BACKGROUND:

This study is a nationwide population-based retrospective cohort study to investigate the risk for developing dementia in thalassemia population.

METHODS:

In a longitudinal cohort of 1 million insured people, we identified 871 thalassemia patients who were newly diagnosed between 2000 and 2004 and selected a comparison cohort of 3484 subjects without thalassemia. We analyzed the risks for thalassemia and dementia using Cox proportional hazard regression models to assess the dementia risk in thalassemia patients after adjusting for age, gender, insured amount, urbanization and comorbidities.

RESULTS:

The overall risks for developing dementia were 1.88-fold (95% CI=1.10-3.21) in patients with thalassemia compared with the comparison cohort after adjusting for age, sex, insured amount, urbanization and comorbidities. The combined effects measured for patients afflicted with thalassemia and the comorbidities of diabetes, hypertension, CAD, head injury, depression, CKD, or substance-related disorder exhibited a significant association with hyperlipidemia risk compared with that measured for patients without thalassemia and without any counterpart comorbidities. In subgroup analysis, the HRs of dementia increased, from 1.69 (95% CI=0.93-3.07) for those who had not undergone transfusion to 2.72 (95% CI=1.09-6.78) for those experienced transfusion compared with the no thalassemia cohort (p for trend<0.01).

CONCLUSION:

Our long-term cohort study result showed that thalassemia should be considered a crucial risk factor for developing dementia.

PURPOSE:

We aimed to identify serum metabolites as potential valuable biomarkers for lung cancer and to improve risk stratification in smokers.

EXPERIMENTAL DESIGN:

We performed global metabolomic profiling followed by targeted validation of individual metabolites in a case-control design of 386 lung cancer cases and 193 matched controls. We then validated bilirubin, which consistently showed significant differential levels in cases and controls, as a risk marker for lung cancer incidence and mortality in a large prospective cohort composed of 425,660 participants.

RESULTS:

Through global metabolomic profiling and following targeted validation, bilirubin levels consistently showed a statistically significant difference among healthy controls and lung cancer cases. In the prospective cohort, the inverse association was only seen in male smokers, regardless of smoking pack-years and intensity. Compared with male smokers in the highest bilirubin group (>1 mg/dL), those in the lowest bilirubin group (<0.75 mg/dL) had 55% and 66% increase in risks of lung cancer incidence and mortality, respectively. For every 0.1 mg/dL decrease of bilirubin, the risks for lung cancer incidence and mortality increased by 5% and 6% in male smokers, respectively (both P < 0.001). There was a significant interaction between low serum bilirubin level and smoking on lung cancer risk (Pinteraction = 0.001).

CONCLUSION:

Low levels of serum bilirubin are associated with higher risks of lung cancer incidence and mortality in male smokers and can be used to identify higher risk smokers for lung cancer.

OBJECTIVE:

Previous research has shown that patients with chronic obstructive pulmonary disease (COPD) tend to have a higher risk for cognitive impairment and dementia, a neurodegenerative disorder. The goal of this study was to examine what relationship, if any, exists between COPD and Parkinson's disease (PD), which is also a neurodegenerative disorder.

METHOD:

Our study analyzed medical data from the population of Taiwan from 1998 to 2008, with a follow-up period extending to the end of 2010. We identified patients with COPD by the Taiwan National Health Insurance Research Database (NHIRD). We selected a comparison cohort from the general population that was random frequency-matched by age (in 5-year increments), sex and index year, and further analyzed the risk of PD using Cox's regression model, including sex, age and comorbidities.

RESULTS:

The study enrolled 20 728 COPD patients (71.1% male, mean age = 68.2 years) and 41 147 controls. The risk of developing PD was 1.37 times greater in patients with COPD compared with patients without COPD after adjusting for age, sex and comorbidities. A significantly increased risk of PD was also found in patients with COPD who had any comorbidity other than diabetes.

CONCLUSION:

This nationwide retrospective cohort study demonstrates that PD risk is significantly increased in patients with COPD compared with those of the general population.

This study examined the relationship between the occupational characteristics of women with uterine fibroids (UFs) and the decision to have a hysterectomy. Data from the Longitudinal Taiwan Health Insurance Database (LTHID) from 2000 to 2009 were analyzed to investigate the association between occupation and hysterectomies. Multivariable logistic regression analysis showed that, compared with white-collar UF patients, the odds ratio (OR) for hysterectomy surgery was 1.21 (95% confidence interval (CI) = 1.11-1.32) for blue-collar UF patients. Moreover, non-government employees with UFs also had significantly increased odds of having a hysterectomy compared to government employees with UFs (OR = 1.19, 95% CI = 1.04-1.36). This study provides information regarding the extent to which differences in occupation and decision-making processes might affect the marked variations in the use of hysterectomies for UFs.

STUDY DESIGN:

A spinal cord injury (SCI) retrospective cohort study was derived from the National Health Insurance Research Database of Taiwan.

OBJECTIVE:

We evaluated risk of acute myocardial infarction (AMI) in patients newly diagnosed with SCI.

SUMMARY OF BACKGROUND DATA:

According to information of the World Health Organization, cardiovascular diseases are the most frequent causes of death in patients with SCI compared with those in the general population.

METHODS:

We obtained claims data from the National Health Insurance Research Database for this cohort study. The SCI group comprised 22,197 patients with a diagnosis of SCI. Case and control patients were based on risk-set sampling in a 1:4 ratio, and we excluded patients with a prior diagnosis of AMI. Comorbidities were categorized as the proportion of prior illnesses in the SCI and non-SCI groups. We used the Cox proportion model to explore adjusted hazard ratio (aHR) for developing AMI between case and control patients.

RESULTS:

Patients with SCI were significantly more likely to exhibit pre-existing illnesses associated with AMI than patients without SCI. Patients with a diagnosis of SCI exhibited significantly higher aHRs for developing AMI than patients without SCI (aHR=1.17; P<0.05). Patients with SCI, compared with patients without SCI, were associated with a subsequent AMI risk (aHR=1.17; P<0.05). Several comorbidities, such as cardiovascular disease (aHR=1.29; P<0.05), chronic obstructive pulmonarydisease (aHR=1.51; P<0.05), hypertension (aHR=1.34; P<0.01), and renal disease (aHR=1.76; P<0.05), were associated with an increased AMI risk. Furthermore, T-spine SCI was significantly associated with an AMI risk (aHR=1.38; P<0.05).

CONCLUSION:

Patients with as diagnosis of SCI exhibited an increased risk of AMI compared with patients without SCI. These findings have broad implications for surveillance among patients with SCI, and future studies should evaluate whether risk factor modification can decrease AMI risk among patients with SCI.

LEVEL OF EVIDENCE:

3.