Chronic Osteomyelitis Cohort Research Articles

Epidemiology of fatal/non-fatal suicide among patients with chronic osteomyelitis (COM): a nationwide population-based study.

ObjectiveChronic osteomyelitis (COM) can induce systemic inflammation, and systemic inflammation may be associated with suicide tendency. However, no studies have investigated the correlation between COM and suicide tendency.MethodsThe aim of this population-based study was to determine the epidemiology of fatal/non-fatal suicide among COM patients. Subjects with at least two outpatient visits or one course of inpatient care diagnosed with COM were recruited into a COM cohort. The control/COM subject ratio was approximately 4:1 matched by age, sex, major depression coding and index year (COM patients). Subjects with suicide attempts before COM diagnosis and subjects aged <20 years were excluded.ResultsCOM patients had 1.93 (95% confidence interval [CI]: 1.11–3.36) times the risk of fatal/non-fatal suicide as control subjects. Considering death as the competing event of fatal/non-fatal suicide, COM patients had 1.76 (95% CI: 1.03–3.01) times the risk of fatal/non-fatal suicide (competing risk regression model). The effect of COM on fatal/non-fatal suicide was more prominent among diabetic patients. COM severity also correlated with the risk of fatal/non-fatal suicide.ConclusionsMore attention must be paid to suicide tendency among COM patients.

Population study evaluating fracture risk among patients with chronic osteomyelitis.

BackgroundStudies investigating the fracture risk in patients with chronic osteomyelitis (COM) limited to case reports. This study evaluated the association between COM and subsequent fracture risk using population-based data.MethodsA subset claims data of the Taiwan National Health Insurance was used to identify 7,147 patients with COM newly diagnosed in 1999–2005 without fracture history and 28,588 general population controls, frequency matched by sex, age and diagnosis date. The incident fractures was measured by the end of 2013.ResultsThe incidence density of fracture was 1.94-fold greater in the COM cohort than in controls (21.5 vs. 11.1 per 1000 person-years), with the adjusted hazard ratio (HR) of 1.81 (95% CI: 1.67–1.95) for COM patients compared to controls after controlling for sex, age, and comorbidities of diabetes, osteoporosis, depression and end-stage renal disease in Cox proportional hazards regression. The fracture risk increased with age and women were at greater risk than men. The fracture incidence increased substantially in those with osteoporosis, 40.2 per 1000 person-years in COM patients. Site specific analysis showed a higher portion of incident fractures for lower limbs, 52.7% in COM cohort and 46.3% in controls.ConclusionFindings in this 15-year follow-up observation support our hypothesis that patients with COM are at an elevated risk of subsequent fracture. COM patients and the elderly deserve adequate consultation and awareness for fracture prevention.

Increased subsequent risk of erectile dysfunction among middle and old age males with chronic osteomyelitis: a nationwide population-based cohort study.

Chronic inflammation may cause endothelial dysfunction and atherosclerosis, resulting in subsequent erectile dysfunction (ED). We examined the relationship between chronic osteomyelitis, which is a chronic inflammatory disease, and ED. A retrospective cohort study was conducted using data from the National Health Insurance Research Database. After excluding patients <40 years of age, 677 male patients newly diagnosed with chronic osteomyelitis (COM) from 1 January 2000 to 31 December 2011 were identified for the study. The non-osteomyelitis comparison cohort consisted of 2706 male participants. The incidence of ED was 2.66-fold higher in the COM cohort than in the non-osteomyelitis cohort (4.01 vs 1.51 per 10 000 person-years). After adjusting for age and comorbidities of coronary heart disease, hypertension, hyperlipidemia, depression, stroke, diabetes, peripheral vascular disease, chronic kidney disease, chronic obstructive pulmonary disease and asthma, the patients with COM had a 2.82-fold risk of ED (95% confidence interval=1.44-5.56). The incidence of ED increased with that of comorbidities in both cohorts. The highest hazard ratio was in patients between 40 and 59 years of age who had COM. Our data showed, for the first time, that COM is a possible risk factor for the development of ED.

Chronic Osteomyelitis Is Associated With Increased Risk of New-Onset Atrial Fibrillation: Evidence From a Nationwide Cohort of 23 Million People

BackgroundThe objective of the study was to determine whether chronic osteomyelitis (COM) is associated with increased risk of new-onset atrial fibrillation (AF). MethodsA national insurance claim data set of 23 million enrollees was used to identify 19,002 patients with newly-diagnosed COM and 76,008 randomly selected age- and sex-matched control subjects between January 1, 2000 and December 31, 2009 for comparing the risk and incidence of AF. The study end point was defined as the first diagnosis of AF, death, withdrawal from the insurance program, or the end of 2010. ResultsDuring a follow-up period of 91,927 person-years, the incidence of new-onset AF in COM cohort was 1.42-fold higher than for the non-COM cohort (4.54 vs 3.19 per 1000 person-years). After adjusting for age, sex, and classical AF risk factors such as hypertension, diabetes, heart failure, coronary artery disease, and valvular heart disease, the risk of new-onset AF remained significantly higher in the COM cohort (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.18-1.49; P < 0.0001). In age-stratified analysis, the younger population carried a higher risk for incident AF than the elderly population (from HR 2.05; 95% CI, 1.12-3.74 in age younger than 50 years to HR 1.19; 95% CI, 0.95-1.49 in age 80 years and older). The adjusted Kaplan-Meier analysis showed a lower AF-free survival rate in the COM group compared with the control group (log-rank P < 0.0001) during the follow-up period. ConclusionsThis study showed that patients with COM carry an increased risk for developing new-onset AF, particularly in the younger population. Further studies are required to explore the underlying mechanisms that link COM and AF.

Association of Head and Neck Cancers in Chronic Osteomyelitis: A National Retrospective Cohort Study.

The aim of study is to determine whether chronic osteomyelitis (COM) is linked to an increased risk of head and neck cancer (HNC).We identify 17,033 patients with osteomyelitis and 68,125 subjects without osteomyelitis during 1996 to 2010 periods. Multivariable Cox proportional hazards regression analysis was used to measure the hazard ratio (HR) of head and neck cancer for the osteomyelitis cohort compared with the comparison cohort.A total of 99 patients in the COM and 228 patients in the comparison cohort developed HNC during an average 5.12 years of follow-up period. The incidence rate of HNC in the COM cohort was 1.51-fold (95% confidence interval [CI]: 1.17–1.95) higher than that in the comparison cohort after adjusting gender, age, urbanization level, monthly income, and comorbidities. In subgroup analysis, younger (less than 45 years-old) and patients without comorbidities have greater risks (adjusted HR: 2.29 [95% CI:1.43-3.66] and 1.74 [95% CI:1.28-2.38] respectively).This study results suggested the association between COM and HNC, particularly in younger population and patients without comorbidities.

Increased risk of intracerebral hemorrhage among patients with chronic osteomyelitis.

Inflammation may provoke cerebral arteriolar ectasia, inducing microaneurysm formation and further promoting intracerebral hemorrhage (ICH). Chronic osteomyelitis (COM) is an inflammatory disorder for which study of its role in ICH is lacking. This study explored whether COM increases the risk of ICH. From Taiwan national insurance inpatient claims, 22,052 patients who were newly diagnosed with COM between 1997 and 2010 were identified; 88, 207 age and sex frequency-matched subjects without COM were selected at random for comparison. Risks of ICH associated with COM and comorbidities, including hypertension, diabetes, hyperlipidemia, chronic kidney disease, and drug abuse, were assessed by the end of 2010. The incidence of ICH was 1.68 times higher in the COM cohort than in the comparison cohort, with an adjusted hazard ratio (HR) of 1.50 (95% CI 1.29-1.74) estimated in the multivariable Cox model. Age-specific analysis showed that the HR of ICH for COM patients decreased with age, with an adjusted HR of 3.28 (95% CI 1.88-5.75) in the < 40-year age group, which declined to 1.11 (95% CI 0.88-1.40) in the elderly. The incidence of ICH increased with the severity of COM; for those with severe COM the adjusted HR was 4.42 (95% CI 3.31-5.89). For subjects without comorbidities, the incidence of ICH was 1.20-fold (95% CI 1.00-1.45) higher in the COM cohort than in the comparison cohort. This study suggests for the first time that COM is an inflammatory factor associated with increased risk of ICH, especially in younger patients.

Association Between Chronic Osteomyelitis and Risk of End-Stage Renal Disease: A Nationwide Population-Based Cohort Study.

Inflammation, which initiates endothelial dysfunction, vascular atherosclerosis, and oxidative stress, may negatively influence renal function and accelerate the development of end-stage renal disease (ESRD). The role of chronic osteomyelitis (COM), a chronic inflammatory disease, in the development of ESRD has not been investigated. This study explored whether patients with COM have a higher risk of ESRD than that of patients without COM.Taiwan National Health Insurance claims from 1997 to 2010 were used to identify 24,267 newly diagnosed patients with COM and 97,068 age- and sex-matched non-COM controls for comparison. The risks of ESRD among COM patients, with adjustment for comorbidities, namely, hypertension, diabetes, coronary artery disease, congestive heart failure, and hyperlipidemia, were assessed until the end of 2010.ESRD risk was 2.01-fold higher (95% confidence interval [CI]: 1.81–2.25) in the COM cohort than in the non-COM cohort. Regarding the joint effect of COM with comorbidity, the ESRD risk was 1.57-fold higher (95% CI: 1.23–2.00) for the COM cohort without comorbidities and increased to 2.25 (95% CI: 1.97–2.57) for the COM cohort with at least 1 comorbidity. Age-specific analysis revealed that the adjusted ESRD risk for the COM cohort increased as age decreased, with the highest hazard ratio being 17.8 (95% CI: 5.18–61.4) for patients aged 20–34 years.This was the first study to report that COM is associated with an increased risk of ESRD, particularly among patients with comorbidities and younger patients.

Increased depression risk among patients with chronic osteomyelitis

ObjectiveInflammatory processes, which provoke alternations of neurotransmitter metabolism, neuroendocrine function, and neuroplasticity in the brain, might promote depression. In depression patients who do not exhibit risk factors, including hypertension, diabetes, coronary heart disease, stroke, Parkinson's disease and dementia, particularly in young people, inflammation is a likely risk factor for depression. We explored whether chronic osteomyelitis (COM), a chronic inflammatory disease, increases depression risk. MethodsA Taiwanese national insurance claims data set of more than 22 million enrollees was used to select 15,529 COM patients without depression history and 62,116 randomly selected age- and gender-matched controls without depression and COM history to trace depression development for an 12-year follow-up period from January 1, 1999 to December 31, 2010. The depression risk was analyzed using the Cox proportional hazards regression model. ResultsThe above-mentioned risk factors for depression were more frequent in the COM cohort, who exhibited significantly higher depression risk than the control group did. Comparing only those without comorbidities, the COM group exhibited higher depression risk than the control group did (hazard ratio [HR]=3.04, 95% confidence interval [CI]: 2.55–3.62). The younger population carried even greater risk (age<45: HR=6.08, 95% CI: 1.71–7.85; age>65: HR=1.75, 95% CI: 1.39–2.19). ConclusionsThis is the first study connecting COM to increased risk of developing depression. The outcomes suggest that COM is a substantial depression predictor and call for a closer focus on these patients for more rigorous depression prevention, particularly in young people.

Increased risk of dementia among chronic osteomyelitis patients.

Inflammatory processes may trigger neuroinflammation and cerebrovascular dysfunctions, further provoking dementia. The role of chronic osteomyelitis (COM), a disorder characterized by persistent inflammation, in dementia development has not been fully explored. This study investigates whether COM increases the risk of dementia. Taiwanese National Health Insurance (NHI) inpatient claims were used to identify 17,238 patients newly diagnosed with COM from 2000 to 2008, and 68,944 age- and gender-matched patients without COM were randomly selected for comparison. Risks of dementia associated with COM and comorbidities, including hypertension, diabetes, stroke, hyperlipidemia, and depression, were evaluated using data from the end of 2011. Dementia risk was 1.6-fold higher (95% confidence interval [CI]: 1.4-1.83) in the COM cohort than in the control group, calculated using the multivariable Cox model. Age-specific analysis indicated that the adjusted hazard ratios (aHRs) of dementia for COM patients decreased with age, with an aHR of 3.65 (95% CI: 1.5-8.9) for patients <55 years old, which gradually decreased to 1.43 (95% CI: 1.23-1.66) for patients ≥ 70 years old. Dementia risk increased with COM severity, with an aHR of 5.48 (95% CI: 4.43-6.79) for patients with severe COM. For those without comorbidities, dementia risk was 1.73-fold (95% CI: 1.37-2.17) higher in the COM cohort than in the control group. This study is the first to find that COM is an inflammatory disorder associated with an increased risk of dementia, particularly among younger people.

Increased risk of epilepsy among patients diagnosed with chronic osteomyelitis

Inflammatory processes, which raise the unsteadiness of brain neuron membrane potentials, might enhance the development of epilepsy. Inflammation is a substantial indicator of epilepsy risk. In this study, we evaluated whether chronic osteomyelitis (COM), a chronic inflammatory disease, increases epilepsy risk. A Taiwanese national insurance claims dataset of more than 22 million enrollees was used to select 20,996 COM patients and 83,973 randomly selected age- and gender-matched controls to investigate epilepsy development over an 11-year follow-up period, starting on January 1, 2000 and ending on December 31, 2010. The epilepsy risk was analyzed using a Cox proportional hazards regression model. Comorbidities known to elevate epilepsy risk, including diabetes, hypertension, head injury, stroke, and cancer, were commonly noted in the COM cohort, which had considerably higher risk of epilepsy than did the control group. Comparing only those without comorbidities, COM patients still exhibited higher epilepsy risk than the control group did (adjusted hazard ratio [aHR]=3.87, 95% confidence interval [CI]: 3.01-4.98). The younger population exhibited an even greater risk (age ≤39 years: aHR=6.10, 95% CI: 4.00-9.30; age ≥65 years: aHR=1.66, 95% CI: 1.28-2.16). This is the first study linking COM to an increased risk in epilepsy development. The results demonstrated that COM is a significant predictor of epilepsy. Further study of COM patients, particularly young patients, is recommended to facilitate epilepsy prevention.

Increased risk of coronary heart disease in patients with chronic osteomyelitis: a population-based study in a cohort of 23 million

ObjectivesChronic inflammatory disease may trigger vascular atherosclerosis. This study aimed to determine whether chronic osteomyelitis (COM) is linked to an increased risk of coronary heart disease (CHD).MethodsA national insurance claim...

The association between chronic osteomyelitis and increased risk of diabetes mellitus: a population-based cohort study.

Chronic inflammation is a well-known risk factor for type 2 diabetes mellitus (T2DM). The influence of chronic osteomyelitis (COM), an inflammatory disease, on the risk of developing T2DM remains unknown. This study investigated the risk of developing T2DM among COM patients. Using a retrospective cohort study, we identified 20,641 patients with COM and 82,564 age- and sex-matched controls for comparison from the Taiwan National Health Insurance Database (NHIRD) from 1997 to 2010. We followed up the COM cohort and the comparison cohort to compare the incidences of diabetes (ICD-9-CM code 250) until the end of 2010 or until the patients were censored because of death or withdrawal from the insurance program. The diabetes risk was analyzed using the Cox proportional hazards regression model. The incidence of T2DM was 1.6-fold higher in the group of COM patients than in the comparison group (29.1 vs. 18.2 per 10,000 person-years). The COM patients exhibited a higher diabetes risk [adjusted hazard ratio (aHR) = 1.64, 95 % confidence interval (CI) = 1.44-1.87] after controlling for the baseline and comorbidities. Younger and higher income patients exhibited a higher COM-to-reference incidence rate ratio (IRR) for T2DM compared with that of their counterparts. We also observed an increased risk of T2DM in COM patients with comorbidities (aHR = 1.70, 95 % CI = 1.47-1.96) compared with that of their non-COM counterparts. This is the first study to report the association between COM and an increased risk of developing T2DM, particularly among younger and higher income patients.