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"Lin, Cheng-Li"
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Irritable Bowel Syndrome Is Associated with an Increased Risk of Dementia: A Nationwide Population-Based Study
Abnormal interaction in the brain-gut axis has emerged as one of the relevant pathophysiological mechanisms for the development of irritable bowel syndrome (IBS). Moreover, the brain-gut axis has recently been demonstrated to be crucial for the maintenance of cognitive performance. Therefore, we assessed the risk of dementia following diagnosis of IBS.
Using the Taiwan National Health Insurance Research Database (NHIRD) to obtain medical claims data from 2000 to 2011, we employed a random sampling method to enroll32 298 adult patients with IBS and frequency-matched them according to sex, age, and baseline year with 129 192 patients without IBS.
The patients with IBS exhibited an increased risk of dementia [adjusted hazard ratio (aHR) = 1.26, 95% confidence interval (CI) = 1.17-1.35]after adjustment for age, sex, diabetes, hypertension, stroke, coronary artery disease (CAD), head injury, depression, and epilepsy, and the overall incidence of dementia for the cohorts with and without IBS was 4.86 and 3.41 per 1000 person-years, respectively. IBS was associated with an increased risk of dementia in patients older than 50 years in both male and female, and in those with comorbidity or without comorbidity. After adjustment for age, sex, and comorbidity, patients with IBS were also more likely to develop either non- Alzheimer's disease (AD) dementia (aHR = 1.24, 95% CI = 1.15-1.33) or AD (aHR = 1.76, 95% CI = 1.28-2.43).
IBS is associated with an increased risk of dementia, and this effect is obvious only in patients who are ≥50 years old.
Journal Article
Association Between Parkinson's Disease and Inflammatory Bowel Disease: a Nationwide Taiwanese Retrospective Cohort Study
ObjectivesInflammatory bowel disease (IBD) is a chronic inflammatory disorder. Previous studies have suggested that chronic systemic inflammation increases the risk of Parkinson's disease (PD). This study examined the effects of IBD on the development of PD.MethodsIn a nationwide population-based cohort of 23.22 million insured residents of Taiwan aged ≥ 20 years, we compared people diagnosed with IBD during 2000 to 2011 (n = 8373) with IBD-free individuals. Patients with PD were identified in the National Health Insurance Research Database. Using univariable and multivariable Cox proportion hazard regression models, we estimated the adjusted hazard ratio (aHR) for PD with a 95% confidence interval (CI) with adjustment for age, sex, and comorbidities.ResultsIn the cohort, IBD was associated with an increased incidence of PD (crude hazard ratio = 1.43, 95% CI = 1.15–1.79). The risk was highest among individuals with Crohn's disease (aHR = 1.40, 95% CI = 1.11–1.77). In the multivariable model, the risk of PD was increased for men (aHR = 1.28, 95% CI = 1.05–1.56) and higher for patients with hypertension (aHR = 1.72, 95% CI = 1.33–2.24), coronary artery disease (aHR = 1.31, 95% CI = 1.04–1.66), or depression (aHR = 2.51, 95% CI = 1.82–3.46).ConclusionsWe suggest that IBD is associated with an increased risk of PD. Patients with IBD should be aware of the potential risk for PD development.
Journal Article
Diabetic Retinopathy in Patients with Diabetic Nephropathy: Development and Progression
The purpose of current study aims to investigate the development and progression of diabetic retinopathy (DR) in patients with diabetic nephropathy (DN) in a nationwide population-based cohort in Taiwan. Newly diagnosed DN patients and age- and sex-matched controls were identified from the Taiwanese Longitudinal Health Insurance Database from 2000 to 2010. We studied the effects of age, sex, hypertension, dyslipidemia, diabetic polyneuropathy (DPN), and medications on the development of nonproliferative DR (NPDR), proliferative DR (PDR), and diabetic macular edema (DME) in patients with DN. Cox proportional hazard regression analyses were used to estimate the adjusted hazard ratios (HRs) of the development of DR. Our results show that the adjusted HRs of NPDR and PDR were 5.01 (95% confidence interval (CI) = 4.68-5.37) and 9.7 (95% CI = 8.15-11.5), respectively, in patients with DN as compared with patients in the non-DN cohort. At 5-year follow-up, patients with DN showed an increased HR of NPDR progression to PDR (HR = 2.26, 95% CI = 1.68-3.03), and the major comorbidities were hypertension (HR = 1.23, 95% CI = 1.10-1.38 with NPDR; HR = 1.33, 95% CI = 1.02-1.72 with PDR) and DPN (HR = 2.03, 95% CI = 1.72-2.41 in NPDR; HR = 2.95, 95% CI = 2.16-4.03 in PDR). Dyslipidemia increased the HR of developing NPDR but not PDR or DME. Moreover, DN did not significantly affect DME development (HR = 1.47, 95% CI = 0.87-2.48) or progression (HR = 0.37, 95% CI = 0.11-1.20). We concluded that DN was an independent risk factor for DR development and progression; however, DN did not markedly affect DME development in this study, and the potential association between these disorders requires further investigation.
Journal Article
Patients with diabetes with and without sodium-glucose cotransporter-2 inhibitors use with incident cancer risk
The study compared the incidence of cancer between patients with diabetes with and without sodium-glucose cotransporter-2 (SGLT2) inhibitors use.
This study identified a non-SGLT2 inhibitor cohort of 325,989 patients and a SGLT2 inhibitor cohort of 325,990 patients. The primary interest of this study was the occurrence of cancer. Hazard ratios (HRs) and 95 % confidence intervals (CIs) were estimated using Cox proportional hazard models.
Patients receiving SGLT2 inhibitors (adjusted HR = 0.79, 95 % CI = 0.76–0.83) had a significantly lower risk of developing cancer than patients without receiving SGLT2 inhibitors.
The results demonstrated that patients with diabetes receiving SGLT2 inhibitors had a significantly lower risk of cancer.
•The study compared the incidence of cancer between patients with diabetes with and without SGLT2 inhibitors use in Taiwan between 2016-2019.•The strength of this study was from a large dataset.•Out study showed that patients with diabetes who took SGLT2 inhibitors had a significantly lower risk of cancer.
Journal Article
Weekend versus weekday hospitalization and clinical outcomes in atrial fibrillation patients with and without stroke
PurposeThe relation between hospitalization timing and risk of clinical outcomes among patients with atrial fibrillation (AF) with and without stroke remained undetermined.MethodsRehospitalization due to AF, cardiovascular (CV) death and all-cause mortality were the outcomes of interest in this study. Multivariable Cox proportional hazard model was applied to estimate the adjusted hazard ratio (HR) and 95% confidence interval (CI).ResultsWhile considering patients with AF hospitalized during weekdays without stroke as the reference group, patients with AF hospitalized during weekends with stroke had the risk of AF rehospitalization, CV death and all-cause death by 1.48 (95% CI 1.44 to 1.51), 1.77 (95% CI 1.71 to 1.83) and 1.17 (95% CI 1.15 to 1.19) times, respectively.ConclusionPatients with AF hospitalized during weekends with stroke had the worst clinical outcomes.
Journal Article
Increased risk of dementia in patients hospitalized with acute kidney injury: A nationwide population-based cohort study
To determine whether acute kidney injury (AKI) is a risk factor for dementia.
This nationwide population-based cohort study was based on data from the Taiwan National Health Insurance Research Database for 2000-2011. The incidence and relative risk of dementia were assessed in 207788 patients hospitalized for AKI. The comparison control was selected using the propensity score based on age, sex, index year and comorbidities.
During the 12-year follow-up, patients with AKI had a significantly higher incidence for developing dementia than did the controls (8.84 vs 5.75 per 1000 person-y). A 1.88-fold increased risk of dementia (95% confidence interval, 1.76-2.01) was observed after adjustment for age, sex, and several comorbidities (diabetes, hypertension, hyperlipidemia, head injury, depression, stroke, chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure, atrial fibrillation, cancer, liver disease, chronic infection/inflammation, autoimmune disease, malnutrition).
We found that patients with AKI exhibited a significantly increased risk of developing dementia. This study provides evidence on the association between AKI and long-term adverse outcomes. Additional clinical studies investigating the related pathways are warranted.
Journal Article
Real-world observational study of assessment of CHA2DS2-VASc, C2HEST and HAVOC scores for atrial fibrillation among patients with rheumatological disorders: a nationwide analysis
PurposeThis is a nationwide-based retrospective study aiming to compare the three different scoring systems (CHA2DS2-VASc, C2HEST and HAVOC scores) in the prediction of atrial fibrillation (AF) in patients with rheumatological disease.MethodsWe used the Fine and Gray model to estimate the risk of AF (subhazard ratio and 95% CI). The predictive accuracy and discriminatory ability of the predictive model were evaluated by receiver operating characteristic (ROC) curve.ResultsAmong the three predictive models, the model using CHA2DS2-VASc score had the better discriminative ability with an ROC of 0.79. The model with C2HEST score had an ROC of 0.78. The discriminative ability of the HAVOC score was 0.77, estimated by ROC.ConclusionWe concluded the CHA2DS2-VASc score has better performance in predicting AF compared with C2HEST score or HAVOC score.
Journal Article
Long-term exposure to air pollution and risk of Sarcopenia in adult residents of Taiwan: a nationwide retrospective cohort study
Background
Sarcopenia is an age-related, multifactorial syndrome. Previous studies have shown that air pollutants are associated with inflammation and oxidative stress. However, the association between long-term exposure to air pollution and sarcopenia is not completely understood.
Methods
The Taiwan National Health Research Database (NHIRD) contains medical records of almost all Taiwanese residents. Daily air pollution data collected by the Taiwan Environmental Protection Agency was used to analyze concentrations of sulfur oxide (SO
2
), carbon monoxide (CO), nitrogen monoxide (NO), nitrogen dioxide (NO
2
), and particulate matter (PM
2.5
, PM
10
). The databases were merged according to the insurants’ living area and the location of the air quality monitoring station. We categorized the pollutants into quartiles (Q1, Q2, Q3, and Q4).
Results
Our study population consisted of 286,044 patients, among whom 54.9% were female and 45.1% were male. Compared to Q1 levels of pollutants, Q4 levels of SO
2
(adjusted hazard ratio [aHR] = 8.43; 95% confidence interval [CI] = 7.84, 9.07); CO (aHR = 3.03; 95%CI = 2.83, 3.25); NO (aHR = 3.47; 95%CI = 3.23, 3.73); NO
2
(aHR = 3.72; 95%CI = 3.48, 3.98); PM
2.5
(aHR = 21.9; 95% CI = 19.7, 24.5) and PM
10
(aHR = 15.6; 95%CI = 14.1, 17.4) increased risk of sarcopenia.
Conclusions
Our findings indicated a significantly increased risk of sarcopenia in both male and female residents exposed to high levels of air pollutants.
Journal Article
Inhaled anesthesia associated with reduced mortality in patients with stage III breast cancer: A population-based study
Patients diagnosed with stage III breast cancer often undergo surgery, radiation therapy, and chemotherapy as part of their treatment. The choice of anesthesia technique during surgery has been a subject of interest due to its potential association with immune changes and prognosis. In this study, we aimed to compare the mortality rates between stage III breast cancer patients undergoing surgery with propofol-based intravenous general anesthesia and those receiving inhaled anesthetics.
Using data from Taiwan's National Health Insurance Research Database and Taiwan Cancer Registry, we identified a cohort of 10,896 stage III breast cancer patients. Among them, 1,506 received propofol-based intravenous anesthetic maintenance, while 9,390 received inhaled anesthetic maintenance. To ensure comparability between the two groups, we performed propensity-score matching.
Our findings revealed a significantly lower mortality rate in patients who received inhaled anesthetics compared to those who received propofol-based intravenous anesthesia. Sensitivity analysis further confirmed the robustness of our results.
This study suggests that inhaled anesthesia technique is associated with a lower mortality rate in clinical stage III breast cancer. Further research is needed to validate and expand upon these results.
Journal Article