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摘要

Objectives: To investigate the association between rheumatoid arthritis (RA) and urbanization and compare the medication selection for RA patients in urban vs. rural areas. Methods: RA patients were identified among 1,000,000 random individuals from a 23-million-person nationwide health insurance database, and controls were matched at a 1 : 10 ratio. Taiwan's 359 townships were grouped into 7 urbanization levels. Geographic region and monthly income were also analyzed. Medication use in the most urbanized and less-urbanized areas were also compared. Results: Rural dwellers had lower odds of having an RA diagnosis. The odds ratio (OR) for level 5 area residents of having an RA diagnosis was 0.62 (95% confidence interval (CI) 0.46 â€" 0.85; p = 0.002), and they were both 0.76 for level 6 â€" 7 area residents (95% CI, 0.61 â€" 0.95 for level 6; p = 0.017 and 0.60 â€" 0.96 for level 7; p = 0.021) compared to level 1 (the most urban dwellers). The ORs of having a new RA diagnosis were 0.57 (95% CI 0.41 â€" 0.79, p = 0.001) in eastern Taiwan and 0.33 (95% CI 0.15 â€" 0.69, p = 0.004) on offshore islands compared to northern Taiwan. No association was found between monthly income and RA. Urban-dwelling RA patients used more tumor necrosis factor-α antagonists (level 1 urbanization; n = 24; 2.3%) than RA patients in less-urbanized areas (level 2 â€" 7 urbanization; n = 30; 1.3%; p = 0.038). Conclusion: Results of this study suggested that an RA diagnosis and treatment are associated with urbanization. © 2016 Dustri-Verlag Dr. K. Feistle.
原文英語
頁(從 - 到)1-10
頁數10
期刊International Journal of Clinical Pharmacology and Therapeutics
54
發行號1
DOIs
出版狀態已發佈 - 2016

指紋

Urbanization
Taiwan
Rheumatoid Arthritis
Confidence Intervals
Health Insurance
Islands
Tumor Necrosis Factor-alpha
Odds Ratio
Databases

引用此文

@article{592b64cb359d4d5a91d034a60ea8aa7f,
title = "The association between urbanization and rheumatoid arthritis in Taiwan",
abstract = "Objectives: To investigate the association between rheumatoid arthritis (RA) and urbanization and compare the medication selection for RA patients in urban vs. rural areas. Methods: RA patients were identified among 1,000,000 random individuals from a 23-million-person nationwide health insurance database, and controls were matched at a 1 : 10 ratio. Taiwan's 359 townships were grouped into 7 urbanization levels. Geographic region and monthly income were also analyzed. Medication use in the most urbanized and less-urbanized areas were also compared. Results: Rural dwellers had lower odds of having an RA diagnosis. The odds ratio (OR) for level 5 area residents of having an RA diagnosis was 0.62 (95{\%} confidence interval (CI) 0.46 {\^a}€{"} 0.85; p = 0.002), and they were both 0.76 for level 6 {\^a}€{"} 7 area residents (95{\%} CI, 0.61 {\^a}€{"} 0.95 for level 6; p = 0.017 and 0.60 {\^a}€{"} 0.96 for level 7; p = 0.021) compared to level 1 (the most urban dwellers). The ORs of having a new RA diagnosis were 0.57 (95{\%} CI 0.41 {\^a}€{"} 0.79, p = 0.001) in eastern Taiwan and 0.33 (95{\%} CI 0.15 {\^a}€{"} 0.69, p = 0.004) on offshore islands compared to northern Taiwan. No association was found between monthly income and RA. Urban-dwelling RA patients used more tumor necrosis factor-α antagonists (level 1 urbanization; n = 24; 2.3{\%}) than RA patients in less-urbanized areas (level 2 {\^a}€{"} 7 urbanization; n = 30; 1.3{\%}; p = 0.038). Conclusion: Results of this study suggested that an RA diagnosis and treatment are associated with urbanization. {\circledC} 2016 Dustri-Verlag Dr. K. Feistle.",
keywords = "Antagonists, Geographic region, Rheumatoid arthritis, TNF-α, Urbanization",
author = "Chiang, {Yi Chun} and Yu-Hsuan Yen and Wei-Chiao Chang and Kuei-Ju Cheng and Chang, {Wei Pin} and Hsiang-Yin Chen",
note = "Export Date: 25 March 2016 CODEN: ICTHE 通訊地址: Chen, H.-Y.; School of Pharmacy, Taipei Medical University, 250 Wu-Hsing Street, Taiwan; 電子郵件: shawn@tmu.edu.tw 參考文獻: Kalkan, A., Hallert, E., Bernfort, L., Husberg, M., Carlsson, P., Costs of rheumatoid arthritis during the period 1990-2010 a register-based cost-ofillness study in Sweden (2014) Rheumatology (Oxford), 53, pp. 153-160. , CrossRef PubMed; Kirchhoff, T., Ruof, J., Mittendorf, T., Rihl, M., Bernateck, M., Mau, W., Zeidler, H., Merkesdal, S., Cost of illness in rheumatoid arthritis in Germany in 1997-98 and 2002: Cost drivers and cost savings (2011) Rheumatology (Oxford), 50, pp. 756-761. , CrossRef PubMed; Michaud, K., Wolfe, F., Comorbidities in rheumatoid arthritis (2007) Best Pract Res Clin Rheumatol, 21, pp. 885-906. , CrossRef PubMed; Holmqvist, M.E., Wedr{\'e}n, S., Jacobsson, L.T., Klareskog, L., Nyberg, F., Rantap{\"a}{\"a}-Dahlqvist, S., Alfredsson, L., Askling, J., Rapid increase in myocardial infarction risk following diagnosis of rheumatoid arthritis amongst patients diagnosed between 1995 and 2006 (2010) J Intern Med, 268, pp. 578-585. , Cross-Ref PubMed; Semb, A.G., Kvien, T.K., Aastveit, A.H., Jungner, I., Pedersen, T.R., Walldius, G., Holme, I., Lipids, myocardial infarction and ischaemic stroke in patients with rheumatoid arthritis in the apolipoproteinrelated mortality risk (amoris) study (2010) Ann Rheum Dis, 69, pp. 1996-2001. , CrossRef PubMed; Lindhardsen, J., Ahlehoff, O., Gislason, G.H., Madsen, O.R., Olesen, J.B., Torp-Pedersen, C., Hansen, P.R., The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: A danish nationwide cohort study (2011) Ann Rheum Dis, 70, pp. 929-934. , CrossRef PubMed; Lindhardsen, J., Ahlehoff, O., Gislason, G.H., Madsen, O.R., Olesen, J.B., Svendsen, J.H., Torp-Pedersen, C., Hansen, P.R., Risk of atrial fibrillation and stroke in rheumatoid arthritis: Danish nationwide cohort study (2012) BMJ, 344, p. e1257. , (mar08 2) Cross-Ref PubMed; Holmqvist, M.E., Neovius, M., Eriksson J-Mantel, A., W{\aa}llberg-Jonsson, S., Jacobsson, L.T., Askling, J., Risk of venous thromboembolism in patients with rheumatoid arthritis and association with disease duration and hospitalization (2012) JAMA, 308, pp. 1350-1356. , CrossRef PubMed; Doran, M.F., Crowson, C.S., Pond, G.R., O'Fallon, W.M., Gabriel, S.E., Frequency of infection in patients with rheumatoid arthritis compared with controls: A population-based study (2002) Arthritis Rheum, 46, pp. 2287-2293. , CrossRef PubMed; Yamada, T., Nakajima, A., Inoue, E., Tanaka, E., Hara, M., Tomatsu, T., Kamatani, N., Yamanaka, H., Increased risk of tuberculosis in patients with rheumatoid arthritis in Japan (2006) Ann Rheum Dis, 65, pp. 1661-1663. , CrossRef PubMed; Lekpa, F.K., Ndongo, S., Tiendrebeogo, J., Ndao, A.C., Daher, A., Pouye, A., Ka, M.M., Diop, T.M., Rheumatoid arthritis in Senegal: A comparison between patients coming from rural and urban areas, in an urban tertiary health care center in Senegal (2012) Clin Rheumatol, 31, pp. 1617-1620. , CrossRef PubMed; Cornelissen, P.G., Rasker, J.J., Valkenburg, H.A., The arthritis sufferer and the community: A comparison of arthritis sufferers in rural and urban areas (1988) Ann Rheum Dis, 47, pp. 150-156. , CrossRef PubMed; Busteed, S., Daly, M., Silke, C., Molloy, M.G., Rheumatoid arthritis impairs driving ability even in pa tients with a low disability index (2004) Rheumatology (Oxford), 43, pp. 107-108. , CrossRef PubMed; Angkurawaranon, C., Wattanatchariya, N., Doyle, P., Nitsch, D., Urbanization and non-communicable disease mortality in Thailand: An ecological correlation study (2013) Trop Med Int Health, 18, pp. 130-140. , CrossRef PubMed; Polinski, J.M., Brookhart, M.A., Ayanian, J.Z., Katz, J.N., Kim, S.C., Lii, J., Tonner, C., Solomon, D.H., Relationships between driving distance, rheumatoid arthritis diagnosis, and disease-modifying antirheumatic drug receipt (2014) Arthritis Care Res (Hoboken), 66, pp. 1634-1643. , CrossRef PubMed; Rodriguez-Amado, J., Pel{\'a}ez-Ballestas, I., Sanin, L.H., Esquivel-Valerio, J.A., Burgos-Vargas, R., P{\'e}rez-Barbosa, L., Riega-Torres, J., Garza-Elizondo, M.A., Epidemiology of rheumatic diseases. A community-based study in urban and rural populations in the state of nuevo Leon, Mexico (2011) J Rheumatol Suppl, 86, pp. 9-14. , CrossRef PubMed; Basu, N., Steven, M., A comparison of rural and urban rheumatoid arthritis populations (2009) Scott Med J, 54, pp. 7-9. , CrossRef PubMed; Jiang, Y.D., Chang, C.H., Tai, T.Y., Chen, J.F., Chuang, L.M., Incidence and prevalence rates of diabetes mellitus in Taiwan: Analysis of the 2000-2009 nationwide health insurance database (2012) J Formos Med Assoc, 111, pp. 599-604. , CrossRef PubMed; Wen, C.P., Tsai, S.P., Chung, W.S., A 10-year experience with universal health insurance in Taiwan: Measuring changes in health and health disparity (2008) Ann Intern Med, 148, pp. 258-267. , CrossRef PubMed; Singh, J.A., Holmgren, A.R., Noorbaloochi, S., Accuracy of veterans administration databases for a diagnosis of rheumatoid arthritis (2004) Arthritis Rheum, 51, pp. 952-957. , CrossRef PubMed; Kim, S.Y., Servi, A., Polinski, J.M., Mogun, H., Weinblatt, M.E., Katz, J.N., Solomon, D.H., Validation of rheumatoid arthritis diagnoses in health care utilization data (2011) Arthritis Res Ther, 13, p. R32. , CrossRef PubMed; Liu, C.Y., Hung, Y.T., Chuang, Y.L., Chen, Y.J., Weng, W.S., Liu, J.S., Liang, K.Y., Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey (2006) J Health Manag, 4, pp. 1-22; Chou, C.T., Pei, L., Chang, D.M., Lee, C.F., Schumacher, H.R., Liang, M.H., Prevalence of rheumatic diseases in Taiwan: A population study of urban, suburban, rural differences (1994) J Rheumatol, 21, pp. 302-306. , PubMed; Bernatsky, S., Lix, L., Hanly, J.G., Hudson, M., Badley, E., Peschken, C., Pineau, C.A., Joseph, L., Surveillance of systemic autoimmune rheumatic diseases using administrative data (2011) Rheumatol Int, 31, pp. 549-554. , CrossRef PubMed; Broten, L., Avi{\~n}a-Zubieta, J.A., Lacaille, D., Joseph, L., Hanly, J.G., Lix, L., O'Donnell, S., Bergeron, L., Systemic autoimmune rheumatic disease prevalence in Canada: Updated analyses across 7 provinces (2014) J Rheumatol, 41, pp. 673-679. , CrossRef PubMed; Carmona, L., Villaverde, V., Hern{\'a}ndez-Garc{\'i}a, C., Ballina, J., Gabriel, R., Laffon, A., The prevalence of rheumatoid arthritis in the general population of Spain (2002) Rheumatology (Oxford), 41, pp. 88-95. , CrossRef PubMed; Neovius, M., Simard, J.F., Askling, J., Nationwide prevalence of rheumatoid arthritis and penetration of disease-modifying drugs in Sweden (2011) Ann Rheum Dis, 70, pp. 624-629. , ARTIS study group CrossRef PubMed; Bernatsky, S., Dekis, A., Hudson, M., Pineau, C., Boire, G., Fortin, P., Bessette, L., Joseph, L., Rheumatoid arthritis prevalence in Quebec (2014) BMC Res Notes, 7, p. 937. , PubMed; Widdifield, J., Paterson, J.M., Bernatsky, S., Tu, K., Thorne, J.C., Ahluwalia, V., Ivers, N., Bombardier, C., The rising burden of rheumatoid arthritis surpasses rheumatology supply in Ontario (2013) Can J Public Health, 104, pp. e450-e455. , PubMed; Davatchi, F., Jamshidi, A.R., Banihashemi, A.T., Gholami, J., Forouzanfar, M.H., Akhlaghi, M., Barghamdi, M., Asgharifard, H., Who-ilar copcord study (stage 1, urban study) in Iran (2008) J Rheumatol, 35, p. 1384. , PubMed; Davatchi, F., Tehrani Banihashemi, A., Gholami, J., Faezi, S.T., Forouzanfar, M.H., Salesi, M., Karimifar, M., Rasker, J.J., The prevalence of musculoskeletal complaints in a rural area in Iran: A whoilar copcord study (stage 1, rural study) in Iran (2009) Clin Rheumatol, 28, pp. 1267-1274. , Cross-Ref PubMed; Joshi, V.L., Chopra, A., Is there an urban-rural divide? 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year = "2016",
doi = "10.5414/CP202306",
language = "English",
volume = "54",
pages = "1--10",
journal = "International Journal of Clinical Pharmacology and Therapeutics",
issn = "0946-1965",
publisher = "Dustri-Verlag Dr. Karl Feistle",
number = "1",

}

TY - JOUR

T1 - The association between urbanization and rheumatoid arthritis in Taiwan

AU - Chiang, Yi Chun

AU - Yen, Yu-Hsuan

AU - Chang, Wei-Chiao

AU - Cheng, Kuei-Ju

AU - Chang, Wei Pin

AU - Chen, Hsiang-Yin

N1 - Export Date: 25 March 2016 CODEN: ICTHE 通訊地址: Chen, H.-Y.; School of Pharmacy, Taipei Medical University, 250 Wu-Hsing Street, Taiwan; 電子郵件: shawn@tmu.edu.tw 參考文獻: Kalkan, A., Hallert, E., Bernfort, L., Husberg, M., Carlsson, P., Costs of rheumatoid arthritis during the period 1990-2010 a register-based cost-ofillness study in Sweden (2014) Rheumatology (Oxford), 53, pp. 153-160. , CrossRef PubMed; Kirchhoff, T., Ruof, J., Mittendorf, T., Rihl, M., Bernateck, M., Mau, W., Zeidler, H., Merkesdal, S., Cost of illness in rheumatoid arthritis in Germany in 1997-98 and 2002: Cost drivers and cost savings (2011) Rheumatology (Oxford), 50, pp. 756-761. , CrossRef PubMed; Michaud, K., Wolfe, F., Comorbidities in rheumatoid arthritis (2007) Best Pract Res Clin Rheumatol, 21, pp. 885-906. , CrossRef PubMed; Holmqvist, M.E., Wedrén, S., Jacobsson, L.T., Klareskog, L., Nyberg, F., Rantapää-Dahlqvist, S., Alfredsson, L., Askling, J., Rapid increase in myocardial infarction risk following diagnosis of rheumatoid arthritis amongst patients diagnosed between 1995 and 2006 (2010) J Intern Med, 268, pp. 578-585. , Cross-Ref PubMed; Semb, A.G., Kvien, T.K., Aastveit, A.H., Jungner, I., Pedersen, T.R., Walldius, G., Holme, I., Lipids, myocardial infarction and ischaemic stroke in patients with rheumatoid arthritis in the apolipoproteinrelated mortality risk (amoris) study (2010) Ann Rheum Dis, 69, pp. 1996-2001. , CrossRef PubMed; Lindhardsen, J., Ahlehoff, O., Gislason, G.H., Madsen, O.R., Olesen, J.B., Torp-Pedersen, C., Hansen, P.R., The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: A danish nationwide cohort study (2011) Ann Rheum Dis, 70, pp. 929-934. , CrossRef PubMed; Lindhardsen, J., Ahlehoff, O., Gislason, G.H., Madsen, O.R., Olesen, J.B., Svendsen, J.H., Torp-Pedersen, C., Hansen, P.R., Risk of atrial fibrillation and stroke in rheumatoid arthritis: Danish nationwide cohort study (2012) BMJ, 344, p. e1257. , (mar08 2) Cross-Ref PubMed; Holmqvist, M.E., Neovius, M., Eriksson J-Mantel, A., Wållberg-Jonsson, S., Jacobsson, L.T., Askling, J., Risk of venous thromboembolism in patients with rheumatoid arthritis and association with disease duration and hospitalization (2012) JAMA, 308, pp. 1350-1356. , CrossRef PubMed; Doran, M.F., Crowson, C.S., Pond, G.R., O'Fallon, W.M., Gabriel, S.E., Frequency of infection in patients with rheumatoid arthritis compared with controls: A population-based study (2002) Arthritis Rheum, 46, pp. 2287-2293. , CrossRef PubMed; Yamada, T., Nakajima, A., Inoue, E., Tanaka, E., Hara, M., Tomatsu, T., Kamatani, N., Yamanaka, H., Increased risk of tuberculosis in patients with rheumatoid arthritis in Japan (2006) Ann Rheum Dis, 65, pp. 1661-1663. , CrossRef PubMed; Lekpa, F.K., Ndongo, S., Tiendrebeogo, J., Ndao, A.C., Daher, A., Pouye, A., Ka, M.M., Diop, T.M., Rheumatoid arthritis in Senegal: A comparison between patients coming from rural and urban areas, in an urban tertiary health care center in Senegal (2012) Clin Rheumatol, 31, pp. 1617-1620. , CrossRef PubMed; Cornelissen, P.G., Rasker, J.J., Valkenburg, H.A., The arthritis sufferer and the community: A comparison of arthritis sufferers in rural and urban areas (1988) Ann Rheum Dis, 47, pp. 150-156. , CrossRef PubMed; Busteed, S., Daly, M., Silke, C., Molloy, M.G., Rheumatoid arthritis impairs driving ability even in pa tients with a low disability index (2004) Rheumatology (Oxford), 43, pp. 107-108. , CrossRef PubMed; Angkurawaranon, C., Wattanatchariya, N., Doyle, P., Nitsch, D., Urbanization and non-communicable disease mortality in Thailand: An ecological correlation study (2013) Trop Med Int Health, 18, pp. 130-140. , CrossRef PubMed; Polinski, J.M., Brookhart, M.A., Ayanian, J.Z., Katz, J.N., Kim, S.C., Lii, J., Tonner, C., Solomon, D.H., Relationships between driving distance, rheumatoid arthritis diagnosis, and disease-modifying antirheumatic drug receipt (2014) Arthritis Care Res (Hoboken), 66, pp. 1634-1643. , CrossRef PubMed; Rodriguez-Amado, J., Peláez-Ballestas, I., Sanin, L.H., Esquivel-Valerio, J.A., Burgos-Vargas, R., Pérez-Barbosa, L., Riega-Torres, J., Garza-Elizondo, M.A., Epidemiology of rheumatic diseases. A community-based study in urban and rural populations in the state of nuevo Leon, Mexico (2011) J Rheumatol Suppl, 86, pp. 9-14. , CrossRef PubMed; Basu, N., Steven, M., A comparison of rural and urban rheumatoid arthritis populations (2009) Scott Med J, 54, pp. 7-9. , CrossRef PubMed; Jiang, Y.D., Chang, C.H., Tai, T.Y., Chen, J.F., Chuang, L.M., Incidence and prevalence rates of diabetes mellitus in Taiwan: Analysis of the 2000-2009 nationwide health insurance database (2012) J Formos Med Assoc, 111, pp. 599-604. , CrossRef PubMed; Wen, C.P., Tsai, S.P., Chung, W.S., A 10-year experience with universal health insurance in Taiwan: Measuring changes in health and health disparity (2008) Ann Intern Med, 148, pp. 258-267. , CrossRef PubMed; Singh, J.A., Holmgren, A.R., Noorbaloochi, S., Accuracy of veterans administration databases for a diagnosis of rheumatoid arthritis (2004) Arthritis Rheum, 51, pp. 952-957. , CrossRef PubMed; Kim, S.Y., Servi, A., Polinski, J.M., Mogun, H., Weinblatt, M.E., Katz, J.N., Solomon, D.H., Validation of rheumatoid arthritis diagnoses in health care utilization data (2011) Arthritis Res Ther, 13, p. R32. , CrossRef PubMed; Liu, C.Y., Hung, Y.T., Chuang, Y.L., Chen, Y.J., Weng, W.S., Liu, J.S., Liang, K.Y., Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey (2006) J Health Manag, 4, pp. 1-22; Chou, C.T., Pei, L., Chang, D.M., Lee, C.F., Schumacher, H.R., Liang, M.H., Prevalence of rheumatic diseases in Taiwan: A population study of urban, suburban, rural differences (1994) J Rheumatol, 21, pp. 302-306. , PubMed; Bernatsky, S., Lix, L., Hanly, J.G., Hudson, M., Badley, E., Peschken, C., Pineau, C.A., Joseph, L., Surveillance of systemic autoimmune rheumatic diseases using administrative data (2011) Rheumatol Int, 31, pp. 549-554. , CrossRef PubMed; Broten, L., Aviña-Zubieta, J.A., Lacaille, D., Joseph, L., Hanly, J.G., Lix, L., O'Donnell, S., Bergeron, L., Systemic autoimmune rheumatic disease prevalence in Canada: Updated analyses across 7 provinces (2014) J Rheumatol, 41, pp. 673-679. , CrossRef PubMed; Carmona, L., Villaverde, V., Hernández-García, C., Ballina, J., Gabriel, R., Laffon, A., The prevalence of rheumatoid arthritis in the general population of Spain (2002) Rheumatology (Oxford), 41, pp. 88-95. , CrossRef PubMed; Neovius, M., Simard, J.F., Askling, J., Nationwide prevalence of rheumatoid arthritis and penetration of disease-modifying drugs in Sweden (2011) Ann Rheum Dis, 70, pp. 624-629. , ARTIS study group CrossRef PubMed; Bernatsky, S., Dekis, A., Hudson, M., Pineau, C., Boire, G., Fortin, P., Bessette, L., Joseph, L., Rheumatoid arthritis prevalence in Quebec (2014) BMC Res Notes, 7, p. 937. , PubMed; Widdifield, J., Paterson, J.M., Bernatsky, S., Tu, K., Thorne, J.C., Ahluwalia, V., Ivers, N., Bombardier, C., The rising burden of rheumatoid arthritis surpasses rheumatology supply in Ontario (2013) Can J Public Health, 104, pp. e450-e455. , PubMed; Davatchi, F., Jamshidi, A.R., Banihashemi, A.T., Gholami, J., Forouzanfar, M.H., Akhlaghi, M., Barghamdi, M., Asgharifard, H., Who-ilar copcord study (stage 1, urban study) in Iran (2008) J Rheumatol, 35, p. 1384. , PubMed; Davatchi, F., Tehrani Banihashemi, A., Gholami, J., Faezi, S.T., Forouzanfar, M.H., Salesi, M., Karimifar, M., Rasker, J.J., The prevalence of musculoskeletal complaints in a rural area in Iran: A whoilar copcord study (stage 1, rural study) in Iran (2009) Clin Rheumatol, 28, pp. 1267-1274. , Cross-Ref PubMed; Joshi, V.L., Chopra, A., Is there an urban-rural divide? Population surveys of rheumatic musculoskeletal disorders in the pune region of India using the copcord bhigwan model (2009) J Rheumatol, 36, pp. 614-622. , CrossRef PubMed; Chopra, A., Saluja, M., Patil, J., Tandale, H.S., Pain and disability, perceptions and beliefs of a rural indian population: A who-ilar copcord study. Who-international league of associations for rheumatology. 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PY - 2016

Y1 - 2016

N2 - Objectives: To investigate the association between rheumatoid arthritis (RA) and urbanization and compare the medication selection for RA patients in urban vs. rural areas. Methods: RA patients were identified among 1,000,000 random individuals from a 23-million-person nationwide health insurance database, and controls were matched at a 1 : 10 ratio. Taiwan's 359 townships were grouped into 7 urbanization levels. Geographic region and monthly income were also analyzed. Medication use in the most urbanized and less-urbanized areas were also compared. Results: Rural dwellers had lower odds of having an RA diagnosis. The odds ratio (OR) for level 5 area residents of having an RA diagnosis was 0.62 (95% confidence interval (CI) 0.46 â€" 0.85; p = 0.002), and they were both 0.76 for level 6 â€" 7 area residents (95% CI, 0.61 â€" 0.95 for level 6; p = 0.017 and 0.60 â€" 0.96 for level 7; p = 0.021) compared to level 1 (the most urban dwellers). The ORs of having a new RA diagnosis were 0.57 (95% CI 0.41 â€" 0.79, p = 0.001) in eastern Taiwan and 0.33 (95% CI 0.15 â€" 0.69, p = 0.004) on offshore islands compared to northern Taiwan. No association was found between monthly income and RA. Urban-dwelling RA patients used more tumor necrosis factor-α antagonists (level 1 urbanization; n = 24; 2.3%) than RA patients in less-urbanized areas (level 2 â€" 7 urbanization; n = 30; 1.3%; p = 0.038). Conclusion: Results of this study suggested that an RA diagnosis and treatment are associated with urbanization. © 2016 Dustri-Verlag Dr. K. Feistle.

AB - Objectives: To investigate the association between rheumatoid arthritis (RA) and urbanization and compare the medication selection for RA patients in urban vs. rural areas. Methods: RA patients were identified among 1,000,000 random individuals from a 23-million-person nationwide health insurance database, and controls were matched at a 1 : 10 ratio. Taiwan's 359 townships were grouped into 7 urbanization levels. Geographic region and monthly income were also analyzed. Medication use in the most urbanized and less-urbanized areas were also compared. Results: Rural dwellers had lower odds of having an RA diagnosis. The odds ratio (OR) for level 5 area residents of having an RA diagnosis was 0.62 (95% confidence interval (CI) 0.46 â€" 0.85; p = 0.002), and they were both 0.76 for level 6 â€" 7 area residents (95% CI, 0.61 â€" 0.95 for level 6; p = 0.017 and 0.60 â€" 0.96 for level 7; p = 0.021) compared to level 1 (the most urban dwellers). The ORs of having a new RA diagnosis were 0.57 (95% CI 0.41 â€" 0.79, p = 0.001) in eastern Taiwan and 0.33 (95% CI 0.15 â€" 0.69, p = 0.004) on offshore islands compared to northern Taiwan. No association was found between monthly income and RA. Urban-dwelling RA patients used more tumor necrosis factor-α antagonists (level 1 urbanization; n = 24; 2.3%) than RA patients in less-urbanized areas (level 2 â€" 7 urbanization; n = 30; 1.3%; p = 0.038). Conclusion: Results of this study suggested that an RA diagnosis and treatment are associated with urbanization. © 2016 Dustri-Verlag Dr. K. Feistle.

KW - Antagonists

KW - Geographic region

KW - Rheumatoid arthritis

KW - TNF-α

KW - Urbanization

UR - https://www.scopus.com/record/display.uri?eid=2-s2.0-84958746367&origin=inward&txGid=7052120499ebc3520d90db782fbca94d

UR - https://www.scopus.com/results/citedbyresults.uri?sort=plf-f&cite=2-s2.0-84958746367&src=s&imp=t&sid=7997a321e9b9fc72ddf6f10952970b11&sot=cite&sdt=a&sl=0&origin=recordpage&editSaveSearch=&txGid=9da633f257d4f5bb02ea7bd58ae84ee2

U2 - 10.5414/CP202306

DO - 10.5414/CP202306

M3 - Article

VL - 54

SP - 1

EP - 10

JO - International Journal of Clinical Pharmacology and Therapeutics

JF - International Journal of Clinical Pharmacology and Therapeutics

SN - 0946-1965

IS - 1

ER -