Hsiao-Yun Hu

Pulmonary tuberculosis increases the risk of lung cancer: a population-based cohort study.

The possible effect of pulmonary tuberculosis (TB) on subsequent lung cancer development has been suspected, but the evidence remains inconsistent. The purpose of this study was to perform a nationwide population‐based cohort study to investigate the risk of lung cancer after pulmonary TB infection.

Association of Body Mass Index with All-Cause and Cardiovascular Disease Mortality in the Elderly

Objectives To evaluate the associations of body mass index (BMI) with all-cause, cardiovascular disease (CVD), and expanded CVD mortality in the elderly. Design Observational cohort study. Setting Annual physical examination program for the elderly from 2006 to 2010. Participants We included 77,541 Taipei residents aged ≥65 years (39,365 men and 38,176 women). Measurements BMI was categorized as underweight (BMI<18.5), normal weight (18.5≤BMI<25), overweight (25≤BMI<30), grade 1 obesity (30≤BMI<35), or grade 2–3 obesity (BMI≥35). Mortality was ascertained by national death files. Results Underweight (hazard ratios [HRs] of all-cause, CVD, and expanded CVD mortality: 1.92, 1.74, and 1.77, respectively), grade 2–3 obesity (HRs: 1.59, 2.36, and 2.22, respectively), older age, male sex, smoking, and high fasting blood sugar were significant predictors of mortality. Meanwhile, being married/cohabitating, higher education, alcohol consumption, more regular exercise, and high total cholesterol were inversely associated with mortality. Multivariate stratified subgroup analyses verified smokers (HRs of all-cause, CVD, and expanded CVD mortality: 3.25, 10.71, and 7.86, respectively, for grade 2–3 obesity), the high triglyceride group (HRs: 5.82, 10.99, and 14.22, respectively for underweight), and patients with 3–4 factors related to metabolic syndrome (HRs: 4.86, 12.72, and 11.42, respectively, for underweight) were associated with mortality. Conclusion The associations of BMI with all-cause, CVD, expanded CVD mortality in the elderly are represented by U-shaped curves, suggesting unilateral promotions or interventions in weight reduction in the elderly may be inappropriate. Heterogeneous effects of grades 1 and 2–3 obesity on mortality were observed and should be treated as different levels of obesity.

Dental Prophylaxis and Periodontal Treatment Are Protective Factors to Ischemic Stroke

Background and Purpose— A correlation has been found between periodontal disease (PD) and stroke. This study was conducted to investigate whether dental prophylaxis and periodontal treatment reduce the incidence rate (IR) of ischemic stroke. Methods— We identified 510 762 PD cases and 208 674 non-PD subjects from January 1, 2000, to December 31, 2010. The PD cases were divided into dental prophylaxis, intensive treatment, and no treatment groups. The stroke IRs were assessed among groups during follow-up. Cox regression analysis was used after adjustment for age, sex, and comorbidities to determine the relationship between periodontal treatment and incidence of ischemic stroke. Results— The stroke IR of the non-PD subjects was 0.32%/year. In the PD group, subjects who received dental prophylaxis had the lowest stroke IR (0.14%/year); subjects with intensive treatment or tooth extraction had a higher stroke IR (0.39%/year); and subjects without PD treatment had the highest stroke IR (0.48%/year; P<0.001). After adjustment for confounders, the dental prophylaxis and intensive treatment groups had a significant lower hazard ratios for stroke than the non-PD group (hazard ratio=0.78 and 0.95; 95% confidence interval=0.75–0.81 and 0.91–0.99, respectively), whereas the PD without treatment group had a significant higher hazard ratio for stroke (1.15; 95% confidence interval=1.07–1.24), especially among the youngest (20–44) age group (hazard ratio=2.17; 95% confidence interval=1.64–2.87) after stratifying for age. Conclusions— Maintaining periodontal health by receiving dental prophylaxis and PD treatment can help reduce the incidence of ischemic stroke.

Cognitive impairment assessed at annual geriatric health examinations predicts mortality among the elderly

OBJECTIVE To determine whether cognitive impairment assessed at annual geriatric health examinations is associated with increased mortality in the elderly. METHOD This cohort study was based on data obtained from the government-sponsored Annual Geriatric Health Examination Program for the elderly in Taipei City between 2006 and 2010. The study sample consisted of 77,541 community-dwelling Taipei citizens aged 65 years or older. The Short Portable Mental Status Questionnaire (SPMSQ) was selected to measure cognitive impairment. Mortality was ascertained by matching cohort IDs with national death files. RESULTS There was a dose-response relationship between cognitive impairment and mortality (increased one score of SPMSQ, Hazard ratio [HR]: 1.12, 95% confidence interval [CI]: 1.10-1.14). Relative to no cognitive impairment, the HRs were 1.67 (95% CI: 1.43-1.94), 2.26 (95% CI: 1.90-2.70), and 2.68 (95% CI: 2.25-3.19) for mild, moderate, and severe cognitive impairments, respectively. The causes of death associated with cognitive impairment were circulatory, respiratory, and other causes, but not death from cancer. CONCLUSION Cognitive impairment as measured by the SPMSQ is associated with an increased risk for mortality. Even mild cognitive impairment was associated with greater risk of mortality at a relatively short follow-up time.

The association of physical activity with all-cause, cardiovascular, and cancer mortalities among older adults.

OBJECTIVE To evaluate the association of physical activity with all-cause, cardiovascular, and cancer mortalities among older adults. METHODS A study sample consisting of 77,541 community-dwelling Taipei citizens aged ≥ 65 years was selected based on data obtained from the government-sponsored Annual Geriatric Health Examination Program between 2006 and 2010. Subjects were asked how many times they had physical activity for ≥ 30 min during the past 6 months. Mortality was determined by matching cohort identifications with national death files. RESULTS Compared to subjects with no physical activity, those who had 1-2 times of physical activity per week had a decreased risk of all-cause mortality [hazard ratio (HR): 0.77; 95% confidence interval (CI): 0.71-0.85). Subjects with 3-5 times of physical activity per week had a further decreased risk of all-cause mortality (HR: 0.64; 95% CI: 0.58-0.70). An inverse dose-response relationship was observed between physical activity and all-cause, cardiovascular, and cancer mortality. According to stratified analyses, physical activity was associated with a decreased risk of mortality in most subgroups. CONCLUSIONS Physical activity had an inverse association with all-cause, cardiovascular, and cancer mortality among older adults. Furthermore, most elderly people can benefit from an active lifestyle.

Increased risk of tuberculosis in patients with end-stage renal disease: a population-based cohort study in Taiwan, a country of high incidence of end-stage renal disease

This nationwide population-based cohort study investigated the risk of tuberculosis (TB) in patients with end-stage renal disease (ESRD) and receiving dialysis. The evaluations included 4131 incident ESRD patients receiving dialysis and 16,524 age- and gender-matched controls, recruited between 1998 and 2009. We used Cox proportional hazards regression analysis to measure the association between TB and ESRD. Compared to the controls, the ESRD cohort had a significantly higher risk of TB within 1 year [incident rate ratio (IRR) 4.13], and 1-2 years (IRR 2.12), of occurrence of ESRD. The Cox proportional hazards model revealed that ESRD [hazard ratio (HR) 2.40], age >65 years (HR 2.41), male sex (HR 1.94), diabetes mellitus (HR 1.36), silicosis (HR 7.70) and chronic obstructive pulmonary disease (HR 1.61) are independent risk factors for TB. Patients with ESRD are associated with an increased risk of TB, and should thus be monitored more carefully for TB, especially within 2 years of onset of ESRD.

Determinants of Long-Term Care Services among the Elderly: A Population-Based Study in Taiwan

Objectives The aim of the study was to investigate determinants of long-term care use and to clarify the differing characteristics of home/community-based and institution-based services users. Design Cross-sectional, population-based study. Setting Utilizing data from the 2005 National Health Interview Survey conducted in Taiwan. Participants A national sample of 2,608 people (1,312 men, 1,296 women) aged 65 and older. Measurements The utilization of long-term care services (both home/community- and institution-based services) was measured. A χ2 analysis tested differences in baseline characteristics between home/community-based and institution-based long-term care users. The multiple-logistic model was adopted with a hierarchical approach adding the Andersen model’s predisposing, enabling, and need factors sequentially. Multiple logistic models further stratified data by gender and age. Results Compared with users of home/community-based care, those using institution-based care had less education (p = 0.019), greater likelihood of being single (p = 0.001), fewer family members (p = 0.002), higher prevalence of stool incontinence (p = 0.011) and dementia (P = .025), and greater disability (p = 0.016). After adjustment, age (compared with 65–69 years; 75–79 years, odds ratio [OR] = 2.08, p = 0.044; age ≥80, OR = 3.30, p = 0.002), being single (OR = 2.16, p = 0.006), urban living (OR = 1.68, p = 0.037), stroke (OR = 2.08, p = 0.015), dementia (OR = 2.32, p = 0.007), 1–3 items of activities of daily living (ADL) disability (OR = 5.56, p<0.001), and 4–6 items of ADL disability (OR = 21.57, p<0.001) were significantly associated with long-term care use. Conclusion Age, single marital status, stroke, dementia, and ADL disability are predictive factors for long-term care use. The utilization was directly proportional to the level of disability.

Association of pulmonary tuberculosis and ethambutol with incident depressive disorder: a nationwide, population-based cohort study.

BACKGROUND Inflammatory responses from chronic infection might affect the brain and increase the risk of depressive disorder. However, the temporal association between chronic infection (eg, tuberculosis [TB]) and incident depressive disorder has not been prospectively evaluated. OBJECTIVE To determine the association of pulmonary tuberculosis (PTB) and anti-TB drugs with incident depressive disorder (ICD-9-CM codes 296.2x-296.3x, 300.4, and 311.x). METHOD From January 1, 2000, we identified adult patients with PTB from the Taiwan National Health Insurance Research Database. A control cohort without PTB, matched for age (± 5 years), sex, comorbidities, and income level, was selected for comparison. The 2 cohorts were followed until December 31, 2011, and observed for occurrence of depressive disorder. RESULTS Of the 23,145 patients (4,629 study patients and 18,516 matched controls), 302 (1.3%) had depressive disorder during a mean follow-up period of 6.53 years, including 79 study patients (1.71%) and 223 controls (1.20%). After adjusting for age, sex, comorbidities, and income level in the Cox proportional hazards model, PTB was found to be an independent risk factor of incident depressive disorder (adjusted hazard ratio [HR], 1.74; 95% CI, 1.35-2.25). The risk of incident depressive disorder was significantly higher (adjusted HR, 2.54; 95% CI, 1.19-5.45) in patients with TB who received more than 60 defined daily doses (DDDs) of ethambutol, and the effect was dose-dependent. CONCLUSIONS PTB patients had a higher risk of incident depressive disorder, particular in those with an ethambutol dose of more than 60 DDDs. Depressive disorder should be sought in patients following tuberculosis.

Dipeptidyl Peptidase-4 Inhibitors and the Risk of Acute Pancreatitis in Patients With Type 2 Diabetes in Taiwan: A Population-Based Cohort Study.

AbstractTo investigate the effects of dipeptidyl peptidase-4 (DPP-4) inhibitors on the risk of acute pancreatitis in patients with type 2 diabetes.This nationwide population-based cohort study used the diabetes patients dataset of Taiwans National Health Research Insurance Research Database. Patients with newly diagnosed type 2 diabetes between January 1, 2008 and December 31, 2009 and no history of acute pancreatitis were selected. This cohort was followed from the index date to the onset of acute pancreatitis or December 31, 2011. The main outcome measure was the hazard ratio (HR) for acute pancreatitis associated with DPP-4 inhibitor use. Cox proportional-hazards regression analyses were adjusted for alcohol use, hypertriglyceridemia, cholelithiasis, neoplasm, and Diabetes Complications Severity Index (DCSI) score. Subgroup analyses stratified by age and sex were conducted.The study cohort comprised 114,141 patients. Significant interaction effects were observed between sex and age (HR 0.80, 95% confidence interval [CI] 0.64–0.99) and age and DCSI score (HR 0.83, 95% CI: 0.71–0.97). In subgroup analyses, significant risks of acute pancreatitis were noted in female and elderly DPP-4 inhibitor users. Among women, the risk of acute pancreatitis was significantly higher among DPP-4 inhibitor users than among nonusers (HR 2.27, 95% CI: 1.30–3.97). This risk was also significantly higher in users than in nonusers among patients aged >65 years (HR 2.39, 95% CI: 1.11–5.15).Female and elderly DPP-4 inhibitor users had significantly elevated risks of acute pancreatitis development. Further well-conducted studies are needed to confirm our findings.

Association Between Tooth Loss, Body Mass Index, and All-Cause Mortality Among Elderly Patients in Taiwan.

AbstractTo date, the effect of tooth loss on all-cause mortality among elderly patients with a different weight group has not been assessed. This retrospective cohort study evaluated the data obtained from a government-sponsored, annual physical examination program for elderly citizens residing in Taipei City during 2005 to 2007, and follow-up to December 31, 2010. We recruited 55,651 eligible citizens of Taipei City aged ≥65 years, including 29,572 men and 26,079 women, in our study. Their mortality data were ascertained based on the national death files. The number of missing teeth was used as a representative of oral health status. We used multivariate Cox proportional hazards regression analysis to determine the association between tooth loss and all-cause mortality. After adjustment for all confounders, the hazard ratios (HRs) of all-cause mortality in participants with no teeth, 1 to 9 teeth, and 10 to 19 teeth were 1.36 [95% confidence interval (CI): 1.15–1.61], 1.24 (95% CI: 1.08–1.42), and 1.19 (95% CI: 1.09–1.31), respectively, compared with participants with 20 or more teeth. A significant positive correlation of body mass index (BMI) with all-cause mortality was found in underweight and overweight elderly patients and was represented as a U-shaped curve. Subgroup analysis revealed a significant positive correlation in underweight (no teeth: HR = 1.49, 95% CI: 1.21–1.83; 1–9 teeth: HR = 1.23, 95% CI: 1.03–1.47; 10–19 teeth: HR = 1.20, 95% CI: 1.06–1.36) and overweight participants (no teeth: HR = 1.37, 95% CI: 1.05–1.79; 1–9 teeth: HR = 1.27, 95% CI: 1.07–1.52). The number of teeth lost is associated with an increased risk of all-cause mortality, particularly for participants with underweight and overweight.