Nationwide Population-based Follow-up Study Research Articles

Increasing climacteric symptoms in untreated perimenopausal Finnish women: a 10-year cohort study

Objective This study aimed to examine changes over a 10-year period in experiencing climacteric symptoms and their associations with sociodemographic and health-related background factors in a birth cohort of Finnish women who have never used menopausal hormone therapy (MHT). Methods This nationwide population-based follow-up study consists of 1491 women who during the follow-up period moved from the age group 42–46 years to the age group 52–56 years. The experience of climacteric symptoms was assessed by 12 symptoms commonly associated with the climacterium. The data were analyzed using statistical techniques. Results Both the intensity, expressed as a symptom score of four symptoms associated with a decrease in estrogen production (sweating, hot flushes, vaginal dryness, sleeping problems), and the prevalence of the five most common symptoms (sweating, hot flushes, sleeping problems, lack of sexual desire, depressive symptoms) increased clearly during the follow-up period. The examined sociodemographic and health-related variables did not explain the changes in experiencing the symptoms. Conclusions The results of this study can be considered in primary and occupational health care and in gynecological settings when working with symptomatic women or women with hidden climacteric problems and carrying out health promotion and counseling for them.

Roles of sedative-hypnotics in patients with recurrent major depressive disorder: a nationwide population-based 14-year follow-up study in Taiwan

The use of sedatives or hypnotics and the recurrence of depression have not been adequately explored. This study investigated the roles of sedative-hypnotics in patients with major depressive disorder (MDD). Various characteristics of sedative-hypnotic use were tested as risk factors for recurrence. Clinical records of 15,510 patients with major depressive disorder who prescribed selective serotonin reuptake inhibitors (SSR) during 1997-2009 were collected from the National Health Insurance Research Database (NHIRD). Cox proportional hazard regression models were used to analyze factors related to depression recurrence. The risk of MDD recurrence was lower for patients using SED/HYP with an indication of both anxiolytics and hypnotics (AHR = 0.66; 95% CI = 0.59-0.72) than for those using SED/HYP with an indication of anxiolytics only. AHR was slightly greater in current users than in recent users (AHR = 0.77; 95% CI = 0.72-0.83) and past users (AHR = 0.70; 95% CI = 0.67-0.74). There was a higher AHR of MDD recurrence in patients who used SED/HYP over 1 DDD in 1 month than those who used SED/HYP less than 1 DDD in 1 month, with the highest-dose users having the highest risk of MDD recurrence (AHR = 7.91; 95% CI = 6.86-9.11). Patterns and characteristics of sedative-hypnotic use may affect depression recurrence. These findings should be considered by clinicians when combining sedative-hypnotics with antidepressant treatment.

Association between process performance measures and 1-year mortality among patients with incident heart failure: a Danish nationwide study.

To examine the association between fulfilment of performance measures supported by clinical guidelines recommendations and 1-year mortality among patients with incident heart failure (HF) in Denmark. A nationwide population-based follow-up study based on the Danish Heart Failure Registry. All Danish hospital departments caring for patients with HF. We identified 24308 in- and outpatients diagnosed with HF from 2003 to 2010. Quality of care was defined as receiving the guideline recommended processes of care: use of echocardiography, New York Heart Association classification, treatment with angiotensin-converting-enzyme inhibitors/angiotensin-II-receptor blocker, beta blockers, physical training, and patient education. Main outcome measure is 1-year mortality. We used multiple imputation and multivariable Cox proportional hazard regression to compute hazard ratios (HRs) for 1-year mortality adjusted for potential confounding factors. Within 1 year, 17.1% of the patients died and the adjusted HRs ranged from 0.61 [95% confidence interval (CI) 0.55-0.67] for patient education to 0.99 (95% CI 0.90-1.10) for beta blocker therapy. The association between meeting more performance measures and 1-year mortality appeared to follow a dose-response pattern: using 0-25% of fulfilled measures as reference, patients who fulfilled 76-100% of the performance measures had an adjusted HR of 0.43 (95% CI 0.38-0.48), while the adjusted HR was 0.96 (95% CI 0.86-1.07) for patients who fulfilled between 26% and 50% of the performance measures. Meeting process performance measures, which reflect care in concordance with clinical guideline recommendations, was associated with substantially lower 1-year mortality among patients with incident HF.

Association between retinal vein occlusion and an increased risk of acute myocardial infarction: A nationwide population-based follow-up study.

ObjectiveTo investigate a possible association between retinal vein occlusion (RVO) and an increased risk of developing acute myocardial infarction (AMI).DesignA population-based retrospective cohort study using the entire population of the Taiwan National Health Insurance Research Database (NHIRD) from 1st January, 2001 to 31st December, 2013.MethodsA total of 37921 subjects with RVO were enrolled in the RVO group, and 113763 subjects without RVO were enrolled in the comparison group. The comparison group consisted of randomly selected individuals who were propensity score (PS)-matched with the RVO group at a ratio of 1:3, based on age, gender, obesity, stroke, hyperviscosity syndrome, glaucoma, and the use of antithrombotic drugs. A log-rank test was used to compare the cumulative hazard of AMI between the two groups. A multivariate Cox regression analysis was used to estimate the adjusted hazard ratios (HRs) of AMI, adjusted for PS, diabetes, hypertension, hyperlipidemia, congestive heart failure, and chronic renal failure.ResultsThe mean age of the cohort was 62.4±13.2 years. RVO patients had significantly higher proportions of diabetes, hypertension, hyperlipidemia, congestive heart failure, and chronic renal failure than the comparisons. The mean follow-up period was 5.52 years in the RVO group and 5.55 years in the comparison group (p = 0.16). A log-rank test comparing the cumulative hazard curves of AMI for the two groups revealed a significant difference (p<0.0001). In the multivariate Cox regression after adjustment for PS and confounders, the RVO group had a significantly higher risk of AMI (adjusted HR = 1.21; 95% CI: 1.13 to 1.30). When the RVO group was divided into central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) and analyzed separately, both groups had significantly higher adjusted HRs for developing AMI than the comparison group. Moreover, the CRVO group had a significantly higher risk of AMI than the BRVO group.ConclusionsPeople with RVO are at significantly greater risk of developing AMI than individuals without RVO.

Compliance with accreditation and recommended hospital care-a Danish nationwide population-based study.

To examine the association between compliance with accreditation and recommended hospital care. A Danish nationwide population-based follow-up study based on data from six national, clinical quality registries between November 2009 and December 2012. Public, non-psychiatric Danish hospitals. Patients with acute stroke, chronic obstructive pulmonary disease, diabetes, heart failure, hip fracture and bleeding/perforated ulcers. All hospitals were accredited by the first version of The Danish Healthcare Quality Programme. Compliance with accreditation was defined by level of accreditation awarded the hospital after an announced onsite survey; hence, hospitals were either fully (n = 11) or partially accredited (n = 20). Recommended hospital care included 48 process performance measures reflecting recommendations from clinical guidelines. We assessed recommended hospital care as fulfilment of the measures individually and as an all-or-none composite score. In total 449 248 processes of care were included corresponding to 68 780 patient pathways. Patients at fully accredited hospitals had a significantly higher probability of receiving care according to clinical guideline recommendations than patients at partially accredited hospitals across conditions (individual measure: adjusted odds ratio (OR) = 1.20, 95% CI: 1.01-1.43, all-or-none: adjusted OR = 1.27, 95% CI: 1.02-1.58). For five of the six included conditions there were an association; the pattern appeared particular strong among patients with acute stroke and hip fracture (all-or-none; acute stroke: adjusted OR = 1.39, 95% CI: 1.05-1.83, hip fracture: adjusted OR = 1.57, 95% CI: 1.00-2.49). High compliance with accreditation standards was associated with a higher level of evidence-based hospital care in Danish hospitals.

The Effect of Renal Function Impairment on the Mortality of Cirrhotic Patients: A Nationwide Population-Based 3-Year Follow-up Study.

Renal function impairment (RFI) contributes to poor prognosis in cirrhotic patients. However, there have been no studies that seek to identify the effect of different types of RFI on the mortality of cirrhotic patients. We used the National Health Insurance Database, derived from the Taiwan National Health Insurance Program, to identify 44365 cirrhotic patients between January 1, 2007 and December 31, 2007. RFI was identified in 2832 cirrhotic patients, including 1075 with acute renal failure (ARF) (169 with hepatorenal syndrome, HRS; 906 with non-hepatorenal syndrome, NHRS), 705 with chronic kidney disease (CKD), and 1052 with end stage renal disease (ESRD). After Cox proportional hazard regression analysis adjusted by gender, age, and comorbid disorders, the 30-day, 30 to 90-day, 90-day to 1-year, and 1 to 3-year mortality hazard ratios (HR) compared to the non-RFI group were: (ARF) 5.19 (4.70–5.74), 3.23 (2.76–3.77), 1.51 (1.26–1.81), and 1.35 (1.13–1.61), respectively; (CKD) 2.70 (2.30–3.18), 2.03 (1.66–2.49), 1.60 (1.34–1.90), and 1.26 (1.06–1.49), respectively; and (ESRD) 1.42 (1.17–1.72), 1.62 (1.35–1.94), 1.90 (1.68–2.15), and 1.67 (1.48–1.89), respectively. Compared to NHRS, the 30-day, 30 to 90-day, 90-day to 1-year, and 1 to 3-year mortality HRs of HRS were 1.03 (0.80–1.32), 2.13 (1.46–3.11), 1.58 (0.90–2.75), and 2.51 (1.41–4.48), respectively, in cirrhotic patients with ARF. These results indicate the effects of CKD and ESRD on the mortality of cirrhotic patients are distributed equally in every survival stage, whereas the effect of ARF appears only in the early stage. Compared to NHRS, HRS contributes to a higher mortality risk at the late survival stage.

Probability and heritability estimates on primary osteoarthritis of the hip leading to total hip arthroplasty: a nationwide population based follow-up study in Danish twins.

IntroductionPrimary hip osteoarthritis, radiographic as well as symptomatic, is highly associated with increasing age in both genders. However, little is known about the mechanisms behind this, in particular if this increase is caused by genetic factors. This study examined the risk and heritability of primary osteoarthritis of the hip leading to a total hip arthroplasty, and if this heritability increased with increasing age.MethodsIn a nationwide population-based follow-up study 118,788 twins from the Danish Twin Register and 90,007 individuals from the Danish Hip Arthroplasty Register for the period 1995 to 2010 were examined. Our main outcomes were the cumulative incidence, proband-wise concordance and heritability on age, within-pair correlations in monozygotic and dizygotic twin pairs, and the genetic and environmental influence estimated in models taking into account that individuals may not have had a total hip arthroplasty at the time of follow-up.ResultsThere were 94,063 twins eligible for analyses, comprising 835 cases of 36 concordant and 763 discordant twin pairs. The probability increased particularly from 50 years of age. After sex and age adjustment a significant additive genetic component of 47 % (12:79), a shared environmental component of 21 % (2:76) and a unique environment component of 32 % (21:41) accounted for the variation in population liability to total hip arthroplasty. The sex-adjusted proband-wise concordance and heritability on age indicated an increasing age-associated genetic influence onwards from 60 years of age.ConclusionThe cumulative incidence in primary hip osteoarthritis leading to total hip arthroplasty increases in particular after the age of 50 years in both genders. Family factors of genes and shared environment are highly significant and account for 68 % of the variation in the population liability to total hip arthroplasty; however, the genetic influence increases significantly from 60 years of age onwards.

Is compliance with hospital accreditation associated with length of stay and acute readmission? A Danish nationwide population-based study

To examine the association between compliance with hospital accreditation and length of stay (LOS) and acute readmission (AR). A nationwide population-based follow-up study from November 2009 to December 2012. Public, non-psychiatric Danish hospitals. In-patients admitted with one of 80 diagnoses. Accreditation by the first version of The Danish Healthcare Quality Programme. Using an on-site survey, surveyors assessed the level of compliance with the standards. The hospital was awarded either fully (n = 11) or partially accredited (n = 20). LOS including transfers between hospitals and all-cause AR within 30 days after discharge. The Cox Proportional Hazard regression was used to compute hazard ratios (HRs) adjusted for potential confounding factors and cluster effect at hospital level. For analyses of LOS, 275 589 in-patients were included of whom 266 532 were discharged alive and included in the AR analyses. The mean LOS was 4.51 days (95% confidence interval (CI): 4.46-4.57) at fully and 4.54 days (95% CI: 4.50-4.57) at partially accredited hospitals, respectively. After adjusting for confounding factors, the adjusted HR for time to discharge was 1.07 (95% CI: 1.01-1.14). AR within 30 days after discharge was 13.70% (95% CI: 13.45-13.95) at fully and 12.72% (95% CI: 12.57-12.86) at partially accredited hospitals, respectively, corresponding to an adjusted HR of 1.01 (95% CI: 0.92-1.10). Admissions at fully accredited hospitals were associated with a shorter LOS compared with admissions at partially accredited hospitals, although the difference was modest. No difference was observed in AR within 30 days after discharge.

Risk of psychiatric disorders in patients with chronic insomnia and sedative-hypnotic prescription: a nationwide population-based follow-up study.

Previous epidemiological studies have established insomnia as a major risk factor for mood, anxiety, and substance use disorders. However, the associations between insomnia with sedative-hypnotic prescriptions and various psychiatric disorders have not been thoroughly examined. The current study involved evaluating the risk of psychiatric disorders, namely schizophrenia, mood, anxiety, somatoform, and substance-related disorders, over a 6-y follow-up period in three groups: patients with insomnia and sedative-hypnotic prescriptions (Inso-Hyp), those with insomnia and without sedative-hypnotic prescriptions (Inso-NonHyp), and those with neither insomnia nor sedative-hypnotic prescriptions (NonInso-NonHyp). We used a historical cohort study design to compare the risk of psychiatric disorders among the three groups. Data regarding these patients were derived from reimbursement claims recorded in Taiwan's National Health Insurance Research Database. Cox proportional hazards regression was used to compare the 6-y risk of subsequent psychiatric disorders among the Inso-Hyp, Inso-NonHyp, and NonInso-NonHyp groups. Compared with the Inso-NonHyp and NonInso-NonHyp group patients, the Inso-Hyp group patients exhibited a higher risk of psychiatric disorders, particularly bipolar disorders (adjusted hazard ratio [AHR]: 7.60; 95% confidence interval [CI]: 5.31-10.89 and AHR: 14.69; 95% CI: 11.11-19.43, respectively). Moreover, among the Inso-Hyp patient group, insomnia prescribed with benzodiazepine, a longer duration of sedative-hypnotic action, and higher doses of sedativehypnotics were significantly associated with a higher risk of depressive and anxiety disorders. The Inso-Hyp group exhibited a higher risk of developing psychiatric disorders than did the Inso-NonHyp and NonInso-NonHyp groups. The results regarding patients with insomnia and sedative-hypnotic prescriptions associated with the risk of psychiatric disorders can serve as a reference for care providers when managing sleep disturbances.

The amputation and mortality rates of diabetic patients with critical limb ischemia: A nationwide population-based follow-up study in Taiwan

Summary Purpose To describe the epidemiological profiles and the amputation and mortality rates of diabetic patients in Taiwan with critical limb ischemia. Materials and methods Data were collected from the Longitudinal Health Insurance Database 2000 (LHID2000), a database composed of one million randomly selected beneficiaries in Taiwan. To measure major amputation and mortality, diabetic patients with critical limb ischemia (CLI) were identified by specific ICD-9-CM diagnostic, procedure, and order codes. The patients were traced until the end of 2009. Cox proportional hazard regressions were used to determine the crude and adjusted hazard ratios for the risk factors for amputation and mortality during the follow-up period. Results We identified 6418 diabetic patients with CLI from the LHID database during 1997–2006. Of these patients, 256 (3.99%) patients underwent surgical revascularization and 6418 (96.01%) patients received conservative treatment only. The revascularization cohort had more comorbidities than the surgical group (e.g., cardiovascular, 13.28% vs. 8.62%, respectively, p = 0.0099; renal, 23.05% vs. 5.34%, respectively, p 50 years), male gender, and comorbid cardiovascular, renal, neurological, and pulmonary diseases. Conclusion Diabetic patients who needed surgical revascularization or who needed conservative treatment for CLI had different comorbid profiles. The common risk factors for amputation and mortality in diabetic CLI patients include male gender, age of >50 years, and concurrent cardiovascular and renal diseases.

Increased Risk of Sexual Dysfunction in Male Patients with Psoriasis: A Nationwide Population-Based Follow-Up Study

An association between psoriasis and sexual dysfunction (SD) has been explored. However, the risk of SD after the diagnosis of psoriasis relative to the age-matched general population remains unknown. Aim. To clarify the risk of developing SD in male patients with psoriasis. From 2000 to 2001, we identified 12,300 male patients with newly diagnosed psoriasis and 61,500 matching controls from National Health Insurance Database in Taiwan. The two cohorts were followed up until 2008, and we observed the occurrence of SD by registry of SD diagnosis in the database. Stratified Cox proportional hazard regressions were used to calculate the 7-year SD risk for these two groups. Of the 73,800 sampled patients, 1,812 patients (2.46%) experienced SD during the 7-year follow-up period, including 373 (3.03% of patients with psoriasis) in the study group and 1,439 (2.34% of patients without psoriasis) in the comparison group. The hazard ratio (HR) for SD for patients with psoriasis was 1.27 times (95% confidence interval [CI], 1.11-1.46; P = 0.001) as high as that for patients without psoriasis after adjusting for age, monthly income, number of health-care visits, systemic treatment, and other comorbidities. Stratified analysis showed that the risk of SD was higher in patients older than 60 years old (HR: 1.42, 95% CI: 1.12-1.81) and patients with psoriatic arthritis (HR: 1.78, 95% CI: 1.08-2.91). However, the risk of SD was not significantly elevated in patients receiving systemic treatment, including retinoid, methotrexate, and cyclosporine. Male patients with psoriasis are at increased risk of developing SD. Physicians should pay attention to the impact of psoriasis on psychosocial and sexual health, especially in old-aged patients.

Cluster headache is associated with an increased risk of depression: A nationwide population-based cohort study

To investigate whether cluster headache (CH) was a risk factor for depression in a nationwide population-based follow-up study. Background There are few studies about the relationship between CH and depression, and prior research has been limited by cross-sectional studies or small sample sizes. We identified 673 CH patients from the Taiwan National Health Insurance database between 2005 and 2009. The two comparison cohorts included age-, sex- and Charlson's score-matched migraine patients (n = 2692) and controls (patients free from migraine or CH, n = 2692). The cumulative incidence of depression was compared among these three cohorts until the end of 2009. We also calculated predictors of depression in the CH cohort. After the median 2.5-year follow-up duration, the CH cohort had a greater risk for developing depression compared to the control cohort (adjusted hazard ratio; aHR = 5.6, 95% CI 3.0-10.6, p < 0.001) but not the migraine cohort (aHR = 1.1, 95% CI 0.7-1.7, p = 0.77). Of the CH patients, the number of cluster bout periods per year was a risk factor for depression (aHR = 3.8, 95% CI 2.6-5.4, p < 0.001). Our results showed that CH is associated with an increased risk for depression. The strength of this association is similar to that of migraine.

Sex Differences in the Development of Malignancies among End-Stage Renal Disease Patients: A Nationwide Population-Based Follow-Up Study in Taiwan

Increasing evidence indicates that end-stage renal disease (ESRD) is associated with the morbidity of cancer. However, whether different dialysis modality and sex effect modify the cancer risks in ESRD patients remains unclear. A total of 3,570 newly diagnosed ESRD patients and 14,280 controls matched for age, sex, index month, and index year were recruited from the National Health Insurance Research Database in Taiwan. The ESRD status was ascertained from the registry of catastrophic illness patients. The incidence of cancer was identified through cross-referencing with the National Cancer Registry System. The Cox proportional hazards model and the Kaplan–Meier method were used for analyses. A similar twofold increase in cancer risk was observed among ESRD patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) after adjusting for other potential risk factors. Patients with the highest cancer risk, approximately fourfold increased risk, were those received renal transplants. Urothelial carcinoma (UC) had the highest incidence in HD and PD patients. However, renal cell carcinoma (RCC) had the highest incidence in the renal transplantation (RT) group. In addition, female patients undergoing RT or PD had a higher incidence of RCC and UC, respectively. Male patients under HD had both higher incidence of RCC and UC. In conclusion, different dialysis modality could modify the cancer risks in ESRD patients. We also found sex effect on genitourinary malignancy when they are under different dialysis modality.

Quality of Care and Patient Outcome in Stroke Units

Specialized stroke unit care improves outcome in stroke patients. However, it is uncertain whether the units should be placed in a neurological or non-neurological (eg, internal medicine or geriatric) setting. To assess whether stroke unit setting (neurological/non-neurological) is associated with quality of care and outcome among patients with stroke, and whether these associations depend on the severity of comorbidity. In a nationwide population-based follow-up study, we identified 45,521 patients admitted to stroke units in Denmark between 2003 and 2008. Outcomes were quality of care (whether patients received evidence-based processes of acute stroke care), mortality, length of stay, and readmission. Charlson comorbidity index was used to assess comorbidity, and comparisons were adjusted for patient and hospital characteristics. Patients admitted to stroke units in neurological settings had higher odds for early antiplatelet therapy (odds ratio, 1.68; 95% confidence interval, 1.10-2.56) and early computed tomographic scan or magnetic resonance imaging (odds ratio, 1.77; 95% confidence interval, 1.29-2.45) compared with patients in non-neurological settings. No other differences were found when studying quality of care and patient outcomes. However, patients with moderate comorbidity admitted to stroke units in neurological settings had higher odds for 1-year mortality, but comparisons across strata of comorbidity were not statistical significant. Except for early antiplatelet therapy and early computed tomographic scan or magnetic resonance imaging, the medical setting was not associated with differences in processes of acute stroke care and patient outcome. No medical setting related differences were found according to comorbidity, although indications of a worse outcome in patients with moderate comorbidity in neurological settings warrant further investigation.

Type of Preadmission Antidiabetic Treatment and Outcome among Patients with Ischemic Stroke: A Nationwide Follow-up Study

We examined whether the preadmission use of sulfonylureas is associated with improved clinical outcome compared with other antidiabetic treatments after hospitalization with ischemic stroke. We conducted a nationwide population-based follow-up study among all Danish patients hospitalized with ischemic stroke between 2003 and 2006 and who were registered in the Danish National Indicator Project. We obtained data on diabetes and type of antidiabetic treatment, patient characteristics, in-hospital quality of care, and mortality and readmissions by linking medical databases. We computed mortality rates and rates of readmission recurrent ischemic stroke or myocardial infarction according to type of treatment and used the Cox proportional hazards regression analysis to compute hazard ratios (HRs). We identified 4817 stroke patients with type 2 diabetes mellitus. We found lower 30-day mortality rates among users of metformin (adjusted HR 0.32; 95% confidence interval [CI] 0.15-0.68), insulin (adjusted HR 0.47; 95% CI 0.27-0.81), and patients without antidiabetic pharmacotherapy (adjusted HR 0.58; 95% CI 0.36-0.93) compared with users of sulfonylureas. Users of any combination had a nonstatistical significant lower 30-day mortality rate (adjusted HR 0.64; 95% CI 0.34-1.21). In contrast, we found no significant differences in 1-year mortality rate. Compared with users of sulfonylureas, users of all other types of treatment had increased risk of readmission; however, it did not reach statistical significance for all treatment groups. Preadmission use of sulfonylureas appeared not to be associated with an overall improved clinical outcome among type 2 diabetic patients admitted with ischemic stroke.

Increased Risk for Cancer Following Erectile Dysfunction: A Nationwide Population-Based Follow-Up Study

Previous studies have suggested that erectile dysfunction (ED) is associated with chronic inflammation, which is also a principle mechanism of carcinogensis. However, very few studies have attempted to examine the association between ED and subsequent cancer. Using a nationwide population-based data set, the aim of this study is to investigate the risk for cancer during a 5-year follow-up period after a diagnosis of ED, compared to patients without ED during the same period, while adjusting for socio-demographic characteristics. Stratified Cox proportional hazard regression was performed to compare the 5-year cancer-free survival rate for the two cohorts. This study used data sourced from the Taiwan "Longitudinal Health Insurance Database." The study cohort comprised 1,882 patients with ED and 9,410 randomly selected subjects as the comparison cohort. Each patient was then individually tracked for 5 years from their index ambulatory care visit to identify those who had diagnosed episodes of cancer. Of the sampled patients, 183 (1.6%) had cancer within the 5-year follow-up period, that is, 43 individuals (2.3% of the patients with ED) from the study cohort and 140 individuals (1.6% of patients in the comparison cohort) from the comparison cohort. After adjusting for the patients' monthly income, the geographic location and urbanization level of the community in which the patient resided, hypertension, diabetes, coronary heart disease, and hyperlipidemia, regression analysis reveals that the hazard of having cancer during the 5-year follow-up period was 1.42 (95% CI = 1.03-2.09, P = 0.039) times greater for patients with ED than comparison patients. However, data on smoking, which is an important factor in ED and cancer, is not available and remains a potential confounder. We conclude that the incidence of cancer in the 5 years after an ED diagnosis is significantly higher than in the general population.

Medical Prophylaxis following Hospitalization for Ischemic Stroke: Age- and Sex-Related Differences and Relation to Mortality

Background: The extent and implications of age- and sex-related differences in prophylaxis following ischemic stroke are unknown. We examined differences in the use of medical prophylaxis across age and sex groups in stroke patients after hospital discharge in Denmark and estimated the possible impact on age- and sex-related differences in mortality. Methods: A nationwide population-based follow-up study was conducted involving 28,634 patients hospitalized for ischemic stroke in 2003–2006 who survived 30 days after discharge. The proportion of patients who filled prescriptions for cardiovascular drugs within 0–6 and 12–18 months after discharge was determined. Mortality rates were compared across age and sex groups with and without controlling for use of medical prophylaxis. Results: Increasing age was associated with lower prophylaxis. Adjusted odds ratios for the use of a combination of a platelet inhibitor, an antihypertensive and a statin were 0.45 [95% confidence interval (CI): 0.38–0.54] and 0.52 (95% CI: 0.43–0.62) for men and women >80 years, respectively, compared with men ≤65 years. No systematic sex-related differences were identified. Continued drug use ranged from 66.1 to 91.9% for different drugs 12–18 months after discharge, with the lowest rate of continued use found among patients >80 years. Controlling for use of medical prophylaxis was associated with lower mortality rate ratios for elderly compared with younger patients. Conclusions: Continuous efforts are warranted to ensure implementation of evidence-based secondary prophylaxis among elderly patients with ischemic stroke.

PW01-207 - Quality of care and crime rates among patients with schizophrenia: a nationwide population-based follow-up study

IntroductionCrime rates are higher among patients with schizophrenia than in the general population. Denmark has seen a substantial increase in the number of forensic patients since 1980 with annual growth rates reaching 7%. In the same period, the population of forensic patients with schizophrenia has increased from 50% to 75%. Evidence-based care for patients with schizophrenia is well-established in international and national guidelines. However, a possible association between quality of care and risk of crime among patients with schizophrenia has not previously been studied.AimTo study the association between quality of care and risk of crime among patients with schizophrenia.MethodsThis nationwide population-based follow-up study is based on the Danish National Indictor Project (DNIP), a national clinical database for patients with schizophrenia, and the Danish Crime Register, a national register of criminal offences. We include all incident and prevalent patients diagnosed with schizophrenia (ICD-10: F20.00-F20.99), who are Danish citizens and older than 18 years. All patients have been admitted as inpatients at a psychiatric ward in the period 1 January 2004 to 31 December 2007 (approx 20,000 patients). In DNIP quality of care is assessed as fulfilment of a set of quality of care criteria related to the diagnostic process, contact with the health care system, use of antipsychotic medication, evaluation of side effects, family intervention, psycho education, planned outpatient treatment by discharge and suicide prevention. All patients will be followed up for 1-year after discharge. We identified all convictions for both violent and property crimes in the population.

Sulfonylureas and prognosis after myocardial infarction in patients with diabetes: a population‐based follow‐up study

The cardiovascular safety, including risk of myocardial infarction (MI), of individual sulfonylureas (SUs) may differ. It remains uncertain whether treatment with individual SUs influences prognosis following MI. We conducted a nationwide population-based follow-up study among all Danish patients hospitalized with first-time MI from 1996 to 2004. From the national health databases, we identified 3930 MI patients who used SUs at the time of admission. We computed mortality rates and rates of MI and heart failure readmission according to type of SU and used Cox's proportional hazards regression analysis to compute hazard ratios (HRs) as estimates of relative risk controlling for differences in prognostic covariates. The 30-day and 1-year mortality after MI among SU users was 22.0% and 35.3%, respectively. We found no substantial differences in 30-day and 1-year mortality among users of different SUs. Use of gliclazide in monotherapy showed a trend towards lower mortality; adjusted HR of 1-year mortality 0.70 (95% CI: 0.48-1.00). Users of the different SUs appeared to have similar risks of new MI and heart failure following MI. The prognosis after MI was not substantially influenced by the choice of SU.

Type of preadmission glucose-lowering treatment and prognosis among patients hospitalised with myocardial infarction: a nationwide follow-up study

We examined whether the type of preadmission glucose-lowering treatments explained differences in mortality rate and risk of readmission with myocardial infarction (MI) and heart failure following first-time hospitalisation for MI in patients with type 2 diabetes mellitus. We conducted a nationwide population-based follow-up study among all Danish patients hospitalised with first-time MI from 1996 to 2004. Data on use of glucose-lowering drugs and other medications, comorbidities, socioeconomic status, laboratory findings, readmission with MI and heart failure, and death were obtained from medical databases. We computed mortality rates and rates of MI and heart failure readmission, according to type of glucose-lowering treatment and used Cox's proportional hazards regression analysis to compute hazard ratios (HRs) as estimates of relative risks. We identified 8,494 MI patients with type 2 diabetes mellitus. The overall cumulative 30 day and 1 year mortality rates were 22.2 and 36.6%, respectively. Patients not receiving any glucose-lowering drugs (adjusted 30 day HR: 0.79, 95% CI: 0.57-1.10) and users of any combination (adjusted 30 day HR: 1.43, 95% CI: 0.98-2.09) had the lowest and highest mortality rates, respectively, when compared with users of sulfonylureas. We found that glycaemic control had no impact on the risk estimates in a subanalysis including biochemical laboratory data. We found no differences in the risk of new MI and heart failure between the different glucose-lowering agents. Type of preadmission glucose-lowering treatment in monotherapy is not associated with substantial differences in prognosis following hospitalisation with MI. However, patients treated with any combination had increased mortality rates.