A comparison of cancer incidence among physician specialists and the general population: a Taiwanese cohort study.
A comparison of cancer incidence among physician specialists and the general population: a Taiwanese cohort study.

BACKGROUND:

Physicians are frequently studied as a population that experiences extremely high stress, burnout, and prolonged working hours that might harm one's health. However, they have sound medical knowledge and have easy access to medical resources. We studied the incidence of cancer among Taiwanese physicians using a nationwide cohort study design.

METHODS:

Data were obtained from the National Health Insurance (NHI) system in Taiwan. The physician cohort contained 22,309 physicians, and each physician was randomly frequency-matched according to age and sex with 4 people from the general population.

RESULTS:

The overall incidence ratio of cancer was 27% lower in the physician cohort than in the nonphysician comparison cohort (33.9 vs. 46.5 people per 10,000 person-years, crude hazard ratio (HR)=0.73, 95% CI=0.70, 0.76). The adjusted HR was 0.78 (95% CI=0.72, 0.84). Female physicians experienced a higher incidence rate ratio of overall cancer, compared to male physicians (crude HR=1.17, 95% CI=1.03, 1.33 vs. crude HR=0.70, 95% CI=0.67, 0.74, respectively). Physicians were at a significantly higher risk of thyroid cancer (HR 1.75, 95% CI=1.14, 2.68), prostate cancer (HR=1.54, 95% CI=1.21, 1.97), breast cancer (HR=1.45, 95% CI=1.00, 2.09), and non-cervical gynecological cancer (HR=4.03, 95% CI=1.77, 9.17), compared with the general population.

CONCLUSIONS:

Physicians are at lower overall risk of cancer than the general population, apart from cancer of the thyroid, prostate, breast, and non-cervical gynecological cancer.

A nationwide population-based retrospective cohort study: decreased risk of stroke in cervical cancer patients after receiving treatment.
A nationwide population-based retrospective cohort study: decreased risk of stroke in cervical cancer patients after receiving treatment.

OBJECTIVE:

To evaluate risk of stroke in patients with cervical cancer using population-based data.

METHODS:

Claims collected in the Taiwan National Health Insurance database were used to identify 20,286 cervical cancer patients receiving diagnosis and treatment during 2000-2008. A reference group of 81,144 non-cancer participants, matched for age, cervical cancer-month and cervical cancer-year, was used for comparison. Risk of stroke was further assessed at follow-up until the end of 2009.

RESULTS:

Patients with cervical cancer had a 42 % lower risk of developing stroke compared with the cancer-free reference population. Increased risk of stroke was observed in patients receiving radiotherapy compared with the surgery treatment group (HR = 1.88, 95 % CI = 1.52-2.32).

CONCLUSION:

Results from this large retrospective cohort study indicate a lower risk of developing stroke in cervical cancer patients after receiving treatment compared with a reference population free of cancer after adjusted for age, sex, urbanization level, and stroke risk factors including hypertension and diabetes. Supplementation of estrogen after cancer treatment could explain this finding. Further prospective randomized controlled analysis is needed to confirm these findings and to elucidate the underlying biological mechanisms.

A population-based cohort study in Taiwan--use of insulin sensitizers can decrease cancer risk in diabetic patients?
A population-based cohort study in Taiwan--use of insulin sensitizers can decrease cancer risk in diabetic patients?

BACKGROUND:

The purpose of the study was to explore the possible association between the use of insulin sensitizers(thiazolidinediones, TZDs) and the risk of cancer in Taiwanese diabetic patients.

PATIENTS AND METHODS:

From the National Health Insurance Research Database (NHIRD) of Taiwan, we identified 22 910 diabeticpatients newly diagnosed from 2001 to 2009 and 91 636 non-diabetic comparisons frequency matched with age, sex, and calendar year, excluding those with cancer at the baseline. Among the diabetics, 4159 patients were treated with TZDs and the rest of 18 752patients were on other anti-diabetic medications (non-TZDs).

RESULTS:

In comparison to the non-diabetes group, the non-TZDs group had an increased risk of developing cancer [the adjusted hazard ratio (HR): 1.20 and 95% confidence interval (CI) = 1.11-1.30]. The TZDs group had a HR of 1.18 (95% CI = 0.98-1.42). Analysis of site-specific cancer risks showed that both TZDs and non-TZDs groups with elevated risks of colorectal and pancreaticcancer. However, the non-TZDs group had an increased risk of liver cancer when comparing with TZD and non-diabetes groups.

CONCLUSION:

This study suggests that patients with diabetes are at an elevated risk of cancer (especially in colorectal and pancreatic cancers), and the use of TZDs might decrease the liver cancer risk in diabetic patients. Further investigation using large samples and rigorous methodology is warranted.

Alzheimer's disease correlates with greater risk of hip fracture in older people: a cohort in Taiwan.
Alzheimer's disease correlates with greater risk of hip fracture in older people: a cohort in Taiwan.
Association between atopic diseases and attention-deficit/hyperactivity disorder in childhood: a population-based case-control study.
Association between atopic diseases and attention-deficit/hyperactivity disorder in childhood: a population-based case-control study.

PURPOSE:

Both atopic diseases (AD) and attention-deficit/hyperactivity disorders (ADHD) are common pediatric disorders that may lead to mental and physical complications. This population-based, case-control design is to correlate the risk of ADHD with AD among a pediatric population.

METHODS:

By using a Longitudinal Health Insurance Database ranged from 2002 to 2009, 4692 children with ADHD and 18,768 randomly selected controls were enrolled. Odds ratios (OR) of ADHD were calculated for the association with AD.

RESULTS:

The children with ADHD had a higher rate of AD than controls, particularly allergic rhinitis and allergic conjunctivitis. The corresponding ORs were 1.81 (95% confidence interval [CI], 1.69-1.93) and 1.69 (95% CI, 1.58-1.81), respectively. Despite the lower prevalence, children with atopic dermatitis and asthma were also at higher risk of ADHD, with ORs of 1.80 (95% CI, 1.58-2.05) and 1.48 (95% CI, 1.24-1.78). Logistic regression analysis estimated ORs showed ADHD risk was higher for those living in urban areas. The risk of ADHD increased with numbers of AD and age.

CONCLUSIONS:

Most of the children with ADHD had a strong association with AD, especially allergic rhinitis. Awareness of these comorbidities may help clinicians to provide better comprehensive management and reduce the burden of disease.