Major depressive disorder (MDD) and dementia are both major contributors to the global burden of disease. Despite existing literature on the association between MDD and dementia, there is a lack of a nationwide longitudinal cohort study that considers the competing risk of death. Therefore, this study assessed the bidirectional associations between MDD and dementia over an 11-year period in population-based settings, accounting for death as a competing risk.We conducted two population-based retrospective cohort studies in Taiwan. We identified 80,742 patients diagnosed with MDD in 2009-2010 and matched them with patients without MDD by sex, age, and year of diagnosis to assess the relative risk of dementia. We also identified 80,108 patients diagnosed with dementia in 2009-2010 and matched them with patients without dementia by sex, age, and year of diagnosis to assess the relative risk of MDD. All patients were followed until they received a diagnosis of new onset MDD or new onset dementia, their death, or the end of 2019. Cause-specific hazards models were used to estimate adjusted hazard ratios (aHRs).The incidence density (ID) of dementia was higher in patients with MDD than in patients without MDD (7.63 vs. 2.99 per 1000 person-years), with an aHR of 2.71 (95% confidence interval [CI]: 2.55-2.88). The ID of MDD was higher in patients with dementia than in patients without dementia (12.77 vs. 4.69 per 1000 person-years), with an aHR of 2.47 (95% CI: 2.35-2.59).This population-based study found a bidirectional association between MDD and dementia. Our findings suggest the need to identify dementia in patients with MDD and vice versa.
Abstract Background The cognitive impairment and motor deficiency due to dementia may adversely affect the ability and skill related to ride motorcycle. However, little information regarding the incidence and risk of motorcycle crash‐related hospitalizations among patients with dementia. This study estimates the incidence rate ratios (IRR) of motorcycle crash‐related hospitalizations between first‐diagnosed dementia and non‐dementia. Method In this retrospective population‐based cohort study, we compared dementia aged 40‐64 years and its age‐ and sex‐ matched subjects without dementia from the Taiwan National Health Insurance Research Database entries and Taiwan Police‐reported Traffic Accident Registry between 2006 and 2015. The incidence of motorcycle crash‐related hospitalizations was compared between first‐diagnosed dementia and non‐dementia cases using IRR, stratified by age, sex, and charlson index. The incidence densities of motorcycle crash‐related hospitalizations were estimated based on Poisson assumption. Result Over 1‐year of follow‐up, the incidence densities of motorcycle crash‐related hospitalizations were 29.73 and 10.46 per 10,000 person‐years for subjects with and without dementia, respectively, with an IRR of 2.84 (95% CI 1.99 to 4.06). Regardless of any age, sex or charlson index, the incidence densities of motorcycle crash‐related hospitalizations were higher in patients with dementia than subjects without dementia, with the IRR ranging from 1.07 (95% CI 0.49 to 2.37) to 7.06 (95% CI 2.48 to 20.14). Unlike subjects without dementia, the incidence density of motorcycle crash‐related hospitalizations decreased with age among patients with dementia. Among them, the highest IRR was 7.06 (95% CI 2.48 to 20.14) in those aged 40‐44. In gender group, the IRR of motorcycle crash‐related hospitalizations were higher in male (3.34, 95% CI 2.07 to 5.38) than in female (2.27, 95% CI 1.32 to 3.89). The effect of dementia on incidence rate of motorcycle crash‐related hospitalizations were highest in those without comorbidities (IRR 4.17, 95% CI 2.74 to 6.36). Conclusion Younger adults with dementia may rise the risk of motorcycle crash‐related hospitalizations within 1 year after diagnosis compared to those without dementia, which suggests the reinforcement transport safety in younger adults with dementia is needed.
Several studies have suggested that older-onset dementia is associated with an increased risk of motor vehicle crash injury (MVCI). However, evidence of an association between young-onset dementia and the risk of MVCI is insufficient, particularly in Asia.
Objective
To investigate the association between young-onset dementia and MVCI-related hospitalization in Taiwan.
Design, Setting, and Participants
In this nationwide, population-based cohort study in Taiwan, a cohort of 39 344 patients aged 40 to 64 years with incident dementia diagnosed between 2006 and 2012 was matched 1:1 with a cohort of participants without dementia by age, sex, and index year (initial diagnosis of dementia). Participants were identified from Taiwan’s National Health Insurance Research Database (NHIRD). Data were analyzed between March 25 and October 22, 2021.
Exposures
Dementia, defined byInternational Classification of Diseases, Ninth Revision, Clinical Modificationcodes.
Main Outcomes and Measures
Hospitalization for MVCI, determined using linked data from Taiwan’s Police-Reported Traffic Accident Registry and the NHIRD from January 1, 2003, to December 31, 2015. Hazard ratios (HRs) for MVCI-related hospitalization were estimated using Cox proportional hazards regression models adjusted for sex, age, salary-based insurance premium, urbanization level, and comorbidities.
Results
Of the 78 688 participants, 47 034 (59.8%) were male; the mean (SD) age was 54.5 (7.4) years. During the 10-year follow-up period, the incidence density of MVCI-related hospitalization was 45.58 per 10 000 person-years (95% CI, 42.77-48.39 per 10 000 person-years) among participants with dementia and 24.10 per 10 000 person-years (95% CI, 22.22-25.99 per 10 000 person-years) among participants without dementia. Compared with participants without dementia, patients with young-onset dementia were at higher risk of MVCI-related hospitalization (adjusted HR [aHR], 1.83; 95% CI, 1.63-2.06), especially those in younger age groups (aged 40-44 years: aHR, 3.54; 95% CI, 2.48-5.07) and within a shorter period (within 1 year of follow-up: aHR, 3.53; 95% CI, 2.50-4.98) after dementia was diagnosed. Patients with young-onset dementia also had a higher risk of being a pedestrian when the crash occurred (aHR, 2.89; 95% CI, 2.04-4.11), having an intracranial or internal injury (aHR, 2.44; 95% CI, 2.02-2.94), and having a severe injury (aHR, 2.90; 95% CI, 2.16-3.89).
Conclusions and Relevance
In this retrospective cohort study, patients in Taiwan with a diagnosis of young-onset dementia had a higher risk of MVCI-related hospitalization than did individuals without dementia and the risk varied by age, disease duration, transport mode, injury type, and injury severity. These findings suggest a need for the planning of strategies to prevent transportation crashes among patients with young-onset dementia.
Background . Very few nationwide studies have focused on the variations in the incidence and prevalence of dementia and Alzheimer’s disease (AD) in Asian countries. This study aims to describe the gender and age differences in the incidence and prevalence of dementia and AD in Taiwan. Methods . The data on dementia and AD were acquired from the Taiwan National Health Insurance Research Database from 2004 to 2010. The sex and age-specific rates were standardized, and the differences of gender and age on dementia or AD were assessed using Poisson regression analysis. Results . Over seven years, the prevalence of dementia and AD significantly increased from 4.7 to 7.6 per hundred people ( β = 0.0784, p<0.0001) and 2.3 to 3.5 per hundred people ( β = 0.0696, p<0.0001), respectively. However, the incidence of both dementia and AD decreased but not significantly from 10.9 to 10.7 and 4.9 to 4.6 per thousand person-years, respectively. Noticeably, both incidence and prevalence increased with age and were higher in women than in men. Conclusions . The standardized incidence rates of dementia and AD are much lower than the data reported in some studies from Europe, the US, and Japan. Further studies are warranted to explore which factors are associated with the differences in the incidence of dementia and AD in Taiwan.
Background and Aims: The existing epidemiological evidence concerning the putative link between exposure to radiofrequency (RF) electromagnetic fields and cancer risk has been mostly acquired from studies of adult population; the cancer risk associated with RF exposure in children has not been adequately addressed. This study was conducted to investigate the relationship between environmental exposure to RF emitted from mobile phone base stations (MPBS) and risks of all cancers, leukemia, and brain tumors in children. Methods: This is a population-based case-control study based on Taiwan's National Health Insurance inpatients claims. Cases were incident cases aged 15 or less and admitted in 2003-2007 for all cancers (ICD-9-CM: 140-239) (n=2,606) including 939 leukemia cases (204-208) and 394 cases of brain cancer (191). Controls were randomly selected from all non-cancer children insured in the same year of case's first-time admission, with frequency matched on age (+/- 5 years) and with a case/control ratio of 1:30. Annual cumulative power (ACP, watt-year) was calculated for each of the 71,185 MPBS in service between 1998 and 2007. Then the annual power density (APD, watt-year/km2) of each township (n=367) was computed as a ratio of summation of ACP of all MPBS in a township to the area of that particular township. Each study subject's exposure to MPBS emitted RF was indicated by the averaged APD within the 5-year period prior to the cancer diagnosis calculated for the township where he/she lived. For those study subjects aged less than 5 years, the APD was only averaged for the time period between birth and child's age. Unconditional logistic regression model with generalized estimation equation was employed to calculate the relative risk estimates of childhood cancer in relation to RF exposure. Results: Per 10 watt-years/km2 increase in 5-year averaged APD was associated with a covariate-adjusted odds ratio (AOR) of 1.02 (95% confidence interval (CI)=0.96-1.08) for all cancers. The corresponding figures for leukemia and brain tumors were also not elevated at 0.97 (0.87-1.08) and 1.09 (0.95-1.25). A higher than median averaged APD (some 168 watt-years/km2) was significantly associated with an increased AOR for all cancers (1.13; 95% CI=1.01-1.28), but not for leukemia (1.23; 95% CI=0.99-1.52) or brain tumor (1.14, 95% CI=0.83-1.55). Conclusions: This study noted a positive but weak association between RF exposure to MPBS and risk of all cancers in children. The elevated risk was also seen for leukemia and brain tumors, but further inferences were limited by inadequate statistical power.
Abstract Objectives Diabetic ketoacidosis (DKA) is a life‐threatening complication of diabetes mellitus, and its risks can be largely reduced by adequate and high‐quality ambulatory diabetic care. The aim of this study is to assess the risk and frequency of developing DKA in relation to the specialty of doctors who provide diabetes cares. Methods In searching for possible episodes of hospitalization due to DKA (ICD‐9‐CM: 250.1), we used a prospective cohort design in which 500 867 diabetic patients identified in the 1997 National Health Insurance (NHI) ambulatory care data set of Taiwan were linked to the 1997–2006 NHI inpatient claims data. The study subjects were categorized into four groups according to doctor specialty. A logistic regression model was used to assess the risk and frequency of DKA admission in relation to doctor's specialty. Results Compared with the patients routinely cared by endocrinologists, those not consistently cared by endocrinologists had significantly increased odds ratios (ORs) of DKA admission, ranging between 1.51 and 2.12. Moreover, the adjusted OR of the higher DKA admission frequency (≥0.133 times/person‐year) for the patients not regularly cared by endocrinologists was also significantly increased, between 4.45 and 6.93. Conclusions Doctor specialty significantly influenced the risk and frequency of DKA admission in diabetes patients in Taiwan. Local health care administrators and policy makers should therefore consider promoting the quality of diabetes care provided by non‐endocrinologists.
171 Received July 26, 2013; revised and accepted October 7, 2013. Published online October 29, 2013; doi: 10.1620/tjem.231.171. *Lin-Chung Woung and Pai-Huei Peng contributed to this article equally. Correspondence: Tsang-Shan Chen, Department of Neurology, Sin-Lau Hospital, the Presbyterian Church in Taiwan, Eastgate Rd. Sec 1, Tainan 70142, Taiwan. e-mail: tschern@gmail.com A Nine-Year Population-Based Cohort Study on the Risk of Multiple Sclerosis in Patients with Optic Neuritis
Abstract Background Prior studies showed dementia had a higher risk of hospitalization for a motor vehicle accident injury than the general population. However, the effect of dementia on the medical cost and length of inpatient days of motorcycle crash‐related hospitalizations still unknown. This study describes the total amount of medial cost and length of inpatient days for motorcycle crash‐related hospitalizations among patients with and without dementia and assesses whether dementia is related to a higher medical cost and length of inpatient days for motorcycle crash‐related hospitalizations. Method This was a population‐based, retrospective cohort study. Dementia aged 40‐64 and its age‐ and sex‐ matched participants without dementia were identified when they had the first hospitalization for MVAI. Data were obtained from the Taiwan National Health Insurance Research Database entries and Taiwan Police‐reported Traffic Accident Registry between 2006 and 2015. Linear regression with generalized estimating equations were applied to compare the medical cost and length of inpatient days of people with and without dementia. Result Over the 10‐year follow‐up periods, the mean medical expenses related to the first hospitalization for MVAI among patient with and without dementia was NTD $ 81207±136647 and NTD $ 58947±135543, respectively, with a difference in log10 average inpatient costs of NTD $ 0.082 (95%CI 0.054‐0.110). Additionally, compared to patients without dementia, patients with dementia were significantly related to a longer inpatient stay due to the first hospitalization for MVAI (11.6±15.9 vs. 9.0±32.3 days), with a difference in log10 average inpatient days of 0.054 days (95%CI 0.029‐0.078). Conclusion In motorcycle crash‐related hospitalizations, dementia was associated with higher medical cost and longer length of inpatient stay than those for patients without dementia.
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