Evaluation of Disease Complications Among Adults With Type 1 Diabetes and a Family History of Type 2 Diabetes in Taiwan.

Importance: Patients with type 1 diabetes (T1D) and a family history of type 2 diabetes (T2D) appear to be at a high risk of diabetes complications and other cardiovascular diseases. However, estimates of individual risks in patients in Taiwan are largely unavailable or unreliable. Objective: To evaluate the risk of diabetes complications and major adverse cardiovascular events (MACEs) in patients with T1D with a family history of T2D. Design, Setting, and Participants: A population-based cohort study used the Taiwan National Health Insurance Research Database. Participants included all individuals registered in that database on December 31, 2017, and followed up since March 1, 1995. The data were analyzed from December 6, 2018, to December 5, 2019. Exposure: Patients with T1D and a family history of T2D were evaluated. Main Outcomes and Measures: The prevalence and hazard ratios (HRs) of diabetes complications and other cardiovascular diseases in patients with T1D were analyzed. The MACEs were identified by diagnostic or procedural codes and heritability was formulated by the registry data of beneficiaries. Results: Of 27 370 965 individuals included in the database, 11 237 (mean [SD] age, 22.7 [14.4] years; 54% were female) had T1D. The crude prevalence of T1D was 0.04%, with a female to male ratio of 1.22: 1. The adjusted HRs in individuals who had a first-degree relative with T2D were 2.61 (95% CI, 1.32-5.16) for MACEs at an age at diagnosis of less than 20 years. Adjusted HRs were 1.44 (95% CI, 1.27-1.64) for diabetic neuropathy, 1.28 (95% CI, 1.12-1.47) for retinopathy, and 1.24 (95% CI, 1.06-1.47) for neuropathy at all ages of diagnosis. Conclusions and Relevance: In this study of patients in Taiwan with T1D, having relatives with T2D was associated with an increase in the individual risks of developing diabetes complications. Patients with T1D and a family history of T2D might have more complications and require close management.

Familial Aggregation and Heritability of Aldosteronism with Cardiovascular Events.

CONTEXT: To date, the effect of positive family history as a risk factor of primary aldosteronism (PA) is largely unknown. Studies have failed to distinguish the heritability of PA as well as the associations between positive family history of PA and clinical outcomes. OBJECTIVES: We quantified the prevalence, the extent of familial aggregation, the heritability of PA among family members of patients with PA, and the association between positive PA family history and major cardiovascular events (MACE). DESIGN AND SETTINGS: Using the Taiwan National Health Insurance Database, 30 245 077 National Health Insurance beneficiaries (both alive and those deceased between January 1, 1999, and December 31, 2015) were identified. RESULTS: We identified 7902 PA patients. Forty-four had PA (0.3%) among 10 234 individuals with affected parents, 2298 with affected offspring, 1924 with affected siblings, and 22 with affected twins. A positive family history was associated with the adjusted relative risk (RR) (95% confidence interval [CI]) of 11.60 (7.63-17.63) for PA in people with an affected first-degree relative. In subgroup analysis, the risk for PA across all relationships (parent, siblings, offspring, and spouse) showed highly significant differences to PA without family history. The accountability for phenotypic variance of PA was 51.0% for genetic factors, 24.9% for shared environmental factors, and 24.1% for nonshared environmental factors. PA patients with an affected first-degree relative were associated with an increased risk for composite major cardiovascular events (RR 1.31; 95% CI 1.24-1.40, P < .001) compared with PA patients without family history. CONCLUSION: Familial clustering of PA exists among a population-based study, supporting a genetic susceptibility leading to PA. There is increased coaggregation of MACE in first-degree relatives of PA patients. Our findings suggest a strong genetic component in the susceptibility of PA, involving different kinships.

Familial aggregation of myocardial infarction and coaggregation of myocardial infarction and autoimmune disease: a nationwide population-based cross-sectional study in Taiwan.

OBJECTIVE: This study examined how a history of myocardial infarction (MI) in a person's first-degree relatives affects that person's risk of developing MI and autoimmune diseases. DESIGN: Nationwide population-based cross-sectional study SETTING: All healthcare facilities in Taiwan. PARTICIPANTS: A total of 24 361 345 individuals were enrolled. METHODS: Using data from the National Health Insurance Research Database in Taiwan, we conducted a nationwide cross-sectional study of data collected from all beneficiaries in the Taiwan National Health Insurance system in 2015, of whom 259 360 subjects had at least one first-degree relative affected by MI in 2015. We estimated the absolute risks and relative risks (RRs) of MI and autoimmune disease in those subjects, and the relative contribution of genetic and environmental factors to their MI susceptibility. RESULTS: The absolute risks of MI for subjects with at least one affected first-degree relative and the general population were 0.87% and 0.56%, respectively, in 2015. Patients with affected first-degree relatives were significantly associated with a higher RR of MI (1.76, 95% CI: 1.68 to 1.85) compared with the general population. There was no association with a higher RR of autoimmune disease. The sibling, offspring and parental MI history conferred RRs (95% CI) for MI of 2.35 (1.96 to 2.83), 2.21 (2.05 to 2.39) and 1.60 (1.52 to 1.68), respectively. The contributions of heritability, shared environmental factors and non-shared environmental factors to MI susceptibility were 19.6%, 3.4% and 77.0%, respectively. CONCLUSIONS: Individuals who have first-degree relatives with a history of MI have a higher risk of developing MI than the general population. Non-shared environmental factors contributed more significantly to MI susceptibility than did heritability and shared environmental factors. A family history of MI was not associated with an increased risk of autoimmune disease.

Trend and survival outcome in Taiwan cervical cancer patients: A population-based study.

Cervical cancer is one of the most common cancers in Taiwan. The aim of this study was to estimate the incidence of cervical cancer in Taiwan, the relationship between cervical cancer and previous co-morbidities, and the long-term trend of cervical cancer mortality differences in the rest of the world.This study was based on the data of cervical cancer in the National Health Insurance Research Database from 1997 to 2013, and estimated the annual prevalence and incidence of cervical cancer. Joinpoint regression analysis was used to obtain the percentage of annual incidence of cervical cancer, morbidity and survival of patients with cervical cancer by statistical regression analysis.The average annual percentage change (APC) was -7.2, indicating a decrease in the incidence of cervical cancer during the study period. The 1-year, 2-year, and 5-year mortality rates of cervical cancer are relatively stable. The average APC of mortality was higher in high Charlson comorbidity index (CCI) group.This study found that both of prevalence and incidence of cervical cancer descend in Taiwan. The incidence of cervical cancer in Taiwan is increasing with age. The sample survival rate was stable in cervical cancer patients during the study period.

Familial Aggregation of Psoriasis and Co-Aggregation of Autoimmune Diseases in Affected Families.

Psoriasis is considered to result from the interaction of genetic factors and environmental exposure. The evidence for familial aggregation in psoriasis has been reported but population-based studies related to the magnitude of genetic contribution to psoriasis are rare. This study aimed to evaluate the relative risks of psoriasis in individuals with affected relatives and to calculate the proportion of genetic, shared, and non-shared environmental factors contributing to psoriasis. The study cohort included 69,828 patients diagnosed with psoriasis enrolled in National health Insurance in 2010. The adjusted relative risks (RR) for individuals with an affected first-degree relative and affected second-degree relative were 5.50 (95% CI (Confidence Interval), 5.19⁻5.82) and 2.54 (95% CI, 2.08⁻3.12) respectively. For those who have affected first-degree relatives, their RR was 1.45 (95% CI, 1.17⁻1.79) for Sjogren's syndrome and 1.94 (95% CI, 1.15⁻3.27) for systemic sclerosis. This nationwide study ascertains that family history of psoriasis is a risk factor for psoriasis. Individuals with relatives affected by psoriasis have higher risks of developing some autoimmune diseases.

Familial Risk of Appendicitis: A Nationwide Population Study.

OBJECTIVE: To investigate the familial risk of appendicitis in the general population. STUDY DESIGN: A nationwide, cross-sectional study consisting of 24 349 599 Taiwan National Health Insurance beneficiaries in 2015 was conducted. Among them, 788 042 individuals had at least 1 first-degree relative with appendicitis. The familial relative risks (RRs) of appendicitis and familial transmission were estimated. RESULTS: The overall RR (95% CI) of appendicitis in individuals with any affected first-degree relatives was 1.67 (1.64-1.71) compared with the general population. The RRs for individuals with an affected twin, sibling, offspring, and parent were 3.40 (2.66-4.35), 1.98 (1.92-2.04), 1.55 (1.51-1.59), and 1.54 (1.50-1.58), respectively. The RRs for individuals with 1, 2, 3 or more affected first-degree relatives were 1.65 (1.62-1.68), 2.63 (2.37-2.91), and 6.70 (4.22-10.63), respectively. Furthermore, there was an age-dependent trend of the RRs, with the greatest RR in the youngest group. The estimated familial transmission (genetic plus shared environmental contribution to the total phenotypic variance of appendicitis) was 23.2%. CONCLUSION: Individuals with a family history of appendicitis have an increased risk of appendicitis. This risk is age-dependent and related to the genetic distance and numbers of affected relatives.

Familial aggregation of Parkinson's disease and coaggregation with neuropsychiatric diseases: a population-based cohort study.

BACKGROUND: Individuals with a family history of Parkinson's disease (PD) appear to have a higher risk of developing PD and other neuropsychiatric diseases. However, estimates of the relative risks (RRs) of PD and the roles of genetic and environmental factors in PD susceptibility are unclear. The aim of this study was to examine familial aggregation and genetic contributions to PD and the RRs of other neuropsychiatric diseases in relatives of PD patients. METHODS: In this population-based family cohort study, the records of all individuals actively registered in the Taiwan National Health Insurance Research Database in 2015 were queried (N=24,349,599). In total, 149,187 individuals with a PD-affected parent, 3,698 with an affected offspring, 3,495 with an affected sibling, and 15 with an affected twin were identified. Diagnoses of PD were ascertained between January 1, 1999, and December 31, 2015. The prevalence and RRs of PD and other neuropsychiatric diseases in individuals with first-degree relatives with PD, as well as the contributions of heritability and environmental factors to PD susceptibility were investigated. RESULTS: The prevalence of PD was 0.46% in the general population and 0.52% in individuals with first-degree relatives with PD. The RR (95% CI) for PD was 2.20 (1.41-3.45) for siblings, 1.59 (1.47-1.73) for parents, 1.86 (1.63-2.11) for offspring, 63.12 (16.45-242.16) for twins, and 1.46 (1.41-1.52) for spouses. The RR (95% CI) in individuals with first-degree relatives with PD was 1.66 (1.57-1.76) for essential tremor, 1.68 (1.61-1.75) for schizophrenia, and 1.20 (1.12-1.28) for Alzheimer's disease. The estimated contribution to the phenotypic variance of PD was 11.0% for heritability, 9.1% for shared environmental factors, and 79.9% for non-shared environmental factors. CONCLUSION: First-degree relatives of PD patients are more likely to develop PD and other neuropsychiatric diseases. Environmental factors account for a high proportion of the phenotypic variance of PD.

The risk of acute kidney injury in Asians treated with apixaban, rivaroxaban, dabigatran, or warfarin for non-valvular atrial fibrillation: A nationwide cohort study in Taiwan.

BACKGROUND: Whether or not non-vitamin K antagonist oral anticoagulants (NOACs) are associated with a lower risk of acute kidney injury (AKI) in patients with non-valvular atrial fibrillation (NVAF) remains unknown in real world practice. METHODS: In this nationwide retrospective cohort study, 1507, 3200, 5765 and 4227 NVAF patients with chronic kidney disease (CKD) and 4368, 16,945, 22,301, and 16,908 NVAF patients without CKD taking apixaban, dabigatran, rivaroxaban, and warfarin, respectively, from June 1, 2012 to December 31, 2016 were enrolled from the Taiwan National Health Insurance Program. Propensity-score weighted method was used to balance covariates across study groups. Patients were followed until occurrence of AKI or end date of study. RESULTS: Three NOACs were all associated with a significantly lower risk of AKI compared with warfarin for both CKD-free (hazard ratio, [95% confidential interval]; 0.65, [0.60-0.72] for apixaban; 0.68, [0.64-0.74] for dabigatran; 0.73, [0.68-0.79] for rivaroxaban) and CKD cohorts (0.50, [0.45-0.56] for apixaban; 0.54, [0.49-0.59] for dabigatran; 0.53, [0.49-0.58] for rivaroxaban). The annual incidence of AKI for all NOACs and warfarin increased gradually as the increment of CHA2DS2-VASc for both CKD-free and CKD cohorts after propensity score weighting. The reduced risk of AKI for three NOACs persisted in most subgroups in either CKD-free or CKD cohort. Multivariate analysis indicated that all three NOACs were all associated with lower risk of AKI than warfarin in either CKD-free or CKD cohort. CONCLUSIONS: All three NOACs are associated with a lower risk of AKI than warfarin among Asians with NVAF in real-world practice.