Risk of acute epiglottitis in patients with preexisting diabetes mellitus: A population-based case–control study

Abstract

ObjectiveStudies have revealed that 3.5%–26.6% of patients with epiglottitis have comorbid diabetes mellitus (DM). However, whether preexisting DM is a risk factor for acute epiglottitis remains unclear. In this study, our aim was to explore the relationship between preexisting DM and acute epiglottitis in different age and sex groups by using population-based data in Taiwan.MethodsWe analyzed data between January 2000 and December 2013 obtained from the Taiwan National Health Insurance Research Database. The case group consisted of 2,393 patients with acute epiglottitis. The control group comprised 9,572 individuals without epiglottitis, frequency matched by sex, age, urbanization level, and income. Underlying DM was retrospectively assessed in the cases and controls. Univariate and multivariate logistic regression analyses were used to investigate the associations between underlying DM and acute epiglottitis.ResultsOf the 2,393 patients, 180 (7.5%) had preexisting DM, whereas only 530 (5.5%) of the 9,572 controls had preexisting DM. Multivariate logistic regression analyses indicated that preexisting DM was significantly associated with acute epiglottitis (adjusted odds ratio [aOR] = 1.42, 95% confidence interval [CI] = 1.15–1.75, P = 0.004). Subgroup analysis showed that the association between DM and epiglottitis remained significant for men (aOR = 1.57, 95% CI: 1.19–2.08, p = 0.002) but not for women. Age-stratified analysis revealed a significant association between DM and acute epiglottitis in patients aged 35–64 years. Use of anti-diabetic agents was not significantly associated with the development of acute epiglottitis among diabetic patients, including oral hypoglycemic agents (OHA) alone (aOR = 0.88, 95% CI = 0.53–1.46, p = 0.616), and OHA combined with insulin/ insulin alone (aOR = 1.30, 95% CI = 0.76–2.22, p = 0.339). The association between presence of diabetes complications and the occurrence of acute epiglottitis was also not significant among diabetic patients in this study setting (aOR = 0.86, 95% CI = 0.59–1.26, p = 0.439).ConclusionsThe results of our large-scale population-based case–control study indicate that preexisting DM is one of the possible factors associated with the development of acute epiglottitis. Physicians should pay attention to the symptoms and signs of acute epiglottitis in DM patients, particularly in men aged 35–64 years.

Impact of chronic urticaria on systemic lupus erythematosus: A nationwide population‐based study in Taiwan

“…A number of sub‐datasets have been created within the NHIRD, including the 2000 Longitudinal Health Insurance Research Dataset (LHIRD) that comprises the complete original medical and pharmaceutical claims data of 1 million randomly sampled beneficiaries enrolled in 2000 of the NHIRD. To validate the representatives of the 2000 LHIRD, there were no significant differences in sex, age or health‐care costs between cohorts in the 2000 LHIRD and all insurance enrollees from the NHIRD . We utilized the 2000 LHIRD to analyze the claims data from 1997 to 2013.…”

“…To validate the representatives of the 2000 LHIRD, there were no significant differences in sex, age or health-care costs between cohorts in the 2000 LHIRD and all insurance enrollees from the NHIRD. 12 We utilized the 2000 LHIRD to analyze the claims data from 1997 to 2013. The 2000 LHIRD provides deidentified secondary data complying with privacy laws for researchers, and thus informed consent was not required in this study.…”

Real‐world evidence for increased deep neck infection risk in patients with rheumatoid arthritis

“…The government of Taiwan established the National Health Insurance Research Database (NHIRD) in 1996; as of 2018, the NHIRD covered 99.6% of Taiwan's population . The NHIRD provides medical claims data for all beneficiaries, including disease diagnoses during clinic visits and hospitalization, prescription drugs and doses, examinations, procedures, surgery, payments, resident locations, and income levels, which were generated during reimbursement for insurance in an electronic format .…”

“…This study was exempted from obtaining informed consent from the participants because the data were deidentified. All insurant information was unidentifiable, and this study did not violate their rights or adversely affect their welfare . All data are anonymous and deidentified by scrambling the identification codes to make the NHI reimbursement data suitable for public research.…”

“…Comorbidities were defined using ICD‐9‐CM codes recorded in the claims data: DM (ICD‐9‐CM code: 250), hypertension (HTN) (ICD‐9‐CM codes: 401–405), chronic kidney disease (CKD) (ICD‐9‐CM codes: 403, 404, 585, and 586), liver cirrhosis (LC) (ICD‐9‐CM codes: 571.2, 571.5–571.6), cerebrovascular accident (CVA) (ICD‐9‐CM codes: 430–438), coronary artery disease (CAD) (ICD‐9‐CM codes: 410–414), systemic lupus erythematosus (SLE) (ICD‐9‐CM codes: 710.0), Sjögren syndrome (SS) (ICD‐9‐CM codes: 710.2), and psoriasis (ICD‐9‐CM codes: 696.1, 696.1) . Medical comorbidities were included if they appeared at least once in the diagnoses of inpatients or at least three times in the diagnoses of outpatients.…”