9 Types of Study Designs Simple Description Association / Relationship Complex computation (Data mining)
10 Simple Description Disease Drug Sector Epidemiologic features of Kawasaki disease in Taiwan,A nationwide survey on epidemiological characteristics of childhood Henoch-Schonlein purpura in Taiwan.Prevalence and risks of chronic airway obstruction: a population cohort study in Taiwan.Seasonal variations in urinary calculi attacks and the association with climate: a population-based study.DrugUtilization of hepatoprotectants within the National Health Insurance in Taiwan.Use frequency of traditional Chinese medicine in Taiwan.SectorPatterns of ambulatory care utilization in Taiwan.Pediatrics : IF 4.789, Ranking 2 / 86Rheumatology : IF 4.136, Ranking 7 / 22Chest : IF 5.154, Ranking 4 / 40J Urology : IF 3.952, Ranking 9 / 57 (Urology …)陳曾基教授, 2011”健保資料庫之應用與未來發展”
11 Association / Relationship Stroke : IF 6.499, Ranking 6 / 156 (Clinical Neurology)A B (no temporal consideration)Association between physician volume and hospitalization costs for patients with stroke in Taiwan: a nationwide population-based study.A => B (temporal sequence)Risk of extrapyramidal syndrome in schizophrenic patients treated with antipsychotics: a population-based study.Sudden sensorineural hearing loss increases the risk of stroke: A 5-year follow-up studyDoes elective caesarean section increase utilization of postpartum maternal medical care?Clin Pharmacol Ther : IF 7.586, Ranking 9 / 219temporal change 時序的變化 是否與觀察值 有相關性 ，不一定有先後關係 temporal sequence 時序上因果的先後關係 驗證Stroke : IF 6.499, Ranking 6 / 156 (Clinical Neurology)Med Care : IF 3.194, Ranking 5 / 62 (Health Care Sciences ...)陳曾基教授, 2011”健保資料庫之應用與未來發展”
12 TIPS & STEPS Familiar with the NHIRD codebooks and NHI regulations - 資料庫量大、追蹤時間長- 瞭解健保資料先天的限制IdeasLiterature review & Discussion with colleaguesFellows familiar with data processing- 嚴謹的研究設計和精準的分析方法Motivation, courage, Tolerance, Endurance
18 Methods Simple Description Sample - Case: 59,257 schizophrenia patients- Control: 178,156 age- and gender-matched individuals without schizophreniaFollow-up period: 9 years ( )Outcome measure- cancer incidence and survival time after cancer diagnosis
19 Results Simple Description Cancer incidence patients with schizophrenia: 1145 (1.93%)control group: 5294 (2.97%)for all types of cancer except breast and cervical/uterine cancerMale: OR=0.50 (95% CI, 0.46–0.55); Female: OR=0.81 (95% CI, 0.74–0.88)adjusted hazard ratio 0.71 (95% CI, 0.66–0.76)
20 Association / Relationship IF 4.224, Ranking 3 / 26 (Anesthesiology )
21 Hypothesis Methods Association / Relationship General anesthesia is associated with a higher odds of acquiring a surgical site infection in women following caesarean deliveryMethodsJanuary 2002 to December 2006Definition0371A (CS delivery)0373B (maternally requested CS delivery)Only the first CS was counted: 303,834 CS cases.The mode of anaesthetic procedure (order codes)96020C-96022C for general anaesthesia96007C and 96008C for spinal anaesthesia96005C and 96006C for epidural anaesthesia
23 Association / Relationship IF , Ranking 1 / 117 (Psychiatry)
24 Association / Relationship HypothesisAcute exposure to antidepressant would increase stroke riskStudy DesignA matched case-cross study
25 Association / Relationship Case-crossover StudyIndex date of eventDrug prescription +Control time windowCase time window28 day141day-+ABCDOdds ratio= A/B
26 Association / Relationship MethodsDefinitionCerebrovascular events- Hemorragic stroke: ICD-9 code: 430, 431, 432- Ischemic stroke: ICD-9 code: 433, 434, 435- Other type: ICD-9 code: 436- Exclusion: Head injury, ICD-9 code 800.x-804.x, 850.x-854.x or 959.xAntidepressantsConfounding factorsThe index date- diagnosed as having a first hospitalization for a stroke
29 Simple Description Birth Seasonality in Schizophrenia: effect of latitude, gender, and incomeChin Cheng, Ching-Heng Lin, El-Wui Loh, Tsuo-Hung LanTaichung Veterans General Hospital, TaiwanUnder Review
30 Methods Study Sample - Case: 5,047 schizophrenia patients - Control: 631,911 general population- Data retrieved for 2005- Data for year of birth ranged from 1950 to 1989 (age20-59)- Data obtained from the inpatient, outpatient, and ambulatory claims database.Measurement- Birth seasonality in schizophrenia, considering influences of gender, and income status
31 Results A gender difference with female predominance A significant winter/spring birth excess in schizophrenia in Taiwan, a low latitude areaA gender difference with female predominanceMore pronounced in low income status
32 Association / Relationship The Correlation of Antidepressants useand Mortality of End-Stage Renal DiseaseChia-Jui Tsai, Ching-Heng Lin, El-Wui Loh, Tsuo-Hung LanTaichung Veterans General Hospital, TaiwanIF 1.25, Ranking / (Nephrology)
33 Methods Definition ESRD : ICD-9-CM code 585 : total 2312 patients Diagnosis of depression :ICD 296.2, Major depressionICD dysthymic disorderICD 311-Depressive disorder, NOS
34 Methods Definition Antidepressants exposure - All kinds of antidepressants prescriptions- At least two consecutive months (outpatients) orinpatients one year before receiving theirdiagnosis of ESRD or after the diagnosisNew onset ESRD during the year , > 30 y/oExclusion: depression diagnosed before new onset ESRDEndpoint : Occurrence of death, or end of study
35 Confounding Factors Well known risk of mortality : * CVD * DM * Hypertension* HyperlipidemiaCurrently well known diseases that contribute to the risk of mortality :
37 Association / Relationship The Association of SSRI Use and Stokein Geriatric PopulationChia-Chun Hung, Ching-Heng Lin, El-Wui Loh,Chin-Hong Chan, Tsuo-Hung LanTaichung Veterans General Hospital, TaiwanUnder Review
38 Methods Definition of stroke The stroke diagnosis was identified by meeting the occurrence of ICD-9, codes from 430 to 438 (cerebro-vascular disease) in any inpatient treatment or outpatient treatments during the 9-years period.Patients who had accompanied diagnosis of head injury (ICD-9 code: , ) and stroke within two weeks of head injury events were excluded.The endpoint of follow-up was occurrence of first stroke event, death, or end of study on December 31, 2009.
39 METHODS Definition of co-morbidities Co-morbidities for stroke, including myocardial infarction (MI), angina pectoris (AP), atrial fibrillation (AF), peripheral arterial occlusive disease (PAOD), congestive heart failure (CHF), diabetes mellitus (DM), hypertension, hyperlipidemia, and renal diseases in the last 12 months before first SSRI prescription were included in analysis.MI (ICD-9 code: ), AP (ICD-9 code: 413), AF (ICD-9 code: 427), PAOD (ICD-9 code: 444), CHF (ICD-9 code: 428), DM (ICD-9 code: 250), hypertension (ICD-9 code: 401 to 405) and hyperlipidemia (ICD-9 code: 272) were confirmed by the records of one or more prescriptions for the diagnoses, while renal diseases were confirmed when ICD-9 code or 585 appeared in the NHI records.
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