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Background: Kawasaki disease (KD) is the most important acquired heart disease in children. This study investigated annual incidence, seasonality, secular trend and the correlation of KD incidence with viral activity in Taiwan. Methods: Through the national health insurance database, we identified KD during 2001–2020. The viral activity was obtained from nationwide surveillance database. We analyzed KD age-specific annual incidence, secular trends, seasonality and the correlation between KD incidence and common enteric or respiratory viral activity. Results: The KD incidence of subjects younger than 18 years significantly increased from 2001 to 2020 (11.78 and 22.40 per 100,000 person-years, respectively), and substantially decreased with age. Infants younger than 1 year presented the highest KD annual incidence at 105.82 to 164.34 per 100,000 person-years from 2001 to 2020. For all KD patients, the most frequently occurring season was summer followed by autumn. The KD incidence of infants younger than 1 year had significantly positive correlation with enteric (r = 0.14) and respiratory (r = 0.18) viral activity. Conclusions: This study demonstrates the increasing trend of KD annual incidence and seasonality (more in summer and autumn) in Taiwan. The activity of common respiratory and enteric viruses was significantly correlated with KD incidence in infants. [ABSTRACT FROM AUTHOR]

Recent studies have demonstrated a global decline in the age at menarche. Our study aimed to determine the age at menarche of Taiwanese women born between 1943 and 1989. Data were obtained from the Taiwan Biobank. To view the trends in age at menarche, we analyzed data from 74,799 women. The mean, standard deviation, and annual percentage change in age at menarche were calculated for birth-year cohorts. The mean age at menarche of Taiwanese women born in 1943 was 14.85 years. The age at menarche decreased to 12.20 years for those born in 1989. The mean age at menarche declined by 2.65 years across the 47-year study period; hence, the reduction rate was 0.56 years per decade. This study demonstrated a downward secular trend in the age at menarche of Taiwanese women born between 1943 and 1989. This trend occurred in three stages of decline: fast (1943–1953), slow (1953–1965), and moderate (1965–1989). The age at menarche decreased by 2.65 years among Taiwanese women born in 1943 compared with those born in 1989. This decline occurred in three stages: fast (1943–1953), slow (1953–1965), and moderate (1965–1989). This significant downward secular trend in age at menarche reflects Taiwan's socioeconomic development. [ABSTRACT FROM AUTHOR]

Osteoporosis is a common metabolic bone disease that benefits from many newly developed anti-osteoporosis medications (AOMs). Reimbursement policies need to allocate medical budgets properly based on evidence-based data. This study aimed to investigate the 11-year secular trend, focusing on older age and males in this adjustment wave of the National Health Insurance reimbursement. We adopted a nationwide cohort from Taiwan's National Health Insurance Research Database (NHIRD). Patients undergoing newly initiated AOMs from 2008 to 2018 were included. The AOMs in this study included denosumab, zoledronate, ibandronate, alendronate, raloxifene, and risedronate. Patients <50 years, pathological fractures, missing data, and two AOMs prescribed were excluded. The real-world trends related to subsequent fragility fracture and death within 1 and 3 years were used to evaluate the potential effects due to revision of reimbursement policies. Of 393,092 patients, among them, 336,229 patients met the criteria, whose mean age ranged from 73.3 to 74.4 years, and nearly 80% were female. Further analysis showed a steady increase of AOMs from 5567 (17.1%) and 8802 (27.0%) in 2008–6697 (18.3%) and 10,793 (29.5%) in 2018 for males and 80+ years respectively. The subsequent fragility fracture within one and three years post AOMs initiation was 5.81% and 11.80% in 2018. This study showed an immediate drop in AOMs prescription after the implementation of a new stricter reimbursement policy. It took 5 years to return the annual prescription number. [ABSTRACT FROM AUTHOR]

In a country with a high prevalence of cigarette smoking, betel chewing, and alcohol drinking, cancers of the oral cavity, nasopharynx, and larynx were the fourth, twelfth and seventeenth leading causes of cancer death, respectively, for men in 2020. We analyzed patients with head and neck cancer from 1980 to 2019 from the Taiwan Cancer Registration Database and discussed the annual average percent change, average percent change, age period, and birth cohort. Obvious period effects and birth effects are seen in oral, oropharyngeal, and hypopharyngeal cancer; however, the most significant period effect was seen between 1990 and 2009, which mainly reflects the consumption of betel nuts per capita. In addition, the period effect lessens after 2010 in oral cancer and hypopharyngeal cancers, while oropharyngeal cancers remain an obvious period effect, which results from the rising prevalence of HPV. Due to the high prevalence rate of betel quid chewing and cigarette smoking in the 1990s, the government executed several acts. As a result, the age-adjusted incidence rates of oral, oropharyngeal, and hypopharyngeal cancers have flattened since 2010, which can be explained by the declining cigarette smoking rate. The strict policy indeed shows an obvious effect on the head and neck cancer incidence rates, and we expect to see a further decline in the future. [ABSTRACT FROM AUTHOR]

• Hip fracture incidences varied substantially in Asia-pacific countries/regions. • Australia, Taiwan and Japan had the highest crude rates. • Korea and Japan had the highest age- and sex- standardized rates. • The female-to-male ratio was highest in Japan and lowest in China. • Temporal decreases in standardized rates were observed in Korea, China and Japan. This systematic review aimed to update fragility hip fracture incidences in the Asia Pacific, and compare rates between countries/regions. A systematic search was conducted in four electronic databases. Studies reporting data between 2010 and 2023 on the geographical incidences of hip fractures in individuals aged ≥50 were included. Exclusion criteria were studies reporting solely on high-trauma, atypical, or periprosthetic fractures. We calculated the crude incidence, age- and sex-standardised incidence, and the female-to-male ratio. The systematic review was registered with PROSPERO (CRD42020162518). Thirty-eight studies were included across nine countries/regions (out of 41 countries/regions). The crude hip fracture incidence ranged from 89 to 341 per 100,000 people aged ≥50, with the highest observed in Australia, Taiwan, and Japan. Age- and sex-standardised rates ranged between 90 and 318 per 100,000 population and were highest in Korea and Japan. Temporal decreases in standardised rates were observed in Korea, China, and Japan. The female-to-male ratio was highest in Japan and lowest in China. Fragility hip fracture incidence varied substantially within the Asia-Pacific region. This observation may reflect actual incidence differences or stem from varying research methods and healthcare recording systems. Future research should use consistent measurement approaches to enhance international comparisons and service planning. [ABSTRACT FROM AUTHOR]

Recent blood distribution profiles for transfusions in Taiwan have not been comprehensively documented. This study aimed to analyze trends in red blood cell (RBC), platelet, and plasma distribution rates, and compares these profiles with those in other countries. The distribution rates of RBC, platelets, and plasma in Taiwan during 2015 were 47.6, 11.1, and 26.8 units per 1000 population, respectively. At least 1.5 and 2.5-fold higher platelet and plasma distribution rates were observed than other selected countries. During 2007-2015, there was no significant change in RBC distribution. However, we observed a significant increase of 0.20 (95% CI: 0.11-0.30) adult doses of platelets, and a significant decrease of 1.69 (95% CI: 1.45-1.93) units of plasma per 1000 population per annum. Seven other countries showed a general significant decreasing trend of RBC distributions. Higher blood distribution rates were observed in Taiwan. Therefore, the adoption of patient blood management is essential. [ABSTRACT FROM AUTHOR]

Objectives: To depict recent secular trend (2001-2005) in prevalence of depression among diabetic population in Taiwan, and to explore the influences of urbanization on the prevalence of depression. Study design: A descriptive correlation study design relating urbanization and prevalence of depression. Methods: Annual prevalence of depression was calculated as the ratio of number of individuals with depression (ICD-9-CM: 296, 309, or 311) to the size of diabetic population (ICD-9-CM: 250), which were ascertained from ambulatory care claim data of Taiwan's National Health Insurance between 2001 and 2005. Multivariate Poisson regression analysis was used to assess the secular trend in the prevalence of comorbid depression, and to appraise the influence of urbanization on prevalence of depression in diabetic patients. Results: The prevalence of depression among diabetic population increased annually from 22.6/10³ in 2001 to 27.0/10³ in 2005 with a significantly and linearly rising trend (β = 0.0461, p < 0.0001). Diabetic population living in urban areas showed the largest increase in prevalence (6.3/10³), followed by those from rural areas (5.6/10³). Compared to the diabetic patients residing in rural areas, those living in urban areas (RR = 1.28, 95% CI = 1.25--1.31) and those from satellite towns (RR = 1.22, 95% CI = 1.19-1.25) both had significantly increased adjusted RR. Conclusions: There is a significant increasing trend in prevalence of depression among diabetic population in recent years in Taiwan. Diabetic patients from urban areas not only had the greatest prevalence of depression but also showed the largest increase in prevalence during the study period, which highlights a need for managing depression in urban diabetes. [ABSTRACT FROM AUTHOR]

Background: Device-associated infection (DAI) plays an important part in nosocomial infection. Active surveillance and infection control are needed to disclose the specific situation in each hospital and to cope with this problem effectively. We examined the rates of DAI by antimicrobial-resistant pathogens, and 30-day and in-hospital mortality in the intensive care unit (ICU). Methods: Prospective surveillance was conducted in a mixed medical and surgical ICU at a major teaching hospital from 2000 through 2008. Trend analysis was performed and logistic regression was used to assess prognostic factors of mortality. Results: The overall rate of DAIs was 3.03 episodes per 1000 device-days. The most common DAI type was catheter-associated urinary tract infection (3.76 per 1000 urinary catheter-days). There was a decrease in DAI rates in 2005 and rates of ventilator-associated pneumonia (VAP, 3.18 per 1000 ventilator-days) have remained low since then (p < 0.001). The crude rates of 30-day (33.6%) and in-hospital (52.3%) mortality, as well as infection by antibiotic-resistant VAP pathogens also decreased. The most common antimicrobial-resistant pathogens were methicillin-resistant Staphylococcus aureus (94.9%) and imipenem-resistant Acinetobacter baumannii (p < 0.001), which also increased at the most rapid rate. The rate of antimicrobial resistance among Enterobacteriaceae also increased significantly (p < 0.05). After controlling for potentially confounding factors, the DAI was an independent prognostic factor for both 30-day mortality (OR 2.51, 95% confidence interval [CI] 1.99-3.17, p = 0.001) and in-hospital mortality (OR 3.61, 95% CI 2.10-3.25, p < 0.001). Conclusions: The decrease in the rate of DAI and infection by resistant bacteria on the impact of severe acute respiratory syndrome can be attributed to active infection control and improved adherence after 2003. [ABSTRACT FROM AUTHOR]

Background/purpose: Diabetic ketoacidosis (DKA) is a fatal complication of diabetes, and is strongly related to the quality of diabetes care. This study aimed to establish recent secular trends of incidence density (ID) of DKA in patients with diabetes in Taiwan and to explore the effects of age and sex on the risk of a DKA emergency.Methods: Using the National Health Insurance claims data, we identified annual diabetic cohorts (around 650,000 diabetic patients annually) from 1997 to 2005, and searched for possible admissions due to DKA emergencies. We performed log-linear regression analysis to assess the trend in ID of DKA and to assess the independent effects of age and sex on the risk of DKA.Results: Although the annual ID of DKA showed a slight but significant declining trend over the study period, from 6/1000 to 5/1000 person-years, the age/sex-specific analysis indicated that female patients aged ≤ 34 years showed a significantly increasing trend. Multivariate analysis revealed that calendar year and sex had significant but small independent effects on risk of DKA admission. In contrast, age was strongly associated with risk of DKA emergency. Compared with patients aged > 65 years, notably high adjusted rate ratios (ARRs) of DKA were observed in patients aged <15 years (ARR = 48.84) and 15-34 years (ARR =15.21).Conclusion: Although the overall ID of DKA linearly decreased between 1997 and 2005, significant rising trends were still observed in female diabetic patients aged < 35 years. More aggressive diabetic care programs aimed at young female patients should be considered to reduce this emergency and possibly fatal diabetic complications. [ABSTRACT FROM AUTHOR]

Background: We examined cervical cancer incidence before and after nationwide cervical cancer screening was initiated in Taiwan in mid-1995.Results: The invasive cancer incidence decreased by 47.8% during 1995-2006. The carcinoma in situ incidence increased 1.7-fold during 1995-2000, and decreased by 19.6% during 2000-2006.Conclusion: The Taiwan national programme has significantly decreased invasive cervical cancer. [ABSTRACT FROM AUTHOR]

Summary Objectives: This study investigated the chronological trend of tow-birth weight in full-term babies (TLBW) in Taiwan in the 1980s and 1990s when the nation experienced a rapid economic advancement, and assessed the association between TLBW and parental education and marital status. Design: Data from liveborn singletons from Taiwan's birth registry, born between 1978 and 1997, were used to calculate overall and socio-economic factor-specific rates of TLBW for every 2-year interval in this 20-year period. Methods: Logistic regression models were used to assess the trend of TLBW rates, and the interaction between secular time, selected demographic factors and other predictors. Results: Among 6,159,070 full-term, liveborn singletons, 208,729 were TLBW. The average annual rate of TLBW was 3.39% in the study period. The period-specific TLBW declined monotonically from 4.41% in 1978-1979 to 2.49% in 1996-1997, representing a 43% deduction. Multiple logistic regression demonstrated persistent declining trends irrespective of the educational level or marital status of the parents. However, the decline was slower for populations of tower socio-economic status, such as less-educated parents and unmarried mothers, which enhanced the inequalities of TLBW risk across populations. The TLBW risk ratios of the least-educated mothers to the most-educated mothers increased from 1.43 in 1978-1979 to 2.05 in 1996-1997. Unmarried status was an independent predictor of elevated risk of TLBW. Conclusions: The association between socio-economic inequality and the risk of TLBW infants was sustained over the 1980s and 1990s in Taiwan. Interventions necessary to promote antenatal care and educational attainment, particularly for lower socio-economic and socially deprived populations in Taiwan. [ABSTRACT FROM AUTHOR]

Abstract: Background: While mortality from coronary heart disease (CHD) has declined substantially in most developed countries in recent decades, discordant rising trends have been observed in many developing and newly developed countries. In this study, we examined the trends of CHD mortality and its hospitalization rate, and correlated the trends with changes in major cardiovascular risk factors in Taiwan. Methods: Mortality data during the period 1971–2001 were obtained from official vital statistics. Hospitalization rates were calculated using information extracted from the National Health Insurance Database, which was available from 1996 to 2001. Changes in major cardiovascular risk factors were obtained from official statistics and review of previous epidemiologic studies. Results: In 2001, the age-standardized CHD mortality in Taiwan was 28.7 per 100,000 for men and 15.5 per 100,000 for women. For both men and women, age-adjusted CHD mortality increased slowly but steadily from 1971 to 1992, but after that, a downward trend was observed. Hospitalization rates for CHD, however, increased substantially from 1996 to 2001. Levels of per-capita cigarette consumption, dietary fat intake, body mass index, and prevalence of hypertension and diabetes had all increased over the past three decades. Conclusions: The overall cardiovascular risk profile has worsened in the general population in Taiwan. The decline in CHD mortality observed in recent years was most likely attributable to the improvement in acute cardiac care and medical treatment among patients with CHD. We anticipated that CHD incidence and prevalence would continue to rise in Taiwan. [Copyright &y& Elsevier]

Aim: To evaluate whether diabetic patients had a higher risk of colon cancer mortality and its associated risk factors., Methods: The sex-specific crude and age-standardized (to the 2000 World Health Organization population) mortality rates of colon cancer in the Taiwanese general population were first calculated from 1995 to 2006. The trends were evaluated by linear regression. A total of 113,347 diabetic men and 131,573 diabetic women aged ≥ 25 years at recruitment from 1995 to 1998 were followed up until the end of 2006. Age/sex-specific colon cancer mortality rate ratios were calculated comparing the mortality rates of the diabetic patients with the average mortality rates of the general population within 12 years (1995-2006). A sub-cohort of diabetic patients (42,260 men and 49,405 women) was interviewed using a baseline questionnaire and Cox's regression was used to evaluate the risk factors for colon cancer mortality in these diabetic patients., Results: The crude and age-standardized trends of colon cancer mortality from 1995 to 2006 increased significantly for both sexes in the general population. A total of 641 diabetic men and 573 diabetic women died of colon cancer, with a mortality rate of 74.4 and 54.3 per 100,000 person-years, respectively. Mortality rate ratios [95% confidence intervals (CIs)] showed a significantly higher risk of mortality from colon cancer for the diabetic patients compared to the general population, with the magnitude increasing with decreasing age: 1.65 (1.40-1.95), 2.01 (1.78-2.27), 2.75 (2.36-3.21) and 5.69 (4.65-6.96) for ≥ 75, 65-74, 55-64 and 25-54 years old, respectively, for men; and 1.46 (1.24-1.72), 2.09 (1.84-2.38), 2.67 (2.27-3.14) and 3.05 (2.29-4.06), respectively, for women. Among the sub-cohort of diabetic patients who had been interviewed with the baseline questionnaire, including information on age, sex, diabetes duration, diabetes type, body mass index, smoking, insulin use and area of residence, age and smoking were significantly predictive for colon cancer mortality, with respective adjusted hazard ratios (HRs) (95% CIs) of 1.077 (1.066-1.088) and 1.384 (1.068-1.792). Diabetes duration became a significant factor when those who died of colon cancer within 5 years of diabetes diagnosis were excluded to minimize the possible contamination of diabetes caused by incipient colon cancer, with an adjusted hazard ratio of 1.021 (1.007-1.034). Sex, diabetes type, insulin use, body mass index and area of residence were not significant predictors for colon cancer mortality in the diabetic patients. Although insulin use was categorized into subgroups of duration of use (non-users and users < 5 years, 5-9 years and ≥ 10 years), none of the HRs for colon cancer mortality was significant with regards to different durations of insulin use., Conclusion: Colon cancer mortality is increasing in Taiwan. A higher risk is observed in diabetic patients. Smoking, but not insulin use, is a modifiable risk factor.