The study aims to examine whether the annual variations in fasting plasma glucose (FPG) measurements, represented by the coefficient of variation (CV), predict cancer incidence and mortality in the subsequent years independent of traditional risk factors of type 2 diabetic patients. A computerized database of patients with type 2 diabetes of 30 years old and older (n=4805) enrolled in the Diabetes Care Management Program of a medical center before 2006 was analyzed using a time-dependent Cox's proportional hazards regression model. The mortality rates for the first, second, and third tertiles of the first annual FPG-CV were 8.64, 12.71, and 30.82 per 1000 person-years respectively. After adjusting for mean FPG, HbA1c, and other risk factors, the annual FPG-CV was independently associated with cancer incidence, cancer mortality, and cancer incidence or mortality, and the corresponding hazard ratios for the third vs first tertile of the annual FPG-CV were 3.03 (1.98, 4.65), 5.04 (2.32, 10.94), and 2.86 (1.91, 4.29) respectively. The annual variation in FPG was a strong predictor of cancer incidence and mortality in type 2 diabetic patients; therefore, glucose variation may be important in the clinical practice of care management and cancer prevention.

Background

The risk of some forms of cancer has been found to be higher in patients with diabetes mellitus (DM) than in the general population. The aim of this study was to examine, with sufficient statistical power, the association between DM and lung cancer and the impact of antidiabetes drugs on lung cancer risk in Taiwan.

Materials and Methods

From a randomly selected data set of 1 million National Health Insurance (NHI) claims in Taiwan from 2000-2005, 19,624 cases (patients ≥ 20 years of age) of newly diagnosed DM were identified. From the same data set, 78,496 enrollees with no record of DM were selected as controls and were matched in sex and age to the first group. The incidence of newly diagnosed lung cancer was compared between patients with DM and controls for a period of 9 years (2000-2008).

Results

The multivariate Cox model analysis showed a slightly increased hazard ratio (HR) of 1.05 of lung cancer in patients with DM, but the association was not statistically significant. However the use of antidiabetes drugs, such as metformin, thiazolidinediones, or alpha-glucosidase inhibitors, correlates with a decreased lung cancer risk of 39%-45%. A significant association was found between lung cancer risk and male sex (HR, 2.23), pulmonary tuberculosis (HR, 1.60), chronic obstructive pulmonary disease (HR, 1.21), and age (HR, 1.07).

Conclusion

Patients with DM are not at increased risk for the development of lung cancer, but the use of antidiabetes drugs would considerably decrease the risk. In this cohort, male sex, age, pulmonary tuberculosis, and chronic obstructive pulmonary disease were all associated with an increased risk of lung cancer, consistent with findings in the literature and indicative of the validity of our study.

The present study evaluated emergency room visit (ERV) risks for all causes and cardiopulmonary diseases associated with temperature and long-lasting extreme temperatures from 2000 to 2009 in four major cities in Taiwan. The city-specific daily average temperatures at the high 95th, 97th, and 99th percentiles, and the low 10th, 5th, and 1st percentiles were defined as extreme heat and cold. A distributed lag non-linear model was used to estimate the cumulative relative risk (RR) of ERV for morbidities associated with temperatures (0 to 3-day lags), extreme heat and cold lasting for 2 to 9 days or longer, and with the annual first extreme heat or cold event after controlling for covariates. Low temperatures were associated with slightly higher ERV risks than high temperatures for circulatory diseases. After accounting for 4-day cumulative temperature effect, the ERV risks for all causes and respiratory diseases were found to be associated with extreme cold at the 5th percentile lasting for >8 days and 1st percentile lasting for >3 days. The annual first extreme cold event of 5th percentile or lower temperatures was also significantly associated with ERV, with RRs ranging from 1.09 to 1.12 for all causes and from 1.15 to 1.26 for respiratory diseases. The annual first extreme heat event of 99th percentile temperature was associated with higher ERV for all causes and circulatory diseases. Annual first extreme temperature event and intensified prolonged extreme cold events are associated with increased ERVs in Taiwan.

PURPOSE:

To determine whether the diagnosis of otitis media (OM) in adults is associated with an increased risk for the subsequent development of nasopharyngeal cancer (NPC) using a nationwide population-based retrospective study.

METHODS AND MATERIALS:

We selected 13,513 adult patients that had been previously diagnosed with OM between 2000 and 2005 from the Taiwan Longitudinal Health Insurance Database 2000 as the study cohort, and randomly extracted the data of 135,130 participants matched by sex, age, and baseline year for the comparison cohort. The follow-up period was terminated upon developing NPC, withdrawal from the national health insurance system, or the end of 2009. Cumulative incidences and hazard ratios (HRs) of NPC development were determined.

RESULTS:

The subsequent NPC incidence rates in the OM and comparison cohorts were 6.41 and 0.58 per 10000 person-years, respectively (adjusted HR, 11.04; 95% CI, 7.68-5.87; P<0.0001). The NPC risk for males was significantly higher than that for females (adjusted HR=3.24; 95% CI, 2.16-4.85). In both female and male patients, the diagnosis of OM was associated with a significantly increased risk for NPC (adjusted HR, 11.91 vs. 10.78, respectively). Among the OM cohort, 62 participants were subsequently diagnosed with NPC, with 71% of them occurring within 1 year following the diagnosis of OM. However, even after 5-year follow-up, the OM cohort still displayed a higher risk for NPC (adjusted HR=2.50). Stratified by the frequency of OM episodes, more than one episode per year had a significantly greater risk of developing NPC, compared with the comparison cohort (HR=29.22; 95% CI, 20.19-42.27).

CONCLUSION:

We found that adult OM is a warning sign for the development of NPC in Taiwan, with approximately an 11-fold higher risk for adult OM patients. We recommend that OM patients undergo follow-up examinations for at least 5 years. To extrapolate our findings, further studies are warranted in other areas in which NPC is endemic.

AIM:

The aim of the present study was to investigate whether polypharmacy correlates with the risk of dementia in older people.

METHODS:

From representative claims data established from the National Health Insurance with a population coverage rate of 99% in Taiwan, we identified 7135 newly diagnosed patients with dementia in 2000-2008 and 2,8540 randomly selected controls without dementia, both aged ≥ 65 years. The daily use of prescribed drugs in the past 2 years was compared between cases and controls, controlling for demographic characters and comorbidities.

RESULTS:

The incidence of dementia increased with the number of medications used and age. Cases were older than controls, predominant with women and more likely to use five or more drugs daily (44.0% vs 32.0%, P < 0.0001). Multivariate logistic regression analysis showed that, compared with participants using zero to one drug, the odds ratios (OR) of dementia were 1.28 (95% confidence interval [CI] 1.18-1.38) for those using two to four drugs, 1.34 (95% CI 1.23-1.46) for those using five to nine drugs and 1.56 (95% CI 1.38-1.76) for those using 10 or more drugs. Cerebrovascular disease (OR 3.19), diabetes mellitus (OR 1.23), chronic kidney disease (OR 1.21) and hypertension (OR 1.08) were significant comorbidities predicting the risk of dementia. There was significant interaction between cerebrovascular disease and the number of medications used in the dementia risk.

CONCLUSIONS:

The risk of dementia increases steadily with the number of medications used and age in older people in Taiwan. Cerebrovascular disease, diabetes mellitus, chronic kidney disease and hypertension might also correlate with the risk of dementia.