Association of Arrhythmia in Patients with Cervical Spondylosis: A Nationwide Population-Based Cohort Study
Abstract
1. Introduction
2. Methods
2.1. Data Source
2.2. Ethics Statement
2.3. Participants
2.4. Outcomes
2.5. Statistical Analysis
3. Results
4. Discussion
Author Contributions
Funding
Conflicts of Interest
References
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Cervical Spondylosis | Standard Mean Difference § | ||
---|---|---|---|
No | Yes | ||
(N = 22,236) | (N = 22,236) | ||
Sex | |||
Women | 12,791 (57.5) | 12,766 (57.4) | 0.002 |
Men | 9445 (42.5) | 8470 (42.6) | 0.002 |
Age stratified | |||
≤49 | 8067 (36.3) | 8817 (39.7) | 0.07 |
50–64 | 8885 (40.0) | 8407 (37.8) | 0.04 |
65 + | 5284 (23.8) | 5012 (22.5) | 0.03 |
Age, mean ± SD | 54.4 (13.4) | 54.3 (13.3) | 0.01 |
Frequency of medical visits/per year, Means (SD) † | 15.1 (13.9) | 15.8 (13.9) | 0.05 |
Occupation | |||
White collar | 11,412 (51.3) | 11,429 (51.4) | 0.002 |
Blue collar | 7889 (35.5) | 7884 (35.5) | 0.000 |
Others & | 2935 (13.2) | 2923 (13.2) | 0.002 |
Urbanization level † | |||
1 (highest) | 7353 (33.1) | 7373 (33.2) | 0.002 |
2 | 6782 (30.5) | 6723 (30.2) | 0.01 |
3 | 3534 (15.9) | 3594 (16.2) | 0.01 |
4 (lowest) | 4567 (20.5) | 4546 (20.4) | 0.002 |
Comorbidity | |||
Diabetes | 2385 (10.7) | 2352 (10.6) | 0.005 |
Hypertension | 8574 (38.6) | 8471 (38.1) | 0.01 |
Hyperlipidemia | 6887 (31.0) | 6785 (30.5) | 0.01 |
CAD | 4366 (19.6) | 4276 (19.2) | 0.01 |
Stroke | 903 (4.06) | 898 (4.04) | 0.001 |
CKD or ESRD | 338 (1.52) | 329 (1.48) | 0.003 |
COPD | 3093 (13.9) | 3054 (13.7) | 0.01 |
Cancer | 623 (2.80) | 618 (2.78) | 0.001 |
CHF | 560 (2.52) | 533 (2.40) | 0.01 |
Sleep apnea | 114 (0.51) | 114 (0.51) | 0.000 |
Medications | |||
NSAID | 7649 (34.4) | 7627 (34.3) | 0.002 |
All Beta blocker | 9088 (40.9) | 9062 (40.8) | 0.002 |
Propranolol | 6293 (28.3) | 6330 (28.5) | 0.004 |
Carvedilol | 789 (3.55) | 782 (3.52) | 0.002 |
Bisoprolol | 1355 (6.09) | 1348 (6.06) | 0.001 |
Variable | Event | PY | Rate # | Crude HR (95% CI) | Adjusted HR § (95% CI) |
---|---|---|---|---|---|
Cervical spondylosis | |||||
No | 537 | 137,401 | 3.91 | 1.00 | 1.00 |
Yes | 1441 | 130,269 | 11.1 | 2.82 (2.55, 3.11) *** | 3.10 (2.80, 3.42) *** |
Age group, year | |||||
20–49 | 440 | 108,197 | 4.07 | 1.00 | 1.00 |
50–64 | 787 | 102,519 | 7.68 | 1.87 (1.66, 2.10) *** | 1.86 (1.64, 2.11) *** |
≥65 | 751 | 56,953 | 13.2 | 3.19 (2.83, 3.59) *** | 2.68 (2.33, 3.10) *** |
Sex | |||||
Female | 1134 | 158,588 | 7.15 | 1.00 | 1.00 |
Male | 844 | 109,082 | 7.74 | 1.07 (0.98, 1.17) | |
Occupation | |||||
White collar | 887 | 135,455 | 6.55 | 1.00 | 1.00 |
Blue collar | 761 | 96,808 | 7.86 | 1.21 (1.10, 1.33) *** | 1.11 (1.00, 1.23) * |
Others & | 330 | 35,407 | 9.32 | 1.43 (1.26, 1.62) *** | 1.22 (1.07, 1.39) ** |
Urbanization level † | |||||
1 (highest) | 615 | 88,016 | 6.99 | 1.00 | 1.00 |
2 | 584 | 81,759 | 7.14 | 1.02 (0.91, 1.15) | 1.01 (0.90, 1.14) |
3 | 313 | 42,595 | 7.35 | 1.05 (0.92, 1.21) | 1.05 (0.92, 1.20) |
4(lowest) | 466 | 55,300 | 8.43 | 1.21 (1.07, 1.36) ** | 1.07 (0.94, 1.22) |
Comorbidity | |||||
Diabetes | |||||
No | 1756 | 241,894 | 7.26 | 1.00 | 1.00 |
Yes | 222 | 25,776 | 8.61 | 1.17 (1.01, 1.34) * | 0.86 (0.75, 1.00) |
Hypertension | |||||
No | 877 | 169,015 | 5.19 | 1.00 | 1.00 |
Yes | 1101 | 98,655 | 11.2 | 2.13 (1.95, 2.33) *** | 1.75 (1.55, 1.97) *** |
Hyperlipidemia | |||||
No | 1200 | 188,751 | 6.36 | 1.00 | 1.00 |
Yes | 778 | 78,919 | 9.86 | 1.54 (1.40, 1.68) *** | 1.44 (1.30, 1.59) *** |
CAD | |||||
No | 1261 | 218,556 | 5.77 | 1.00 | 1.00 |
Yes | 717 | 49,114 | 14.6 | 2.51 (2.29, 2.75) *** | 1.94 (1.74, 2.17) *** |
Stroke | |||||
No | 1885 | 258,451 | 7.29 | 1.00 | 1.00 |
Yes | 93 | 9219 | 10.1 | 1.35 (1.10, 1.67) ** | 0.72 (0.58, 0.89) ** |
CKD or ESRD | |||||
No | 1939 | 264,481 | 7.33 | 1.00 | 1.00 |
Yes | 39 | 3189 | 12.2 | 1.61 (1.17, 2.21) ** | 0.93 (0.67, 1.29) |
COPD | |||||
No | 1569 | 233,782 | 6.71 | 1.00 | 1.00 |
Yes | 409 | 33,888 | 12.1 | 1.77 (1.59, 1.98) *** | 1.42 (1.27, 1.60) *** |
Cancer | |||||
No | 1917 | 261,697 | 7.33 | 1.00 | 1.00 |
Yes | 61 | 5973 | 10.2 | 1.36 (1.05, 1.75) * | 1.18 (0.91, 1.53) |
CHF | |||||
No | 1878 | 262,212 | 7.16 | 1.00 | 1.00 |
Yes | 100 | 5458 | 18.3 | 2.49 (2.04, 3.04) *** | 1.24 (1.00, 1.54) * |
Sleep apnea | |||||
No | 1968 | 266,718 | 7.38 | 1.00 | 1.00 |
Yes | 10 | 952 | 10.5 | 1.34 (0.72, 2.49) | |
Medication | |||||
NSAID | |||||
No | 1003 | 136,500 | 7.35 | 1.00 | 1.00 |
Yes | 975 | 131,170 | 7.43 | 1.12 (1.02, 1.23) * | 2.49 (2.25, 2.75) *** |
All Beta blocker | |||||
No | 915 | 165,352 | 5.53 | 1.00 | 1.00 |
Yes | 1063 | 102,318 | 10.4 | 1.85 (1.69, 2.02) *** | 1.20 (1.03, 1.39) * |
Propranolol | |||||
No | 1227 | 197,835 | 6.20 | 1.00 | 1.00 |
Yes | 751 | 69,835 | 10.8 | 1.71 (1.56, 1.87) *** | 1.43 (1.25, 1.64) *** |
Carvedilol | |||||
No | 1886 | 260,263 | 7.25 | 1.00 | 1.00 |
Yes | 92 | 7407 | 12.4 | 1.65 (1.34, 2.04) *** | 0.79 (0.64, 0.99) * |
Bisoprolol | |||||
No | 1830 | 255,203 | 7.17 | 1.00 | 1.00 |
Yes | 148 | 12,467 | 11.9 | 1.59 (1.34, 1.88) *** | 0.74 (0.62, 0.89) ** |
Cervical Spondylosis | ||||||||
---|---|---|---|---|---|---|---|---|
No | Yes | |||||||
Event | PY | Rate # | Event | PY | Rate # | Crude HR (95% CI) | Adjusted HR § (95% CI) | |
Sex | ||||||||
Women | 293 | 81,923 | 3.58 | 841 | 76,664 | 11.0 | 3.04 (2.66, 3.48) *** | 3.38 (2.95, 3.86) *** |
Men | 244 | 55,477 | 4.40 | 600 | 53,605 | 11.2 | 2.54 (2.19, 2.94) *** | 2.84 (2.44, 3.30) *** |
Stratify age | ||||||||
≤49 | 99 | 51,648 | 1.92 | 341 | 56,550 | 6.03 | 3.14 (2.51, 3.93) *** | 3.61 (2.88, 4.53) *** |
50–64 | 213 | 54,428 | 3.91 | 574 | 48,091 | 11.9 | 3.03 (2.59, 3.55) *** | 3.48 (2.97, 4.08) *** |
65+ | 225 | 31,325 | 7.18 | 526 | 25,628 | 20.5 | 2.81 (2.40, 3.29) *** | 2.77 (2.37, 3.25) *** |
Occupation | ||||||||
White collar | 252 | 68,498 | 3.68 | 635 | 66,957 | 9.48 | 2.57 (2.22, 2.98) *** | 2.98 (2.57, 3.45) *** |
Blue collar | 209 | 50,511 | 4.14 | 552 | 46,298 | 11.9 | 2.85 (2.43, 3.35) *** | 2.98 (2.57, 3.45) *** |
Others & | 76 | 18,392 | 4.13 | 254 | 17,015 | 14.9 | 3.59 (2.78, 4.63) *** | 3.63 (2.80, 4.70) *** |
Urbanization level † | ||||||||
1 (highest) | 176 | 44,789 | 3.93 | 439 | 43,227 | 10.2 | 2.57 (2.16, 3.06) *** | 2.91 (2.44, 3.47) *** |
2 | 166 | 41,892 | 3.96 | 418 | 39,867 | 10.5 | 2.64 (2.20, 3.16) *** | 2.95 (2.46, 3.53) *** |
3 | 66 | 21,780 | 3.03 | 247 | 20,815 | 11.9 | 3.89 (2.96, 5.10) *** | 4.23 (3.22, 5.56) *** |
4 (lowest) | 129 | 28,940 | 4.46 | 337 | 26,360 | 12.8 | 2.84 (2.32, 3.48) *** | 3.01 (2.45, 3.69) *** |
Comorbidity ‡ | ||||||||
No | 115 | 60,271 | 1.91 | 344 | 59,401 | 5.79 | 3.04 (2.46, 3.75) *** | 3.66 (2.96, 4.53) *** |
Yes | 422 | 77,130 | 5.47 | 1097 | 70,868 | 15.5 | 2.80 (2.50, 3.13) *** | 2.89 (2.58, 3.23) *** |
Variable | N | Events | PYs | Rate # | Crude HR (95% CI) | Adjusted HR & (95% CI) |
---|---|---|---|---|---|---|
Without cervical spondylosis | 22,236 | 537 | 137,401 | 3.91 | 1.00 | 1.00 |
Type of Cervical spondylosis | ||||||
Cervical spondylosis without myelopathy | 14,414 | 882 | 81,743 | 10.8 | 2.73 (2.46, 3.04) *** | 2.87 (2.58, 3.20) *** |
Cervical spondylosis with myelopathy | 7822 | 559 | 48,526 | 11.5 | 2.95 (2.62, 3.33) *** | 3.53 (3.13, 3.97) *** |
Variable | N | Events | PYs | Rate # | Crude HR (95% CI) | Adjusted HR & (95% CI) | Crude HR (95% CI) | Adjusted HR & (95% CI) |
---|---|---|---|---|---|---|---|---|
Without cervical spondylosis | 22,236 | 537 | 137,401 | 3.91 | 1.00 | 1.00 | ||
With cervical spondylosis | ||||||||
Mild: cervical spondylosis no signs | 19,047 | 1335 | 107,982 | 12.4 | 3.13 (2.84, 3.47) *** | 3.32 (3.01, 3.68) *** | 1.00 | 1.00 |
Moderate: cervical spondylosis receiving rehabilitation | 1996 | 67 | 14,352 | 4.67 | 1.22 (0.94, 1.57) | 1.94 (1.51, 2.51) *** | 0.40 (0.31, 0.50) *** | 0.61 (0.48, 0.78) *** |
Severe: cervical spondylosis with neurological signs receiving spinal decompression | 1193 | 39 | 7935 | 4.91 | 1.27 (0.92, 1.75) | 1.84 (1.33, 2.55) *** | 0.41 (0.30, 0.56) *** | 0.58 (0.42, 0.79) *** |
Cervical Spondylosis | ||||||
---|---|---|---|---|---|---|
No | Yes | |||||
Variable (ICD-9-CM) | Event | Rate # | Event | Rate # | Crude HR (95% CI) | Adjusted HR § (95% CI) |
Atrial fibrillation (427.31) | 127 | 0.92 | 252 | 1.93 | 2.08 (1.68, 2.58) *** | 2.22 (1.79, 2.76) *** |
Ventricular tachycardia (427.1) | 12 | 0.09 | 33 | 0.25 | 2.89 (1.49, 5.59) ** | 3.19 (1.64, 6.20) *** |
Supraventricular tachycardia (427.0) | 35 | 0.25 | 78 | 0.60 | 2.33 (1.56, 3.47) *** | 2.54 (1.70, 3.79) *** |
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Lin, S.-Y.; Hsu, W.-H.; Lin, C.-C.; Lin, C.-L.; Tsai, C.-H.; Lin, C.-H.; Chen, D.-C.; Lin, T.-C.; Hsu, C.-Y.; Kao, C.-H. Association of Arrhythmia in Patients with Cervical Spondylosis: A Nationwide Population-Based Cohort Study. J. Clin. Med. 2018, 7, 236. https://doi.org/10.3390/jcm7090236
Lin S-Y, Hsu W-H, Lin C-C, Lin C-L, Tsai C-H, Lin C-H, Chen D-C, Lin T-C, Hsu C-Y, Kao C-H. Association of Arrhythmia in Patients with Cervical Spondylosis: A Nationwide Population-Based Cohort Study. Journal of Clinical Medicine. 2018; 7(9):236. https://doi.org/10.3390/jcm7090236
Chicago/Turabian StyleLin, Shih-Yi, Wu-Huei Hsu, Cheng-Chieh Lin, Cheng-Li Lin, Chun-Hao Tsai, Chih-Hsueh Lin, Der-Cherng Chen, Tsung-Chih Lin, Chung-Y. Hsu, and Chia-Hung Kao. 2018. "Association of Arrhythmia in Patients with Cervical Spondylosis: A Nationwide Population-Based Cohort Study" Journal of Clinical Medicine 7, no. 9: 236. https://doi.org/10.3390/jcm7090236
APA StyleLin, S.-Y., Hsu, W.-H., Lin, C.-C., Lin, C.-L., Tsai, C.-H., Lin, C.-H., Chen, D.-C., Lin, T.-C., Hsu, C.-Y., & Kao, C.-H. (2018). Association of Arrhythmia in Patients with Cervical Spondylosis: A Nationwide Population-Based Cohort Study. Journal of Clinical Medicine, 7(9), 236. https://doi.org/10.3390/jcm7090236