Polycystic kidney disease increases the stoke incidence in Taiwan: A retrospective population-based cohort study using National Health Insurance Database

Lukas Jyuhn-Hsiarn Lee; Li-Kai Tsai; Yu-Yin Chang; Jung-Der Wang; Juliana Tze-Wah Kao

doi:10.1016/j.bj.2021.10.005

Polycystic kidney disease increases the stoke incidence in Taiwan: A retrospective population-based cohort study using National Health Insurance Database

Biomed J. 2022 Oct;45(5):806-813. doi: 10.1016/j.bj.2021.10.005. Epub 2021 Oct 27.

Authors

Lukas Jyuhn-Hsiarn Lee¹, Li-Kai Tsai², Yu-Yin Chang³, Jung-Der Wang⁴, Juliana Tze-Wah Kao⁵

Affiliations

¹ National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Neurology and Stroke Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan; Research Center for Environmental Medicine, Ph.D. Program of Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
² Department of Neurology and Stroke Center, National Taiwan University Hospital, Taipei, Taiwan.
³ National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
⁴ Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
⁵ School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: 137063@mail.fju.edu.tw.

Abstract

Background: Few studies documented incidence rates of different types of stroke among patients with polycystic kidney disease (PKD).

Methods: We conducted a retrospective cohort study based on the National Health Insurance (NHI) Database of Taiwan. The PKD cohort comprised patients aged≥20 years diagnosed with PKD using inpatient claims from 1998 to 2011, excluding prior stroke. The reference cohort was established by inpatients without PKD using 1:4 frequency-matched with age, gender, and baseline comorbidities. The two cohorts were followed-up until stroke hospitalization, death, withdrawal from the NHI program, or the end of 2012. To account for competing risks of death, we used multivariable competing risks regression models to estimate sub-distribution hazard ratio (SHR) adjusted for age, gender, baseline comorbidities and end stage renal disease.

Results: 7837 PKD patients and 31,211 reference subjects were followed up through 2012. A total of 955 cases of stroke were identified in the PKD cohort, including 441 ischemic stroke (IS), 289 intracranial hemorrhage (ICH), 73 subarachnoid hemorrhage (SAH) and 232 other stroke. The incidence rates of overall stroke, IS, ICH, and SAH were 21.3, 10.2, 6.8, and 1.7 per 1000 person-years, respectively. The SHR for overall stroke was 1.39 [95% confidence interval (CI) 1.28-1.50]. SAH had the highest SHR, 4.55 [95% CI 3.26-6.37], followed by ICH (1.84), other stroke (1.24), and IS (1.22).

Conclusion: This study illustrated the incidence rates of stroke among inpatient of PKD. The PKD patients had a significantly increased risk of all kinds of stroke after adjusting baseline comorbidities.

Keywords: Cohort; National health insurance (NHI); Polycystic kidney disease (PKD); Stroke.

MeSH terms

Cohort Studies
Humans
Incidence
National Health Programs
Polycystic Kidney Diseases* / epidemiology
Retrospective Studies
Risk Factors
Stroke* / epidemiology
Subarachnoid Hemorrhage*
Taiwan / epidemiology