Yu-Hsiang Tsao

Ambient air pollution, particularly fine particulate matter (PM₂.₅), poses a major global public health concern. We examined trends in all-cause and respiratory disease-specific mortality and their association with PM₂.₅ concentrations during three time periods (2008-2011, 2012-2015, 2016-2019) in Linyuan District, Kaohsiung City, and Taiwan, using generalized Poisson mixed models. PM₂.₅ concentrations declined by 23.6% in Taiwan, from 24.5 µg/m³ (2008-2011) to 18.8 µg/m³ (2016-2019), with similar reductions observed in Kaohsiung City and Linyuan District. Age-standardized all-cause mortality rates also decreased over time. Nevertheless, residents of Linyuan consistently exhibited higher mortality than those in Kaohsiung City and Taiwan. Each 1 µg/m³ increase in PM₂.₅ was associated with higher all-cause mortality risk (men: RR = 1.011, 95% CI: 1.001-1.021; women: RR = 1.017, 95% CI: 1.004-1.031). Despite overall declines in PM₂.₅ and mortality rates, excess risks persist in heavily industrialized areas. These findings highlight the public health benefits of air-quality improvements and the need for sustained pollution control efforts. In addition, as this study is observational and ecological in nature, the findings should be interpreted with caution and not as evidence of causality.

Background/Objectives: Autosomal dominant polycystic kidney disease (ADPKD) is a progressive genetic disorder marked by bilateral renal cysts and extrarenal manifestations, ultimately resulting in renal failure. Emerging research indicates that metformin might influence the intracellular mechanisms of ADPKD, though its clinical significance remains uncertain. Methods: We applied the Taiwan National Health Insurance Database (NHIRD) to investigate the clinical impact of metformin utilization in ADPKD patients in real-world practice. The metformin user group was defined by more than 90 days of usage. To mitigate selection bias, we established a non-user group with a 1:2 ratio, matching for age, sex, and comorbidities by a propensity score matching method. Results: A total of 10,222 ADPKD cases were identified in the NHIRD between 2009 and 2018. After matching, the metformin user group was composed of 778 cases with a mean age of 59.5 ± 13.9 years, and the non-user group of 1546 cases with a mean age of 59.3 ± 14.4 years. The time from the index date to the outcome of ESKD in ADPKD was 5.3 ± 2.2 years in the metformin user group and 5.3 ± 2.3 years in the metformin non-user group, respectively. The metformin user group exhibited a significant reduction in the risk of end-stage kidney disease (ESKD), as indicated in the fully adjusted model (0.75, 95% CI 0.58–0.97, p = 0.03). A decreased risk of major adverse cardiovascular events (MACEs) was noted in metformin users, with an adjusted hazard ratio (HR) of 0.78 (95% CI 0.65–0.95, p = 0.01). Sensitivity analysis showed similar results by excluding late-stage CKD (CKD stage 5 or erythropoietin-stimulating agents use). Conclusions: Metformin usage in real-world practice showed lower hazards of ESKD and MACEs in patients with ADPKD, except for those with advanced CKD.

Taiwan implemented the Cancer Screening Quality Improvement Program (CAQIP) in 2010. The program sought to enhance mass breast cancer screening accessibility. This study aimed to examine socioeconomic disparities in outreach screening utilization pre-CAQIP (2005–2009) and post-CAQIP (2010–2014). We conducted a nationwide population-based observational study in Taiwan, analyzing four population databases to evaluate socioeconomic disparities among women aged 50 to 69 years undergoing their first mammography screening pre-CAQIP. Multivariate logistic regression was used to examine changes in utilization of outreach screening pre- and post-CAQIP implementation, and to estimate the Slope Index of Inequity (SII) and Relative Index of Inequity (RII) values. Utilization of outreach screening through mobile mammography units (MMUs) increased from 6.12 to 32.87% between the two periods. Following CAQIP, a higher proportion of screened women were older, less educated, and from suburban or rural areas. The SII and RII for age, income, and urbanization levels decreased post-CAQIP. However, regarding education level, SII was − 0.592 and RII was 0.392 in the pre-CAQIP period, increasing to -0.173 and 0.804 post-CAQIP, respectively. Our study observed that utilization of outreach screening through MMUs increased after CAQIP. The MMUs made outreach screening services more accessible in Taiwan. Expanding outreach screening services and educational programs to promote mammography uptake in local communities could help reduce the potential effect of socioeconomic disparities, and thus may enhance early detection of breast cancer. Further study could focus on the accessibility of outreach screening and breast cancer outcomes.

Background: Air pollution is known to increase the incidence of dementia, but whether dementia in areas with high air pollution likely to get worse is still unclear. We investigate the impact of high air pollution areas on the progression in dementia, and which air pollutants have more obvious influences.Method: A retrospective case‐control study was performed using the data from the Kaohsiung Medical University Hospital Research Database and Environmental Protection and Administration, Taiwan. Clinical data and air pollution data were concatenated with addresses to assess the exposure to each case. Further, divide Kaohsiung into areas with severe air pollution and compare them with general areas. Exacerbation of dementia was defined as detection with use of advanced medications. We constructed conditional logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs).Result: There were 529 cases in the group of worsening dementia and 2351 cases in the control group. The OR of dementia exacerbation in the general area is significantly lower than that of the high SO₂ exposure area (OR: 0.745, 95% CI: 0.616‐0.901). Exposure to SO₂ and PM_2.5 at all five time points studied were significantly associated with an increased risk of worsening dementia of all types and non‐degenerative types. The maximum total peak ORs (95% CI) were 1.285 (1.154–1.431) in the first year with exposure to high SO₂ and 1.111 (1.043–1.183) in the four years with exposure to high PM_2.5, respectively. In the dementia of degenerative types, exposure to SO₂ were significantly associated with an increased risk of worsening dementia. The maximum total peak ORs (95% CI) were 1.386 (1.174–1.638) in the first year.Conclusion: This study confirms that cumulative exposure in the previous one to five years in high‐exposure areas has a significantly higher risk of all dementia worsening. SO₂ pollutant has the obvious effect on the progression of dementia of all types, degenerative and non‐degenerative types. PM_2.5 pollutant has the obvious effect on the progression of dementia of all types and non‐degenerative types. The protection from air pollution, especially SO₂ and PM_2.5 pollutants is very important in the treatment of dementia.

Background: Female cancers, including breast, cervical, uterine, and ovarian cancer, remain among the ten most common cancers among women worldwide, but the relationship between female cancers and abortion from previous studies is inconsistent. This study aimed to investigate risks of incident female cancers among women aged 20 to 45 years who underwent abortion in Taiwan compared with those who did not. Method: A longitudinal observational cohort study was conducted using three nationwide population-based databases in Taiwan, focusing on 20- to 45-year-old women, with 10 years of follow-up. Matched cohorts were identified with propensity score 1-to-3 matching between 269,050 women who underwent abortion and 807,150 who did not. Multivariable Cox proportional hazard modeling was used for analysis after adjusting for covariates including age, average monthly payroll, fertility, diabetes mellitus, polycystic ovarian syndrome, endometrial hyperplasia, endometriosis, hormone-related drugs, and Charlson comorbidity index. Results: We found lower risk of uterine cancer (hazard ratio [HR]: 0.77, 95% CI: 0.70–0.85) and ovarian cancer (HR: 0.81, 95% CI: 0.75–0.88), but no significant difference in risk of breast cancer or cervical cancer, among matched abortion compared with non-abortion cohorts. Regarding subgroup analysis, cervical cancer risk was higher for parous women who underwent abortion, and uterine cancer risk was lower for nulliparous women who underwent abortion compared with non-abortion groups. Conclusions: Abortion was related to lower uterine and ovarian cancer risk but was not associated with risks of incident breast cancer or cervical cancer. Longer follow-up may be necessary to observe risks of female cancers at older ages.