Jiunn Horng Kang

Comorbidities amongst patients with multiple sclerosis: A population-based controlled study

Background:  Data regarding the wide spectrum of comorbidity amongst patients with multiple sclerosis (MS) are still scanty, especially in Asian populations. Our goal was to analyze comorbidity prevalences and risks amongst Chinese patients with MS, compared to matched controls.

Obstructive sleep apnea and the subsequent risk of depressive disorder: A population-based follow-up study

STUDY OBJECTIVES Empirical findings on the prospective link between obstructive sleep apnea (OSA) and subsequent depression are mixed. This nationwide, population-based study thus aimed at assessing the risk of depressive disorder within the first year following a diagnosis with OSA. Gender effects were further examined. DESIGN Cohort study. SETTING Taiwan. PATIENTS This study used data from the Longitudinal Health Insurance Database 2000. A total of 2,818 patients diagnosed with OSA between 2002 and 2008 were evaluated, and 14,090 matched non-OSA enrollees used as a comparison cohort. MEASUREMENTS AND RESULTS Each patient was followed for one year to identify subsequent depressive disorder. We found that during the one-year follow-up, the incidence of depressive disorder per thousand person-years was about twice as high among patients with OSA (18.10, 95% CI = 13.62-23.61) as those without OSA (8.23, 95% CI = 6.83-9.84). The Cox proportional hazards model revealed that patients with OSA were independently associated with a 2.18 times (95% CI = 1.55-3.08) increased risk of subsequent depressive disorder within a year, compared to those without OSA. As epidemiological studies have consistently documented an increased risk for depression in women, we hypothesized and confirmed higher risks of depressive disorder among female patients with OSA (2.72, 95% CI = 1.68-4.40) than their male counterparts (1.81, 95% CI = 1.09-3.01). CONCLUSION A prospective link between OSA and subsequent depressive disorder within one year was confirmed by the current study. The risk was particularly evident among women. Regular psychiatric screening among patients with OSA is suggested to prompt the timely detection of depression. COMMENTARY A commentary on this article appears in this issue on page 425.

Asian Dust Storm Events are Associated With an Acute Increase in Pneumonia Hospitalization

PURPOSE This study aims to examine the association of Asian dust storm (ADS) events with the daily number of pneumonia admissions using 10-year population-based data in the Taipei metropolitan region. METHODS We identified 1,933,247 admissions with a principal discharge diagnosis of pneumonia between 2000 and 2009. The auto-regressive integrated moving average (ARIMA) method was used to examine the associations between ADS episodes and the logarithm of the daily number of pneumonia hospitalizations. RESULTS There was a significant difference in the mean number of daily pneumonia admissions between ADS event days, post-ADS event days, and non-ADS event days (P < .001); the mean number of daily admissions for ADS event days, post-ADS event days, and non-ADS event days were 292.5, 305.7, and 279.0, respectively. After adjusting for the time-trend effect, ambient temperature, and SO(2), CO, and O(3), the ARIMA showed that compared with non-ADS event days, ADS event days and post-ADS event days 1 through 4 had a significantly higher mean number of pneumonia admissions for the total group. CONCLUSIONS Our results suggest that ADS event days and post-ADS days 1 through 4 had significantly higher mean numbers of pneumonia admissions than non-ADS days.

Population‐Based Estimates of Medical Comorbidities in Erectile Dysfunction in a Taiwanese Population

INTRODUCTION Erectile dysfunction (ED) is usually associated with systemic disorders. This population-based study supports and expands on previous research. It also presents data in a Taiwanese male population where existing data on this topic remain sparse. AIM The aim of this study is to analyze the prevalence and risk of 36 medical comorbidities in patients with ED compared with the general population. METHODS A total of 2,213 patients with ED and 11,065 matching controls were selected from the Taiwan National Health Insurance Research Dataset. We chose 22 comorbidities from the Elixhauser comorbidity index, 10 highly prevalent medical conditions in an Asian population, and four male gender-specific comorbidities for analysis. MAIN OUTCOME MEASUREMENT Conditional logistic regression analyses conditioned on age group and monthly income were performed to investigate the risk of various comorbidities for patients with and without ED, after adjusting for the geographic region and level of urbanization of the patients community. RESULTS Patients with ED were at an increased risk for multiple systemic comorbidities. Conditional regression analyses showed that patients with ED were at a higher risk for hypertrophy of the prostate (odds ratio [OR] = 12.87), chronic prostatitis (OR = 9.36), alcohol abuse (OR = 3.60), drug abuse (OR = 2.62), urinary incontinence (OR = 2.58), ankylosing spondylitis (OR = 2.19), peripheral vascular disorder (OR = 1.98), ischemic heart disease (OR = 1.94), psychoses (OR = 1.97), depression (OR = 1.88), uncomplicated diabetes (OR = 1.91), complicated diabetes (OR = 1.84), hepatitis B or C (OR = 1.71), hyperlipidemia (OR = 1.69), and chronic pulmonary disease (OR = 1.55) than patients without ED. CONCLUSION The results show that patients with ED have a higher prevalence of multiple noncardiovascular comorbidities than the general population in Taiwan.

Increased Risk of Multiple Sclerosis Following Herpes Zoster: A Nationwide, Population-Based Study

UNLABELLED (See the editorial commentary by Corona and Flores, on pages 177-8.) OBJECTIVE  Varicella zoster virus (VZV) has been proposed to be involved in the pathogenesis of multiple sclerosis (MS). However, the epidemiological data regarding the MS occurrence rate following herpes zoster are still scanty. The goal of this study is to investigate the frequency and risk for MS following occurrence of herpes zoster. METHODS  This study used the Taiwan National Health Insurance Research Database. A total of 315,550 patients with herpes zoster were included as the study group, and the control group consisted of 946,650 randomly selected subjects. The stratified Cox proportional hazard regression was performed to calculate the 1-year MS-free survival rate. RESULTS  Of 1,262,200 sampled patients, 29 from the study group (.009%) and 24 from the control group (.003%) had MS during the 1-year follow-up period. After adjusting for monthly income and geographic region, the hazard of MS was 3.96 times greater (95% CI = 2.22-7.07, p < 0.001) for the study group than controls. CONCLUSIONS  Our findings support the notion that occurrence of MS could be associated with herpes zoster attack. We found a significantly higher risk for MS within 1 year of herpes zoster attack compared with the control population.

Chronic rhinosinusitis increased the risk of stroke: A 5-year follow-up study

It has been recognized that chronic rhinosinusitis (CRS) involves intracranial vessels and may be associated with stroke occurrence. However, the detailed epidemiological profile of stroke risk among patients with CRS is still not well understood. Therefore, this study aimed to explore the frequency and risk for stroke among patients with CRS by conducting a large scale population‐based cohort study in Taiwan.

Association of acute myocardial infarction with sudden sensorineural hearing loss: a population-based case-control study.

Objective: Although the etiology of sudden sensorineural hearing loss (SSNHL) remains unknown, there is increasing evidence suggesting an underlying cardiovascular pathomechanism. This study set out to explore a possible association between acute myocardial infarction (AMI) and having previously been diagnosed with SSNHL by using a population-based dataset with a case-control design. Methods: In this study, we utilized administrative claims data from the Taiwan National Health Insurance program to identify 48,674 cases with AMI and to randomly select 243,370 controls. Conditional logistic regression was used to explore the association between AMI and having previously been diagnosed with SSNHL. Results: Of the sampled patients, 1,313 (0.4%) had been diagnosed with SSNHL within 5 years before the index date; 340 (0.75% of the cases) were from the cases and 974 (0.4% of controls) were from the controls. After adjusting for patient geographic region, monthly income, hypertension, diabetes, hyperlipidemia, and coronary heart disease, conditional logistic regression analysis (conditioned on sex, age group, urbanization level, and index date) revealed that the odds ratio for prior SSNHL in patients with AMI was 1.50 (95% CI 1.30–1.70; p < 0.001) that of controls. We found that the adjusted odds ratio of prior hospitalization for the treatment of SSNHL for cases was 2.11 (95% CI 1.65–2.69; p < 0.001) times that of controls. Conclusions: This study identified a novel association between AMI and prior SSNHL. The results of this study highlight a need for clinicians dealing with SSNHL patients to be alert to their risk of subsequent AMI.

Attention-deficit/hyperactivity disorder increased the risk of injury: a population-based follow-up study

To explore the frequency and risk for injury among children with Attention‐deficit/hyperactivity Disorder (ADHD) in Taiwan through a population‐based study.

Zolpidem use and the risk of injury: a population-based follow-up study

Background While an association between zolpidem use and fracture and road accident was previously proposed, this study aimed to further explore the frequency and risk of a wide spectrum of injuries in subjects prescribed with zolpidem in Taiwan. Methods We identified 77,036 subjects who received Zolpidem treatment between 2005 and 2007. We randomly selected 77,036 comparison subjects who were frequency-matched based-on their demographic profiles. We individually tracked each subject for a 90-day period to identify those who subsequently suffered an injury. Cox proportional hazards regressions were performed to calculate the hazard ratio of injury between the two groups. Results The incidence rate of injury during the 90-day follow-up period for the total subjects was 18.11 (95% CI = 17.69–18.54) per 100 person-years; this was 24.35 (95% CI = 23.66–25.05) and 11.86 (95% CI = 11.39–12.36) for the study and comparison cohort, respectively. After adjusting for demographic variables, the hazard ratio (HR) of injury during the 90-day follow-up period for study subjects was 1.83 (95% CI = 1.73–1.94) that of comparison subjects. Additionally, compared to comparison subjects, the adjusted HR of injury during the 90-day follow-up period for study subjects who were prescribed Zolpidem for >30 days was as high as 2.17 (95% CI = 2.05–2.32). The adjusted HR of injury to blood vessels for study subjects was particularly high when compared to comparison subjects (HR = 6.34; 95% CI = 1.37–29.38). Conclusions We found that patients prescribed with Zolpidem were at a higher risk for a wide range of injuries.

Association between Traumatic Brain Injury and the Subsequent Risk of Brain Cancer

This population-based study in Taiwan aimed to investigate the risk of having a diagnosis of malignant brain tumors within 3 years after a traumatic brain injury (TBI). This study used data from the Traumatic Brain Injury Registry and the National Health Insurance Research Database. The study cohort comprised 5007 patients who had visited ambulatory care centers or had been hospitalized with a diagnosis of TBI between 2001 and 2002. The comparison cohort was 25,035 randomly selected enrollees. Each patients brain cancer status was individually tracked for a 3-year period following their index date. Stratified Cox proportional hazards regressions were performed for analyses. During the 3 years of follow-up, nine patients in each cohort, both the TBI and the non-TBI cohort, were diagnosed with brain cancer. As compared to those patients without TBI, patients with TBI were more likely to receive a diagnosis of malignant brain tumors within the 3-year period following their index date: the incidence rate of malignant brain tumors was 6.28 (95% CI: 3.06-11.53) per 10,000 person-years in patients with TBI and 1.25 (95% CI: 0.61-2.29) per 10,000 person-years in patients without TBI. After adjusting for sociodemographic characteristics, the hazard of being diagnosed with malignant brain tumors during the 3-year follow-up period was 4.67 (95% CI: 1.84-11.83) times greater for those who sustained a TBI than for patients in the comparison cohort. In addition, we found an association between TBI severity and malignant brain tumor among patients with TBI (p=0.033). Our findings suggest a positive correlation between TBI and the relatively short-term development of malignant neoplasms of the brain.