Suchergebnisse

Tomor Harnod,1,2 Cheng-Li Lin,3,4 Chia-Hung Kao5–71Department of Neurosurgery, Hualien Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; 2College of Medicine, Tzu Chi University, Hualien, Taiwan; 3Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; 4College of Medicine, China Medical University, Taichung, Taiwan; 5Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan; 6Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan; 7Department of Bioinformatics and Medical Engineering, Asia University, Taichung, TaiwanObjective: To use the National Health Insurance Research Database (NHIRD) of Taiwan to determine whether patients with poststroke epilepsy (PSE) in Taiwan have an increased risk of mortality.Methods: We analyzed the data from the NHIRD of patients (≥40 years) who had received stroke diagnoses between 2000 and 2012. The patients with stroke were divided into PSE and poststroke non-epilepsy (PSN) cohorts and compared against a sex-, age-, comorbidity-, and index-date-matched cohort from normal population. We calculated adjusted HRs (aHRs) and 95% CIs of all-cause mortality risk in these cohorts after adjustment for age, sex, and comorbidities.Results: Among the poststroke patients, 12.14% constituted the PSE cohort. The cumulative mortality rate was considerably higher in the PSE than in the PSN cohort. The PSE (aHR=4.18, 95% CI=3.91–4.48) and PSN (aHR=1.90, 95% CI=1.83–1.98) cohorts were associated with higher risks of mortality than the comparison cohort. Furthermore, advanced age (≥65 years), male sex, alcohol-related illness, chronic obstructive pulmonary disease, coronary artery disease, diabetes, hypertension, asthma, and cancer would further increase the risk of mortality after a stroke event.Conclusion: The mortality risk in poststroke patients is approximately two times the likelihood in those with PSE than in those without, and approximately four times higher than that in the normal population. Our findings provide crucial information for clinicians and the government to improve survival after stroke.Keywords: cohort study, epilepsy, mortality, stroke, National Health Insurance

Objective: To use the National Health Insurance Research Database (NHIRD) of Taiwan to determine whether patients with poststroke epilepsy (PSE) in Taiwan have an increased risk of mortality. Methods: We analyzed the data from the NHIRD of patients (≥40 years) who had received stroke diagnoses between 2000 and 2012. The patients with stroke were divided into PSE and poststroke non-epilepsy (PSN) cohorts and compared against a sex-, age-, comorbidity-, and index-date-matched cohort from normal population. We calculated adjusted HRs (aHRs) and 95% CIs of all-cause mortality risk in these cohorts after adjustment for age, sex, and comorbidities. Results: Among the poststroke patients, 12.14% constituted the PSE cohort. The cumulative mortality rate was considerably higher in the PSE than in the PSN cohort. The PSE (aHR=4.18, 95% CI=3.91–4.48) and PSN (aHR=1.90, 95% CI=1.83–1.98) cohorts were associated with higher risks of mortality than the comparison cohort. Furthermore, advanced age (≥65 years), male sex, alcohol-related illness, chronic obstructive pulmonary disease, coronary artery disease, diabetes, hypertension, asthma, and cancer would further increase the risk of mortality after a stroke event. Conclusion: The mortality risk in poststroke patients is approximately two times the likelihood in those with PSE than in those without, and approximately four times higher than that in the normal population. Our findings provide crucial information for clinicians and the government to improve survival after stroke.

Objective: To investigate the risk and risk factors for suicide attempt by patients with regular migraines (RM) and status migrainosus (SM) in Taiwan. Methods: We analyzed a subset of the National Health Insurance Research Database of Taiwan and enrolled patients (≥20 years old) who had ever received a diagnosis of RM or SM between 2000 and 2012 in the RM and SM cohort. The SM cohort included 13,605 patients, the RM cohort had 21,485 patients, and the comparison cohort contained approximately four times that many patients. We calculated the adjusted hazard ratios and 95% confidence intervals (CI) for suicide attempts after adjusting for age, sex, monthly income, urbanization level, occupation, and comorbidities. Results: The SM cohort had a 1.81-fold risk of attempting suicide (95% CI = 1.14–2.89) compared to the comparison cohort. Other factors that predispose patients with SM to attempt suicide include the following: female sex, relatively young age (<50 years old), and low monthly income (<15,000 New Taiwan Dollars, approximately equivalent to 495 US Dollars). Additionally, the risk of attempting suicide only increased in patients who had been diagnosed with SM for longer than five years. Conclusion: SM is associated with a higher risk for suicide attempt in migraineurs in Taiwan. This finding is important to clinicians and government officials seeking to prevent patients from attempting suicide in Taiwan and other similar East Asian countries.

We used the National Health Insurance Research Database of Taiwan to determine whether patients with posttraumatic dementia (PTD) exhibit increased mortality and medical burden than those without it. Patients ≥20 years of age having head injury admission (per the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 850–854, 959.01) between 2000 and 2012 were enrolled as traumatic brain injury (TBI) cohort. A PTD cohort (with ICD-9-CM codes 290, 294.1, 331.0) and a posttraumatic nondementia (PTN) cohort were established and compared in terms of age, sex, and comorbidities. We calculated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of all-cause mortality risk, number of hospital days, and frequency of medical visits in these cohorts. Patients with PTD had a higher mortality rate than did patients with TBI alone (rate per 1000 person-years: 12.00 vs. 6.32), with an aHR of 1.54 (95% CI: 1.32–1.80). Patients with PTD who were aged ≥65 years (aHR = 1.54, 95% CI: 1.31–1.80) or male (aHR = 1.78, 95% CI: 1.45–2.18) exhibited greatly increased risks of mortality. Furthermore, patients with PTD had 19.9 more hospital days and required medical visits 4.49 times more frequently compared with the PTN cohort. Taiwanese patients with PTD had increased mortality risk and medical burden compared with patients who had TBI only. Our findings provide crucial information for clinicians and the government to improve TBI and PTD outcomes.

Aim: Use the National Health Insurance Research Database of Taiwan to determine whether patients with posttraumatic epilepsy (PTE) have an increased risk of mortality. Methods: Patients ≥20 years old ever admitted because of head injury (per International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 850–854 and 959.01) during 2000–2012 were enrolled into a traumatic brain injury (TBI) cohort. The TBI cohort was divided into with PTE (ICD-9-CM code 345) and posttraumatic nonepilepsy (PTN) cohorts. We compared the PTE and PTN cohorts in terms of age, sex, and comorbidities. We calculated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of all-cause mortality risk in these cohorts. Results: Patients with PTE had a higher incidence rate (IR) of mortality than did patients with TBI alone (IR per 1000 person-years: 71.8 vs. 27.6), with an aHR 2.31 (95% CI = 1.96–2.73). Patients with PTE aged 20–49, 50–64, and ≥65 years had, respectively, 2.78, 4.14, and 2.48 times the mortality risk of the PTN cohort. Patients with any comorbidity and PTE had 2.71 times the mortality risk as patients in the PTN cohort. Furthermore, patients with PTE had 28.2 increased hospital days and 7.85 times as frequent medical visits per year compared with the PTN cohort. Conclusion: Taiwanese patients with PTE had approximately 2 times the mortality risk and an increased medical burden compared to patients with TBI only. Our findings provide crucial information for clinicians and the government to improve TBI outcomes.

Objective: To determine the differences in the incidences and risks of suicide attempt (SA) and suicidal drug overdose (SDO) between patients with epilepsy with and without comorbid depression by using data from Taiwan's National Health Insurance Research Database. Methods: We analyzed data of patients (≥20 years) who had received epilepsy diagnoses between 2000 and 2012; the diagnosis date of epilepsy was defined as the index date. The epilepsy patients were divided into the cohorts, with and without comorbid depression, and compared against a cohort from the non-affected population. We calculated adjusted hazard ratios and the corresponding 95% confidence intervals for SA and SDO in the three cohorts after adjustment for age, sex, and comorbidities. Results: The incidences of SA and SDO in the cohort with epilepsy and depression were 42.9 and 97.4 per 10,000 person-years, respectively. The epilepsy with depression cohort had 21.3 times of SA risk; and 22.9 times of SDO risk than did the comparison cohort had a 6.03-fold increased risk of SA and a 2.56-fold increased risk of SDO than did the epilepsy patients without depression. Moreover, patients' age <65 years, and female sex would further increase the risk of SA in patients with epilepsy and comorbid depression. Conclusion: Risks of SA and SDO in patients with epilepsy are proportionally increased when depression is coexisted. Our findings provide crucial information for clinicians and the government for suicide prevention and to question whether prescribing a large number of medications to patients with epilepsy and depression is safe.