General Taiwanese Population Research Articles

Pneumonia Risk and Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers

BackgroundRecent studies have shown that use of angiotensin-converting enzyme (ACE) inhibitors may decrease pneumonia risk in various populations. We investigated the effect of ACE inhibitors and angiotensin II receptor blockers (ARBs) on pneumonia hospitalization in the general population of Taiwan.MethodsWe conducted a case-crossover study using the Taiwan Longitudinal Health Insurance Database for the year 2005. Data from patients hospitalized for the first time for pneumonia during 1997–2007 were analyzed. The case period was defined as the 30 days before admission; the periods 90 to 120 days and 180 to 210 days before admission were used as control periods. Prescribing status of ACE inhibitors and ARBs during the 3 periods was assessed for each patient. Conditional logistic regression was used to estimate the odds ratio (OR) for pneumonia associated with use of ACE inhibitors and ARBs.ResultsWe identified 10 990 cases of hospitalization for new pneumonia. After adjustment for time-variant confounding factors, pneumonia was not associated with use of ACEI or ARBS: the ORs were 0.99 (95% CI, 0.81–1.21) and 0.96 (0.72–1.28), respectively. No association was seen for cumulative defined daily doses (DDDs), as compared with nonusers, for 0 to 30, 31 to 60, or more than 60 DDDs. The results were found to be robust in sensitivity analysis.ConclusionsNeither the use nor cumulative dose of ACE inhibitors or ARBs was associated with pneumonia among the Taiwanese general population.

Underlying Cause and Place of Death Among Patients With Amyotrophic Lateral Sclerosis in Taiwan: A Population-Based Study, 2003^|^ndash;2008

BackgroundFew studies have assessed cause of death among patients with amyotrophic lateral sclerosis (ALS). We investigated underlying cause and place of death among patients with ALS in Taiwan during 2003–2008.MethodsThe data source was the Taiwan National Health Insurance database for the period 2003–2008. In total, 751 patients older than 15 years with a primary diagnosis of ALS were included and followed until 2008 in the national mortality database. Crude mortality rates (per 100 person-years) and standardized mortality ratios (SMRs) were calculated in relation to cause of death, sex, and age group (15–44, 45–64, 65+ years).ResultsIn total, 297 (39.6%) patients died during the follow-up period, an age- and sex-standardized mortality rate 13 times (95% CI, 10.6–15.6) that of the Taiwanese general population. The leading cause of death among the patients was respiratory diseases, and the second most frequent cause was cardiovascular diseases. During the first year after an ALS diagnosis, suicide was much more frequent (SMR, 6.9; 95% CI, 1.9–17.6) than among the general population.ConclusionsDuring 2003–2008, respiratory diseases and cardiovascular diseases were the most frequent causes of death among Taiwanese patients with ALS. In addition, our findings indicate that suicide prevention is an urgent priority during the period soon after an ALS diagnosis.

Oral cancer in Taiwan: is diabetes a risk factor?

The association between diabetes and oral cancer is rarely studied. We investigated the trends of oral cancer in the Taiwanese general population and the possible link with diabetes. The trend of age-standardized oral cancer incidence in 1979-2007 in Taiwan was calculated from the Taiwan Cancer Registry database. A total of 494,817 men and 503,723 women without oral cancer from a random sample of 1,000,000 individuals covered by the National Health Insurance were followed up from 2003 to 2005. Cox regression evaluated the adjusted relative risk considering potential detection bias and covariates. The trends increased significantly in both sexes. Diabetic patients had a higher chance of oral cancer detection because they more frequently visited related medical professionals. Although diabetes status and duration were significantly associated with oral cancer in unadjusted models, none was significant after multivariable adjustment. For comorbidities, chronic obstructive pulmonary disease (a surrogate for smoking) and alcohol-related diagnoses were significant for men, and hypertension and alcohol-related diagnoses were significant for women. Additionally, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and insulin were significant with relative risk (95% confidence interval) of 1.642 (1.174-2.295) and 2.136 (1.003-4.547), respectively, in men. Oral cancer is increasing in Taiwan. Diabetes is not a risk factor after multivariable adjustment. The increasing trend of oral cancer may not be ascribed to diabetes. The association between oral cancer and some comorbidities and medications requires confirmation and may provide strategies for the prevention of oral cancer.

Body mass index and mental health problems in general adults: Disparity in gender and socioeconomic status

ObjectiveThis nationwide population-based study aims to evaluate the association between Body Mass Index (BMI) and mental health problems, and to investigate the effects of gender and socioeconomic status (SES) on this association. MethodsThis study was a longitudinal study. 12,862 adults (aged 18years or older), who responded to the 2001 National Health Interview Survey (NHIS) and gave consent to the linking of the survey data to their National Health Insurance (NHI) claims records, were included. The 2002–2004 NHI claims records of the sample were analyzed. Logistic regression was used to evaluate the odds ratios. Those with middle and high income (per capita annual household income ≧US$9375) in the sample were referred to as the better-offs. ResultsAfter adjustment, increased BMI was significantly associated with a higher risk of schizophrenia (OR: 1.14, 95% CI: 1.07–1.22) and a lower risk of mood disorder (OR: 0.95, 95% CI: 0.91–0.99) in women. In addition, a higher BMI was significantly associated with a lower risk of mood disorders (risk reduction: 6%) and a lower risk of any major mental health problem (risk reduction: 3%) among the better-offs. ConclusionsIn contrast to other (cross-sectional) studies in other countries, our longitudinal results suggest that in a general Taiwanese population, the association between BMI and mental health may vary by type of mental health problems. Gender and SES may have influenced this relationship. Further studies are required to elucidate the biological or social factors underlying these empirical observations.

Diabetes but not insulin is associated with higher colon cancer mortality

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

Body composition, C-reactive protein, carotid artery remodeling and subclinical atherosclerosis in a general Taiwanese population

Obesity, an escalating problem worldwide, increases the risk of serious disease, particularly atherosclerosis. A community-based cross-sectional study was designed to screen for undetected atherosclerosis. High-sensitivity C-reactive protein (hs-CRP), the presence of the metabolic syndrome (MetS), and ultrasound studies to detect fatty liver and measure carotid intimal-medial thickness were performed. A total of 1,005 subjects (595 men and 410 women; mean age of 52.4 ± 11.1 years) were included in the final study cohort. 237 subjects (23.7%) fulfilled National Cholesterol Education Program Adult Treatment Panel ATP-III criteria for MetS. Significant differences between female and male subjects were noted in body mass index (BMI), % body fat mass (Fat%), waist-to-hip ratio, waist circumference, fasting glucose levels, triglyceride levels, fatty liver, and carotid artery changes (P < 0.05). When female subjects were classified by hs-CRP levels, significant differences were reported among the three groups in age, BMI, Fat%, waist-to-hip ratio, waist circumference, blood pressure, fasting glucose, HDL, triglycerides, fatty liver grade and common carotid artery changes (P < 0.05). In this study, high hs-CRP was associated with increased cholesterol and cardiovascular changes supporting the idea that it may be a useful biomarker for detecting early asymptomatic vascular and coronary heart disease resulting from obesity.

AN OCCUPATIONAL EXPOSURE ASSESSMENT OF POLYCHLORINATED DIBENZO- p -DIOXIN AND DIBENZOFURANS IN FIREFIGHTERS

Background and Aims: Polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) are unintentional byproducts of combustion and industrial processes. Firefighters face the risk of occupational exposure to PCDD/Fs. A survey of the PCDD/F levels in firefighters was conducted. Furthermore, we intended to identify potential risk factors associated with the exposure to high PCDD/F levels in firefighters and confirm the presence of high PCDD/F levels in fire accidents. Methods: Congener-specific analyses of 17 PCDD/Fs were performed on 20 serum samples collected from firefighters and fire scene investigators, and four soot samples that had deposited on the surfaces of the fire helmets and were collected after the firefighters had fought fires. Results: The PCDD/F concentrations on the helmets that were contaminated by being worn at the fire scenes were 63 - 285 times higher than those on a clean helmet. The median serum PCDD/F concentration of the 16 firefighters (12 pg WHO2005-TEQ g-1 lipid) was not different from those of the males from the general Taiwanese population (9.4 pg WHO2005-TEQ g-1 lipid). However, the median PCDD/F level in the four fire scene investigators (15 pg WHO2005-TEQ g-1 lipid) was higher than those in the male from the general Taiwanese population (Mann-Whitney U test, p&lt; 0.01). Furthermore, the serum samples from the firefighters and fire scene investigators, and the soot samples from the fire scenes presented similarly distinctive PCDD/F profiles that had elevated proportions for 10 PCDF congeners. Conclusions: Firefighters face an elevated risk of occupational exposure to PCDD/Fs due to the large amounts of PCDD/Fs deposited on the surfaces of the fire helmets at the fire scene. The firefighters’ thermal protective uniforms provided a protective barrier for exposure to PCDD/Fs. However, the fire scene investigators may have had more occupational exposures to PCDD/Fs due to poor personal protection; however, this requires further investigation.

Eczema and cancer risk: a critical appraisal and review of the literature

Hwang et al. aimed to evaluate the risk of malignancy among individuals with eczema, allergic rhinitis (AR) and asthma, compared with the general Taiwanese population. People with atopic conditions, including eczema, have an altered risk of malignancy. This was a prospective nationwide cohort study. The authors used the Taiwanese National Health Insurance Research Database (NHIRD) to compare the incidence of cancers among people with established allergic disease relative to the risk in the general population. STUDY EXPOSURE: Exposure was the presence of one or more atopic conditions (eczema, AR or asthma). Data were extracted on 997,729 randomly selected people registered on the NHIRD at any time point between 1996 and 2008. Eczema was identified via ICD-9-CM codes with the diagnosis being made by a dermatologist, paediatrician or allergist. Follow-up was until 2008, date of first cancer or death. The outcome was a new diagnosis of malignancy, identified via catastrophic illness insurance certificates, again using ICD-9-CM diagnostic codes. Standardized incidence ratios (SIRs) for cancers overall and different types of malignancy among patients with eczema, AR or asthma were calculated against the expected number of cancer cases in the general population, adjusted for age and sex. The number of patients identified with eczema, AR and asthma was 34,263, 225,315 and 107,601, respectively. Overall cancer rates in patients with these conditions were not significantly different from those in the general population [SIR eczema = 0·97 (95% confidence interval 0·87-1·09), SIR AR = 1·02 (0·98-1·05) and SIR asthma = 1·01 (0·97-1·04)]. However, when the results for eczema were stratified by age, people aged between 20 and 39 years appeared to have a 56% increase in risk in relation to 'any cancer' [SIR = 1·56 (1·13-2·09)]. Looking at individual cancer types in patients with eczema, only the risk of brain cancer was significantly raised [SIR = 2·52 (1·15-4·79)]. Patients who had had all three allergic conditions had a reduced SIR for 'cancers overall' [SIR = 0·59 (0·37-0·88)]. This inverse association was less strong for those with eczema and asthma [SIR = 0·73 (0·55-0·97)] or asthma and AR [SIR = 0·79 (0·73-0·84)] and statistically only of borderline significance for those with eczema and AR [SIR = 0·85 (0·67-1·07)]. Hwang et al. conclude that the relationship between allergic diseases and cancer risk is complex and site specific. The risk of malignancy was highest in all atopic conditions in the 20-39-year age group. In patients with eczema, the incidence of brain cancer was higher than expected, which the authors note is at odds with previous studies. However, numbers were too small to allow stratification by histological subtypes. The authors warn against deriving conclusions for rarer cancers and that borderline SIRs must be interpreted with caution.

ACTN3 Genotype and Swimming Performance in Taiwan

Studies have shown that the 577R allele of α-actinin-3 (ACTN3) is more prevalent in sprint athletes than in the general population or in endurance athletes. We examined the distribution of ACTN3 R577X (rs 1815739) genotypes and alleles in the Taiwanese general population (603) and in elite sprint swimmers who had participated in international/national events (168). Additionally, 50 pre-adolescent (age 11-13 years) male students and 38 adult males who completed 12-weeks of swimming training, were included in the present study. We found that the frequencies of the R allele were significantly higher in female international sprint swimmers (67.6%) than in national sprint swimmers (50.0%) or in the general population (53.7%). The 25-m performance was significantly improved across the genotypes after swimming training among the pre-adolescent males but not among the adult males. In addition, pre-adolescents with the RR genotype had the best performance both before and after training although not statistically significant. In conclusion, the frequencies of ACTN3 577R allele were significantly higher in female international sprint swimmers than among national sprint swimmers or the general population. Furthermore, male pre-adolescents with either the ACTN3 RX or XX genotype showed a greater improvement in 25-meter swimming performance than those with the RR genotype.

An occupational exposure assessment of polychlorinated dibenzo- p-dioxin and dibenzofurans in firefighters

Polychlorinated dibenzo- p-dioxins and dibenzofurans (PCDD/Fs) are unintentional byproducts of combustion and industrial processes. Firefighters face the risk of occupational exposure to PCDD/Fs. Congener-specific analyses of 17 PCDD/Fs were performed on 20 serum samples collected from firefighters and fire scene investigators, and four soot samples that had deposited on the surfaces of the fire helmets and were collected after the firefighters had fought fires. The PCDD/F concentrations on the helmets that were contaminated by being worn at the fire scenes were 63–285 times higher than those on a clean helmet. The median serum PCDD/F concentration of the 16 firefighters (12 pg WHO 2005-TEQ g −1 lipid) was not different from those of the males from the general Taiwanese population (9.4 pg WHO 2005-TEQ g −1 lipid). However, the median PCDD/F level in the four fire scene investigators (15 pg WHO 2005-TEQ g −1 lipid) was higher than those in the male from the general Taiwanese population (Mann–Whitney U test, p < 0.01). Furthermore, the serum samples from the firefighters and fire scene investigators, and the soot samples from the fire scenes presented similarly distinctive PCDD/F profiles that had elevated proportions for 10 PCDF congeners. Limited data indicated that the fire scene investigators were occupationally exposed to PCDD/Fs at the fire scenes. We suggested that the firefighters were not occupationally exposed to PCDD/Fs at the fire scenes due to appropriate protection. However, the fire scene investigators may have had more occupational exposure to PCDD/Fs due to poor protection, and further research must be performed to confirm this.

Diabetes and Risk of Prostate Cancer

OBJECTIVEThe link between diabetes and prostate cancer is rarely studied in Asians.RESEARCH DESIGN AND METHODSThe trend of age-standardized prostate cancer incidence in 1995–2006 in the Taiwanese general population was calculated. A random sample of 1,000,000 subjects covered by the National Health Insurance in 2005 was recruited. A total of 494,630 men for all ages and 204,741 men ≥40 years old and without prostate cancer at the beginning of 2003 were followed to the end of 2005. Cumulative incidence and risk ratio between diabetic and nondiabetic men were calculated. Logistic regression estimated the adjusted odds ratios for risk factors.RESULTSThe trend of prostate cancer incidence increased significantly (P < 0.0001). The cumulative incidence markedly increased with age in either the diabetic or nondiabetic men. The respective risk ratio (95% CI) for all ages and age 40–64, 65–74, and ≥75 years was 5.83 (5.10–6.66), 2.09 (1.60–2.74), 1.35 (1.07–1.71), and 1.39 (1.12–1.71). In logistic regression for all ages or for age ≥40 years, age, diabetes, nephropathy, ischemic heart disease, dyslipidemia, living region, and occupation were significantly associated with increased risk, but medications including insulin and oral antidiabetic agents were not.CONCLUSIONSProstate cancer incidence is increasing in Taiwan. A positive link between diabetes and prostate cancer is observed, which is more remarkable in the youngest age of 40–64 years. The association between prostate cancer and comorbidities commonly seen in diabetic patients suggests a more complicated scenario in the link between prostate cancer and diabetes at different disease stages.

Prostate cancer mortality in Taiwanese men: Increasing age-standardized trend in general population and increased risk in diabetic men

Background. To evaluate the trend of prostate cancer mortality in Taiwanese general population and the association between diabetes and prostate cancer mortality.Materials and methods. In the general population during 1995–2006, the trends of prostate cancer mortality were evaluated, followed by calculation of age-specific mortality rates for age 40–64, 65–74, and ≥ 75 years. A cohort of 102,651 diabetic men aged ≥ 40 years recruited in 1995–1998 was followed prospectively.Results. The trends of crude and age-standardized mortality from prostate cancer in the general population increased significantly (P < 0.0001). In the general population, 7,966 men aged ≥ 40 years died of prostate cancer, and aging was associated with increased risk. Age-specific prostate cancer mortality suggested significantly increasing trend for ages 65–74 and ≥ 75 years. A total of 321 diabetic men died of prostate cancer (crude mortality rate 41.9/100,000 person-years). Mortality rate ratios (95% confidence interval) showed higher risk of prostate cancer mortality in the diabetic patients, with magnitude increased with decreasing age: 1.55 (1.29–1.86), 2.68 (2.29–3.13), and 6.84 (5.34–8.75) for age ≥ 75, 65–74, and 40–64 years, respectively.Conclusions. Prostate cancer mortality in the Taiwanese general population is increasing. Diabetic patients have a higher risk of prostate cancer mortality, which is more remarkable with decreasing age.

Diabetes conveys a higher risk of gastric cancer mortality despite an age-standardised decreasing trend in the general population in Taiwan

BackgroundThe association between diabetes and gastric cancer has been rarely studied.ObjectiveTo investigate gastric cancer mortality trends, the mortality rate ratios between patients with diabetes and the general population, and the...

The role of insulin-like growth factor-1 and growth hormone in the mortality of patients with acromegaly after trans-sphenoidal surgery

Context Acromegaly is associated with a significant increase in mortality. With the development of new modalities of treatment, it has become important to identify prognostic factors relating to mortality. Objective This study aimed to determine the all-cause mortality of patients with acromegaly after trans-sphenoidal surgery, and assess the impact of biochemical markers on survival. Design Two hundred thirty-four patients were admitted to the Taipei Veterans General Hospital for acromegaly between 1979 and 2007. Of the 163 patients who underwent trans-sphenoidal surgery, 142 had data available for insulin-like growth factor-1 (IGF-1), and their survival status was analyzed. Serial data for fasting growth hormone (GH) and IGF-1 were collected. This study also used the last follow-up data for mortality analysis. The patients with acromegaly were grouped according to the last follow-up GH level (≤ 2 or > 2 μg/L) and IGF-1 SD score (≤ 2 or > 2). All-cause mortality was followed to the end of 2007 and compared to the general Taiwanese population by standardized mortality ratios. Results Serial GH and IGF-1 data revealed that the GH levels in the first 3 years after surgery were important predictors of mortality in acromegaly. However, there are insufficient IGF-1 data for deceased patients to determine the significance of a raised IGF-1 immediately following treatment. Comparison of crude death rates suggests that a fasting GH level of 2 μg/L and normalization of the IGF-1 level are appropriate targets. After subgroup analysis to assess the impact of discordant GH and IGF-1 levels on survival, the data showed that the elevated GH group had a trend toward a higher mortality than the elevated IGF-1 group. Conclusions An elevated GH value in the first 3 years after surgery may be the best predictor of mortality. Thus, the follow-up of patients with acromegaly at relatively frequent intervals after trans-sphenoidal surgery should be routine.

Optimal anthropometric factor cutoffs for hyperglycemia, hypertension and dyslipidemia for the Taiwanese population

BackgroundOptimal cutoffs for obesity indices are rarely studied in Asians. We evaluated these cutoffs for diabetes, hypertension, dyslipidemia and any risk factor for the Taiwanese general population. MethodsBody mass index (BMI), waist circumference (WC), waist–hip ratio (WHR), waist–height ratio (WHeiR) and other data for 4683 (2280 men and 2403 women) participants of the population-based Taiwanese Survey on Hypertension, Hyperglycemia and Hyperlipidemia were used. Areas under curves (AUCs) were analyzed and optimal cutoffs were estimated by maximizing the sums of sensitivity and specificity. Potential confounders included age, smoking, alcohol, betel nut chewing and exercise. ResultsOptimal cutoffs for men and women, respectively, were 23.7–26.3 and 22.1–23.2kg/m2 for BMI; 85.0–87.0 and 74.0–83.0cm for WC; 0.87–0.90 and 0.78–0.83 for WHR; and 0.48–0.52 and 0.48–0.52 for WHeiR. AUCs were not significantly different among the indices for diabetes in men and for hypertension in women. In men, WHR was significantly inferior to the other indices for predicting hypertension, dyslipidemia and any risk factor. In women, BMI was significantly inferior to the others for diabetes. For dyslipidemia and any risk factor in women, WHeiR showed the largest AUCs and significant differences were seen in the following pairs: WHeiR vs. BMI and WHeiR vs. WHR for dyslipidemia and WC vs. WHR and WHeiR vs. WHR for any risk factor. ConclusionsWC and WHeiR have similar efficacy and are superior to BMI and WHR. However, WHeiR has the extra benefit of a unisex cutoff within a narrow range.

The Risk Perception of Nanotechnology in Taiwanese General Population, Workers, and Experts

The Risk Perception of Nanotechnology in Taiwanese General Population, Workers, and Experts

Serum uric acid level as an independent risk factor for all‐cause, cardiovascular, and ischemic stroke mortality: A chinese cohort study

The association between hyperuricemia and cardiovascular events has been documented in high-risk groups, but is still undetermined in general populations, especially Chinese. This study assessed the temporal association between serum uric acid level, hyperuricemia, and cardiovascular mortality. A prospective cohort study of 41,879 men and 48,514 women ages > or = 35 years was conducted using data from the MJ Health Screening Centers in Taiwan. Mortality from all causes, total cardiovascular disease (CVD), ischemic stroke, congestive heart failure, hypertensive disease, and coronary heart disease were compared according to increasing serum uric acid levels. A total of 1,151 (21.2%) events of 5,427 total deaths were ascribed to CVD (mean followup 8.2 years). Hazard ratios (HRs) for hyperuricemia (serum uric acid level >7 mg/dl) were estimated with Cox regression model after adjusting for age, sex, body mass index, cholesterol, triglycerides, diabetes, hypertension, heavy cigarette smoking, and frequent alcohol consumption. In all patients, HRs were 1.16 (P < 0.001) for all-cause mortality, 1.39 (P < 0.001) for total CVD, and 1.35 (P = 0.02) for ischemic stroke. In subgroup analysis, the HRs for cardiovascular risk remained significant in patients with hypertension (1.44, P < 0.001) and in patients with diabetes (1.64, P < 0.001). In addition, in a low metabolic risk subgroup, the HRs for all-cause mortality and total cardiovascular morbidity were 1.24 (P = 0.02) and 1.48 (P = 0.16), respectively. Hyperuricemia was an independent risk factor of mortality from all causes, total CVD, and ischemic stroke in the Taiwanese general population, in high-risk groups, and potentially in low-risk groups.

Age-related risk of mortality from bladder cancer in diabetic patients: A 12-year follow-up of a national cohort in Taiwan

Background. To compare bladder cancer mortality between diabetic patients and the general population.Materials and methods. Yearly sex-specific mortality rates for age 25–64, 65–74, and ≥75 years in Taiwanese general population for 1995–2006 were calculated; 113,347 diabetic men and 131,573 diabetic women aged ≥25 years recruited in 1995–1998 were followed prospectively.Results. In the general population, 4,943 men and 2,291 women died of bladder cancer, and aging was associated with increased risk. Although the trend of crude mortality was increasing in either sex, the trend of age-standardized rates had been steady. The average crude and age-standardized mortality rates were 5.35 and 5.98 (per 100,000 population), respectively, for men; and were 2.63 and 3.02 for women. A total of 224 diabetic men and 126 diabetic women died of bladder cancer with crude mortality of 26.0 and 11.9 per 100,000 person-years, respectively. The relative risk of bladder cancer mortality (95% confidence interval) for diabetic patients was 2.18 (1.75–2.72), 2.50 (2.06–3.04), and 5.95 (4.57–7.74), in men, and 1.34 (0.96–1.89), 2.48 (1.92–3.19), and 7.44 (5.46–10.15), in women, for ages ≥75, 65–74, and 25–64 years, respectively.Conclusions. Diabetic patients had a higher risk of bladder cancer mortality, which is more remarkable in the younger population.

Secular trend for mortality from breast cancer and the association between diabetes and breast cancer in Taiwan between 1995 and 2006

Studies have identified an association between diabetes and breast cancer in postmenopausal women in Western countries. Such an association needs to be confirmed in an Asian population. The aim of this study was to evaluate the secular trend for breast cancer mortality in Taiwanese women in the general population and the mortality rate ratios between diabetic patients and the general population. Age-specific mortality rates for the general population, categorised into groups aged 25-54, 55-64, 65-74 and > or =75 years, were calculated for the years between 1995 and 2006 (inclusive) from vital statistics published by the Taiwanese government. Linear regression was used to test the trends. A total of 131,573 diabetic women aged > or =25 years from a national cohort recruited between 1995 and 1998 (inclusive) were followed prospectively for vital status, determined from the National Register of Deaths. Mortality rates and mortality rate ratios (mortality rate in diabetic women vs the average and highest mortality rates for the general population) were calculated. A total of 14,230 women aged > or =25 years in the general population died of breast cancer between 1995 and 2006. A trend for an increase in the annual rate was observed for all age groups. A total of 482 diabetic women died of breast cancer, with a crude mortality rate of 45.7 per 100,000 person-years. Compared with the general population the relative risk of mortality for those with diabetes ranged from 1.37 (for the group aged 55-64 years) to 2.43 (for the group aged 25-54 years). We identified a secular trend of an increase in the rate of breast cancer mortality in the Taiwanese general population. Our data suggest a higher risk of breast cancer mortality in diabetic patients in all age groups.

Human leukocyte antigen-A, -B, and -DRB1 haplotypes of cord blood units in the Tzu Chi Taiwan Cord Blood Bank

Cord blood (CB) is considered an alternative resource to bone marrow and peripheral blood stem cells (PBSC) for allogeneic stem cell transplantation. In this study, human leukocyte antigen (HLA)-A, -B, and -DRB1 high-resolution allele types were analyzed from a total of 710 CB units in the Tzu Chi Taiwan Cord Blood Bank. We observed 21 HLA-A alleles, 59 HLA-B alleles, and 28 HLA-DRB1 alleles, whereas 19 unique alleles were present in the CB units of 2,023 individuals selected for confirmatory testing in the Tzu Chi Taiwan Marrow Donor Registry (TCTMDR). The allelic associations between the HLA-A and -B locus were stronger than that of either the HLA-B and -DRB1 loci or the HLA-A and -DRB1 loci. The most common haplotype of CB units in the general Taiwanese population was A*3303-B*5801-DRB1*0301 (6.59%), followed by A*0207-B*4601-DRB1*0901 (3.47%) and then A*1101-B*4001-DRB1*0901 (2.11%). Moreover, two haplotypes, A*2402-B*5201-DRB1*1502 and A*0201-B*1301-DRB1*1202, existed uniquely in the CB units but were not observed in the data of TCTMDR. Although the number of CB units studied for high-resolution of HLA typing in the current study is small, we believe our data should provide useful information to increase the chances of obtaining acceptable HLA-A-, -B-, and -DRB1-matched CB units for patients.