Nationwide Population-based Study Research Articles

Periodontitis and the incidence of inflammatory bowel diseases: A nationwide population-based cohort study.

Periodontitis and other oral health indicators are reportedly related to systemic inflammation. Our study aimed to investigate a possible association of oral health status (periodontitis and number of missing teeth) and oral hygiene behaviors (frequency of tooth brushing, dental visit, and dental scaling) with the risk of inflammatory bowel disease (IBD) incidence. Utilizing the Korean National Health Insurance Database, we conducted a nationwide, population-based cohort study involving participants from the 2003 national health screening program. We followed these individuals until December 2020 or the occurrence of censoring events. Crohn's disease (CD) and ulcerative colitis (UC) were defined by disease classification codes from the International Classification of Diseases-10 and national codes for rare intractable disease. The occurrence of IBD was analyzed using the Cox proportional hazard model, with propensity score matching (PSM) performed to balance baseline characteristics between participants with and without periodontitis. Our analysis involved a total of 2,272,012 participants with a median follow-up period of 17.0 years. The incidence rates for CD and UC were 11.6 and 32.4 per 100,000 person-years, respectively. In multivariable analysis after PSM, the presence of periodontitis was associated with an increased risk of both CD (adjusted hazard ratio [aHR], 1.32, 95% confidence interval [CI], 1.14-1.52, p<0.001) and UC (aHR 1.21, 95% CI 1.10-1.32, p<0.001). Conversely, frequent tooth brushing ≥3 times a day was associated with a reduced risk of CD (aHR 0.81, 95% CI 0.65-0.99, p=0.049) but no significant association was observed with UC. Periodontitis may augment the risk of incidence for CD and UC. This association underscores the potential significance of periodontal health in the context of IBD, emphasizing the importance of comprehensive oral hygiene practices and potential preventive strategies to reduce the risk of CD and UC incidence.

Age did not affect the rate of subsequent hysterectomy following hysteroscopic surgery: A population-based retrospective cohort study from 2000 to 2020.

Previous studies found younger age was associated with an increased risk of hysterectomy after hysteroscopic surgeries (HS) due to abnormal uterine bleeding (AUB). The present study aimed to evaluate the effect of age on the incidence of hysterectomy after HS for treating AUB in Taiwan. This was a nationwide population-based retrospective cohort study which utilized the Taiwan National Health Insurance Database. The present study involved 4150 participants who underwent HS due to AUB. The study focused on females aged ≥40 years diagnosed with AUB who underwent HS between 2000 and 2020. Hysterectomy outcomes were analyzed using the Cox proportional hazards model, and age was categorized into three groups (40-44, 45-49, and 50-55 years). Statistical significance was set at P < 0.05. This study involved 4150 participants with an average age of 46.1 years, categorized into the following age groups: 40-44 years (39.6%), 45-49 years (38.8%), and 50-55 years (21.6%). Approximately 8.1% of participants required hysterectomy treatment; the highest incidence was observed in the 40-44-year age group (8.6%). The median time from HS to hysterectomy varied across age groups, ranging from 0.25-2.78 years. The presence of uterine myoma (adjusted hazard ration [aHR]: 2.11; 95% CI: 1.70-2.64; P < 0.0001) and adenomyosis (aHR: 10.24; 95% CI: 8.17-12.85; P < 0.0001) significantly increased the risk of hysterectomy. Kaplan-Meier survival curves demonstrated a comparable likelihood of hysterectomy across age groups within 5 years post-HS, with most occurrences occurring in the initial 5 years. Our study found no age effect on subsequent hysterectomy after HS. This study contributes to a significant understanding of HS outcomes, aiding information for patients seeking AUB surgical options.

Risk of Osteoporotic Fractures among Patients with Thyroid Cancer: A Nationwide Population-Based Cohort Study.

The associations between thyroid cancer and skeletal outcomes have not been thoroughly investigated. We aimed to investigate the risk of osteoporotic fractures in patients with thyroid cancer compared to that in a matched control group. This retrospective cohort study included 2,514 patients with thyroid cancer and 75,420 matched controls from the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC, 2006-2019). The rates of osteoporotic fractures were analyzed, and associations with the levothyroxine dose were evaluated. Patients with thyroid cancer had a significantly lower risk of fracture than did the control group (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.69 to 0.94; P=0.006). Patients diagnosed with thyroid cancer after the age of 50 years (older cancer group) had a significantly lower risk of fracture than did those in the control group (HR, 0.72; 95% CI, 0.6 to 0.85; P<0.001), especially those diagnosed with spinal fractures (HR, 0.66; 95% CI, 0.51 to 0.85; P=0.001). Patients in the older cancer group started osteoporosis treatment earlier than did those in the control group (65.5±7.5 years vs. 67.3±7.6 years, P<0.001). Additionally, a lower dose of levothyroxine was associated with a reduced risk of fractures. In the clinical setting, the risk of fracture in women diagnosed with thyroid cancer after the age of 50 years was lower than that in the control group, which was caused by more proactive osteoporosis treatment in postmenopausal women with thyroid cancer.

Impact of Uterine Leiomyomas on Cardiovascular Disease Risk in Young Reproductive-Aged Women: A Nationwide Population-Based Cohort Study

Background/Objectives: Uterine leiomyomas are the most common benign gynecological tumors in women of reproductive age and are often associated with localized symptoms. However, emerging evidence suggests a link between uterine leiomyomas and systemic conditions such as cardiovascular disease (CVD), particularly myocardial infarction (MI) and ischemic stroke (IS). This study aimed to investigate the relationship between uterine leiomyomas and the risk of CVD events in young women aged 20–39 years using a large, nationwide, population-based cohort. Methods: This retrospective cohort study analyzed data from the National Health Insurance Service database of South Korea of 2,581,700 women aged 20–39 years who underwent health screening between 2009 and 2012. Uterine leiomyomas were identified using International Code of Disease, 10th Edition codes. CVD events (MI and IS) were defined according to hospital claims and radiological data. Multivariate hazard ratios (HRs) were calculated to evaluate the association between leiomyomas and CVD after adjusting for confounders (age, lifestyle factors, comorbidities, and body mass index). Results: In all, 58,812 were diagnosed with uterine leiomyomas, and 25,063 underwent surgical treatment. During the follow-up period, MI occurred in 115 women (0.21%) and IS in 82 women (0.15%) in the leiomyoma group, compared with 3107 cases of MI (0.12%) and 2240 cases of IS (0.09%) in the non-leiomyoma group. The leiomyoma group demonstrated a higher incidence rate of CVD (IR: 0.63 vs. 0.39 per 1000 person-years). After adjusting for confounding factors such as age, lifestyle, comorbidities, and body mass index (BMI), the hazard ratio (HR) for MI was 1.32, indicating a statistically significant increase in cardiovascular risk. The risk of CVD was lower in women who underwent surgical treatment; however, when specifically analyzing the occurrence of MI and IS, no statistically significant differences were observed between the two groups. Conclusions: Uterine leiomyomas are associated with an increased risk of MI and IS in young women. Surgical treatment itself may be associated with additional cardiovascular risks. Further research is needed to develop strategies to mitigate these risks and elucidate the underlying mechanisms.

Changes in Myasthenia Gravis Incidence in Denmark From 1985 to 2021: A Nationwide Population-Based Study.

Previous studies on incident myasthenia gravis (MG) have shown inconsistent results. In this study, we determined the MG incidence rates (IRs) over a 36-year period to detect potential trends in MG incidence over time and for different age groups. In this nationwide population-based study from 1985 to 2021, we identified patients aged 18 and older with a primary MG diagnosis in the Danish National Patient Registry. The patients were categorized into 3 distinct groups defined by age at onset: early-onset (≤50 years of age), late-onset (>50 and ≤65 years of age), and very late-onset (>65 years of age). MG IRs were calculated and stratified by sex and time periods in the specified age groups. To increase the validity of the MG IRs, we performed sensitivity analyses from 1995 until 2021, adding ≥2 prescriptions of pyridostigmine and/or acetylcholine receptor seropositivity. We identified 2,110 patients with MG (1,060 women), with a median age of 57.1 (interquartile range [IQR] 40.2-74.0) years for women and 63.6 (IQR 56.4-74.3) years for men. In the study period, the MG IR was 1.4 (95% CI 1.3-1.4) per 100,000 person-years, which persisted in our sensitivity analyses, with no significant differences between the sexes. Overall, 579 patients (27.4%) were classified as early-onset, 490 (23.2%) as late-onset, and 1,040 (49.3%) as very late-onset. For early-onset MG, the IR was 0.7 (95% CI 0.6-0.7) and remained stable throughout the study period. Inversely, the IRs for late-onset and very late-onset MG increased over time, with corresponding incidence rate ratios (IRRs) of 1.9 (95% CI 1.3-2.6) and 2.2 (95% CI 1.7-2.9), from the first 5 years from 1985 to 1990 until the last 6 years of the study period from 2015 to 2021. The overall IR of MG increased from 1985 to 2021, aligning with recent reports from neighboring European countries. The most significant rise occurred during the last 6 years of the study period compared with the first 5 years, with an IRR reaching 1.9 (95% CI 1.6-2.3). This increase in IRs was observed only in the late-onset and very late-onset age groups.

Development and Validation of a Predictive Model of Prostate Screening Compliance: A Nationwide Population-Based Study.

Prostate cancer (PCa) is the second most common cancer in men worldwide, with significant incidence and mortality, particularly in Mexico, where diagnosis at advanced stages is common. Early detection through screening methods such as digital rectal examination and prostate-specific antigen testing is essential to improve outcomes. Despite current efforts, compliance with prostate screening (PS) remains low due to several barriers. This study aims to develop and validate a predictive model for PCa screening compliance in Mexican men. Retrospective observational design with data from the Mexican Health and Aging Study (MHAS). Participants were men aged 50-69 from three cohorts: development/internal validation, temporal validation, and external validation. Key predictors were identified using relaxed Least Absolute Shrinkage and Selection Operator (LASSO) regression, and model performance was assessed using the area under the curve (AUC) from receiver operating characteristic (ROC) analyses, along with calibration and decision curve analysis (DCA). A web nomogram was also developed. The final model included seven key predictors. AUC values indicated good predictive performance: 0.783 for the training subgroup, 0.722 for the test subgroup, 0.748 for the time cohort, and 0.756 for the external cohort, with sensitivities of 73.5%. The DCA demonstrated the superior clinical utility of the model compared to the reference strategies. The predictive model developed for performance to PCa screening is robust across different cohorts and highlights critical factors influencing performance. The accompanying web-based nomogram enhances clinical applicability and supports interventions aimed at improving PCa screening rates among Mexican men.

Statin Use and the Risk of Graves' Orbitopathy: A Nationwide Population-Based Cohort Study.

Background: Statin use is reported to reduce the risk of Graves' orbitopathy (GO) in Western populations. However, study regarding the protective effect of statins against GO in Asians with Graves' disease (GD) is scarce. This study aims to investigate the efficacy of statins in preventing GO in Asian GD patients. Materials and Methods: This nationwide, population-based retrospective cohort study used data from beneficiaries aged >40 years diagnosed with GD from the National Health Insurance Research Database (NHIRD) from 2010 to 2020. The International Classification of Diseases codes, Anatomical Therapeutic Chemical codes, and the surgery/procedure codes derived from the NHIRD were used to obtain the information on GD, GO, and statin use. Propensity score (PS) analysis with matching and inverse probability of treatment weighting analysis (IPTW) was conducted to minimize confounding. The Kaplan-Meier survival analysis and multivariable Cox regression analysis were used to compare the risk of GO among statin users and nonusers. Results: The final analysis included 102,858 patients; 7,073 were statin users (62.9 ± 10.6 years, 29.7% male), and 95,785 were nonusers (53.6 ± 10.4 years, 25.7% male). The crude incidence rate of GO among statin users and nonusers was 5.00‰ versus 6.75‰ and 4.91‰ versus 5.15‰ for the overall population and population after PS matching method, respectively. The Cox regression analysis showed that statin users had a significantly lower risk of GO (adjusted hazard ratio [HR] after PS matching 0.79, 95% confidence interval [CI]: 0.63-0.99, p = 0.037; adjusted HR after IPTW method: 0.64, CI: 0.51-0.79, p < 0.001). The risk of GO was not different among users of different kinds of statins (i.e., atorvastatin, rosuvastatin, pitavastatin, and other statins) or among different intensities of statins (low-to-moderate intensity vs. high intensity). Conclusions: The use of statins in Asian GD patients was associated with a reduced risk of GO. In addition, the risk of developing GO among users of commonly prescribed statins or users of different intensities of statins was not significantly different.

Pregnancy among thyroid cancer survivors: do thyroidectomy and radioactive iodine matter?

Thyroid cancer primarily affects young women and raises concerns about future fertility due to treatments of thyroidectomy and radioactive iodine (RAI) therapy. This study investigated the effects of these treatments on pregnancy probability in young female patients post-diagnosis. A nationwide, population-based study using data from Taiwan's National Health Insurance Research Database (2000-2017) examined pregnancy likelihood in women ≤45years with thyroid cancer. The effects of thyroidectomy and RAI therapy on pregnancy were analyzed using logistic regression and Cox proportional-hazards models. In a cohort of 10 937 patients with thyroid cancer, 7022 (64.2%) underwent total thyroidectomy, with 718 receiving RAI treatment. The type of thyroidectomy and RAI treatment, even at doses exceeding 120 millicuries, did not reduce the likelihood of pregnancy. Age was identified as the most critical factor influencing pregnancy; women aged >30years had a significantly lower likelihood of becoming pregnant than younger women did. Other factors associated with a reduced likelihood of pregnancy included comorbidity with diabetes (HR = 0.65, P = .002) and higher socioeconomic status (HR = 0.69, P = .085). Thyroidectomy and RAI therapy do not diminish pregnancy probability in young women with thyroid cancer. Age remains a crucial factor, with younger women more likely to conceive. These findings are critical for fertility counseling and treatment planning. Key message What is already known on this subjec? Thyroid cancer primarily affects young women, and its standard treatments, including thyroidectomy and radioactive iodine (RAI) therapy, have raised concerns about their potential impact on fertility. Previous studies have shown that RAI treatment may temporarily affect ovarian function but typically does not have a significant long-term effect on fertility. What this study adds? This nationwide population-based study found that neither total nor partial thyroidectomy, nor RAI treatment, adversely affects the likelihood of pregnancy in young women with thyroid cancer. Age was identified as the most significant factor influencing pregnancy, with younger women having a higher probability of becoming pregnant after treatment. How this study might affect research, practice, or policy? Clinicians should recognize that age, rather than the type of thyroidectomy or RAI treatment, is the most critical factor influencing fertility in young women with thyroid cancer. This insight can guide personalized fertility counseling and treatment planning to optimize outcomes.

Birth Outcomes of Infants Born to Mothers with Alopecia Areata: A Nationwide Population-based Study in Korea.

Data on pregnancy outcomes in patients with alopecia areata (AA) are limited. The aim of this study is to determine the association between maternal AA and risk of adverse birth outcomes in children. A retrospective cohort study was conducted on 45,328 children born to mothers with AA and 4,703,253 controls born to mothers without AA using the Korean National Health Insurance Claims database from 2002 to 2016. Multivariate logistic regression analyses were performed to evaluate the association between maternal AA and the birth outcomes of their children. Infants born to mothers with AA exhibited a significantly higher risk of preterm birth (odds ratio [OR] 1.39, 95% CI 1.33-1.45; adjusted OR [aOR] 1.07, 95% CI 1.01-1.13), low birthweight (OR 1.36, 95% CI 1.30-1.42; aOR 1.11, 95% CI 1.05-1.17), and Caesarean section birth (OR 1.24, 95% CI 1.22-1.26; aOR 1.12, 95% CI 1.08-1.15) than controls. In addition, the risk of congenital malformations was also significantly higher in infants born to mothers with AA (OR 1.19, 95% CI 1.15-1.22; aOR 1.10, 95% CI 1.07-1.14), especially for malformations of the urinary (OR 1.33, 95% CI 1.19-1.48; aOR 1.16, 95% CI 1.04-1.29) and musculoskeletal (OR 1.19, 95% CI 1.12-1.27; aOR 1.12, 95% CI 1.05-1.19) systems, than controls. Maternal AA is associated with an increased risk of adverse birth outcomes in infants.

Sex differences in psychiatric comorbidities of attention-deficit/hyperactivity disorder among children, adolescents, and adults: A nationwide population-based cohort study

This cross-sectional, nationwide, population-based study aimed to elucidate sex differences in psychiatric comorbidities of Attention-deficit/hyperactivity disorder (ADHD) across children, adolescents, and adults. We analyzed data from Taiwan’s comprehensive healthcare database, including 112,225 individuals diagnosed with ADHD, categorized by age (0–12, 13–18, ≥18 years) and sex. Psychiatric comorbidities were assessed using ICD-9-CM codes, focusing on age and sex-specific prevalence. Among the cohort, 83.50% were children (0–12 years) presenting primarily with learning disabilities and tics, while adolescents (13–18 years; 11.88%) had higher instances of oppositional defiant and conduct disorders. In adults (≥18 years; 4.62%), the prevalence of anxiety, depression, bipolar disorder, and substance misuse was notably higher. Males under 18 predominantly had ADHD, whereas females exhibited increased vulnerability to emotional disorders. In adulthood, males showed greater susceptibility to most psychiatric comorbidities, except sleep disorders. The study highlights the evolving nature of ADHD-related psychiatric comorbidities across different life stages, with distinct sex-based patterns. The transition from childhood to adulthood sees an increased prevalence of various psychiatric conditions, particularly impacting adult males. These findings underscore the need for age- and sex-specific therapeutic approaches in ADHD management. The cultural context of the study necessitates further research in diverse populations for broader applicability of the findings.

Real-World Utilization Patterns of Oral Corticosteroids During Pregnancy: A Nationwide Population-Based Study in Korea.

Oral corticosteroids (OCS) are frequently used during pregnancy, but patterns of their usage and indications are understudied. We described OCS utilization among pregnant women in South Korea using the Health Insurance Review and Assessment database, 2010-2021. Among 4,574,294 pregnancies, 6.2% (n = 283,001) were exposed to OCS, with the annual prevalence increasing from 4.98% in 2010 to 6.65% in 2021. Methylprednisolone and prednisolone accounted for 90% of OCS use during pregnancy, and the median duration of prescriptions was four days. Respiratory and skin diseases were the most common indications, and prescriptions for pregnancy-associated conditions increased notably after 2017, coinciding with insurance coverage for infertility treatments. OCS prescriptions declined during the first trimester and increased near delivery, suggesting discontinuation upon pregnancy recognition. Our findings highlight the common and increasing use of OCS during pregnancy, mainly for acute conditions, underscoring the need for further research on their safety in pregnant populations.

Incidence and characteristics of sudden sensorineural hearing loss during pregnancy and the postpartum period: A nationwide population-based study using customized cohort data

Incidence and characteristics of sudden sensorineural hearing loss during pregnancy and the postpartum period: A nationwide population-based study using customized cohort data

Prevalence and Incidence of Ethambutol-Induced Optic Neuropathy and Its Risk Factors in Korea: A Nationwide Population-Based Study

Prevalence and Incidence of Ethambutol-Induced Optic Neuropathy and Its Risk Factors in Korea: A Nationwide Population-Based Study

Natural History of Hypertrophic Cardiomyopathy in Korea: A Nationwide Population-Based Retrospective Cohort Study

Natural History of Hypertrophic Cardiomyopathy in Korea: A Nationwide Population-Based Retrospective Cohort Study

Incidence and mortality of upper tract urothelial carcinoma in Korea: A nationwide population-based study conducted from 2002 to 2020.

To describe the incidence and mortality of upper tract urothelial carcinoma (UTUC) from 2002-2020 using data from the Korean National Health Insurance Service, which contains data from the entire Korean population. Reimbursement records for 43,255 patients diagnosed with primary UTUC (according to the International Classification of Disease 10th revision code C65 and C66) between 2002-2020 were retrieved. The study period was split into four: period I (2002-2005), period II (2006-2010), period III (2011-2015), and period IV (2016-2020). Trends were quantified by calculating the annual percentage change (APC). Mortality data were obtained from the Statistics Korea. From 2002-2020, the incidence of UTUC in Korea increased gradually from 9.34 to 11.40 per 100,000 person-years. Although there was a male predominance, the male to female ratio did not change significantly over time; however, age at the time of diagnosis, the comorbidity index, and the proportion of patients undergoing open/laparoscopic surgery increased significantly over time. There was a modest improvement in 5-year survival (both all cause- and cancer-specific) over the study period. Multivariate analysis identified age at diagnosis, sex, the comorbidity index, and open/laparoscopic surgery as being associated with survival. Between 2002 and 2020, the incidence of UTUC in Korea showed a general upward trend; however, survival outcomes have improved. These representative datasets from the Korean population might provide crucial information that enables clinicians to better understand of the epidemiology of UTUC in Korea.

Infectious intestinal diseases elevate neurodegenerative disease risk based on a nationwide population-based cohort study

Infectious intestinal diseases (IIDs) pose a significant health and economic burden worldwide. Recent observations at the Tri-Service General Hospital, Taiwan, suggest a potential association between IIDs and neurodegenerative diseases, prompting an investigation into this relationship. This study explored interactions between IIDs and neurodegenerative diseases. We conducted a population-based retrospective cohort analysis using data from the National Health Insurance Research Database (NHIRD) of Taiwan. Patients diagnosed with IIDs between 2000 and 2015 were identified along with a matched control group. Covariates, including demographics, comorbidities, and healthcare utilization were considered. The hazard ratios (HRs) of neurodegenerative diseases were assessed using a Cox proportional regression analysis. This study included 297,438 patients: 99,146 and 198,292 patients in the IID and control groups, respectively. Patients with IIDs showed a significantly higher overall risk of neurodegenerative diseases (adjusted hazard ratio [aHR] = 1.144, P < 0.001). Subgroup analyses revealed an elevated risk of Parkinson's disease, multiple sclerosis, and other neurodegeneration-associated disorders in the study group. Additionally, a positive correlation was observed between the frequency of medical visits for IIDs and neurodegenerative disease risk. This study provides evidence for a significant association between IIDs and the neurodegenerative disease risk. Early detection and management of IIDs may have implications for long-term neurological health outcomes. Further research is required to elucidate underlying mechanisms and develop targeted interventions and preventive strategies.

Association between gestational age and severe maternal morbidity in preterm delivery: A nationwide population-based cohort study.

This study investigates whether early gestational age (GA) at delivery is associated with an increased risk for severe maternal morbidity (SMM) in women with preterm delivery. This retrospective national cohort study based on the Programme de Médicalisation des Systèmes d'Information database included mothers who gave birth between 22 and 37 weeks in metropolitan France in 2019 (in utero deaths and medical terminations of pregnancies were excluded). SMM was defined as a composite criterion consisting of the occurrence of at least one of the following events: death, severe preeclampsia, obstetric surgical complications, severe maternal diseases, and admission to the intensive care unit. The association between GA as a categorical variable (22-24 weeks, 24-26 weeks, 26-28 weeks, 28-32 weeks, 32-34 weeks, and >34 weeks) and SMM was assessed by performing multivariate logistic regressions. Interaction tests were performed to identify factors that might influence the association between SMM and GA. Among the 42 821 women who gave birth prematurely in metropolitan France in 2019 (6.2% of all parturients), 6249 (1.6%) presented with an SMM event (mostly severe preeclampsia, at 74.3%). GA was associated with SMM (adjusted odds ratio ranging from 1.83 between 32 and 34 weeks to 2.67 between 22 and 24 weeks compared to the reference group of 34-37 weeks, P < 0.001). The evolution of the risk of SMM according to GA appeared linear. Early GA at delivery was associated with an increased risk of SMM in women with preterm delivery. This study showed that SMM is also increased in cases of spontaneous prematurity and vaginal delivery.

Persisting Chronic Periodontal Disease as a Risk Factor for Cardiovascular Disease: A Nationwide Population-Based Cohort Study.

Epidemiological studies have consistently established a positive association between periodontal disease (PD) and cardiovascular disease (CVD). However, large-scale investigations exploring the impact of changes in PD status on CVD risk are scarce. This study aimed to investigate the association between the dynamics in PD and the risk of incident CVD in a nationally representative population. Utilising data from the Korean National Health Insurance Service, a cohort of 1,242,570 participants who underwent oral health exams in 2003 and a follow-up exam in 2005-2006 was analysed. Participants were categorized into groups based on changes in PD status: absent, improvement, onset and persistent. Cox proportional hazard models were employed to assess the multivariate-adjusted hazard ratios (HRs) for composite CVD outcomes, including death, myocardial infarction and stroke. Over a mean follow-up of 14.4 years, 79,810 (6.4%) cases of composite CVD occurred, including 14,296 (1.2%) myocardial infarctions, 3247 (0.3%) hemorrhagic strokes and 8900 (0.7%) ischemic strokes. Individuals with persistent PD showed the highest risk of CVD (HR: 1.04, 95% CI: 1.03-1.06, p < 0.001). In the pairwise comparisons, the PD improvement group exhibited a lower composite CVD risk than the PD persistent group (HR: 0.97, 95% CI: 0.96-0.99, p = 0.010); similarly, the PD onset group showed a lower risk than the PD persistent group (HR: 0.94, 95% CI: 0.93-0.96, p < 0.001). This pattern was consistent in the risk of death, with both the PD improvement and PD onset groups showing a lower risk of death than the PD persistent group. This study suggests the dynamic nature of PD as a potential modifiable risk factor for CVD. Individuals with chronically persistent PD showed an elevated incidence risk of CVD, emphasizing the importance of managing PD in preventive strategies.

A Nationwide Population-based Study for Audio-vestibular Disorders Following COVID-19 Infection.

To date, no study has reported the various otologic conditions associated with COVID-19 using population-based design. The aim of this study was to investigate the incidence and risk of audio-vestibular disorders (benign paroxysmal positional vertigo, sudden sensorineural hearing loss, Meniere's disease, vestibular neuritis, and tinnitus) increase after COVID-19 infection. This retrospective population-based study was conducted using National Health Insurance Service (NHIS)-COVID-19 cohort database of South Korea. We identified participants in the COVID-19 group using real-time reverse transcription-polymerase chain reaction tests. A matched cohort without COVID-19 was randomly selected in a 1:1 ratio. Benign paroxysmal positional vertigo, sudden sensorineural hearing loss, Meniere's disease, vestibular neuritis, and tinnitus were defined using diagnostic, medication, and procedure codes. The incidence and risk of these disorders were assessed in both groups using univariate and multivariate Cox proportional hazard analyses. In total, 4,976,589 COVID-19 patients and an equivalent number of matched non-infected controls were analyzed. COVID-19 patients faced an increased risk of developing benign paroxysmal positional vertigo, sudden sensorineural hearing loss, vestibular neuritis, and tinnitus compared to controls in univariate and multivariate Cox hazard analyses. COVID patients were at an increased risk of Meniere's disease in the univariate analysis; however, the risk of Meniere's disease after COVID-19 did not reach statistical significance in the multivariate analysis. COVID-19 infection may increase the risk of benign paroxysmal positional vertigo, sudden sensorineural hearing loss, vestibular neuritis, and tinnitus.

Accelerated risk of renal disease progression in pre-ESRD patients with proton pump inhibitors use: a nationwide population-based study

Abstract Background Although Proton pump inhibitors (PPIs) were mostly prescribed for gastrointestinal (GI) disease widely, there were numerous studies about PPIs and adverse renal outcome. Most evidence was to evaluate the risk of PPIs in patients with normal renal function and in the absence of the moderate to advanced chronic kidney disease (CKD). This study focuses on the accelerated progression of renal function following proton pump inhibitors (PPIs) use, and the increased risks of acute kidney injury (AKI) among moderate to advanced CKD (pre-ESRD) patients. Patients and methods A retrospective cohort study was conducted by including adult patients with chronic kidney disease (CKD) stages 3b to 5 who initiated PPI or H2 blocker (H2B) therapy between 2011 and 2018. The risk of renal events was assessed using the Cox proportional hazard model to estimate the adjusted hazard ratio (HR) and 95% confidence interval (CI). Sensitivity analyses were performed, including propensity score matching, as-treated analysis, and subgroup analysis. Results The cohort comprised 83,432 pre-ESRD patients, with 5,138 treated with H2B and 1,051 with PPIs. The progression to ESRD was significantly more likely in patients using PPIs compared to those using H2B (adjusted HR, 1.495; 95% CI: 1.198–1.867). Specifically, omeprazole (adjusted HR, 1.784; 95% CI: 1.079–2.951) and esomeprazole (adjusted HR, 1.847; 95% CI: 1.332–2.561) were associated with a notably higher risk of ESRD and AKI. Conclusions The study highlights the significance of the accelerated renal risk, especially for moderate to advanced CKD patients, when prescribing PPIs and to implicate the clinicians prescribed PPIs and H2B in pre-ESRD patients.