Hypertensive disorders in pregnancy and preterm delivery and subsequent stroke in Asian women: a retrospective cohort study
Hypertensive disorders in pregnancy and preterm delivery and subsequent stroke in Asian women: a retrospective cohort study

BACKGROUND AND PURPOSE:

Few studies exist concerning the risk of stroke associated with hypertensive disorders in pregnancy (HDP) in Asian women. This study investigates whether preterm delivery further complicates this risk in women with HDP in Taiwan.

METHODS:

Based on universal insurance claims data, 1092 pregnant women with newly diagnosed HDP from 2000 to 2004 and aged 15 to 40 years were identified as the HDP cohort. Then, 4715 randomly selected persons without HDP frequency matched with the index year were designated as the non-HDP controls. Both cohorts were followed-up until the end of 2008 to measure the incidence of stroke.

RESULTS:

The HDP cohort had a higher incidence of stroke than the non-HDP cohort (30.1 vs 12.8 per 10 000 person-years), with an overall adjusted hazard ratio of 2.04 (95% CI, 1.18- 3.51) for stroke. Preterm delivery increased the risk of stroke to 3.22-fold (95% CI, 1.48-6.99; P for trend=0.002). The age-specific V-shape risk association showed that the highest risk of stroke was noted among subjects 15 to 18 years old in the HDP group (hazard ratio, 13.4; 95% CI, 1.54-116.7) and followed by women aged 35 years and older (hazard ratio, 5.56; 95% CI, 1.47-21.0).

CONCLUSIONS:

Pregnant women with HDP have an increased risk of subsequent stroke. Preterm delivery and older ages increase the risk of subsequent stroke. Adolescents with HDP also have an elevated risk of stroke. Early identification of women with HDP is needed for prevention.

Increased lung cancer risk among patients with pulmonary tuberculosis: a population cohort study
Increased lung cancer risk among patients with pulmonary tuberculosis: a population cohort study

INTRODUCTION:

Given one third of the human population have been infected with tuberculosis, it is important to delineate the relationship between tuberculosis and lung cancer. This study explored whether contracting pulmonary tuberculosis is associated with an increased risk of developing lung cancers.

METHODS:

In a cohort of 716,872 insured subjects, free from cancers, aged 20 years and older, 4480 patients with newly diagnosed tuberculosis were identified from the universal insurance claims in 1998-2000 and tracked until 2007 with the remaining insured without tuberculosis. We compared the incidence of lung cancers between the two cohorts and measured the associated hazard of developing lung cancer.

RESULTS:

The incidence of lung cancers was approximately 11-fold higher in the cohort of patients with tuberculosis than nontuberculosis subjects (26.3 versus 2.41 per 10,000 person-years). Cox proportional hazard regression analysis showed a hazard ratio of 4.37 (95% confidence interval [CI]: 3.56-5.36) for the tuberculosis cohort after adjustment for the sociodemographic variables or 3.32 (95% CI: 2.70-4.09) after further adjustment for chronic obstructive pulmonary disease (COPD), smoking-related cancers (other than lung cancer), etc. The hazard ratio increased to 6.22 (95% CI: 4.87-7.94) with the combined effect with COPD or to 15.5 (95% CI: 2.17-110) with the combined effect with other smoking-related cancers.

CONCLUSIONS:

This study provides a compelling evidence of increased lung cancer risk among individuals with tuberculosis. The risk may increase further with coexisting COPD or other smoking-related cancers.

Laparoscopic appendectomy for acute appendicitis is more favorable for patients with comorbidities, the elderly, and those with complicated appendicitis: a nationwide population-based study
Laparoscopic appendectomy for acute appendicitis is more favorable for patients with comorbidities, the elderly, and those with complicated appendicitis: a nationwide population-based study

BACKGROUND:

Laparoscopic appendectomy (LA) is not routinely performed for appendicitis because the costs associated with that procedure are higher than those for open appendectomy (OA). However, few studies have investigated the economic influence of LA and OA on specific subpopulations including the elderly, patients with comorbidities, and patients with complicated appendicitis. This population-based study was designed to investigate determinants of costs and hospital length of stay (LOS) for patients undergoing appendectomy. Furthermore, the differences in costs and LOS were compared between LA and OA for various subpopulations.

METHODS:

Inpatients who underwent LA or OA for appendicitis during the period 2001-2008 were identified from claims data obtained from Taiwan's National Health Insurance program. Costs and LOS were evaluated by multiple linear regression models for various subpopulations stratified according to age, number of comorbidities, and severity of appendicitis.

RESULTS:

Between 2001 and 2008, 22,252 patients (13.3%) underwent LA and 14,4438 (86.7%) had OA. Age, comorbidity, and severity of appendicitis were determinants of costs and LOS for both LA and OA. Although the costs and LOS for appendectomy increased with age and number of comorbidities, a sharper increase was noted for OA patients. Laparoscopic appendectomy mildly decreased LOS at the expense of significantly higher costs for young patients, those without comorbidities, and patients with uncomplicated appendicitis. In contrast, compared with OA, LA was associated with comparable costs and reduced LOS for the elderly, patients with comorbidities, and those with complicated appendicitis. In addition, hospital mortality and readmission rates for postoperative complications did not differ significantly between LA and OA.

CONCLUSION:

Considering costs and LOS, patients older than 65 years, patients with comorbidities, and patients with complicated appendicitis benefit more from the laparoscopic approach for the treatment of appendicitis.

Offspring birth weight and parental cardiovascular mortality
Offspring birth weight and parental cardiovascular mortality

BACKGROUND:

Mothers bearing small offspring are at increased risk of cardiovascular disease (CVD) mortality. The cardiovascular risk for fathers of small offspring is, however, inconclusive. Very few studies with sufficiently large sample sizes have been conducted to specifically differentiate the maternal/paternal CVD risk in association with offspring birth weight in the same population.

METHODS:

This study followed 1,400,383 primigravida and their spouses with singleton births registered in Taiwan between 1978 and 1987 to the end of 2006. By linking to the mortality registry, the hazards ratio (HR) of parental cardiovascular mortality was measured in relation to lower offspring birth weights.

RESULTS:

The covariate-adjusted HR and 95% confidence interval (CI) of CVD mortality for 1 standard deviation higher offspring birth weight was reduced (HR = 0.89; 95% CI: 0.85-0.94) for mothers, but less obvious for fathers (HR = 0.97; 95% CI: 0.95-1.00). Analyses of the categorical offspring birth weights revealed that the association between bearing low-birth-weight offspring (<2500 g) and CVD mortality was also stronger in mothers (adjusted HR = 1.85; 95% CI: 1.67-2.18) than in fathers (adjusted HR = 1.13; 95% CI: 1.03-1.24). On standardizing the birth weight for gestational age, the observed associations persisted, although these associations were relatively weak.

CONCLUSIONS:

This large cohort analysis confirmed that the bearing of smaller size infants is associated with a stronger elevated risk for CVD mortality in mothers than in fathers. Women who have had a lower birth-weight offspring can be targeted for CVD-prevention measures.

Offspring birth weight and risk of mortality from diabetes in mothers
Offspring birth weight and risk of mortality from diabetes in mothers

BACKGROUND:

Mothers with lower birth weight (LBW) offspring have been found to be associated with cardiovascular disease (CVD) morbidity, which shares many risk factors with diabetes. Aims To investigate the relation between offspring birth weight and maternal risk of mortality from diabetes.

METHODS:

A total of 1 400 383 singletons of primigravida registered in Taiwan between 1978 and 1987 were followed to the end of 2006. The offspring birth weight was assessed with and without standardisation for the gestational age of offspring. Cox model was used to estimate the HR of maternal diabetes mortality in relation to offspring birth weights.

RESULTS:

Altogether, 812 (5.8%) mothers died of diabetes. Mothers with LBW (<2500 g) and macrosomia (>4000 g) offspring were both at increased risks of mortality from diabetes with HR 1.76 (95% CI 1.46 to 2.19) and 2.86 (95% CI 2.32 to 3.53), respectively. Similar results were seen while birth weight was standardised for gestational age.

CONCLUSIONS:

This cohort study found that mothers with LBW and macrosomia offspring had an increased mortality risk of diabetes. This relationship could be attributable to the possible pathway of intergenerational effects or maternal insulin resistance due to maladaptation to pregnancy.