETTING Taiwan. Patients This study linked 2 nationwide population-based data sets: Taiwans birth certificate registry and the Taiwan National Health Insurance Research Data set. A total of 1016 women with epilepsy were selected who had single births from 2001 to 2003 and who had been diagnosed with epilepsy within 2 years prior to their index delivery, together with 8128 matched women without chronic disease as a comparison cohort. Women with epilepsy were further stratified into 2 groups for analysis: women who did and did not have seizures during pregnancy. MAIN OUTCOME MEASURES Low-birth-weight infants, preterm delivery, and infants who are small for gestational age (SGA). RESULTS Compared with women without epilepsy, epileptic seizures during pregnancy were independently associated with a 1.36-fold (95% confidence interval [CI], 1.01-1.88), 1.63-fold (95% CI, 1.21-2.19), and 1.37-fold (95% CI, 1.09-1.70) increased risk of low-birth-weight infants, preterm delivery, and SGA, respectively, after adjusting for family income and parental and infant characteristics. Further, the risk of SGA increased significantly (odds ratio, 1.34; 95% CI, 1.01-1.84) for women with seizures during pregnancy compared with women with epilepsy who did not have seizures during pregnancy. CONCLUSION We suggest preventing seizures during pregnancy as an essential step to reduce risk of adverse pregnancy outcomes.

Urbanization and stroke prevalence in Taiwan: analysis of a nationwide survey.

This study aims to explore the prevalence of strokes among individuals and the association with urbanization levels. A total sample of 9,794 individuals was obtained from a nationwide survey on Taiwan for subsequent analysis in this study. After adjusting for gender, age, other risk factors for stroke and individual socioeconomic status, a multivariate logistic regression model was employed to investigate the relationships existing between the prevalence of strokes and the level of urbanization. This study finds that those living in areas at the highest level of urbanization (level 1) had the highest prevalence of strokes (2.49%). With decreasing urbanization level, there was a general decline in stroke prevalence. After adjusting for other factors, the multivariate logistic regression analyses showed that compared to participants living in the highest urbanization level, the respective odds ratios of suffering a stroke for those living in areas at the lowest levels of urbanization (levels 7 and 8), were 0.43 and 0.30. We conclude that after adjusting for other stroke risk factors, the level of urbanization is an important contributory factor to the overall prevalence of strokes in Taiwan.

Institutional factors in cesarean delivery rates: policy and research implications.

OBJECTIVE: To examine the association of health care institutional characteristics with cesarean delivery. METHODS: Cross-sectional data from Taiwan’s National Health Insurance database was used, covering all 270,774 women admitted for singleton deliveries, in 2000. Bivariate and multiple logistic regression analyses were used. RESULTS: The overall cesarean rate was 32.3% of all deliveries. Obstetrics and gynecology clinics (with fewer than 10 beds) had a very high likelihood of cesarean delivery compared with all categories of hospitals (odds ratios 17–25), after adjusting for clinical complications and patient, physician, and institutional characteristics. The likelihood of cesarean delivery was similar across hospitals, regardless of level and ownership category. High cesarean propensity at clinics arose from higher cesarean rates in all complication categories, including “No complications.” The overall hospital cesarean rate, 31.2%, is also higher than that in other developed countries with universal health care coverage. CONCLUSION: Taiwan has very high cesarean rates, with a particularly high propensity for this procedure at clinics. The cesarean delivery profile in the various clinical complication categories suggests a significantly lower clinical threshold triggering cesarean delivery decisions in Taiwan, especially at obstetrics and gynecology clinics. Countries currently having or contemplating large expansions in health insurance coverage should document obstetric practice profiles before initiating coverage expansions. There is also a need for well designed research on the medical and life-satisfaction impacts of cesarean compared with vaginal delivery to enable an informed policy stand on this issue. LEVEL OF EVIDENCE: III

Hospital Volume and Inpatient Mortality After Cancer-Related Gastrointestinal Resections: The Experience of an Asian Country

BackgroundUsing 4-year nationwide population-based data for Taiwan, this study compared in-hospital surgical mortality rates with hospital volume for five cancer-related gastrointestinal resections.MethodsThe study sample was drawn from the Taiwan National Health Insurance Research Database. A total of 34,715 patients, each of whom had undergone a cancer-related colectomy, gastrectomy, esophagectomy, pancreatic resection, or liver lobectomy between 2000 and 2003, were selected as the study sample. The outcome measure was in-hospital mortality. The study sample was categorized into five patient groups for each procedure, and logistic regression analyses were performed for each procedure after adjustment for hospital and patient characteristics to assess the independent association between hospital volume and in-hospital mortality.ResultsThe adjusted odds ratios showed a steady decline in mortality rates for colectomy, gastrectomy, esophagectomy, and liver lobectomy with increasing hospital volume. The adjusted mortality odds for these four procedures in very-high-volume hospitals, relative to very-low-volume hospitals, ranged from .65 to .05. As regards pancreatic resection, after adjustment for patient, clinical, and hospital factors, no statistically significant association was discernible between hospital volume and the likelihood of mortality.ConclusionsAfter adjustment for hospital and physician characteristics, in four of the five procedures, patients treated at higher-volume hospitals had lower in-hospital mortality rates than those treated at lower-volume hospitals. Our findings confirm, for the most part, the hypothesis that better outcomes are associated with higher-volume hospitals.

Association between maternal age and the likelihood of a cesarean section: a population-based multivariate logistic regression analysis

Background.  A majority of studies examining the relationship between advancing maternal age and the likelihood of cesarean section (CS) use data from regional samples or from a limited number of medical institutions. This study uses population‐based data from Taiwan to explore the relationship between maternal age and the likelihood of a CS.