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嚴重的膽結石病患中心血管疾病的罹病風險：以族群為基礎的世代研究
Other Title
Risk of Cardiovascular Disease among Patients with Gallstone Disease: a Population-based Cohort Study
Type
thesis
Date Issued
2013-07-10
Author(s)
歐拉亞 謬頓
Advisor
謝芳宜
Subjects
系所名稱：公共衛生學系暨研究所
Description
學位別：碩士
語文別：英文
指導教授：謝芳宜
共同指導教授：
口試委員：邱弘毅;邱月暇
中文關鍵字：膽結石;心血管疾病;世代研究;流行病學
語文別：英文
指導教授：謝芳宜
共同指導教授：
口試委員：邱弘毅;邱月暇
中文關鍵字：膽結石;心血管疾病;世代研究;流行病學
Abstract
Objective: To investigate whether gallstone disease (GD) increases the risk of developing cardiovascular disease (CVD) in a large population-based cohort.
Methods: A study population including 6,981 patients with GD was identified from the Taiwan National Health Insurance Research Database between 2004 and 2005. GD patients were defined as patients with principal discharge diagnoses of cholelithiasis using the International Classification of Diseases, Ninth Revision, Clinical Modication (ICD-9-CM) code 574. 27,924 patients without GD were randomly selected and matched for age and gender. All patients were followed for 6 years or until diagnosis for CVD. Cox proportional hazards regression model was used to assess the risk of developing CVD with adjustment for age, gender and co-morbid conditions.
Results: During the six years follow-up period, 940 patients with GD and 2,780 patients without GD developed CVD. Patients with GD had an elevated risk of CVD (HR, 1.32; 95% CI, 1.22-1.42) when compared with those without GD. Similar relationship was observed when CVD was categorized i.e. stroke (HR, 1.23; 95% CI, 1.09-1.39), coronary heart disease (HR, 1.46; 95% CI, 1.33-1.61) and heart failure (HR, 1.54; 95% CI, 1.23-1.91). When GD was classified according to the level of severity, using patients without GD as reference, the risks of CVD were elevated in patients with non-severe GD (HR, 1.36; 95% CI, 1.25-1.49) as well as those with severe GD (HR, 1.20, 95% CI, 1.06-1.36), after adjusting for age, gender and co-morbidities. In age-stratified analysis, patients aged 18-40 years with GD were at higher risk of developing CVD (HR, 1.41; 95% CI, 1.09-1.83) than older GD patients.
Conclusion: This study found an increased risk of CVD in patients diagnosed with GD. The excess risk was particularly high in younger GD patients. Prevention of GD could help reduce the risk of developing CVD, and the better effect could be achieved for the younger age groups.
Methods: A study population including 6,981 patients with GD was identified from the Taiwan National Health Insurance Research Database between 2004 and 2005. GD patients were defined as patients with principal discharge diagnoses of cholelithiasis using the International Classification of Diseases, Ninth Revision, Clinical Modication (ICD-9-CM) code 574. 27,924 patients without GD were randomly selected and matched for age and gender. All patients were followed for 6 years or until diagnosis for CVD. Cox proportional hazards regression model was used to assess the risk of developing CVD with adjustment for age, gender and co-morbid conditions.
Results: During the six years follow-up period, 940 patients with GD and 2,780 patients without GD developed CVD. Patients with GD had an elevated risk of CVD (HR, 1.32; 95% CI, 1.22-1.42) when compared with those without GD. Similar relationship was observed when CVD was categorized i.e. stroke (HR, 1.23; 95% CI, 1.09-1.39), coronary heart disease (HR, 1.46; 95% CI, 1.33-1.61) and heart failure (HR, 1.54; 95% CI, 1.23-1.91). When GD was classified according to the level of severity, using patients without GD as reference, the risks of CVD were elevated in patients with non-severe GD (HR, 1.36; 95% CI, 1.25-1.49) as well as those with severe GD (HR, 1.20, 95% CI, 1.06-1.36), after adjusting for age, gender and co-morbidities. In age-stratified analysis, patients aged 18-40 years with GD were at higher risk of developing CVD (HR, 1.41; 95% CI, 1.09-1.83) than older GD patients.
Conclusion: This study found an increased risk of CVD in patients diagnosed with GD. The excess risk was particularly high in younger GD patients. Prevention of GD could help reduce the risk of developing CVD, and the better effect could be achieved for the younger age groups.