STUDY OBJECTIVES:

Previous literature lacks the analysis of non-apnea sleep disorder (NASD) and peripheral arterial disease (PAD). The aim of this study was to evaluate the association between NASD and risk of developing PAD using retrospective data from a national database in Taiwan.

DESIGN, SETTING, AND PARTICIPANTS:

We identified 46,064 patients with NASD using the catastrophic illness registry of the Taiwan National Health Insurance Research Database (NHIRD) from 1996 to 2010. We also selected a comparison cohort of 92,128 subjects who were randomly frequency-matched by age, sex, and entry year of the NASD cohort from the same database.

INTERVENTIONS:

non-apnea sleep disorders.

MAIN OUTCOME AND MEASUREMENTS:

The study followed up all subjects from their entry date to the occurrence of PAD. We evaluated the risks of PAD using Cox proportional hazards regression models. The survival function for PAD was assessed using the Kaplan-Meier method.

RESULTS:

The risk of PAD was 1.49-fold in patients with NASD compared with patients without NASD after adjusting for age, sex, and comorbidities. Patients with NASD and diabetes or with NASD and hyperlipidemia had an increased risk of PAD compared to those without NASD and diabetes or hyperlipidemia.

CONCLUSIONS:

We demonstrated the significantly increased risk of PAD in NASD patients through a nationwide population-based retrospective cohort study.

OBJECTIVE:

Studies investigating the relationship between sleep disorders (SDs) and the risk of venous thromboembolism (VTE) are scarce. The present study from Taiwan evaluated whether the risk of VTE was associated with SDs other than sleep apnea.

METHODS:

The present study investigated the incidence and risk of VTE in 46,371 people with SDs, compared with 92,742 controls without SDs. The follow-up period began from the date of entering the study cohort to the date of a VTE event, censoring, or December 31, 2011. A Cox proportional hazards regression analysis was conducted to estimate the effects of SDs on the risk of VTE.

RESULTS:

The SD cohort had a 1.79-fold adjusted hazard ratio (HR) of subsequent VTE, compared with the non-SD cohort (95% CI 1.49-2.16). The incidence of VTE increased with age for both cohorts but was higher for those in the SD cohort. However, the adjusted HRs for VTE were significantly higher for the people with SDs aged ≦49 years (HR 3.29, 95% CI 2.12-5.12) and 50-64 years (HR 2.43, 95% CI 1.76-3.35), but were not significant for the oldest group (HR 1.11, 95% CI 0.84-1.47), compared with the controls. The multiplicative increased risk of VTE was significant for the people with SDs with any comorbidity.

CONCLUSION:

This nationwide cohort study determined that the VTE risk significantly increased in people with SDs compared with those of the general population.

This study examined the use of the Pap cervical cancer screening test among women with mental disabilities in Taiwan and analyzed factors related thereto. Data were obtained from three national databases in Taiwan: the 2008 database of physically and mentally disabled persons from the Ministry of the Interior, 2007-2008 Pap smear test data from the Health Promotion Administration, and claims data from the National Health Insurance Research Database. The study subjects included 49,642 Taiwanese women aged ≥30 years with mental disabilities. Besides descriptive and bivariate analyses, logistic regression analysis was also performed to examine factors affecting Pap smear use. In 2007-2008, Taiwanese women with mental disabilities had a Pap screening rate of 11.05%. Age, income, education, marital status, catastrophic illness/injury, relevant chronic illnesses, and severity of disability were identified as factors affecting their Pap smear use. Age and severity of disability were negatively correlated with Pap screening, with the odds of screening being 0.37 times as high in ≥70-year-olds as in 30-39-year-olds and 0.49 times as high for very severe disability as for mild disability. Income was positively correlated with Pap screening. Being married (OR=2.55) or divorced or widowed (OR=2.40) relative to being unmarried, and having a catastrophic illness/injury (OR=1.13), cancer (OR=1.47), or diabetes (OR=1.25), were associated with greater odds of screening. In Taiwan, women with mental disabilities receive Pap smears at a far lower rate than women in general.

BACKGROUND:

Splenectomy has been suggested to have an impact on immunological function, and subsequent development of cancer has been recognized as a possible adverse effect of splenectomy. This study evaluated the possible association between splenectomy and malignancy in Taiwan.

METHODS:

A cohort study consisted of including 2,603 patients with nontraumatic and 2,295 patients with traumatic splenectomy, and then randomly frequency matched with 4 participants without splenectomy. The Cox proportional hazard regression analysis was conducted to estimate the influence of splenectomy on cancer risk.

RESULTS:

Both nontraumatic and traumatic splenectomy had a significantly higher risk for overall cancer development (adjusted hazard ratios are 2.64 and 1.29 for nontraumatic and traumatic reasons, respectively). After adjusting for age, sex, and comorbidities, patients with splenectomy were associated with significantly higher risks for developing certain gastrointestinal tract cancers, other head and neck cancers, and hematological malignancies, and the phenomenon is more prominent in nontraumatic splenectomy group.

CONCLUSION:

This nationwide population-based study found that people with splenectomy have higher risks of developing overall cancer, as well as certain site-specific cancers, especially for patients with nontraumatic reasons.

AIMS:

Cholangiocarcinoma (CCA) is the second most common primary liver cancer in the world. Due to the lack of effective treatments, the survival rate of CCA is low and it is usually considered difficult to diagnose early. To date, no effective strategies for the prevention of CCA have been developed. Statins are cholesterol-lowering agents which possess pleiotropic properties and the use of statins may reduce cancer risk. The aim of the study was to investigate the effect of statin use on the risk of CCA.

METHODS:

We used nationwide insurance data to perform a case-control study including 3174 CCA patients diagnosed in 2002-2011 and 3174 propensity score matched controls. Odds ratios (ORs) and 95% confidence intervals (CI) were calculated to assess the association between CCA risk and statin use by type of statin and dose.

RESULTS:

Patients with CCA were slightly younger than controls with mean ages of 67.4 (SD 12.3) and 68.5 (SD 13.2) years (P = 0.001), respectively, and had less users of statins (22.7 vs. 26.5%, P < 0.001). The overall adjusted OR of statin use associated CCA was 0.80 (95% CI 0.71, 0.90) and lowered for those with longer medications. The OR ranged from 0.65 to 0.77. Stronger dose-response association was seen when using lovastatin.

CONCLUSIONS:

Statin use is associated with reduced risk of CCA and there is a dose-response relationship between the use of statins and risk of CCA.