The association between herpes zoster (HZ) infection and subsequent risk of end stage renal disease (ESRD) in chronic kidney disease (CKD) patients is unknown. We aim to conduct a population-based cohort study to investigate the risks of developing ESRD after a HZ attack in CKD patients. From the Taiwan National Health Insurance Research Database, we identified 1,144 CKD patients who had HZ over the period 1997-2008 as HZ cohort. We selected 3,855 age- and sex-matched CKD patients without HZ as comparison cohort. All subjects were followed until the end of 2008 or censored. Cox-proportional hazard regression model was used to estimate the effects of HZ on ESRD risks. A total of 396 patients developed ESRD during the follow-up period, of which 108 subjects were from the HZ cohort and 288 from the comparison cohort. The log-rank test demonstrated that the HZ cohort had significantly higher risk of developing ESRD than the comparison cohort (P = 0.0071). The adjusted hazard ratio of subsequent ESRD in the HZ cohort was 1.36 (95 % CI 1.09-1.70) and the hazard ratio increased to 8.71 (95 % CI 5.23-14.5) if the HZ cohort was with concomitant diabetes and hypertension. CKD patients with HZ are at an increased risk of subsequent ESRD. CKD patients with HZ, diabetes, and hypertension have extremely high risk of developing ESRD.

OBJECTIVES:

To determine whether irritable bowel syndrome (IBS) is associated with an increased risk for the subsequent colorectal cancer (CRC).

METHODS:

We identified 91,746 patients who were diagnosed with IBS between 2000 and 2010 from the Taiwan National Health Insurance Research Database (NHIRD) as the study cohort, and randomly extracted the data of 183,492 patients matched by sex, age, and baseline year for the comparison cohort. The follow-up period was terminated after CRC development, withdrawal from the national health insurance (NHI) system, or at the end of 2010. Cumulative incidences and hazard ratios (HRs) of CRC development were determined.

RESULTS:

During the first 2years of follow-up, the subsequent CRC incidence rates in the IBS and comparison cohorts were 37.3 and 5.61 per 10,000person-years, respectively (adjusted HR, 6.72; 95% CI, 5.70-7.92; p<.0001). Thereafter, the risk did not differ significantly between the 2 cohorts (adjusted HR, 1.08; 95% CI, 0.93-1.26); the participants in the IBS cohort commonly underwent more colonoscopies/sigmoidoscopies than did the non-IBS cohort.

CONCLUSIONS:

IBS was not associated with the long-term development of CRC in Taiwan. The increased risk of CRC in the first 2years may have occurred because some CRC patients were initially misclassified as IBS patients.

AIM:

The frequency of employing radiography is increasing. Long-term risks of performing X-ray procedures on children and adolescents for medical diagnosis have raised significant concerns.

METHODS:

In this study, we adopt the case-control methodology to evaluate the relationship between the incidence rate of acute leukaemia and exposure to radiation during diagnostic X-ray examinations for children. Based on 1998-2010 data obtained from the Taiwan Bureau of National Health Insurance database, we selected 58 children with leukaemia and randomly selected an additional 232 children as the control group.

RESULTS:

The mean age of children with leukaemia is 8.92 ± 5.24 years. The risk of leukaemia in children who underwent X-ray examinations increased 2.14-fold (95% CI, 1.18-3.87). In this study, we identified that, when undergoing X-ray examinations, the risk of leukaemia in children increased for both sex and age groups. Specifically, the relationship between leukaemia and X-ray in boys (OR = 3.28, 95%CI, 1.33-8.07) and in ages of 6 to 11 years (OR = 2.58, 95%CI, 1.09-6.10) was significant. Overall, the risk of leukaemia in children who underwent X-ray examinations progressively increased from a ratio of 1.65 to 3.14. Moreover, an identical trend was observed for boys (1.85 to 6.42).

CONCLUSION:

Exposure to X-ray increased the risk of leukaemia in children.

BACKGROUND AND PURPOSE:

Migraine and irritable bowel syndrome (IBS) share many similarities characterized by their epidemiology, periodic pain, lack of definable organic causes, trigger factors, comorbidities and proposed pathophysiology. In this retrospective case-control study, the association between migraine and IBS was investigated using a nationwide population-based database in Taiwan.

METHODS:

The data were retrieved from the National Health Insurance Research Database (NHIRD) of Taiwan. In all, 14 117 newly diagnosed migraine cases were identified in a subset of the NHIRD and 56 468 migraine-free individuals were randomly selected as the comparison cohort. The multivariate Cox proportional hazards regression model was used to explore the risk of IBS in migraine sufferers after adjusting for demographic characteristics and comorbidities.

RESULTS:

After adjusting for the covariates, the incidence of IBS was 1.95-fold higher in the migraine cohort than in the comparison cohort (73.87 vs. 30.14 per 10 000 person-years). The adjusted cumulative incidence of IBS was also higher in the migraine group than in the control group in the follow-up years (log-rank test, P < 0.0001). In addition, the risk was most prominent in the youngest group (<30 years old), exhibiting a 3.36-fold increased risk (95% confidence interval 2.44-4.63) of IBS compared with the migraine-free cohort. Moreover, the incidence of IBS in migraine sufferers tended to increase with the frequency of migraine diagnoses.

CONCLUSION:

The current population-based study demonstrated that migraine is associated with an increased risk of IBS after adjusting for comorbidities, particularly in the young population.

BACKGROUND:

Obstructive sleep apnea (OSA) is a major contributor to cardiovascular disease, and may cause severe morbidity and mortality. Recent studies have indicated that OSA patients exhibited elevated platelet activity, fibrinogen levels, and platelet aggregation.

OBJECTIVES:

We investigated the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients diagnosed with OSA compared with age- and sex-matched unaffected people.

PATIENTS/METHODS:

This longitudinal, nationwide, population-based cohort study was conducted using data from Taiwan National Health Insurance Research Database (NHIRD) recorded between January 2000 and December 2011. The study consisted of 3511 patients with OSA and 35110 matched comparison individuals. A Cox proportional hazard regression was used to compute the risk of DVT and PE in patients with OSA compared with those without OSA.

RESULTS:

The DVT and PE risks were 3.50- and 3.97-fold higher (95% CI=1.83-6.69 and 1.85-8.51) respectively, in the OSA cohort than in the reference cohort after we adjusted for age, sex, and comorbidities.

CONCLUSION:

This nationwide population-based cohort study indicates that patients with OSA exhibit a higher risk of subsequent DVT and PE.