Stomach Cancer and Exposure to Talc Powder without Asbestos via Chinese Herbal Medicine: A Population-Based Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Setting
- Registry for Beneficiaries contains the registration data of all beneficiaries.
- Registry for drug prescriptions contains the names of all approved medications and related information including the drug codes issued by the National Health Insurance Administration (NHI)
- Ambulatory Care Expenditures by Visits contains the physician billing claims data, including the diagnosis, the medical orders and the names of medication prescribed.
- Details of Ambulatory Care Orders connects the Ambulatory Care Expenditures by Visits to show the details of drug prescription record, including the days of prescription, the frequency of usage, and the total amount prescribed by a physician.
2.2. Participants
- patients younger than 20 on 1 January 1997,
- patients with diagnosis of cancer in or before 1997,
- patients with gastric ulcer, duodenal ulcer, peptic ulcer, gastritis, duodenitis, or Helicobacter pylori infection in or before 1997
2.3. Variables
2.4. Exposure Assessment
2.5. Statistical Analysis
3. Results
3.1. Descriptive Data
3.2. Main Results
3.3. Other Analyses
4. Discussion
4.1. Key Results
4.2. Mineral Analysis of Talc in Taiwan
- (1)
- Fourier Transform Infrared spectrometry (FTIR)
- (2)
- X-ray Powder Diffraction (XRD)
- (3)
- Microscopy of asbestos
4.3. Limitations
4.4. Interpretation
4.5. Generalisability
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variable | Non-Users N = 584,077 | Talc Users N = 21,575 |
---|---|---|
Gender | ||
Female | 292,319 (50.1%) | 13,180 (61.1%) |
Male | 291,758 (49.9%) | 8395 (38.9%) |
Age (year) a | 40.2 ± 14.7 | 39.0 ± 13.2 |
Monthly Income b | 21,822 ± 12,575 | 21,630 ± 11,380 |
Urbanization c | ||
Level 1 (high) | 173,513 (29.9%) | 5,486 (25.1%) |
Level 2 (medium) | 249,744 (43.0%) | 9602 (44.7%) |
Level 3 (low) | 157,831 (27.2%) | 6414 (29.8%) |
Charlson Comorbidity Index d | ||
0–2 | 583,744 (99.94%) | 21,558 (99.92%) |
>2 | 333 (0.06%) | 17 (0.08%) |
Follow-up time in month | 196.2 ± 21.7 | 200.3 ± 13.4 |
Variable | Person-Years | No. of Stomach Cancer | Rate/10,000 Person-Years (95% CI a) |
---|---|---|---|
Age | |||
<65 | 9,171,234 | 1202 | 1.31 (1.24–1.39) |
≥65 | 737,872 | 647 | 8.77 (8.11–9.47) |
Gender | |||
Female | 5,024,262 | 715 | 1.42 (1.32–1.53) |
Male | 4,884,844 | 1134 | 2.32 (2.19–2.46) |
Urbanization | |||
Level 1 (high) | 2,944,130 | 519 | 1.76 (1.61–1.92) |
Level 2 (medium) | 4,247,016 | 796 | 1.87 (1.75–2.01) |
Level 3 (low) | 2,668,495 | 516 | 1.93 (1.77–2.11) |
Charlson Comorbidity Index b | |||
0–2 | 9,904,066 | 1848 | 1.87 (1.78–1.95) |
>2 | 5040 | 1 | 1.98 (0.05–11.06) |
Exposure of talc c | |||
Unexposed period | 9,728,639 | 1804 | 1.85 (1.77–1.94) |
Talc-exposed period | 180,467 | 45 | 2.49 (1.82–3.34) |
Cumulative talc exposure c | |||
Low to none (≤ 6 g) | 9,774,552 | 1816 | 1.86 (1.77–1.95) |
Medium (6–21 g) | 87,550 | 23 | 2.63 (1.67–3.94) |
High (>21 g) | 47,004 | 10 | 2.13 (1.02–3.91) |
Risk Factor | Person-Years (Cases) | Crude Hazard Ratio a | Adjusted Hazard Ratio b | Ten-Year Absolute Risk/1000 Persons (95% CI) | ||
---|---|---|---|---|---|---|
HR (95% CI) | p-Value | HR (95% CI) | p-Value | |||
Exposure of talc | ||||||
Unexposed period | 9,728,639 (1804) | 1.00 | 1.00 | 1.07 (0.99–1.15) | ||
Talc-exposed period | 180,467 (45) | 1.83 (1.32–2.52) | <0.001 | 2.13 (1.54–2.94) | <0.001 | 1.95 (1.33–2.57) |
Cumulative talc exposure | ||||||
Low to none (≤6 g) | 9,774,552 (1816) | 1.00 | 1.00 | 1.07 (0.99–1.16) | ||
Medium (6–21 g) | 87,550 (23) | 1.99 (1.28–3.09) | 0.002 | 2.30 (1.48–3.57) | <0.001 | 2.13 (1.19–3.07) |
High (>21 g) | 47,004 (10) | 1.43 (0.71–2.87) | 0.31 | 1.58 (0.79–3.17) | 0.19 | 1.54 (0.47–2.60) |
Model | Person-Years (Cases) | Adjusted Hazard Ratio | |
---|---|---|---|
HR (95% CI) | p-Value | ||
Original model | |||
Cumulative talc exposure | |||
Low to none (≤ 6g) | 9,774,552 (1816) | 1.00 | |
Medium (6~21g) | 87,550 (23) | 2.30 (1.48–3.57) | <0.001 |
High (>21g) | 47,004 (10) | 1.58 (0.79–3.17) | 0.19 |
Changing the cut-off points for levels of talc exposure a | |||
Cumulative talc exposure | |||
Unexposed | 9,728,639 (1804) | 1.00 | |
Low (≤10.5 g) | 88,312 (23) | 2.40 (1.54–3.73) | 0.007 |
High (>10.5 g) | 92,155 (22) | 1.89 (1.19–3.01) | <0.001 |
Excluding time to event less than five years b | |||
Cumulative talc exposure | |||
Low to none (≤6 g) | 9,755,288 (1671) | 1.00 | |
Medium (6–21 g) | 78,828 (6) | 0.86 (0.39–1.93) | 0.72 |
High (>21 g) | 43,288 (7) | 1.99 (0.81–3.59) | 0.16 |
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Chang, C.-J.; Yang, Y.-H.; Chen, P.-C.; Peng, H.-Y.; Lu, Y.-C.; Song, S.-R.; Yang, H.-Y. Stomach Cancer and Exposure to Talc Powder without Asbestos via Chinese Herbal Medicine: A Population-Based Cohort Study. Int. J. Environ. Res. Public Health 2019, 16, 717. https://doi.org/10.3390/ijerph16050717
Chang C-J, Yang Y-H, Chen P-C, Peng H-Y, Lu Y-C, Song S-R, Yang H-Y. Stomach Cancer and Exposure to Talc Powder without Asbestos via Chinese Herbal Medicine: A Population-Based Cohort Study. International Journal of Environmental Research and Public Health. 2019; 16(5):717. https://doi.org/10.3390/ijerph16050717
Chicago/Turabian StyleChang, Che-Jui, Yao-Hsu Yang, Pau-Chung Chen, Hsin-Yi Peng, Yi-Chia Lu, Sheng-Rong Song, and Hsiao-Yu Yang. 2019. "Stomach Cancer and Exposure to Talc Powder without Asbestos via Chinese Herbal Medicine: A Population-Based Cohort Study" International Journal of Environmental Research and Public Health 16, no. 5: 717. https://doi.org/10.3390/ijerph16050717
APA StyleChang, C. -J., Yang, Y. -H., Chen, P. -C., Peng, H. -Y., Lu, Y. -C., Song, S. -R., & Yang, H. -Y. (2019). Stomach Cancer and Exposure to Talc Powder without Asbestos via Chinese Herbal Medicine: A Population-Based Cohort Study. International Journal of Environmental Research and Public Health, 16(5), 717. https://doi.org/10.3390/ijerph16050717