Increased risk of concurrent gastroesophageal reflux disease among patients with Sjögren's syndrome: A nationwide population-based study.

BACKGROUND: Little data is available on the risk of gastroesophageal reflux disease in patients diagnosed with Sjögren's syndrome. METHODS: We identified 4650 Sjögren's syndrome patients between 2000 and 2011 from the National Health Insurance Research Database. Each Sjögren's syndrome patient was matched to 4 controls based on age, sex, and index year, and all subjects were followed up from the index date to December 31, 2011. Cox proportional hazards regression model was used to estimate the risk of gastroesophageal reflux disease. RESULTS: The risk of gastroesophageal reflux disease for Sjögren's syndrome patients was 2.41-fold greater than that for the comparison cohort after adjusting for age, sex, and comorbidities. In age stratified analyses, the youngest Sjögren's syndrome cohort (age: 20-44years old) had the highest risk (HR=3.02; 95% CI=2.48-3.69) and the lowest risk at age ≥65years (HR=1.95; 95% CI=1.61-2.36). Regardless of in subjects with and without comorbidity, Sjögren's syndrome patients had a higher risk than the controls. Sjögren's syndrome subjects with ischemic heart disease, hyperlipidemia and renal disease had the highest risk for gastroesophageal reflux disease compared with the comparison cohort without those diseases (HR=7.67; 95% CI=5.32-11.1). CONCLUSION: Patients with Sjögren's syndrome have a significantly greater risk of developing subsequent gastroesophageal reflux disease than the general population.

Association Between Statin Use and Open-angle Glaucoma in Hyperlipidemia Patients: A Taiwanese Population-based Case-control Study.

The aim of the study was to investigate the association between statin use and open-angle glaucoma (OAG) risk in hyperlipidemia patients.We used the research database of the Taiwan National Health Insurance program to conduct a population-based case-control study. A total of 1276 patients with newly diagnosed OAG were identified from 2004 to 2011. Controls comprised of 12,760 patients without glaucoma and were frequency-matched for age, sex, history of diabetes mellitus, and year of hyperlipidemia diagnosis at a 1:10 ratio. Accumulated defined daily doses (DDDs) of statins prescribed during follow-up were calculated. Average statin use was calculated as the sum of DDDs divided by the duration from the initial statin prescription date to the index date (per year), and was subdivided into 3 levels: <30, 30 to 119, and ≥120 DDDs. Comorbidity, including hypertension, depression, and the Charlson comorbidity index, the frequency of eye care visits, and the use of nonstatin cholesterol-lowering drugs, were all considered as confounding factors.For the group with statin use, the adjusted odds ratio of OAG was 1.02 (95% confidence interval 0.90-1.15) when compared with the group without statin use. Subanalysis showed that a high dosage of statin use (≥120 DDD/y) resulted in a1.24-fold increased risk of OAG (odds ratio 1.24, 95% confidence interval 1.03-1.49). The incidence of OAG was increased with the increase of the dosage of statin use (P for trend = 0.0458).Clinicians should be cautious of hyperlipidemia patients with a high dosage of statin use because it might be associated with an increased risk of OAG. Ophthalmologist consultation is necessary for this high-risk group.

Febrile convulsions increase risk of Tourette syndrome.

PURPOSE: Febrile convulsion (FC) and Tourette syndrome (TS) are both common neurological disorders in infants and children. Both disorders share clinical similarities, such as paroxysmal symptoms with normal neurodevelopment and expected remission over time. This population-based study investigated the association between FC with TS during childhood neurodevelopment. METHOD: We used the Taiwan National Health Insurance Research Database to conduct a retrospective cohort analysis on 1586 FC patients. A reference cohort of 6344 non-FC patients, matched for age, sex, urbanization level, parental occupation, and index year, was used for comparison. The risk of the occurrence of TS in FC patients was assessed using a Cox proportional hazard regression model. RESULTS: The overall incidence of TS was higher in the FC cohort than in the non-FC cohort (28.5 vs 13.9 per 10,000 person-years; adjusted hazard ratio=1.91, 95% confidence interval=1.32-2.75). The associated risk factors for FC patients to develop TS were boys, children living in rural areas, and children whose parents held blue-collar positions. Moreover, the risk of TS in FC patients rose from 0.89 to 16.0 (trend test P<0.0001) when the frequency of FC-related medical visits increased from 1 to 2 times to more than 4 times. The adjusted hazard ratio for TS in related to FC-related medical visits was 1.02 (95% CI=1.02-1.03) per one frequency increment. CONCLUSION: FC may increase the risk of subsequent TS occurrence in children. Children who had frequent medical visits for FC were particularly vulnerable.

Patients with epilepsy are at an increased risk of subsequent stroke: a population-based cohort study.

PURPOSE: Epilepsy is well known as a disorder in poststroke patients. However, studies that have investigated the association between epilepsy and the risk of subsequent stroke are limited. This population-based study investigated the incidence and risk of stroke in patients with epilepsy by using the Taiwan National Health Insurance claims data. METHODS: We identified 3812 patients newly diagnosed with epilepsy in 2000-2008 and 15,248 nonepilepsy comparisons frequency matched according to sex, age, and index year. We searched for subsequent stroke diagnoses in both cohorts until the end of 2009. The incidence rates and hazard ratios of stroke were estimated based on sex, age, the average defined daily doses (DDDs) of antiepilepsy drugs, and comorbidity. RESULTS: The stroke incidence of the epilepsy cohort was 3-fold higher than that of the comparison cohort. The age-specific results indicated that in the epilepsy cohort and the comparison cohort, the risk was the highest for the youngest group (20-39 years). CONCLUSION: The patients with epilepsy exhibited a higher incidence of cerebral stroke than the general population did. In addition, younger patients with epilepsy and patients who took a high doses of antiepileptic drugs exhibited a high risk of stroke.