| Summary: | 博士 === 國立陽明大學 === 公共衛生研究所 === 101 === Background:
Central serous chorioretinopathy (CSCR) is a common maculopathy characterized by serous detachment of neurosensory retina in the acute phase. Circulatory disturbance in the choroids of the CSCR eyes can be observed with the different image techniques. Though CSCR has been reported to be associated with psychological stress and exposure to exogenous corticosteroids, the epidemiology of CSCR has not been systemically surveyed and the data about CSCR incidence is rare in an Asian population. The purpose of this serial studies is to investigate the epidemiology of CSCR using the Taiwan National Health Insurance Research Database (NHIRD). The first study focused on the incidence and risk factors for corticosteroid-unrelated (idiopathic) CSCR. The second study aimed to investigate the incidence and risk factors for CSCR in adults using oral corticosteroids. The last two studies explored the association of CSCR with other circulatory disorders: erectile dysfunction in males and ischemic strokes.
Methods:
These nationwide population-based studies were based on data obtained from the 1,000,000 beneficiaries sampling files of Taiwan NHIRD.
In the first study about idiopathic CSCR, we identified newly diagnosed CSCR patients, with no history of corticosteroid prescription, as incident cases of idiopathic CSCR and calculated the annual incidence from 2001 to 2006. Subjects without CSCR diagnosis, matched for age, gender and the time of enrollment, were randomly selected as the control group. Conditional logistic regression was used to estimate the odds ratios (ORs) for potential risk factors of idiopathic CSCR.
In the second study about CSCR in oral corticosteroids users, we used the nested case-control study design. Adults who were repetitively prescribed oral corticosteroids were included as the study cohort. Of those, we identified newly diagnosed CSCR cases and calculated the CSCR incidence. Subjects matched for age, gender and the enrollment time were randomly selected as the controls. Corticosteroids use was compared between the cases and controls. Poisson and conditional logistic regressions were used to analyze the potential risk factors for CSCR.
In the third study about the association between CSCR and ischemic stroke, we identified eligible cases with incident CSCR. Using stratified random sampling, enrollees who had no history of CSCR and matched with the study subjects in terms of sex, age, monthly income, geographic location and time of enrollment were selected as the control group. Stroke-free survival analysis was assessed using a Kaplan-Meier method. Cox proportional hazard regressions were performed to calculate the hazard ratios (HR) of ischemic stroke for the 2 groups after adjusting for possible confounding variables.
In the fourth study about the association between CSCR and erectile dysfunction in males, we identified eligible cases with incident CSCR. Males who had no history of CSCR and matched for age, monthly income and time of enrollment were randomly selected as the control group. Cox proportional hazard regressions were performed to calculate the hazard ratios of clinically diagnosed erectile dysfunction (including organic origin and/or psychogenic origin) for the two groups. Erectile dysfunction-free survival analysis was assessed using a Kaplan-Meier method.
Results:
In the first study about idiopathic CSCR, the mean annual incidence was 0.21‰ between 2001 and 2006 (0.27‰ for males, and 0.15‰ for females; P < 0.001), with a male/female ratio of 1.74. The peak incidence was in the 35- to 39-year-old age group (0.30‰), followed by the 40- to 44-year-old age group (0.26‰). Only exposure to anti-anxiety drugs (OR, 1.63; 95% confidence interval [CI], 1.09-2.44) was found to be independently associated with idiopathic CSCR among males. No risk factors of idiopathic CSCR were found for females.
In the second study about CSCR in oral corticosteroids users, the incidence rate of CSCR was 44.4 (95% CI, 39.5-49.3) cases per 100 000 person-years. Multivariate Poisson regression showed that male patients and those aged 35 to 44 years had significantly higher incidence rates of CSCR. There were no differences in either median dosage or mean duration of systemic corticosteroid treatment between the cases and controls. After adjusting for other confounders, current use of oral corticosteroids was found to be significantly associated with the risk of CSCR (OR = 2.40; 95% CI, 1.49-3.89). CSCR patients with higher average daily dosages were more likely to have shorter latency period (P for lineal trend <0.001).
In the third study about the association between CSCR and ischemic stroke, 45 patients (2.5%) from the CSCR cohort (n=1814) and 157 patients (1.6%) from the control group (n=9648) developed ischemic stroke during a mean follow-up period of 3.9 years. CSCR patients had a significantly higher incidence of ischemic stroke than those without a diagnosis of CSCR (p = 0.003). After adjusting for age, sex and chronic comorbidities at baseline, CSCR patients were found to have a 1.56-fold (95% CI, 1.11– 2.18) risk of a subsequent ischemic stroke than the matched controls.
In the fourth study about the association between CSCR and erectile dysfunction in males, 25 patients (2.0%) from the CSCR cohort (n=1220) and 103 (0.9%) from the control group (n=10870) were diagnosed erectile dysfunction clinically during a mean observation period of 4.3 years. CSCR patients had a significantly higher incidence of erectile dysfunction diagnosis than those without CSCR (P <0.001). After adjusting for age, geographic location, chronic comorbidities, and medication habits, CSCR patients were found to have a 2.22-fold (95% CI, 1.42 – 3.46) higher hazard ratio of a subsequent erectile dysfunction diagnosis than the matched controls. The adjusted hazard ratios for organic and psychogenic erectile dysfunction were 2.14 (95% CI: 1.34 – 3.44) and 3.83 (95% CI: 1.47 – 10.01), respectively.
Conclusions:
The present study provides nationwide, population-based data on the incidence of CSCR in Taiwan. Compared to the published literature, the incidence of CSCR seems higher in the Chinese-ethnicity population than in the predominant Caucasian one. Male gender, middle age, and current use of corticosteroids were shown to be the significant risk factors for CSCR. We also found that the dosage and duration of corticosteroid treatment were not associated with the risk for CSCR. However, exposure to anti-anxiety drugs was significantly associated with idiopathic (corticosteroid-unrelated) CSCR among males only.
In the last two studies, CSCR has been proven to be associated with the future development of some circulatory disorders. CSCR is an independent indicator for the increased risk of subsequent ischemic stroke development and the clinically diagnosed erectile dysfunction in males.
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