Objectives
No large population‐based studies have reported on the risk of cholesteatoma developing after allergic rhinitis (AR). This study used a nationwide population‐based claims database to ...investigate the hypothesis that AR may increase the risk of cholesteatoma.
Study Design
Retrospective cohort study.
Methods
Data from Taiwan's Longitudinal Health Insurance Database were analyzed to compile the following: 1) 15,953 patients newly diagnosed with AR between 1997 and 2000, and 2) a comparison cohort of 63,812 matched non‐AR enrollees (with a ratio of 1 to 4). Each patient was followed for 10 years to identify cases in which cholesteatoma subsequently developed. The Kaplan‐Meier method was used to determine the cholesteatoma‐free survival rate, and the log‐rank test was used to compare survival curves. Cox proportional hazard regressions were performed to compute adjusted hazard ratios (HRs).
Results
Among the 79,765 patients enrolled in this study, 45 (159,364 person‐years) from the AR cohort and 88 (638,130 person‐years) from the comparison cohort were diagnosed with cholesteatoma during the follow‐up period (incidence rates 0.28 and 0.14 of 1,000 person‐years, respectively). Patients with AR were more likely to develop cholesteatoma compared to those without AR (adjusted HR 1.57, 95% confidence interval = 1.05–2.34, P < 0.05). Patients with AR presented a significantly lower 10‐year cholesteatoma‐free survival rate than did those in the comparison group (log‐rank, P < 0.001).
Conclusion
This is the first study to demonstrate a link between AR and the development of cholesteatoma. We suggest that clinicians keep this association in mind and carefully investigate the possibility of development of cholesteatoma among patients with AR.
Level of Evidence
3b. Laryngoscope, 128:547–553, 2018
Background
Epidemiological studies have reported an association between urolithiasis and cardiovascular disease. However, studies examining the risks of ischaemic and haemorrhagic stroke in patients ...with urolithiasis are limited.
Aims and methods
By using a nationwide population database, we conducted a matched cohort study to investigate the association between urolithiasis and longitudinal risks of ischaemic and haemorrhagic stroke.
Results
The urolithiasis and non‐urolithiasis cohorts included 12 979 and 64 895 patients respectively. Of these, 728 (5.6%) and 2802 (4.3%) patients in the urolithiasis and non‐urolithiasis cohorts, respectively, had a stroke during the 5‐year follow‐up period. The hazard ratio (HR) for stroke was 1.19 times higher (95% confidence interval CI = 1.10–1.29; P < 0.001) in the urolithiasis cohort than in the non‐urolithiasis cohort after adjustment for potential confounders. The risk of both ischaemic (adjusted HR = 1.16; 95% CI = 1.05–1.29) and haemorrhagic stroke (adjusted HR = 1.30; 95% CI = 1.03–1.64) remained significant in the urolithiasis cohort. Furthermore, the risk of stroke was significant in both men (adjusted HR = 1.16; 95% CI = 1.05–1.28) and women (adjusted HR = 1.26; 95% CI = 1.10–1.45). Middle‐aged (40–59 years; adjusted HR = 1.26; 95% CI = 1.10–1.45) and older (≥60 years; adjusted HR = 1.14; 95% CI = 1.03–1.27) patients had a particularly high risk of stroke.
Conclusions
The present study detected an increased risk of both ischaemic and haemorrhagic stroke in patients with urolithiasis, particularly in those older than 40 years.
The effect of comorbidities and the immune profiles of the kidney cancer microenvironment play a major role in patients’ prognosis and survival. Using the National Health Insurance Research Database ...(Taiwan), we identified patients aged >20 years with a first diagnosis of kidney cancer between 2005 and 2014. Differences in demographic characteristics and comorbidities were examined using the Pearson chi-squared test or the t test. The Cox regression model was used to construct the nomogram. RNA-seq data were applied from The Cancer Genome Atlas database, and correlations between immune metagenes and clinical characteristics were determined using a linear regression model. In this nationwide cohort study, including 5090 patients with kidney cancer, predictors in our prediction models included age, sex, chronic kidney disease, dialysis requirements, renal stones, cerebrovascular disease, and metastasis tumor. In the tumor tissue profiles, significant positive correlations between immune metagenes and clinical stage or overall survival were observed among Natural Killer (NK) cells (CD56−), CD4+ T-helper 2 (Th2) cells, and activated Dendritic Cell (aDC). A negative correlation was observed between expression level of Dendritic Cell (DC) and overall survival. Patients with kidney cancer exhibit high prevalence of comorbid disease, especially in older patients. Comorbid disease types exert unique effects, and a particular comorbidity can affect cancer mortality. Moreover, the expression of immune metagenes can be utilized as potentialbiomarkers especially for further study of molecular mechanisms as well as microenvironments in kidney cancer.
Sleep apnea (SA) is a common sleep disorder characterized by chronic intermittent hypoxia (IH). Chronic IH induces systemic inflammatory processes, which can cause tissue damage and contribute to ...prostatic enlargement. The purpose of this study was to evaluate the association between benign prostate hyperplasia (BPH) and SA in a Taiwanese population.
The study population was identified from Taiwan's National Health Insurance Research Database (NHIRD) and contained 202 SA patients and 1010 control patients. The study cohort consisted of men aged ≥ 30 years who were newly diagnosed with SA between January 1997 and December 2005. Each patient was monitored for 5 years from the index date for the development of BPH. A Cox regression analysis was used to calculate the hazard ratios (HRs) for BPH in the SA and control patients.
During the 5-year follow-up, 18 SA patients (8.9%) and 32 non-SA control patients (3.2%) developed BPH. The adjusted HR for BPH was 2.35-fold higher in the patients with SA than in the control patients (95% confidence interval (CI) 1.28-4.29, P<.01). We further divided the SA patients into 4 age groups. After adjusting for potential confounding factors, the highest adjusted HR for BPH in the SA patients compared with the control patients was 5.59 (95% CI = 2.19-14.31, P<.001) in the patients aged between 51 and 65 years.
Our study results indicate that patients with SA are associated with increased longitudinal risk of BPH development, and that the effects of SA on BPH development are age-dependent.
The association between liver cirrhosis (LC) and herpes zoster has rarely been studied. We investigated the hypothesis that LC, known as an immunodeficiency disease, may increase the risk of herpes ...zoster using a national health insurance database in Taiwan.
The study cohort included cirrhotic patients between 1998 and 2005 (n = 4667), and a ratio of 1:5 randomly sampled age- and gender-matched control patients (n = 23,335). All subjects were followed up for 5 years from the date of cohort entry to identify whether or not they had developed herpes zoster. Cox proportional-hazard regressions were performed to evaluate 5-year herpes zoster-free survival rates.
Of all patients, 523 patients developed herpes zoster during the 5-year follow-up period, among whom 82 were LC patients and 441 were in the comparison cohort. The adjusted hazard ratio (AHR) of herpes zoster in patients with LC was not higher (AHR: 0.77, 95% confidence interval: 0.59-1.01, p = 0.06) than that of the controls during the 5-year follow-up. No increased risk of herpes zoster was found in LC patients after stratification by age, gender, urbanization level, income, geographic region, and all comorbidities.
This large nationwide population-based cohort study suggests that there is no increased risk for herpes zoster among people who have LC compared to a matching population.
Bronchial asthma (BA), atopic dermatitis (AD), and allergic rhinitis (AR) are common allergic diseases. Environmental factors were indicated to influence the development of allergic diseases.
To ...evaluate the correlation between the month of birth and the prevalence of allergic diseases in Taiwan.
Data from 104,455 children were collected from the National Insurance Research Database of Taiwan. Subjects were identified by at least two service claims for ambulatory care or one claim for inpatient care. All of the enrolled patients were aged 7∼15 years in 2010. In a bio-clinical data analysis, total immunoglobulin E (IgE) and ImmunoCAP™ allergen data (CAP) from mothers and infants were collected in a medical center in Taiwan. Correlations between children's allergic factors and the season of birth were assessed.
A significant difference in the prevalence of BA according to the month of birth (Χ(2) = 18.2, p<0.001) was found in the Taiwanese population. The fewest schoolchildren with were born in May (7.21%), and the most were born in October (10.59%). However, no tendency for the prevalence of AD (Χ(2) = 4.6, P = 0.204) or AR (Χ(2) = 4.3 P = 0.229) was found. In addition, we found that children born in autumn (August to October) had a higher prevalence of BA compared to those born in spring (February to April) (odds ratio: 1.13; 95% confidence interval: 1.05∼1.21). In a bio-clinical data study, markers of maternal and childhood allergies including IgE and CAP were detected in a risk analysis section. Children who were born in autumn had higher levels of CAP and total IgE.
The findings of this study showed that the month of birth was closely correlated with the prevalence of BA and higher levels of CAP and IgE.
This study estimates the risk of stroke within 5 years of newly diagnosed dementia among elderly persons aged 65 and above. We examined the relationship between antipsychotic usage and development of ...stroke in patients with dementia.
We conducted a nationwide 5-year population-based study using data retrieved from the Longitudinal Health Insurance Database 2005 (LHID2005) in Taiwan. The study cohort comprised 2243 patients with dementia aged ≥65 years who had at least one inpatient service claim or at least 2 ambulatory care claims, whereas the comparison cohort consisted of 6714 randomly selected subjects (3 for every dementia patient) and were matched with the study group according to sex, age, and index year. We further classified dementia patients into 2 groups based on their history of antipsychotic usage. A total of 1450 patients were classified into the antipsychotic usage group and the remaining 793 patients were classified into the non-antipsychotic usage group. Cox proportional-hazards regressions were performed to compute the 5-year stroke-free survival rates after adjusting for potentially confounding factors.
The dementia patients have a 2-fold greater risk of developing stroke within 5 years of diagnosis compared to non-dementia age- and sex-matched subjects, after adjusting for other risk factors (95% confidence interval (CI) = 2.58-3.08; P<.001). Antipsychotic usage among patients with dementia increases risk of stroke 1.17-fold compared to patients without antipsychotic treatment (95% CI = 1.01-1.40; P<.05).
Dementia may be an independent risk factor for stroke, and the use of antipsychotics may further increase the risk of stroke in dementia patients.
Background: Osteoporosis and periodontitis are both considered global health issues that threaten postmenopausal women and the older population. However, the correlation between osteoporosis and ...periodontitis is still unclear.
Methods: Using a nationwide Taiwanese population‐based database, data from patients with osteoporosis (2003 to 2005; n = 2,527) and 7,575 individuals who were matched to each patient by age and sex were analyzed. All participants were tracked for 5 years from the date of enrollment to observe the percentage of patients who developed periodontitis. Cox proportional hazard regressions were performed to evaluate 5‐year periodontitis‐free survival rates.
Results: Among the total sample, 3,060 individuals were diagnosed with periodontitis during the 5‐year follow‐up period: 792 in the study cohort and 2,268 in the comparison cohort. The adjusted hazard ratio for periodontitis in patients with osteoporosis compared with individuals without osteoporosis during the 5‐year follow‐up was 1.14 (95% confidence interval = 1.05 to 1.24, P <0.01).
Conclusion: This population‐based study indicated that patients with osteoporosis may have an increased risk of periodontitis.
Sleep apnea (SA)-induced chronic intermittent hypoxia increases oxidative stress and inflammation, which may contribute to the pathophysiology of Parkinson's disease (PD). This study evaluated the ...risk of PD following SA diagnosis.
This was a 3-year nationwide population-based matched cohort study using claims data from the National Health Insurance Research Database (NHIRD), Taiwan. We analyzed 1,944 patients diagnosed as having SA between 1997 and 2005 and a matched cohort of 9,720 non-SA patients from the NHIRD. Patients with a history of PD were excluded. Each patient was followed up for 3 years to evaluate subsequent PD development.
Of the 11,664 patients, 17 (0.9%) and 38 (0.4%) from the SA and matched non-SA cohorts, respectively, were subsequently diagnosed as having PD during follow-up. After adjustments for potential confounders, the SA cohort had a 1.85-fold higher risk of PD than the non-SA cohort (95% confidence interval CI =1.02-3.35;
=0.042). After age and sex stratification, PD development was independently associated with SA only in men (adjusted hazard ratio HR, 2.26; 95% CI =1.11-4.63;
<0.05) and in patients aged ≥60 years (adjusted HR, 1.93; 95% CI =1.01-3.71;
<0.05).
Our study suggests that patients with SA are at an increased longitudinal risk of PD. Furthermore, age and male sex are independently associated with the risk of PD.
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