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Background Previous studies have suggested relationship between diverticular disease and cardiovascular disease. Since cardiovascular disease and cerebrovascular accident share a lot of pathogenesis, diverticulitis could also be a risk factor for stroke. This study tried to establish epidemiological evidence of the relationship between colon diverticulitis and ischemic stroke. Methods In this retrospective cohort study, patients with newly diagnosed colon diverticulitis (N = 6238) and patients without colon diverticulitis (control group; N = 24 952) were recruited between January 1, 2000, and December 31, 2017. Both groups were matched by propensity score at a 1:4 ratio by age, sex, comorbidities and medications. Cox proportional hazard regression was applied to estimate the hazard ratio (HR) and 95% confidence interval (CI) of ischemic stroke. We also conducted 4 different regression models and 2 sensitivity analyses to test the robustness of our findings. Results The diverticulitis group had a higher risk of IS than the control group (adjusted HR, 1.25; 95% CI, 1.12–1.39; P < 0.001). Serial sensitivity analyses yielded consistent positive link between diverticulitis and IS. Further subgroup analysis showed that in the study group, the risk of IS was 2.54-fold higher than the matched controls in 30–39 years. Conclusions Our study found that colon diverticulitis was associated with a higher risk of developing subsequent ischemic stroke, especially for patients aged 30–39 years, among Asian population. This result provides us a chance to undertake preventive measures for ischemic stroke in high-risk patients. Key message What is already known on this topic? Cardiovascular disease and cerebrovascular accident share a lot of pathogenesis. Previous studies have suggested relationship between diverticular disease and cardiovascular disease. What this study adds? Our study shows that diverticulitis was associated with higher risk of subsequent ischemic stroke, but not hemorrhagic stroke, especially for patients of younger age. The risk of ischemic stroke was 2.54-fold higher than the matched controls in 30–39 years. How this study might affect research, practice or policy? The risk of ischemic stroke in diverticulitis patients receiving colectomy seems to be ameliorated. Clinically, this gives us a chance to undertake preventive measures and reduce mortality and morbidity resulting from strokes in young adults. [ABSTRACT FROM AUTHOR]

Purpose: Low-dose aspirin was associated with a reduced risk of breast cancer in women with diabetes. However, whether the protective effect of aspirin varies as a function of the hormone receptor status of breast cancer remained an unanswered question. This study aims to explore the association between aspirin use and the risk of specific breast cancer subtypes in women with diabetes. Methods: Population-based retrospective cohort study of women with diabetes, using the Taiwan National Health Insurance reimbursement database (year 1998 to 2011). Patients diagnosed to have diabetes with new low-dose aspirin use (75–165 mg per day) for at least 28 days of prescription were identified as the study population, while patients without low-dose aspirin use were selected as controls. The main outcome measure was breast cancer by aspirin use and hormone receptor status. Results: We studied a total of 148,739 patients with diabetes. Their mean (standard deviation) age was 63.3 (12.8) years. During follow-up, a total of 849 breast cancers occurred, including 329 hormone receptor-positive and 529 hormone receptor-negative tumors. A total of 27,378 patients were taking aspirin. The reduction in risk with aspirin use was seen among those with hormone receptor-positive breast cancer (Hazard ratio [HR]: 0.73; 95% confidence interval [CI]: 0.59–0.91) but not for women with hormone receptor-negative breast cancer (HR: 0.88; 95% CI: 0.74–1.05). A cumulative dose of aspirin use of more than 8,600 mg was found to reduce the risk of hormone receptor-positive breast cancer by 31% (HR: 0.69; 95% CI: 0.50–0.97). A cumulative dose of aspirin use of more than 88,900 mg was found to reduce both the risk of hormone receptor-positive and negative breast cancer. Conclusion: These data add to the growing evidence that supports the use of low-dose aspirin as a potential chemopreventive agent for specific subtypes of breast cancer. Further studies are necessary to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Both inflammatory bowel disease (IBD) and chronic rhinosinusitis (CRS) are characterised by dysregulated immune responses. Though previous studies have demonstrated the coexistence of IBD and CRS, investigations of their association using large sets of epidemiologic data are lacking. Methods: We examined IBD and the subsequent risk of CRS in a nationwide setting. For 1 January 2000 to 31 December 2010, we identified in the National Health Insurance Dataset of Taiwan a total of 8313 patients over the age of 20 years with IBD. We randomly extracted 33 252 cases without IBD to create a comparison group matching patients by age, sex and index year. Cumulative incidences were obtained using the Kaplan‐Meier method, and we calculated risk estimates for the development of CRS using the Cox proportional hazards model. Results: In 295 007 person‐years, we identified 521 (1.25%) cases of IBD. The IBD cohort had a 1.26‐fold (95% confidence interval [CI], 1.17‐1.35) greater risk of developing CRS than the comparison group; for ulcerative colitis, it was 1.73‐fold (95% CI, 1.48‐2.05) and for Crohn's disease it was 1.20‐fold (95% CI = 1.11‐1.29). Subsequent analysis stratified by age revealed that the risk was highest among the population with IBD aged 50 to 64 years (adjusted hazard ratio = 1.37; 95% CI, 1.18‐1.59). A follow‐up‐specific analysis demonstrated that the risk appeared to be highest with a follow‐up duration of less than 2 years. Conclusion: The present analysis indicates that personal history of IBD, especially the phenotype ulcerative colitis, is associated with increased risk of subsequent CRS. [ABSTRACT FROM AUTHOR]

Introduction: Both cardiovascular diseases (CVD) and osteoporosis are common comorbidities in rheumatoid arthritis (RA) patients. Although accumulating evidence indicates a link between CVD and osteoporotic fracture, whether CVD contributes to osteoporotic fracture risk in RA has yet to be explored. We examined the incidence rate and risk factors of osteoporotic vertebral fracture in RA patients with new-onset CVD (RA-CVD) and evaluated the effects of medications on such fracture risk. Methods: A retrospective study was conducted using a nationwide database from 2000 to 2010: 1267 RA-CVD and 1267 non-CVD patients were enrolled from 30,507 patients with newly diagnosed RA. The main outcome was the development of osteoporotic vertebral fracture. After being adjusted for age, gender, and comorbidities, the Cox proportional hazard model was used to identify independent factors contributing to osteoporotic vertebral fracture. Results: The adjusted hazard ratio (aHR) of developing osteoporotic vertebral fracture was 1.47-fold greater in RA-CVD group than in non-CVD group (95% confidence interval 1.19–1.81, p < 0.001). Both the age above 40 years and female gender were significant risk factors for developing osteoporotic vertebral fracture in RA-CVD patients. Using patients not taking medication as a reference group, the aHR of osteoporotic vertebral fracture was significantly lower in those receiving statins (0.50), low-dose corticosteroids (0.57), or hydroxychloroquine (0.12). Conclusions: The risk of osteoporotic vertebral fracture was significantly increased in RA-CVD patients, particularly women above 40 years of age, and could be reduced by statin therapy. However, the protective effect of low-dose corticosteroids or hydroxychloroquine on osteoporotic vertebral fracture risk needs further validation. [ABSTRACT FROM AUTHOR]

Rosacea is a chronic inflammatory skin disorder linked to various mental disorders, but little is known about the impact of rosacea on sleep disorders. The aim of this study is to confirm the association of rosacea with sleep disorders using a large administrative data set. This nationwide population-based retrospective cohort study enrolled 1129 individuals with rosacea and 11 017 age- and sex-matched controls without rosacea from the Korean National Health Insurance System database from 2002 to 2015. The prevalence of sleep disorder (7.8%) was significantly higher in patients with rosacea than in controls (5.81%; p < 0.001). Rosacea was associated with an increased risk of sleep disorder (adjusted odds ratio [aOR], 1.287 [95% confidence interval (CI), 1.022-1.623]). Among a variety of sleep disorders, patients with rosacea were likely to have an increased risk of insomnia (aOR, 1.318 [95% CI, 1.002-1.743]). In subgroup analysis, female patients with rosacea (aOR, 1.297 [95% CI, 1.010-1.722]) and those with rosacea and dyslipidemia (aOR, 1.417 [95% CI, 1.062-1.891]) were at a higher risk of having a sleep disorder. Rosacea is associated with an increased risk of having sleep disorders. The management of modifiable risk factors is important for managing sleep disorders in patients with rosacea., (© 2023 Japanese Dermatological Association.)

Background The incidence of the inflammatory bowel diseases (IBD), ulcerative colitis (UC) and Crohn's disease (CD), has been increasing in Asia. We probed the nationwide registered database to assess the incidence, prevalence, gender distribution, age of diagnosis and the survival status of IBD patients in Taiwan. Methods A retrospective study was conducted to analyze the registered database compiled by the National Health Insurance provided by the Department of Health, Taiwan, from January 1998 through December 2008. Results A total of 1591 IBD patients were registered from 1998 to 2008 in Taiwan (CD: 385; UC: 1206). The incidence of CD increased from 0.19/100,000 in 1998 to 0.24/100,000 in 2008. The incidence of UC increased from 0.61/100,000 in 1998 to 0.94/100,000 in 2008. The prevalence of CD increased from 0.19/100,000 in 1998 to 1.78/100,000 in 2008. The prevalence of UC increased from 0.61/100,000 in 1998 to 7.62/100,000 in 2008. Male to female ratio for CD was 2.22 and 1.64 for UC. Age of registered for CD was predominantly between 20 to 39, and for UC between 30 to 49 years of age. The standardized mortality ratio (95% CI) was 4.97 (3.72-6.63) for CD and 1.78 (1.46-2.17) for UC, from 1998 to 2008 in Taiwan. Conclusions Using the Taiwan nationwide database for IBD, the incidence and prevalence of IBD in Taiwan significantly increased from 1998 to 2008. The mortality rate was higher for CD patients than UC patients, and both were higher than the general population. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the nationwide stillbirth rate and explore the potential risk factors associated with stillbirths. Patients and methods: Data from vital registrations during the time period from January 1, 2001 through to December 31, 2004 in Taiwan were used. Stillbirth was defined as fetal death with more than 20 completed weeks’ gestational age (GA) or with birth weight more than 500 g if the GA was not known. Results: There were a total of 8481 stillbirths identified nationwide between January 1, 2001 and December 31, 2004. The stillbirth rate was nine per 1000 total births in the study period, and the proportionate decline was nearly 48.8% in the most recent decade. There was a significant increase in average maternal age during this period. Advanced maternal age and teenage pregnancy were independent significant risk factors for stillbirths even after accounting for the effects of medical conditions that were more likely to occur among these particular age groups. Those fetuses that had been exposed to cord prolapse, maternal cervical incompetence and oligohydramnios/polyhydramnios were especially vulnerable. By contrast, women who had foreign nationality, fetal ultrasound surveys, fetal heart beat monitoring and hastened parturition were less likely to have stillbirth. Conclusion: The stillbirth rate in Taiwan has remained high despite advancements in medical care. Prenatal evaluation of high risk women may decrease the adverse fetal outcomes. [ABSTRACT FROM AUTHOR]

Objective: This nationwide study aimed to investigate the association between newly diagnosed systemic sclerosis (SSc) and previous appendicitis history. Methods: A total of 1595 patients who were newly diagnosed with SSc were recruited as the SSc cases from the 2003 to 2012 claims data of the entire population in Taiwan. The other 15,950 individuals who had never been diagnosed with SSc during 2003 and 2012 were selected as the non-SSc controls to match the SSc cases. We defined that the index date as the first date of SSc diagnosis of SSc cases and the first date of ambulatory visit for any reason of non-SSc controls. Conditional logistic regression analysis was applied for the association between appendicitis and the risk of the incident SSc, tested by estimating odds ratios (ORs) with 95% confidence intervals (CIs). Potential confounders, including the Charlson comorbidity index (CCI), a history of periodontal disease, salmonella infection, and intestinal infection, were controlled. We further designed sensitivity analyses by varying the definition of appendicitis according to the status of receiving primary appendectomy. Results: The mean age was 51 years in the case and control groups. Females accounted for 77.5%. A total of 17 (1.1%) out of 1595 SSc cases and 81 (0.5%) out of 15,950 non-SSc controls had a history of appendicitis before the index date had a history of appendicitis. A significant association between appendicitis and the risk of SSc was confirmed (OR, 2.03; 95% CI, 1.14–3.60) after adjusting potential confounders. CCI ≥ 1 (OR, 8.48; 95% CI, 7.50–9.58) and periodontal disease (OR, 1.55; 95% CI, 1.39–1.74) were also significantly associated with the risk of SSc. The association between appendicitis and SSc risk remained robust using various definitions of appendicitis. Conclusion: Our study demonstrated appendicitis was associated with the incident SSc. CCI ≥ 1 and periodontal disease also contributed to the risk of developing SSc. [ABSTRACT FROM AUTHOR]

Objective/hypothesis: To investigate the risk of nasal septal abscess (NSA) in patients with type 2 diabetes mellitus (T2DM) after septoplasty., Study Design: Retrospective cohort study through Taiwan National Health Insurance database., Methods: The Taiwan National Health Insurance Research Database was used to conduct this retrospective cohort study. A total of 382 patients with T2DM (DM group) diagnosed between 2000 and 2010 and 382 matched patients without a DM diagnosis (non-DM group) were enrolled. Patients were followed up until death or December 31, 2013. NSA incidence was the main outcome., Results: After septoplasty, the cumulative incidence of NSA in the DM group was significantly higher than that in the non-DM group (P < .001). Cox proportional hazards regression indicated a significant association between T2DM and higher NSA incidence (adjusted hazard ratio, 2.62; 95% CI, 1.44-3.61; P < .001). However, subgroup analysis and sensitivity testing demonstrated that the effect of T2DM on NSA risk was stable. In addition, the subgroup with a Diabetes Complications Severity Index (DCSI) of ≥1 had higher NSA risk than that with DCSI = 0 (adjusted hazard ratio, 3.58; 95% CI, 2.10-6.09; P < .001). The treatment type for NSA did not differ between the groups., Conclusions: T2DM is an independent risk factor for NSA in patients undergoing nasal septoplasty, and the NSA risk is greater among patients with high DM severity., Level of Evidence: IV Laryngoscope, 131:E2420-E2425, 2021., (© 2020 American Laryngological, Rhinological and Otological Society Inc, "The Triological Society" and American Laryngological Association (ALA).)

Both periodontal disease (PD) and inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are important diseases of the alimentary tract. Microbiome and immune-mediated inflammatory processes play important roles in these diseases. An association between PD and IBD may exist. This study investigated the risk of IBD in patients with PD. This study used data from the National Health Insurance Research Database of Taiwan from 1996 to 2013. A total of 27,041 patients with PD were enrolled as a study group, and 108,149 patients without PD were selected as the control group after matching by gender, age, insured region, urbanization, and income with a 1:4 ratio. Cox proportional hazards regression was used to calculate the risk of IBD. Of the 135,190 participants enrolled in this study, 5392 (4%) with newly diagnosed IBD were identified. The overall incidence of subsequent IBD was similar in both groups (3.8% vs. 4%, adjusted hazard ratio (aHR) = 1.01, 95% confidence interval (CI): 0.94⁻1.08). However, an increased risk of UC in the PD group was found after adjusting confounding factors (aHR: 1.56, 95% CI: 1.13⁻2.15; p < 0.05). This study demonstrated that patients with PD had approximately one-half higher risk of subsequent UC. Further studies are warranted to elucidate the relationship between PD and UC.

Solid organ transplantation has become the therapy of choice for patients with end-stage organ disease. The frequently transplanted organs in Taiwan include liver, kidney, heart, and lung, and the success rate has improved significantly worldwide for the past decades. However, organ recipients are known to be at a higher risk of post-transplant infections and de novo cancer due to immunosuppression and oncogenic viral infections. Organ recipients are known to be at a two- to fourfold increased risk of cancer and the risks are particularly high for malignancies caused by viral infections, including post-transplant lymphoproliferative disorders via Epstein-Barr virus, Kaposi sarcoma via Kaposi sarcoma herpesvirus, anogenital cancers via human papillomavirus, and hepatocellular carcinoma via hepatitis B and C virus. Population-based cohort studies may help better understand the pattern of infection and cancer risk in transplant recipients and clarify the role of the immune system, infection, and risk factors in the development of malignancy. Improvement of surgical techniques, advancement of immunosuppressant therapy in addition to early detection and prevention of infection, and regular surveillance of de novo cancer after transplantation have become the mainstay of successful organ transplantation., (Copyright © 2016. Published by Elsevier B.V.)

Background and Objectives: Atopic dermatitis (AD) is a chronic relapsing dermatitis of unknown etiology. It is thought that abnormal regulation of Th1 and Th2 is not only the major cause of AD, but also the vital pathogenesis of many autoimmune diseases. To date, no large-scale studies have been performed on the relationship between AD and autoimmune disease. By conducting a nationwide population-based study with case-controls in Taiwan, we sought to clarify the association of AD with other autoimmune diseases to obtain a better understanding of its pathogenesis., Methods: Data were obtained from the National Health Insurance Research Database (NHIRD) of Taiwan from 1997 to 2010. In total, 41950 patients with AD and 167800 age- and gender-matched controls were enrolled., Results: Patients with AD tended to have a high risk of associated lupus erythematosus (LE) (OR: 1.94, 95% CI: 1.48-2.54). The risk of LE was higher in female AD patients (OR: 2.05, 95% CI: 1.53-2.76) than in male AD patients (OR: 1.48, 95% CI: 0.76-2.85). Juvenile patients younger than 18 yrs with AD had higher risk of LE (OR: 3.02, 95% CI: 1.30-7.03) than adult patients with AD (OR: 1.68, 95% CI: 1.26-2.24)., Conclusions: Our study confirmed the association between AD and LE. Early survey for LE in juvenile patients with AD is recommended., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)