Men with nonapnea sleep disorders have a high risk of developing subsequent epilepsy: A nationwide population-based cohort study.

[[abstract]]Objective This nationwide population-based cohort study evaluated the effects of nonapnea sleep disorders (NSDs) on the development of epilepsy. Methods We identified 63,865 patients aged ≥ 20 years, diagnosed with NSDs (ICD-9-CM: 307.4 or 780.5), and without coding for apnea-related sleep disorders (ICD-9-CM: 780.51, 780.53, or 780.57) during 2000–2003 as the NSD cohort. In addition, we enrolled a comparison cohort of 127,728 patients. We calculated the adjusted hazard ratio (aHR) for developing epilepsy (ICD-9-CM: 345) after adjustment for age, sex, comorbidities, and drug use. A Kaplan–Meier analysis was used to measure the cumulative incidence of epilepsy between the 2 groups until the end of 2011. Results The cumulative incidence of epilepsy was significantly higher in the NSD cohort than in the comparison cohort. The aHR for developing epilepsy in the NSD cohort was 1.52 (95% CI = 1.37–1.69). The risk of developing epilepsy was higher among males (aHR = 1.41) than among females. The age-stratified effects of NSDs on developing epilepsy were the highest among patients aged ≥ 65 years. When comorbidities and NSDs coexisted, the risk of epilepsy was specifically increased in patients having an NSD and stroke (aHR: 8.61, 95% CI: 7.43–9.98) in addition to brain tumors (aHR: 7.66, 95% CI: 5.06–11.6). Conclusion This study indicated that patients with NSDs have a higher risk of developing epilepsy and that the risk is much higher among men and older patients. These findings suggest that NSDs constitute a predisposing, possibly independent factor for developing subsequent epilepsy in adulthood

Evaluating clinical risk factors for suicide attempts in patients with epilepsy

[[abstract]]Abstract Objective We would like to exam whether epilepsy patients in Taiwan have a high risk of attempted and completed suicide. Methods In this study, we used a subset of the National Health Insurance Research Database (NHIRD) of Taiwan. Inpatients (≥ 18 years) who received a new diagnosis of epilepsy between 2000 and 2011 were enrolled in the epilepsy cohort. The epilepsy and comparison cohorts included 68,543 patients and 2-fold controls respectively. We calculated the adjusted hazard ratio (aHR) for suicide attempts after adjustment for age, sex, monthly income, the urbanization level, occupation, and comorbidity. Results The epilepsy cohort had a 2.06-fold risk of suicide attempts (95% CI = 1.65–2.56) compared with the control cohort. The suicide attempt risk did not significantly differ between men and women and between patients with and without psychiatric comorbidity. The mortality risk after a suicide attempt was higher in the epilepsy cohort than in the comparison cohort (aHR = 1.66, 95% CI = 1.02–2.69). Conclusion Epilepsy is an independent and predisposing factor for suicide attempt. These results provide important information for clinicians and governments to prevent suicide in epilepsy patients in Asian countries

Risk of Suicide Attempt in Poststroke Patients: A Population-Based Cohort Study.

[[abstract]]Background This nationwide population‐based cohort study evaluated the risk of and risk factors for suicide attempt in poststroke patients in Taiwan. Methods and Results The poststroke and nonstroke cohorts consisted of 713 690 patients and 1 426 009 controls, respectively. Adults (aged >18 years) who received new stroke diagnoses according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM; codes 430–438) between 2000 and 2011 were included in the poststroke cohort. We calculated the adjusted hazard ratio for suicide attempt (ICD‐9‐CM codes E950–E959) after adjustment for age, sex, monthly income, urbanization level, occupation category, and various comorbidities. Kaplan–Meier analysis was used to measure the cumulative incidence of suicide attempt, and the Fine and Gray method was used as a competing event when estimating death subhazard ratios and 95% confidence intervals between groups. The cumulative incidence of suicide attempt was higher in the poststroke cohort, and the adjusted hazard ratio of suicide attempt was 2.20 (95% confidence interval, 2.04–2.37) compared with that of the controls. The leading risk factors for poststroke suicide attempt were earning low monthly income (<660 US dollars), living in less urbanized regions, doing manual labor, and having a stroke before age 50 years. The attempted suicide risk did not differ significantly between male and female patients in this study. Conclusions These results convey crucial information to clinicians and governments for preventing suicide attempt in poststroke patients in Taiwan and other Asian countries. Keywords: cohort study, National Health Insurance, population studies, stroke, suicide Subject Categories: Epidemiology, Mental Health, Ischemic Stroke, Intracranial Hemorrhag

Men with nonapnea sleep disorders have a high risk of developing subsequent epilepsy: A nationwide population-based cohort study.

[[abstract]]Objective This nationwide population-based cohort study evaluated the effects of nonapnea sleep disorders (NSDs) on the development of epilepsy. Methods We identified 63,865 patients aged ≥ 20 years, diagnosed with NSDs (ICD-9-CM: 307.4 or 780.5), and without coding for apnea-related sleep disorders (ICD-9-CM: 780.51, 780.53, or 780.57) during 2000–2003 as the NSD cohort. In addition, we enrolled a comparison cohort of 127,728 patients. We calculated the adjusted hazard ratio (aHR) for developing epilepsy (ICD-9-CM: 345) after adjustment for age, sex, comorbidities, and drug use. A Kaplan–Meier analysis was used to measure the cumulative incidence of epilepsy between the 2 groups until the end of 2011. Results The cumulative incidence of epilepsy was significantly higher in the NSD cohort than in the comparison cohort. The aHR for developing epilepsy in the NSD cohort was 1.52 (95% CI = 1.37–1.69). The risk of developing epilepsy was higher among males (aHR = 1.41) than among females. The age-stratified effects of NSDs on developing epilepsy were the highest among patients aged ≥ 65 years. When comorbidities and NSDs coexisted, the risk of epilepsy was specifically increased in patients having an NSD and stroke (aHR: 8.61, 95% CI: 7.43–9.98) in addition to brain tumors (aHR: 7.66, 95% CI: 5.06–11.6). Conclusion This study indicated that patients with NSDs have a higher risk of developing epilepsy and that the risk is much higher among men and older patients. These findings suggest that NSDs constitute a predisposing, possibly independent factor for developing subsequent epilepsy in adulthood

Epilepsy is associated with higher subsequent mortality risk in patients after stroke: a population-based cohort study in Taiwan

[[abstract]]Objective: To use the National Health Insurance Research Database (NHIRD) of Taiwan to determine whether patients with poststroke epilepsy (PSE) in Taiwan have an increased risk of mortality. Methods: We analyzed the data from the NHIRD of patients (≥40 years) who had received stroke diagnoses between 2000 and 2012. The patients with stroke were divided into PSE and poststroke non-epilepsy (PSN) cohorts and compared against a sex-, age-, comorbidity-, and index-date-matched cohort from normal population. We calculated adjusted HRs (aHRs) and 95% CIs of all-cause mortality risk in these cohorts after adjustment for age, sex, and comorbidities. Results: Among the poststroke patients, 12.14% constituted the PSE cohort. The cumulative mortality rate was considerably higher in the PSE than in the PSN cohort. The PSE (aHR=4.18, 95% CI=3.91–4.48) and PSN (aHR=1.90, 95% CI=1.83–1.98) cohorts were associated with higher risks of mortality than the comparison cohort. Furthermore, advanced age (≥65 years), male sex, alcohol-related illness, chronic obstructive pulmonary disease, coronary artery disease, diabetes, hypertension, asthma, and cancer would further increase the risk of mortality after a stroke event. Conclusion: The mortality risk in poststroke patients is approximately two times the likelihood in those with PSE than in those without, and approximately four times higher than that in the normal population. Our findings provide crucial information for clinicians and the government to improve survival after stroke. Keywords: cohort study, epilepsy, mortality, stroke, National Health Insuranc

Post-stroke dementia is associated with increased subsequent all-cause mortality: A population-based cohort study

[[abstract]]Background and aims We aimed to determine whether patients with post-stroke dementia (PSD) have increased mortality risk in Taiwan. Methods We included ≥40-year-old patients who received a stroke diagnosis between 2000 and 2012 from a subset of the National Health Insurance Research Database of Taiwan. These patients were divided into PSD (International Classification of Diseases, Ninth Revision, Clinical Modification codes 290, 294.1, and 331.0) and post-stroke non-dementia (PSN) cohorts. Furthermore, we propensity score (PS) matched the PSD and PSN groups. PS was calculated through logistic regression to estimate the probability of stroke status assignment given the baseline variables, namely age, sex, and comorbidity. We calculated the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for death in the PSD and PSN cohorts after adjustments for age, sex, and comorbidities. Results Overall incidence density rates of death were 148.7 and 106.7 per 1,000 person-years in the PSD and PSN PS-matched cohorts, with the aHR of 1.42 (95% CI = 1.34–1.50). Average hospital days increased by 9.03 days and frequency of medical visits increased by 15.8 times per year in the PSD cohort compared with the PSN cohort. Conclusions The subsequent mortality rate in patients with PSD is increased compared with those without PSD. Moreover, the average hospital days and frequency of medical visit are increased in patients with PSD. Our findings provide crucial information for clinicians and the government to improve survival of patients after stroke

Analyzing Mortality Risk and Medical Burden among Patients with Traumatic Brain Injury and Subsequent Dementia

We used the National Health Insurance Research Database of Taiwan to determine whether patients with posttraumatic dementia (PTD) exhibit increased mortality and medical burden than those without it. Patients &ge;20 years of age having head injury admission (per the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 850&ndash;854, 959.01) between 2000 and 2012 were enrolled as traumatic brain injury (TBI) cohort. A PTD cohort (with ICD-9-CM codes 290, 294.1, 331.0) and a posttraumatic nondementia (PTN) cohort were established and compared in terms of age, sex, and comorbidities. We calculated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of all-cause mortality risk, number of hospital days, and frequency of medical visits in these cohorts. Patients with PTD had a higher mortality rate than did patients with TBI alone (rate per 1000 person-years: 12.00 vs. 6.32), with an aHR of 1.54 (95% CI: 1.32&ndash;1.80). Patients with PTD who were aged &ge;65 years (aHR = 1.54, 95% CI: 1.31&ndash;1.80) or male (aHR = 1.78, 95% CI: 1.45&ndash;2.18) exhibited greatly increased risks of mortality. Furthermore, patients with PTD had 19.9 more hospital days and required medical visits 4.49 times more frequently compared with the PTN cohort. Taiwanese patients with PTD had increased mortality risk and medical burden compared with patients who had TBI only. Our findings provide crucial information for clinicians and the government to improve TBI and PTD outcomes