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Acute Anticholinesterase Pesticide Poisoning Caused a Long-Term Mortality Increase: A Nationwide Population-Based Cohort Study.

Huang HS, Hsu CC, Weng SF, Lin HJ, Wang JJ, Su SB, Huang CC, Guo HR - Medicine (Baltimore) (2015)

Bottom Line: Older age (≥35 years), male gender, diabetes mellitus, coronary artery disease, hypertension, stroke, mental disorder, and lower monthly income also predicted death.ACPP significantly increased long-term mortality.In addition to early follow-up after acute treatment, comorbidity control and socioeconomic assistance are needed for patients with ACPP.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan (H-SH, C-C Hsu, H-JL, C-C Huang); Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan (H-SH, S-BS, C-C Huang); Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan (C-C Hsu, H-JL); Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan (S-FW, J-JW); Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan (S-FW); Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan (H-JL); Department of Leisure, Recreation, and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan (S-BS); Department of Medical Research, Chi Mei Medical Center, Liouying, Tainan, Taiwan (S-BS); Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C-C Huang, H-RG); Department of Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan (C-C Huang); Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan (C-C Huang); Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan (H-RG).

ABSTRACT
Acute anticholinesterase pesticide (organophosphate and carbamate) poisoning (ACPP) often produces severe complications, and sometimes death. We investigated the long-term mortality of patients with ACPP because it is not sufficiently understood. In this retrospective nationwide population-based cohort study, 818 patients with ACPP and 16,360 healthy comparisons from 1999 to 2010 were selected from Taiwan's National Health Insurance Research Database. They were followed until 2011. Ninety-four (11.5%) ACPP patients and 793 (4.9%) comparisons died (P < 0.01) during follow-up. The incidence rate ratios (IRRs) of death were 2.5 times higher in ACPP patients than in comparisons (P < 0.01). The risk of death was particularly high in the first month after ACPP (IRR: 92.7; 95% confidence interval [CI]: 45.0-191.0) and still high for ~6 months (IRR: 3.8; 95% CI: 1.9-7.4). After adjusting for age, gender, selected comorbidities, geographic area, and monthly income, the hazard ratio of death for ACPP patients was still 2.4 times higher than for comparisons. Older age (≥35 years), male gender, diabetes mellitus, coronary artery disease, hypertension, stroke, mental disorder, and lower monthly income also predicted death. ACPP significantly increased long-term mortality. In addition to early follow-up after acute treatment, comorbidity control and socioeconomic assistance are needed for patients with ACPP.

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Related in: MedlinePlus

Flowchart of the study. ACPP = anticholinesterase pesticide poisoning, LHID2000 = Longitudinal Health Insurance Database 2000.
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Figure 1: Flowchart of the study. ACPP = anticholinesterase pesticide poisoning, LHID2000 = Longitudinal Health Insurance Database 2000.

Mentions: We linked to the diagnostic codes through the NHIRD and collected data including demographics, comorbidities, survival status, and date of death. Comorbidities affecting mortality that may have presented before the index date were defined as follows: diabetes mellitus (DM) (ICD-9 code 250), coronary artery disease (CAD) (ICD-9 codes 410–414), stroke (ICD-9 codes 430–438), hypertension (HTN) (ICD-9 codes 401–405), and mental disease (ICD-9 codes 290–319). We considered these to be comorbidities if they occurred either in the inpatient setting or in 3 or more ambulatory care claims coded before the index date. Patients were followed from the index date to the date of death or the end of the database period. All citizens in Taiwan are required to participate in the NHI, and their enrollment must be withdrawn within 30 days postmortem. Therefore, patients recorded as deceased or disenrolled within 30 days of their discharge were presumed dead, and the discharge date was designated as the date of death. Figure 1 shows a flowchart of this study.


Acute Anticholinesterase Pesticide Poisoning Caused a Long-Term Mortality Increase: A Nationwide Population-Based Cohort Study.

Huang HS, Hsu CC, Weng SF, Lin HJ, Wang JJ, Su SB, Huang CC, Guo HR - Medicine (Baltimore) (2015)

Flowchart of the study. ACPP = anticholinesterase pesticide poisoning, LHID2000 = Longitudinal Health Insurance Database 2000.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554117&req=5

Figure 1: Flowchart of the study. ACPP = anticholinesterase pesticide poisoning, LHID2000 = Longitudinal Health Insurance Database 2000.
Mentions: We linked to the diagnostic codes through the NHIRD and collected data including demographics, comorbidities, survival status, and date of death. Comorbidities affecting mortality that may have presented before the index date were defined as follows: diabetes mellitus (DM) (ICD-9 code 250), coronary artery disease (CAD) (ICD-9 codes 410–414), stroke (ICD-9 codes 430–438), hypertension (HTN) (ICD-9 codes 401–405), and mental disease (ICD-9 codes 290–319). We considered these to be comorbidities if they occurred either in the inpatient setting or in 3 or more ambulatory care claims coded before the index date. Patients were followed from the index date to the date of death or the end of the database period. All citizens in Taiwan are required to participate in the NHI, and their enrollment must be withdrawn within 30 days postmortem. Therefore, patients recorded as deceased or disenrolled within 30 days of their discharge were presumed dead, and the discharge date was designated as the date of death. Figure 1 shows a flowchart of this study.

Bottom Line: Older age (≥35 years), male gender, diabetes mellitus, coronary artery disease, hypertension, stroke, mental disorder, and lower monthly income also predicted death.ACPP significantly increased long-term mortality.In addition to early follow-up after acute treatment, comorbidity control and socioeconomic assistance are needed for patients with ACPP.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan (H-SH, C-C Hsu, H-JL, C-C Huang); Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan (H-SH, S-BS, C-C Huang); Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan (C-C Hsu, H-JL); Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan (S-FW, J-JW); Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan (S-FW); Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan (H-JL); Department of Leisure, Recreation, and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan (S-BS); Department of Medical Research, Chi Mei Medical Center, Liouying, Tainan, Taiwan (S-BS); Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C-C Huang, H-RG); Department of Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan (C-C Huang); Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan (C-C Huang); Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan (H-RG).

ABSTRACT
Acute anticholinesterase pesticide (organophosphate and carbamate) poisoning (ACPP) often produces severe complications, and sometimes death. We investigated the long-term mortality of patients with ACPP because it is not sufficiently understood. In this retrospective nationwide population-based cohort study, 818 patients with ACPP and 16,360 healthy comparisons from 1999 to 2010 were selected from Taiwan's National Health Insurance Research Database. They were followed until 2011. Ninety-four (11.5%) ACPP patients and 793 (4.9%) comparisons died (P < 0.01) during follow-up. The incidence rate ratios (IRRs) of death were 2.5 times higher in ACPP patients than in comparisons (P < 0.01). The risk of death was particularly high in the first month after ACPP (IRR: 92.7; 95% confidence interval [CI]: 45.0-191.0) and still high for ~6 months (IRR: 3.8; 95% CI: 1.9-7.4). After adjusting for age, gender, selected comorbidities, geographic area, and monthly income, the hazard ratio of death for ACPP patients was still 2.4 times higher than for comparisons. Older age (≥35 years), male gender, diabetes mellitus, coronary artery disease, hypertension, stroke, mental disorder, and lower monthly income also predicted death. ACPP significantly increased long-term mortality. In addition to early follow-up after acute treatment, comorbidity control and socioeconomic assistance are needed for patients with ACPP.

Show MeSH
Related in: MedlinePlus