The purpose of this study was to estimate the prevalence of children aged 0-6 years with developmental delay (DD) and to examine age-period trends in the prevalence of DD diagnosis in Taiwan. For the study population, we selected children aged <6 years at baseline (in 1997-2002, N=2,308,790) from the National Health Insurance Research Database (a longitudinal database with annual medical records of children in Taiwan) to estimate the prevalence of DD. All study subjects were followed up until they were 5 years old; the study period was from 1997 to 2008. The prevalence of DD by year gradually increased from 0.16% to 3.25% from 1997 to 2008 with an increasing ratio of prevalence of 20% over the 12-year study period. The prevalence of DD in boys was 2.13 times (2.09-2.18 from 1997 to 2008) that in girls. The prevalence of DD increased by year of study. The effect of sex on the prevalence of DD was significant. Understanding the trend of prevalence in the study period and the gap between the rate of early treatment and DD prevalence are critical concerns for future research.

BACKGROUND:

We used the Taiwan National Health Insurance Database for analysis and statistics to investigate the role of computed tomography (CT) in diagnosing acute appendicitis.

MATERIALS AND METHODS:

All 10 046 patients with acute appendicitis were selected and categorized into two groups based on those who did and did not receive CT 3 days before acute appendicitis diagnosis: non-CT and CT groups. A noteworthy outcome was the incidence of peritonitis within 90 days after diagnosis of acute appendicitis.

RESULTS:

The rate of using CT for patients with acute appendicitis increased considerably from 7.9% to 52.9% from 2000 to 2010. The peritonitis incidence rates were 3.54% and 10.7% in the non-CT and CT groups, respectively. Patients who received CT on the same day exhibited a 3.8-fold higher risk of peritonitis than did those in the non-CT group. Those who underwent CT before diagnosis of acute appendicitis exhibited no significant difference of peritonitis risk when compared with those in the non-CT group. The CT group patients were hospitalized 2.19 days longer than the non-CT group patients. Patients who received CT before and on the same day were hospitalized 1.31 and 2.43 days longer than those who did not undergo CT.

CONCLUSION:

Patients who underwent CT exhibited higher risks of peritonitis and longer hospital stays compared with those who did not. Moreover, patients who received CT on the same day of operation exhibited a higher risk of peritonitis than those who underwent CT 1 or 2 days before operation.

BACKGROUND:

The evidence indicated breast cancer was a cancer with high survival rate. However, there were still some breast cancer patients delaying or refusing therapy. So we conducted a cohort study to explore the relationship between characteristics of breast cancer patients and delay or refusal of therapy within four months after cancer diagnosed.

METHODS:

This was a retrospective national population-based study from 2004 to 2010 in Taiwan. This study included 35,095 patients with new diagnosis breast cancer from Taiwan Cancer Registry Database. Several analysis methods, including t test, Chi-square test, generalized estimating equations of logistic regression analysis, and Cox proportional hazards model, were performed to explore the characteristics of these patients and the relative risk of mortality with delay or refusal of therapy.

RESULTS:

Our study showed that the overall survival rates were significantly different (p <0.05) between the breast cancer patients who delayed or refused therapy and those with treatment. The patients who delayed or refused therapy had lower 5-year overall survival rate compared with the treated group. The related factors included age, Charlson comorbidity index, cancer staging (OR = 1.30-19.69; p <0.05), other catastrophic illnesses or injuries and the level of diagnostic hospitals. However, the patients with different income levels and degree of urbanization in living area were not statistically significant factors.

CONCLUSION:

Our results demonstrated that age and cancer staging were the main patient characteristics affecting whether the patients delayed or refused therapy. The delay or refusal of treatment was associated with the level of diagnosing hospital.

BACKGROUND:

Chronic obstructive pulmonary disease and allied conditions (COPD) is frequently associated with various comorbidities. This study examined the association between osteoporosis and pathologic fractures in a sample of patients with COPD.

METHODS:

In this cohort study, claims data from the National Health Insurance Research Database of Taiwan were used to evaluate the risk between COPD and osteoporosis. Using data from the Longitudinal Health Insurance Database 2000, we conducted a retrospective cohort study by investigating patients aged 20 years and older who were newly diagnosed with COPD and comparing them with controls without COPD during 2000-2010. In addition, we used univariable and multivariable Cox proportional hazards regression models to measure the association between COPD and the risk of osteoporosis.

RESULTS:

Our results revealed that COPD was significantly associated with a high risk of osteoporosis, regardless of whether the patients with COPD were corticosteroid users and irrespective of age and sex. After adjustment for covariates, the COPD patients exhibited a 1.54-fold higher risk of developing osteoporosis (hazard ratio 1.54, 95% confidence interval 1.44-1.64). COPD was a stronger risk factor for osteoporosis in men. Moreover, patients with severe COPD had a higher risk of osteoporosis or pathologic fractures.

CONCLUSION:

This study revealed that COPD, which shares the characteristics of inflammatory diseases, is associated with a higher risk of osteoporosis after adjustment for comorbidities.

An association between occult infection and the development of rheumatoid arthritis (RA) has been suggested. This study aimed to determine if patients with chronic osteomyelitis (COM) are at increased risk of developing RA. A national insurance claim dataset of 22 million enrollees in Taiwan was used to identify 21,105 hospital inpatients with COM and 84,420 reference subjects matched by sex, age, and index date of diagnosis with a mean of 5.12 years of follow-up from 2000 to 2011. The risk of RA development was analyzed using Cox proportional hazards modeling. The mean age of hospital inpatients with COM was 55.8 ± 19.4 years. The incidence of RA was 5.43 per 10(4) person-years in the case cohort, which was more than twofold higher than that of 2.20 per 10(4) person-years in the reference cohort. After adjustment, the hazard ratio (HR) was 2.21 (95 % confidence interval, 1.51-3.24). The HR was greatest in the youngest age group (<45 years, HR [95 % confidence interval] = 9.08 [3.22-25.6]; 45-64 years, 1.76 [1.01-3.06]; ≥65 years, 1.68 [0.88-3.24]). In addition, HR was greatest in inpatients with more severe COM (HR [95 % confidence interval] = 0.72 [0.40-1.30] and 11.2 [6.63-18.9] for patients with ≤1 or >2 hospitalization due to recurrent osteomyelitis every two follow-up years, respectively). This is the first report linking COM to risk of incident RA. Patients of a younger age and with frequently recurrent COM had a greater increase in RA risk.