BackgroundNumerous studies have verified that insomnia is associated with suicidal ideation, suicide attempts, and death by suicide. Limited population-based cohort studies have been conducted to examine the association. The present study aimed to analyze whether insomnia increases the risk of suicide attempts and verify the effects of insomnia on suicide risk.MethodsThis study is a cohort study using 2000–2013 hospitalization data from the National Health Insurance Research Database (NHIRD) to track the rate of suicide attempts among insomnia patients aged 15 years or older. In addition, a 1:2 pairing based on sex, age, and date of hospitalization was conducted to identify the reference cohort (patients without insomnia). Cox proportional hazard model was used to assess the effects of insomnia on suicide risk.ResultsThe total number of hospitalized patients aged 15 years or older was 479,967 between 2000 and 2013 (159,989 patients with insomnia and 319,978 patients without insomnia). After adjusting for confounders, suicide risk in insomnia patients was 3.533-fold that of patients without insomnia (adjusted hazard ratio [HR] = 3.533, 95% confidence interval [CI] = 3.059–4.080, P < 0.001). Suicide risk in low-income patients was 1.434-fold (adjusted HR = 1.434, 95% CI = 1.184–1.736, P < 0.001) that of non-low-income patients. Suicide risk in patients with drug dependence and with mental disorders was 1.592-fold (adjusted HR = 1.592, 95% CI = 1.220–2.077, P < 0.001) and 4.483-fold (adjusted HR = 4.483, 95% CI = 3.934–5.109, P < 0.001) that of patients without drug dependence and without mental disorders, respectively. In the female population, suicide risk in insomnia patients was 4.186-fold (adjusted HR = 4.186, 95% CI = 3.429–5.111, P < 0.001) that of patients without insomnia. Among patients aged 25–44 years, suicide risk in insomnia patients was 5.546-fold (adjusted HR = 5.546, 95% CI = 4.236–7.262, P < 0.001) that of patients without insomnia. Furthermore, the suicide risk of insomnia patients with mental disorders was 18.322-fold that of patients without insomnia and mental disorders (P < 0.001).ConclusionInsomnia, low income, drug dependence, and mental disorders are independent risk factors for suicide attempts. Female patients and those aged 25–44 years are at high risk of suicide due to insomnia. Insomnia, mental disorders, and low income exhibit a synergistic effect on suicide attempts. Clinicians should pay attention to mental status and income level of insomnia patients.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1702-2) contains supplementary material, which is available to authorized users.

IntroductionFalls are one of the most important causes of injuries and accidental deaths among this segment of over the age of 65 years.The long-term follow-up study of fall-related injuries was conducted in elderly veterans over the age of 65 years, and the risk of falls in veterans and non-veterans was compared.MethodsThis study used the National Health Insurance Research Database for the period from 2000 to 2013 in Taiwan. This longitudinal study tracked falls in veterans over the age of 65 years, designated a control group (non-veterans), using 1:2 pairing on the basis of sex and time receiving medical care, and used Cox regression to analyse and compare the risk of falls among veterans and non-veterans.ResultsThis study subjects consisted of 35 454 of the veterans had suffered falls (9.5%), as had 55 037 of the non-veterans (7.4%). After controlling for factors such as comorbidities/complications, the veterans had 1.252 times the risk of falls of the non-veterans. Furthermore, among persons in the 75–84 years old age group, veterans had 1.313 times the risk of falls of non-veterans, and among persons with mental illnesses and diseases of the eyes, veterans had 1.300 and 1.362 times the risk of falls of non-veterans. In addition, each veteran had an average of 4.07 falls during the 2000–2013 period, which was significantly higher than in the case of non-veterans (3.88 falls).ConclusionsVeterans’ risk of falls and recurrent falls were both higher than those of non-veterans, and age level, comorbidities/complications and level of low urbanisation were all important factors affecting veterans’ falls. The responsible authorities should, therefore, use appropriate protective measures to reduce the risk of falls and medical expenses in high-risk groups.