Chung-Yi Li

Publications (90)224.5 Total impact

• Article: Mortality among shipbreaking workers in Taiwan-A retrospective cohort study from 1985 to 2008.

  Wei-Te Wu, Yao-Hua Lu, Yu-Jen Lin, Ya-Hui Yang, Huei-Sheng Shiue, Jin-Huei Hsu, Chung-Yi Li, Chun-Yuh Yang, Saou-Hsing Liou, Trong-Neng Wu
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  ABSTRACT: BACKGROUND: Shipbreaking workers are typically exposed to a wide range of hazardous chemicals. However, long-term follow-up studies of their mortality patterns are lacking. This study examined mortality among shipbreaking workers over a 24-year follow-up period. METHODS: A total of 4,962 shipbreaking workers were recruited from the database of the Kaohsiung Shipbreaking Workers Union. The data were then linked to the Taiwan National Death Registry from 1985 to 2008. The mortality ratios-standardized for age and calendar years-(SMRs) for various causes of deaths were calculated with reference to the general population of Taiwan. RESULTS: Among men workers, a statistically significant increased SMR was observed for all causes (SMR = 1.28), all cancers (SMR = 1.26; particularly noteworthy for lesions of oral and nasopharyngeal: SMR 2.03, liver: SMR 4.63, and lung: SMR 1.36), cirrhosis of the liver (SMR = 1.32), and accidents (SMR = 1.91). A statistically significant increase in mortality was observed for respiratory system cancer (SMR = 1.87) and lung cancer (SMR = 1.91) among workers with a longer duration of employment (≥7 years). The result also showed that among shipbreaking workers who were still alive, two people had mesothelioma and 10 people have asbestosis. CONCLUSIONS: Those employed in shipbreaking industries experienced an increase in mortality from all causes. The increased SMR for lung cancer was probably related to asbestos, metals, and welding fume exposure. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.
  American Journal of Industrial Medicine 03/2013; · 1.63 Impact Factor
• Article: Trajectory and influencing factors of depressive symptoms in family caregivers before and after the death of terminally ill patients with cancer.

  Sing-Fang Ling, Mei-Ling Chen, Chung-Yi Li, Wen-Cheng Chang, Wen Chi Shen, Siew Tzuh Tang
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  ABSTRACT: Purpose/Objectives: To explore the occurrence of depressive symptoms and factors that affect them in family caregivers before and 1, 3, 6, and 13 months after the death of a care recipient with cancer.Design: Descriptive, longitudinal study.Setting: A medical center in northern Taiwan.Sample: Convenience sample of 186 primary family caregivers.Methods: Changes in caregivers' depressive symptoms and their influencing factors during bereavement were analyzed with the generalized estimating equation, which uses robust standard error estimates to account for within-subject correlations of scores during the follow-up period.Main Research Variables: Caregivers' depressive symptoms; potential influencing factors included intrapersonal risk or protective factors, social resources, caregiving situation, and time in relation to the patient's death.Findings: Caregivers' depressive symptoms peaked at one month and decreased significantly during the first 13 months after the patient's death. Bereaved caregivers experienced a lower level of depressive symptoms if they had cared for older patients, reported a higher level of subjective caregiving burden during the patient's dying process, and had greater social support. Caregivers reported a higher level of depressive symptoms after bereavement if they had a higher level of depressive symptoms before the patient's death, had poorer health, and were the patient's spouse.Conclusions: Caregivers' depressive symptoms improved significantly from one month before to 13 months after the patient's death.Implications for Nursing: Nurses should increase their ability to identify factors influencing caregivers' depressive symptoms before and after the death of their terminally ill family member and provide appropriate care to facilitate caregivers' psychological adjustments to bereavement.Knowledge Translation: Healthcare professionals should pay special attention to caregivers who are the patient's spouse, have poorer health, and suffer from a higher level of depressive symptoms. Appropriate care before and after the patient's death is needed to facilitate caregivers' psychological adjustment to the loss of their relative.
  Oncology Nursing Forum 01/2013; 40(1):E32-40. · 1.91 Impact Factor
• Article: Population-Based Cohort Analyses of the Bidirectional Relationship Between Type 2 Diabetes and Depression.

  Pei-Chun Chen, Yen-Ting Chan, Hua-Fen Chen, Ming-Chung Ko, Chung-Yi Li
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  ABSTRACT: OBJECTIVE This study addresses the strength of association for the bidirectional relationship between type 2 diabetes and depression.RESEARCH DESIGN AND METHODS We used two cohort studies with the same source of database to determine the link between depression and type 2 diabetes. The data analyzed included a random sample of 1 million beneficiaries selected from the National Health Insurance claims in 2000. The analysis of diabetes predicting the depression onset consisted of 16,957 diabetic patients and the same number of sex- and age-matched nondiabetic control subjects. The analysis of depression predicting diabetes onset included 5,847 depressive patients and 5,847 sex- and age-matched nondepressive control subjects. The follow-up period was between 2000 and 2006, and onset of end points was identified from ambulatory care claims. The Cox proportional hazards regression model adjusted for potential confounders was used to estimate relative hazards.RESULTSThe first cohort analysis noted an incidence density (ID) of 7.03 per 1,000 person-years (PY) and 5.04 per 1,000 PY for depression in diabetic and nondiabetic subjects, respectively, representing a covariate-adjusted hazard ratio (HR) of 1.43 (95% CI 1.16-1.77). The second cohort analysis noted an ID of 27.59 per 1,000 PY and 9.22 per 1,000 PY for diabetes in depressive and nondepressive subjects, respectively. The covariate-adjusted HR was stronger at 2.02 (1.80-2.27) for incident diabetes associated with baseline depression.CONCLUSIONS The two cohort studies provided evidence for the bidirectional relationship between diabetes and depression, with a stronger association noted for the depression predicting onset of diabetes.
  Diabetes care 11/2012; · 8.09 Impact Factor
• Article: Socio-demographic and meteorological correlates of sudden infant death in Taiwan.

  Hua-Pin Chang, Chung-Yi Li, Ya-Hui Chang, Shiow-Li Hwang, Ying-Hwa Su, Chi-Wen Chen
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  ABSTRACT: BACKGROUND: This study was designed, using three national datasets including the Taiwan Death Registry, Taiwan Birth Registry, and National Meteorological Dataset, to examine the socio-demographic, geographic and meteorological correlates of sudden infant death syndrome (SIDS). METHODS: One thousand six hundred seventy-one cases of SIDS occurring between 1994 and 2003 and 8,355 matched controls were included in this nested case-control study. RESULTS: Over the study period, the annual rate of SIDS declined only slightly, with an averaged annual rate of 57.9/10(5) . Male infants [AOR, 1.19; 95% CI-1.06, 1.33], preterm births [AOR, 1.69; 95% CI-1.33, 2.13], low birth weight [AOR, 2.87; 95% CI- 2.30, 3.59], and birth order > =3 [AOR, 1.62; 95% CI-1.37, 1.92] were the demographic risk factors for SIDS. Additionally, parental age with < 25 years [AOR, 1.37; 95% CI- 1.09, 1.71], urbanization [AOR, 1.46; 95% CI-1.20, 1.78], lower paternal education (elementary and less) [AOR, 1.28; 95% CI-1.01, 1.64], and parental age difference greater than 10 years [AOR, 1.72; 95% CI-1.24, 2.39] were also associated with increased risks of SIDS. We also noted that daily average temperature ranging from 9.2 to 14.2°C [AOR, 2.10; 95% CI-1.67, 2.64] emerged the most increased risk, while temperature of 26.4°C or higher [AOR 0.60, 0.61] was significantly associated with the most reduced risk. CONCLUSION: Socio-demographic, geographic and meteorological data can be used to identify families in greater need of early guidance and to promote various prevention measures to avoid the occurrence of SIDS.
  Pediatrics International 09/2012; · 0.63 Impact Factor
• Article: Contributions of diabetic macro-vascular complications and hip fracture to depression onset in elderly patients with diabetes: an 8-year population-based follow-up study.

  Hsueh-Hsing Pan, Chung-Yi Li, Pei-Chun Chen, Ming-Der Lee, Chun-Yu Liang, Wen-Hsuan Hou, Kwua-Yun Wang
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  ABSTRACT: To prospectively examine the roles of diabetic macro-vascular complications and hip fracture in association with depression onset in Taiwan's elderly diabetic population. A representative sample of elderly diabetic patients (n=144,216) identified in 2000 were linked to National Health Insurance claims (2000-2007) to ascertain the diagnoses of depression in both outpatient and inpatient settings. The person-year approach with Poisson assumption was used to estimate the hazard rates. Using Cox proportional hazard regression model, we evaluated the relative risk of depression in relation to diabetic macro-vascular complications and hip fracture. The additive effects from the above medical conditions were also assessed. The 8-year cumulative risk of depression was 5.08%, representing an incidence density of 8.40 per 1000 patient-years. Hazard ratio (HR) with 95% confidence interval (CI) for the elderly diabetes associated with cardiovascular disease (CVD), hip fracture, and lower extremity amputation was 1.13 (1.04-1.23), 1.10 (0.91-1.34), and 1.25 (0.95-1.65), respectively. Additionally, we found that the more the complications or hip fracture, the higher the risk of depression onset in elderly diabetes. The increased number of diabetic macro-vascular complications and hip fracture is significantly associated with a higher risk of depression onset in elderly diabetes. Future studies should be conducted to assess the feasibility and cost-effectiveness of intensive depression screening program in elderly diabetes suffering from macro-vascular complications and hip fracture.
  Journal of psychosomatic research 09/2012; 73(3):180-4. · 2.91 Impact Factor
• Article: Outpatient visits by dentists: a nationwide cohort study in taiwan.

  Chang-Ta Chiu, Shu-Min Huang, Yu-Wen Lin, Ming-Chung Ko, Chung-Yi Li
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  ABSTRACT: We conducted a cohort study of 7,760 dentists in Taiwan between 2003 and 2007 to assess the risk of outpatient visit among dentists. Control groups included physicians and other health personnel. Over the 5-yr study period, the dentist cohort made a total of 270,712 outpatient visits, representing an incidence rate of 7,038 visits /10(3) person-years. Compared to physicians, dentists experienced a significantly reduced covariate adjusted rate ratio (ARR) for all-cause visits (ARR=0.59, 95%CI=0.58-0.59), as well as for nearly all other causes, except neoplasm (ARR=1.06, 95%CI=1.02-1.09). Compared to other health personnel, the dentists still experienced a significantly reduced ARR for all causes (ARR=0.70), but had a slightly but significantly increased risk for endocrine/metabolic/immunity (ARR=1.04, 95%CI=1.02-1.05) and mental (ARR=1.04, 95%CI=1.01-1.07) disorders. Although the dentists in Taiwan utilized lesser outpatient visits than did their medical colleagues, they tended to have slightly higher rates of outpatient visits for neoplasm, endocrine/metabolic/immunity disorders, and mental illnesses. Policy makers and hospital administrators must not overlook dentists' potentially unseen health problems. A mandatory periodical physical examination for dentists can seriously be considered.
  Industrial Health 08/2012; 50(5):437-44. · 0.94 Impact Factor
• Article: A population-based case-control study of radiofrequency exposure in relation to childhood neoplasm.

  Chung-Yi Li, Chih-Ching Liu, Ya-Hui Chang, Li-Ping Chou, Ming-Chung Ko
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  ABSTRACT: This population-based case-control study in Taiwan considered incident cases aged 15years or less and admitted in 2003 to 2007 for all neoplasm (ICD-9-CM: 140-239) (n=2606), including 939 leukemia and 394 brain neoplasm cases. Controls were randomly selected, with a case/control ratio of 1:30 and matched on year of birth, from all non-neoplasm children insured in the same year when the index case was admitted. Annual summarized power (ASP, watt-year) was calculated for each of the 71,185 mobile phone base stations (MPBS) in service between 1998 and 2007. Then, the annual power density (APD, watt-year/km(2)) of each township (n=367) was computed as a ratio of the total ASP of all MPBS in a township to the area of that particular township. Exposure of each study subject to radio frequency (RF) was indicated by the averaged APD within 5years prior to the neoplasm diagnosis (cases) or July 1st of the year when the index case was admitted (controls) in the township where the subject lived. Unconditional logistic regression model with generalized estimation equation was employed to calculate the covariate-adjusted odds ratio [AOR] of childhood neoplasm in relation to RF exposure. A higher than median averaged APD (approximately 168WYs/km(2)) was significantly associated with an increased AOR for all neoplasms (1.13; 1.01 to 1.28), but not for leukemia (1.23; 0.99 to 1.52) or brain neoplasm (1.14, 0.83 to 1.55). This study noted a significantly increased risk of all neoplasms in children with higher-than-median RF exposure to MPBS. The slightly elevated risk was seen for leukemia and brain neoplasm, but was not statistically significant. These results may occur due to several methodological limitations.
  Science of The Total Environment 08/2012; 435-436:472-8. · 3.29 Impact Factor
• Article: Course and predictors of depressive symptoms among family caregivers of terminally ill cancer patients until their death.

  Siew Tzuh Tang, Wen-Cheng Chang, Jen-Shi Chen, Hung-Ming Wang, Wen Chi Shen, Chung-Yi Li, Yen-Chi Liao
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  ABSTRACT: OBJECTIVE: Few studies have investigated the impact of providing end-of-life care on family caregivers' depressive symptoms over time, especially until the patient's death. The purpose of this study was to identify the course and predictors of depressive symptoms in caregivers of terminally ill cancer patients until they died. METHODS: For this prospective, longitudinal study of 193 caregivers, data were collected using the Center for Epidemiological Studies Depression Scale, Symptom Distress Scale, Medical Outcomes Study Social Support Survey, and Caregiver Reaction Assessment scale. The course and predictors of depressive symptoms were analyzed using the generalized estimating equation model. RESULTS: Caregivers' depressive symptoms increased as the patient's death approached. Spousal or adult child family caregivers suffered more depressive symptoms if they self-identified as lacking social support and confidence in offering substantial assistance for younger terminally ill cancer patients with higher levels of symptom distress. Caregivers were susceptible to higher levels of depressive symptoms if they were heavily burdened by caregiving, that is, experienced more disruptions in schedules, greater health deterioration, stronger sense of family abandonment, and lower caregiver esteem. CONCLUSIONS: Psychological well-being of caregivers of terminally ill cancer patients deteriorated in response to progression of the patient's disease and impending death. Effective interventions should be developed and provided to high-risk caregivers as identified in our study. Increasing caregivers' strength of perceived social support, facilitating their confidence in caregiving, and alleviating their subjective burden may lessen the development of depressive symptoms in caregivers of terminally ill cancer patients throughout the dying process. Copyright © 2012 John Wiley & Sons, Ltd.
  Psycho-Oncology 07/2012; · 3.34 Impact Factor
• Article: Health-seeking behavior, alternative medicine, and quality of life in Taiwanese panic disorder patients.

  Miao-Tzu Chen, Chung-Yi Li, Herng-Ching Lin, Winston W Shen, Pi-Ching Hsieh, Chu-Chieh Chen
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  ABSTRACT: Objective. Panic disorder (PD) is an anxiety disorder characterized by spontaneous and unexpected panic attacks of varying frequency. Clinically manifest PD is widespread among the general population in developed countries worldwide. This study is aimed to identify factors influencing Taiwanese patients' decision to seek psychiatric help and to assess relationships between patients' health-seeking behaviors and quality of life (QOL). Methods. One hundred patients from the outpatient psychiatric clinic of a university hospital in Taiwan were evaluated for PD. Results. Delayed diagnosis of panic disorder, high comorbidity with other mental and physical disorders, and high utilization of health care services were identified. Thirty-three percent of PD patients sought alternative therapies, delaying their seeking psychiatric care. Conclusions. More PD patients in Taiwan seek care from family practitioners and alternative and complementary medicine than from psychiatrists. Taiwanese patients with PD who seek psychiatric consultation more than one year after disease onset have lower QOL and lower physical health scores.
  International Journal of Psychiatry in Clinical Practice 07/2012; · 0.43 Impact Factor
• Article: Trends and characteristics of pethidine use in Taiwan: a six-year-long survey.

  Hsueh-Hsing Pan, Chung-Yi Li, Tso-Chou Lin, Ju-O Wang, Shung-Tai Ho, Kwua-Yun Wang
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  ABSTRACT: To investigate the trends and characteristics of pethidine prescriptions and users in Taiwan from 2002 to 2007. All pethidine users (n = 3,301,136) in Taiwan from 2002 to 2007 were linked to National Health Insurance claims to identify pethidine prescriptions. We examined the trends in pethidine user prevalence and the proportion of pethidine prescriptions according to health care characteristics. A logistic regression model was used to compare patient demographics and health care characteristics associated with pethidine prescriptions between 2002 and 2007. Despite the decline in the number of pethidine users and prescriptions over the six-year period, more than half a million people were prescribed pethidine annually. In fact, an increasing proportion of pethidine prescriptions were observed in clinics, outpatient settings, and patients who had both operations and cancer diagnoses. Pethidine prescriptions were mostly associated with a non-operation status without a cancer diagnosis (>60%). However, approximately 10% of the total pethidine prescriptions were found in patients with a cancer diagnosis but no operation. Compared to those in 2002, pethidine prescriptions in 2007 were more likely to be found in people 80 years or older, rural residents, patients from clinics, outpatient settings and operation patients with cancer diagnoses. A population-based survey in Taiwan demonstrated decreasing consumption of pethidine from 2002 to 2007; however, an increased proportion of prescriptions in certain health care settings was observed. In addition, 10% of the pethidine prescriptions were for cancer patients without operations. These cases need further evaluation for the determination of appropriate pethidine use.
  Clinics (São Paulo, Brazil) 07/2012; 67(7):749-55. · 1.59 Impact Factor
• Article: Risk of Alzheimer's disease in relation to diabetes: a population-based cohort study.

  Kai-Chen Wang, Lin-Chung Woung, Ming-Tsu Tsai, Chih-Ching Liu, Ying-Hwa Su, Chung-Yi Li
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  ABSTRACT: Detailed information on the age- and sex-specific relationships between diabetes and Alzheimer's disease (AD) is scarce. This study aims to prospectively investigate the age- and sex-specific incidence density and relative hazards of AD in relation to diabetes. A total of 615,529 diabetic patients and 614,871 age- and sex-matched random controls were linked to the claim data from 2000-2008 to identify the first occurrence of a primary or secondary diagnosis of AD. Incidence density was calculated under the Poisson assumption. We also assessed the age- and sex-specific risk of AD in relation to diabetes with the Cox proportional hazards regression model. Over nearly 9 years of follow-up, a total of 4,615 diabetic subjects developed AD, representing a cumulative incidence rate of 0.75% (n = 3,873; 0.63% in controls). The overall incidence densities of AD for diabetic men and women, respectively, were 0.82 and 1.15 per 1,000 person-years, which were higher than those for control men and women (0.63 and 0.89 per 1,000 person-years, respectively). Diabetic patients had a significantly higher hazard ratio (HR) of AD [1.45, 95% confidence interval (CI) 1.38-1.52]. Diabetic women ≥65 years had a higher HR (1.52, 95% CI 1.42-1.62) than diabetic women <65 years (1.34, 95% CI 1.15-1.56). Diabetes may increase the risk of AD in both sexes and in all ages. A higher HR of AD was especially notable in older diabetic women.
  Neuroepidemiology 05/2012; 38(4):237-44. · 2.31 Impact Factor
• Article: Are Diabetic Physicians at a Lower Risk of Hospitalization for Coronary Heart Disease? A Nationwide Cohort Study in Taiwan.

  Yen-Chun Lin, Chih-Ching Liu, Shiow-Li Hwang, Chung-Yi Li, Li-Ping Chou, Chi-Chu Liu
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  ABSTRACT: It is not uncommon for physicians to work through illness and to be reluctant to seek health care from their colleagues, which is detrimental for quality of care. This study sought to assess the risk of admission for coronary artery diseases (CADs) in diabetic physicians. A cohort of 995 diabetic physicians and 9950 age- and sex-matched controls with diabetes were identified in 2000 and were followed to the end of 2008. Over an 8-year period, 200 (20.1%) diabetic physicians and 2255 (22.7%) controls were admitted for CAD. After controlling for potential confounders, diabetic physicians experienced a reduced, but insignificantly, adjusted odds ratio (OR) of CAD admission (OR = 0.89; 95% confidence interval = 0.75-1.06). Diabetic physicians in Taiwan were not at a significantly reduced risk of CAD admission. Future studies are needed to further explore the barriers that impede diabetic physicians from appropriately managing their disease.
  Asia-Pacific Journal of Public Health 04/2012; · 1.06 Impact Factor
• Article: A population-based cohort study of symptomatic gallstone disease in diabetic patients.

  Chi-Ming Liu, Chung-Te Hsu, Chung-Yi Li, Chu-Chieh Chen, Meng-Lun Liu, Jorn-Hon Liu
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  ABSTRACT: To investigate the prevalence of gallstone disease (GSD) and to evaluate the risk of symptomatic GSD among diabetic patients. The study was conducted by analyzing the National Health Research Institutes (NHRI) dataset of ambulatory care patients, inpatient claims, and the updated registry of beneficiaries from 2000 to 2008. A total of 615,532 diabetic patients without a prior history of hospital treatment or ambulatory care visits for symptomatic GSD were identified in the year 2000. Age- and gender-matched control individuals free from both GSD and diabetes from 1997 to 1999 were randomly selected from the NHIR database (n = 614,871). The incidence densities of symptomatic GSD were estimated according to the subjects' diabetic status. The distributions of age, gender, occupation, income, and residential area urbanization were compared between diabetic patients and control subjects using Cox proportion hazards models. Differences between the rates of selected comorbidities were also assessed in the two groups. Overall, 60,734 diabetic patients and 48,116 control patients developed symptomatic GSD and underwent operations, resulting in cumulative operation rates of 9.87% and 7.83%, respectively. The age and gender distributions of both groups were similar, with a mean age of 60 years and a predominance of females. The diabetic group had a significantly higher prevalence of all comorbidities of interest. A higher incidence of symptomatic GSD was observed in females than in males in both groups. In the control group, females under the age of 64 had a significantly higher incidence of GSD than the corresponding males, but this difference was reduced with increasing age. The cumulative incidences of operations for symptomatic GSD in the diabetic and control groups were 13.06 and 9.52 cases per 1000 person-years, respectively. Diabetic men exhibited a higher incidence of operations for symptomatic GSD than did their counterparts in the control group (12.35 vs 8.75 cases per 1000 person-years). The association of diabetes with increased symptomatic GSD may provide insight to the treatment or management of diabetes in clinical settings.
  World Journal of Gastroenterology 04/2012; 18(14):1652-9. · 2.47 Impact Factor
• Article: Risk of Parkinson disease onset in patients with diabetes: a 9-year population-based cohort study with age and sex stratifications.

  Yu Sun, Ya-Hui Chang, Hua-Fen Chen, Ying-Hwa Su, Hui-Fang Su, Chung-Yi Li
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  ABSTRACT: We retrospectively assessed the age- and sex-specific incidence and relative risk of Parkinson disease (PD) in Taiwan's diabetic population. Study cohort included 603,416 diabetic patients and 472,188 nondiabetic control subjects. Incidence rate and relative risk of PD (ICD-9-CM 332.0) were evaluated. The incidence of PD was 3.59 and 2.15 per 10,000 person-years for the diabetic and control group, respectively, representing a covariate adjusted hazard ratio (HR) of 1.61 (95% CI 1.56-1.66), which was substantially reduced to 1.37 (1.32-1.41) after adjusting for medical visits. Diabetes was associated with a significantly elevated risk of PD in all sex and age stratifications except in young women, with the highest HR noted for young men aged 21-40 years (2.10 [1.01-4.42]), followed by women aged 41-60 (2.05 [1.82-2.30]) and >60 years (1.65 [1.58-1.73]). Diabetes is associated with an increased risk of PD onset in a Chinese population, and the relation is stronger in women and younger patients.
  Diabetes care 03/2012; 35(5):1047-9. · 8.09 Impact Factor
• Article: Risk of mortality among patients with epilepsy in southern Taiwan.

  Ya-Hui Chang, Wen-Chao Ho, Jing-Jane Tsai, Chung-Yi Li, Tsung-Hsueh Lu
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  ABSTRACT: Previous studies suggested a higher risk of all-cause mortality in patients with epilepsy than in the general population. However, information on the age- and sex-specific risk of mortality, as well as on the cause-specific risk of mortality has been sparse. This study aims to determine sex-, age-, and cause-specific risk of mortality among patients with epilepsy from southern Taiwan. A total of 2180 patients treated in a tertiary hospital in southern Taiwan between 1989 and 2008 were compared to the general population of Taiwan for age-, sex- and cause-specific mortalities. The age-, sex-, and calendar year-standardized mortality ratios (SMRs) were calculated to estimate the relative risks of mortality associated with the epilepsy. There are 266 (12.2%) deaths noted in the study period. The patients with epilepsy experienced a significantly increased SMR of all-cause mortality (SMR, 2.5; 95% confidence interval (CI), 2.2-2.8). The most significantly elevated age-specific SMR was 51.8 (95% CI, 6.2-187.2) and 8.6 (95% CI, 4.4-14.9) for male patients aged 0-9 years and female patients aged 20-29 years, respectively. Additionally, the most increased cause-specific SMR was noted for brain tumor (SMR, 21.4; 95% CI, 9.23-23.1), followed by accidental drowning (SMR, 8.8; 95% CI, 3.5-9.6) and falls (SMR, 5.7; 95% CI, 2.2-6.1). Younger epilepsy should be the object of aggressive treatments. Advancement in treating brain tumors and prevention of accidental injuries may help improve the survival of patients with epilepsy.
  Seizure 02/2012; 21(4):254-9. · 1.80 Impact Factor
• Article: Reply.

  Hsin-Shui Chen, Li-Ting Su, Shinn-Zong Lin, Fung-Chang Sung, Ming-Chung Ko, Chung-Yi Li
  Urology 01/2012; 79(1):93-4. · 2.43 Impact Factor
• Article: Age- and sex-specific risks of colorectal cancers in diabetic patients.

  Hua-Fen Chen, Peter Chen, Ying-Hwa Su, Hui-Fang Su, Chung-Yi Li
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  ABSTRACT: Diabetes has been reported to increase the risk of colorectal neoplasm in most but not all studies. However, the data on age- and sex-specific incidence rates and relative risks associated with diabetes are limited. We carried out this population-based cohort study to investigate the overall sex- and age-specific risks of colorectal cancer in association with diabetes. Diabetic patients (n = 615,532) and age- and sex-matched control individuals (n = 614,871), selected from the claim datasets, were followed up from 2000 to 2006. The rates of admission due to colon and rectum cancers were estimated using the person-years approach, and the age- and sex-specific hazard ratio (HR) for both the malignancies were determined using the Cox regression model. The overall incidence rate of colon cancer was 9.94 per 10,000 patient-years for the diabetic patients, as opposed to 7.84 per 10,000 patient-years for the control-group patients. The corresponding observation for rectal cancer was 7.16 and 6.28 per 10,000 patient-years. Diabetic patients aged ≥ 45 years had significantly high HRs for developing colon cancer (1.20-1.45-fold). We also noted a significantly high HR of rectal cancer in diabetic men (1.18-fold) aged ≥ 45 years, but not in diabetic women. In conclusion, diabetes may significantly increase the risk of colorectal cancer, especially in patients aged 45-64 years. Diabetologists should keep this relationship in mind while treating middle-aged diabetic men and should also advise these patients to undergo regular screening tests for colorectal cancer.
  The Tohoku Journal of Experimental Medicine 01/2012; 226(4):259-65. · 1.24 Impact Factor
• Article: Suicide method runs in families: a birth certificate cohort study of adolescent suicide in Taiwan.

  Tsung-Hsueh Lu, Wan-Ting Chang, Jin-Jia Lin, Chung-Yi Li
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  ABSTRACT: Suicide method used by adolescents was examined to determine if it was the same as that employed by their suicidal parents. Six hundred eighty adolescents completed suicide between 1997 and 2007, of whom 12 had parents who had previously died by suicide. The suicide method used by these adolescents was compared with that employed by their suicidal parent and that of a matched peer control adolescent with no exposure to parental suicide and living in the same area. In 10 of the 12 suicidal parent-adolescent dyads, the same suicide method was employed by parent and adolescent. Of seven adolescents whose age at parental suicide was 15 years or above, six used the same suicide method as their suicidal parent had. On the contrary, of 12 exposure-nonexposure suicidal adolescent dyads, the same method was used in only four. Adolescents exposed to parental suicide are more likely to use the suicide method employed by their suicidal parents than the method used by adolescent peers with no exposure to parental suicide.
  Suicide and Life-Threatening Behavior 12/2011; 41(6):685-90. · 1.33 Impact Factor
• Article: Increased risk of urinary tract calculi among patients with diabetes mellitus--a population-based cohort study.

  Hsin-Shui Chen, Li-Ting Su, Shinn-Zong Lin, Fung-Chang Sung, Ming-Chung Ko, Chung-Yi Li
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  ABSTRACT: To investigate the inter-relationship among diabetes, urinary tract infection (UTI), and urinary tract calculi (UTC). This study used Taiwan's National Health Insurance claims data of ambulatory care visits and hospitalizations. A total of 12,257 newly diagnosed diabetes cases in 2000-2002 and 96,781 controls were followed to the end of 2007. The person-year approach with Poisson assumption was used to estimate the incidence density (ID) of UTC by diabetic status. Relative risk of UTC in relation to diabetes and UTI were estimated from Cox proportional hazard model with adjustment for sociodemographic variables and comorbidities. Over nearly 8 years of follow-up, 8.9% of diabetes and 7.2% of control subjects sought ambulatory care or were hospitalized for UTC, representing the ID of 14.4 and 11.4 per 1000 person-years, respectively. The multivariate analysis indicated that UTC risk was independently associated with diabetes (hazard ratio 1.18, 95% CI 1.10-1.27) and UTI (HR 1.68, 95% CI 1.60-1.76). The hazard ratio of UTC in relation to diabetes in men and women without UTI was 1.24 and 1.26, respectively. Diabetes may further increase the rate of UTC in women with UTI, with an hazard ratio increased from 1.79-2.12. Such additive effect by diabetes in men with UTI was only marginal (HR 1.68 vs 1.67). This cohort study provides epidemiologic support for the causal association between diabetes and UTC, which is independent of UTI. In addition, female patients with UTI accompanied by diabetes tended to be associated with a greater rate of UTC.
  Urology 11/2011; 79(1):86-92. · 2.43 Impact Factor
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  Available from: cmu.edu.tw

  Article: Offspring birth weight and risk of mortality from diabetes in mothers.

  Chung-Yi Li, Fung-Chang Sung, Pi-Ching Hsieh, Ming-Der Lee, Tsung-Hsueh Lu, Hua-Fen Chen
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  ABSTRACT: Mothers with lower birth weight (LBW) offspring have been found to be associated with cardiovascular disease (CVD) morbidity, which shares many risk factors with diabetes. Aims To investigate the relation between offspring birth weight and maternal risk of mortality from diabetes. A total of 1 400 383 singletons of primigravida registered in Taiwan between 1978 and 1987 were followed to the end of 2006. The offspring birth weight was assessed with and without standardisation for the gestational age of offspring. Cox model was used to estimate the HR of maternal diabetes mortality in relation to offspring birth weights. Altogether, 812 (5.8%) mothers died of diabetes. Mothers with LBW (<2500 g) and macrosomia (>4000 g) offspring were both at increased risks of mortality from diabetes with HR 1.76 (95% CI 1.46 to 2.19) and 2.86 (95% CI 2.32 to 3.53), respectively. Similar results were seen while birth weight was standardised for gestational age. This cohort study found that mothers with LBW and macrosomia offspring had an increased mortality risk of diabetes. This relationship could be attributable to the possible pathway of intergenerational effects or maternal insulin resistance due to maladaptation to pregnancy.
  Journal of epidemiology and community health 09/2011; 65(9):775-9. · 3.04 Impact Factor