Yiing-Jeng Chou

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.

The Risk of Epithelial Ovarian Cancer of Women With Endometriosis May be Varied Greatly if Diagnostic Criteria Are Different: A Nationwide Population-Based Cohort Study

AbstractThis article aims to test the hypothesis that the risk of epithelial ovarian cancer (EOC) in women with endometriosis might be changed by enrolling different population.A nationwide 14-year historic cohort study using the National Health Insurance Research Database (NHIRD) of Taiwan and the Registry for Catastrophic Illness Patients was conducted. A total of 239,385 women aged between 20 and 51 years, with at least 1 gynecologic visit after 2000, were analyzed. Cases included women with a diagnosed endometriosis, which was established along a spectrum from at least 1 medical record of endometriosis (recalled endometriosis) to tissue-proved ovarian endometriosis (n = X). Controls included women without any diagnosis of endometriosis (n = 239,385 – X). We used Cox regression, and computed hazard ratios (HRs) with 95% confidence intervals (95% CI) to determine the risk of EOC in patients.The EOC incidence rates (IRs, per 10,000 person-years) of women with endometriosis ranged from 1.90 in women with recalled endometriosis to 18.70 in women with tissue-proved ovarian endometrioma, compared with those women without any diagnosis of endometriosis (0.77–0.89), contributing to crude HRs ranging from 2.59 (95% CI, 2.09–3.21; P < 0.001) to 24.04 (95% CI, 17.48–33.05; P < 0.001). After adjustment for pelvic inflammatory disease, infertility, Charlson co-morbidity index, and age, adjusted HRs were ranged from the lowest of 1.90 (95% CI, 1.51–2.37; P < 0.001) in recalled endometriosis to the highest of 18.57 (95% CI, 13.37–25.79; P < 0.001) in tissue-proved ovarian endometrioma, which was inversely related to the prevalence rate of endometriosis (from the highest of 30.80% in recalled endometriosis to the lowest of 1.54% in tissue-proved ovarian endometrioma).The risk of EOC in women with endometriosis varied greatly by different criteria used. Women with endometriosis might have a more apparently higher risk than those reported by systematic review and meta-analysis.

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.

Do the health‐care workers gain protection against herpes zoster infection? A 6‐year population‐based study in Taiwan

Varicella zoster virus (VZV) causes varicella, and may reactivate to cause herpes zoster later in the life of the host. It has been previously observed that exposure to VZV may boost the host’s latent immunity. Health‐care workers who are frequently exposed to ill patients ought to receive a protective effect. We investigated the incidence of herpes zoster among health‐care workers and the general population in Taiwan to see whether such a protective effect exists among health‐care workers against herpes zoster. This nationwide population‐based retrospective cohort study was based on data obtained from the Taiwan National Health Insurance Database. In total, 7744 health‐care workers, including 168 dermatologists and pediatricians, and 695 188 general adults were recruited for the study. Health‐care workers in the age groups 20–29, 30–39 and 40–49 years were found to have a significant higher herpes zoster incidence compared to the general adults (P < 0.001, 0.011 and <0.001, respectively). Both logistic regression and Cox regression showed that dermatologists, pediatricians, and other medical professionals have a higher herpes zoster incidence than the general population (odds ratio [OR] = 1.36, 95% confidence interval [95% CI] = 0.63–2.90, hazards ratio [HR] = 1.35, 95% CI = 0.64–2.82 in dermatologist and pediatrician groups, and OR = 1.39, 95% CI = 1.23–1.58, HR = 1.38, 95% CI = 1.22–1.56 in other medical professionals). The incidence of herpes zoster is higher among health‐care workers and it can be clearly concluded that no protective effect against herpes zoster exists for health‐care workers in Taiwan.

The association between functional disability and acute care utilization among the elderly in Taiwan

Disability is associated with increased long-term care use among the elderly, but its association with utilization of acute care is not well understood. The aim of this study is to investigate the association between functional disability and acute medical care utilization among the elderly. This nationwide, population-based cohort study was based on data from the 2005 National Health Interview Survey (NHIS), linking to the 2004-2007 National Health Insurance (NHI) claims data. A total of 1521 elderly subjects aged 65 years or above were observed from the year 2004 to 2006; this sample was considered to be a national representative sample. The utilization of acute medical care (including outpatient services, emergency services, and inpatient services) and medical expenditure were measured. Functional disability was measured by determining limitations on activities of daily living (ADLs), instrumental activities of daily living (IADLs), and mobility. After adjusting for age, comorbidity, and sociodemographic characteristics, functional disability that affected IADLs or mobility was a significant factor contributing to the increased use of care. A clear proportional relationship existed between disability and utilization, and this pattern persisted across different types of acute care services. Disability affecting IADLs or mobility, rather than ADLs, was a more sensitive predictor of acute medical care utilization. Compared to elderly persons with no limitations, the medical expenditure of those with moderate-to-severe limitations was 2-3 times higher for outpatient, emergency, and inpatient services. In conclusion, functional disability among the elderly is a significant factor contributing to the increased use of acute care services.

Do nurses have worse pregnancy outcomes than non-nurses?

BACKGROUND Nurses encounter multiple occupational exposures at work which may harm their reproductive health. The purpose of the study was to compare pregnancy complications and outcomes including cesarean deliveries, tocolysis, miscarriage, and preterm labor between female nurses and comparable women who were not nurses in Taiwan. METHODS This nationwide population-based study was performed using the National Health Insurance Research Database from 1997 to 2008. We identified 3,656 pregnancies among 2,326 nurses and 111,889 pregnancies among 74,919 non-nurses. A generalized estimating equation was used to compare risks between the two groups. RESULTS The rates of tocolysis (28.6 vs 22.3%), miscarriage (6.0 vs 5.3%), and preterm labor (8.1 vs 4.4%) were significantly higher among nurses than non-nurses. After adjustment for background differences, nurses had significantly higher risks for cesarean section (adjusted OR 1.12 [95% confidence interval (CI) 1.03-1.22]), tocolysis (OR 1.18 [95% CI 1.09-1.29]), and preterm labor (OR 1.46 [95% CI 1.28-1.67]) than non-nurses. CONCLUSIONS Nurses are at higher risk for cesarean section, tocolysis, and preterm labor than non-nurses. Occupational exposure related to these adverse pregnancy outcomes should be examined. Strategies to decrease the risks should be developed to improve reproductive health among nurses.

Investigating the utilization of radiological services by physician patients: a population-based cohort study in Taiwan.

BackgroundAdvances in radiology technology have contributed to a substantial increase in utilization of radiology services. Physicians, who are well educated in medical matters, would be expected to be knowledgeable about prudent or injudicious use of radiological services. The aim of this study was to evaluate differences in the utilization of radiology modalities among physician and non-physician patients.MethodsThis nationwide population-based cohort study was carried out using data obtained from the Taiwan National Insurance Database from 1997 to 2008. Physicians and comparison controls selected by propensity score matching were enrolled in the current study. The claims data of ambulatory care and inpatient discharge records were used to measure the utilization of various radiology modalities. Utilization rates of each modality were compared between physicians and non-physicians, and odds ratios of the utilization of each radiology modality were measured. Multiple logistic regression analysis was used to examine the predictors of X-ray, MRI, and interventional procedures utilization during the study period.ResultsThe utilization of most radiologic services increased among physicians and the comparison group during the observation period. Compared to non-physicians, physicians had significantly higher utilization rates of computed tomography and magnetic resonance imaging (MRI) but lower utilization rates of X-rays, sonography, and interventional procedures. After adjusting for age, gender, major diseases, urbanicity, and residential regions, logistic regression analysis showed that, compared to non-physicians, the physicians used significantly more MRI (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.68–2.84, P < 0.001) and significantly less X-rays and interventional procedures (OR: 0.85, 95% CI: 0.72–0.99, P = 0.04 for X-rays and OR: 0.67, 95% CI: 0.54–0.83, P < 0.001 for interventional procedures). Being a physician was a significant predictor of greater usage of MRI and of less usage of X-ray and interventional procedures.ConclusionsThis study revealed different utilization patterns of X-rays, MRI, and interventional procedures between physician and non-physician patients, even after controlling for such factors as socioeconomic status and major diseases.

Comorbidity profiles of psoriasis in Taiwan: A latent class analysis

Background Psoriasis is associated with many comorbidities. An understanding of these comorbidity patterns can help foster better care of patients with psoriasis. Objective To identify the heterogeneity of psoriasis comorbidities using latent class analysis (LCA). Methods LCA was used to empirically identify psoriasis comorbidity patterns in a nationwide sample of 110,729 incident cases of psoriasis (2002–2012) from the National Health Insurance database in Taiwan. Results The mean age of incident psoriasis was 46.1 years. Hypertension (28.8%), dyslipidemia (18.9%), and chronic liver disease/cirrhosis/hepatitis (18.1%) were the top three comorbidities in patients with psoriasis. LCA identified four distinct comorbidity classes among these patients, including 9.9% of patients in the “multi-comorbidity” class, 17.9% in the “metabolic syndrome” class, 11.3% in the “hypertension and chronic obstructive pulmonary disease (COPD)” class, and 60.9% in the “relatively healthy” class. Psoriatic arthritis was evenly distributed among each class. Relative to membership in the “relative healthy” class, an increase of one year of age had a higher probability of membership in the “multi-comorbidity” (odds ratio [OR], 1.25), “metabolic syndrome” (OR, 1.11), or “hypertension and COPD” (OR, 1.34) classes. Relative to membership in the “relative healthy” class, compared to women, men had a higher probability of membership in the “multi-comorbidity” (OR, 1.39), “metabolic syndrome” (OR, 1.77), or “hypertension and COPD” (OR, 1.22) classes. Conclusion We observed four distinct classes of psoriasis comorbidities, including the “multi-comorbidity”, “metabolic syndrome”, “hypertension and COPD”, and “relatively healthy” classes, as well as the clustering of liver diseases with metabolic syndrome and clustering of COPD with hypertension.

Antiretroviral treatment attrition in Swaziland: a population-based study.

Swaziland has the highest prevalence of human immunodeficiency virus (HIV) in the world. Attrition (loss to follow-up and mortality) in people living with HIV/AIDS (PLWHA) already on treatment is a major challenge, undermining achievements of the antiretroviral treatment (ART) programme in Swaziland. The contributing factors to attrition in the Swazi context are unclear. This study aims to (1) estimate attrition from the ART programme 12 months after ART initiation in Swaziland, and (2) determine the predictors of attrition in PLWHA treated with ART in Swaziland. A retrospective cohort study using national baseline data was conducted. A competing-risk Cox proportional hazard regression was used to determine the predictors of attrition. We estimated 10·3% (95% confidence interval 10·1-10·6) attrition in 16 423 participants that initiated ART in 2012. Attrition was significantly associated with sex, age, district, treatment supporter at initiation, co-infection of HIV and TB, functional status, WHO clinical stage, and ownership of facility. Our study can form a base of policies, plans, and service delivery strategies for preventing and controlling attrition in Swaziland.