Children with disabilities face more barriers accessing preventive health services. Prior research has documented disparities in the receipt of these services. However, most are limited to specific types of disability or care. This study investigates disparities in the use of preventive health care among children with disabilities in Taiwan. Three nationwide databases from the Ministry of the Interior, Bureau of Health Promotion, and National Health Research Institutes were linked to gather related information between 2006 and 2008. A total of 8572 children with disabilities aged 1-7 years were included in this study. Multivariate logistic regression analysis was conducted to adjust for covariates. Nationally, only 37.58% of children with disabilities received preventive health care in 2008. Children with severe and very severe disabilities were less likely to use preventive care than those with mild severity. Children with disabilities from the lowest income family were less likely to have preventive care than other income groups. Urbanization was strongly associated with the receipt of preventive health care. However, surprisingly, urban children with disabilities were less likely to receive preventive care than all others. Under universal health insurance coverage, the overall usage of preventive health care is still low among children with disabilities. The study also identified several disparities in their usage. Potential factors affecting the lack of use deserve additional research. Policymakers should target low socioeconomic brackets and foster education about the importance of preventive care. Mobile health services should be continually provided in those areas in need. Capitation reimbursement and other incentives should be considered in improving the utilization among children with disabilities.

OBJECTIVES:

The incidence of oral cavity cancer is high in Taiwan. To improve patient survival, multidisciplinary team (MDT) care was implemented. This research compared the survival of MDT care participants/non-participants and examined the effect of MDT care on patient characteristics.

MATERIALS AND METHODS:

In this study, 19,513 patients with newly diagnosed oral cavity cancer were recruited from 2004 to 2007 in Taiwan. Matching based on the propensity of receiving MDT care was used. In total, 9297 patients were observed until 2008. A Cox proportional hazards model was applied to elucidate the relative risks of death.

RESULTS:

The relative risk of death was lower for patients with MDT care than for those without such care (HR=0.84; 95% CI=0.78-0.90). Males had a higher risk of death than females (HR=1.20; 95% CI=1.04-1.38). Older age, lower income, and more severe comorbidity were associated with a higher risk of death. The effect of MDT care was stronger for older patients than for younger patients. Patients treated in public hospitals had a 1.24-fold (95% CI=1.13-1.36) higher risk of death than patients treated in private hospitals. Patients treated in hospitals or by attending physicians with higher service volumes had a lower relative risk of death (HR=0.89 and 0.78, respectively). The effect of MDT care was strong among patients with less severe comorbidities and patients without catastrophic illnesses.

CONCLUSION:

The relative risk of death was lower for MDT care participants. The effect of MDT care was stronger among older patients and patients with fewer comorbidities.

Background

The purpose of this study was to explore the possible association between coronary artery disease (CAD) risk and cervical cancer.

Methods

We used data from the National Health Insurance system of Taiwan to address the research topic. The exposure cohort contained 728 patients with cervical cancer. Each cancer patient was randomly frequency-matched with 4 participants by age, index-month, and index-year from the general population who did not have a cancer history before the index date (control group). Cox's proportion hazard regression analyses were conducted to estimate the relationship between cervical cancer and CAD risk.

Results

Among patients with cervical cancer, the overall risk for developing CADs was significantly lower than that of the control group [adjusted hazard ratio (aHR): 0.57, 95% confidence interval (95% CI): 0.41–0.79]. Further analyses revealed that the lower risk was observed only in patients with older age (aHR: 0.57, 95% CI: 0.40–0.82), a shorter follow-up duration (aHR: 0.47, 95% CI: 0.31–0.72), or with estrogen supplements (aHR: 0.39, 95% CI: 0.22–0.68).

Conclusions

The findings from this population-based study suggest that estrogen supplements are associated with a decreased CAD risk in patients with cervical cancer.

AIM:

To investigate the risk factors and comorbidities associated with ethambutol-induced optic neuropathy (EON).

METHOD:

Using the Taiwan Longitudinal Health Insurance Database, we conducted a study within a nationwide representative cohort of patients treated with EMB. We identified 231 patients newly diagnosed with EON between 2000 and 2008, and 924 control subjects. Adjusted OR by estimating the risk of EON in relation to comorbidities and EMB prescription protocol was determined.

RESULTS:

Compared with the control group, EON patients were at risk with older age, hypertension (adjusted OR=1.62, 95% CI 1.16 to 2.26) and renal diseases (without end-stage renal diseases (ESRD), adjusted OR=2.11, 95% CI 1.02 to 4.35; with ESRD, adjusted OR=3.73, 95% CI 1.79 to 7.74). Patients with an EMB prescription duration longer than 3 months were not at elevated risk compared with those whose prescription less than 3 months (OR=1.35, 95% CI 0.99 to 1.83, adjusted for age, sex, hypertension and renal diseases). Patients whose average daily dose was greater than 1200 mg, compared with the other two groups (800~1199 mg, less than 800 mg) were not at increased risk for EON.

CONCLUSIONS:

Age, hypertension and renal diseases are risk factors for EON in the Taiwanese population.

OBJECTIVES:

The increasing use of complementary, alternative medicine (CAM) and traditional Chinese medicine (TCM) has attracted attention. We report on the gender difference in TCM use among the general population in Taiwan in a population-based, cross-sectional study.

METHODS:

We collected data on socio-demographic factors, lifestyle and health behavior from the 2001 Taiwan National Health Interview Survey. The medical records of interviewees aged 20-69 years were obtained from National Health Insurance claims data with informed consent. The prevalence of TCM use and the average frequency of TCM use were compared between women and men.

RESULTS:

Among 14,064 eligible participants, the one-year prevalence of TCM use for women and men was 31.8% and 22.4%, respectively. Compared with men, women had a higher average TCM use frequency (1.55 visits vs. 1.04 visits, p<0.001). This significant difference remained evident after excluding gender-specific diseases (1.43 visits vs. 1.03 visits, p<0.001). The average TCM use frequency was significantly higher in women than in men across all age groups. TCM use correlates differed for women and men. Marital status (odds ratio [OR] = 1.55, 95% confidence interval [CI] = 1.30-1.85), family income and unhealthy lifestyle (OR = 1.50, 95% CI = 1.30-1.74) were factors associated with TCM use in men but not in women.

CONCLUSIONS:

In Taiwan, women used more TCM services than men and the gender differences in the TCM use profile persisted across age groups.