Investigating the risk of metabolic and cardiovascular comorbidities in patients with parathyroid cancer: a nationally representative cohort study in Taiwan | BMC Medical

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Study population and design

Established in 1979, the National Taiwan Cancer Registry Database (NTCRD) is a population-based, retrospective cohort study based on a representative sample of 97.8% of Taiwanese cancer patients. Details of NTCRD, its methodology, and participants have been previously reported. [22]. The NTCRD has undergone three revisions since its inception and has been merged with the National Health Insurance Research Database (NHIRD) and national death records. We used individual-level long-term NHIRD registration and claim data from 01/01/2004 to 31/12/2019.


Patients had a diagnosis of parathyroid carcinoma (ICD-O-FT: 1941 for 2007-2013 and ICD-0-3 C750 for 2013-2018) from January 1, 2007 to December 31, 2018 participated in the study on the basis of Patients younger than 20 years of age, diagnosed before 1 January 2007, or lacking age or gender demographic information were excluded (Additional File 1: Figure S1). Individuals were matched based on variables such as age, gender, urbanization, occupation, and index year, and completed in a one-to-five fashion. Due to the limited sample size of our database, a total of 72 patients with parathyroid cancer and her 360 gender- and age-matched general population, to reduce waste in the number of cases, according to different outcome assessments He builds 6 cohorts. Each cohort enrolled participants with and without parathyroid carcinoma, and excluded pre-existing comorbidities according to various checks.


Primary outcomes included 1 hospitalization for the first to fifth diagnosis of hypertension, diabetes, or hyperlipidemia, or ambulatory care with concomitant antihypertensive, antidiabetic, or lipid-lowering drugs at least 7 days after the index date. 1 was included. In addition, primary outcomes included clinical diagnosis of atrial fibrillation, coronary artery disease, and heart failure at 1 inpatient or 2 outpatient visits. Secondary outcomes were overall mortality and cancer-specific mortality. The study protocol and consent form were approved by the Mackay Memorial Hospital Institutional Review Board. As the data were anonymized, the informed consent requirement was waived.

statistical analysis

NTCRD was analyzed from 1 January 2007 to 31 December 2018 and was associated with NHIRD from 1 January 2004 to 31 December 2019. Patients with primary parathyroid cancer were compared by age, sex, occupation, geography and index year.Match the general population using two-tailed tests during follow-up t– testing of continuous variables and χ
2 Test a categorical baseline variable. Baseline characteristics for the pre-index period were reported as percentages for categorical variables and as means with standard deviations (SD) for continuous variables. Survival probabilities were estimated using the Kaplan-Meier method and the log-rank test was analyzed. Because parathyroid cancer patients have a higher risk of death than non-parathyroid cancer patients, we plotted the cumulative incidence function based on the cumulative incidence competing risk analysis.

Unadjusted multivariate Cox proportional hazards regression was performed using model 1 adjusted for age and sex to reduce imperfect match bias and hazard ratios (HR) and 95% confidence intervals (CI) were estimated . The model was further adjusted for outcomes such as occupation (white-collar, blue-collar, etc.), urbanization, average monthly income (<35,000 NTD, ≥35,000 NTD), chronic kidney disease, nephrolithiasis, and osteoporosis. Satisfaction of the proportional hazards assumption of the Cox model was checked using the standard method log (-log (survival function)). In addition, competing mortality rates were used to perform competing risk regression analyzes with subdistribution hazard models (fine and gray models).

To assess the risk of metabolic and cardiovascular comorbidity progression, we stratified the estimated incidence rates by outcome at different years since diagnosis of parathyroid carcinoma. Metabolic and cardiovascular comorbidities among patients stratified by age criteria (<60 years vs. ≥60 years) and Subgroup analyzes evaluating unadjusted and multivariate-adjusted interaction products were performed. model. A likelihood-ratio test for interaction terms was used to determine association corrections. Hazard ratio trends for all metabolic and cardiovascular comorbidities were plotted.

Sensitivity analyzes were performed to determine the original age, gender, urbanization, occupation, index year of the model, as well as mean monthly income (0-34,999, ≥35,000 NTD), chronic kidney disease (with or without baseline), nephrolithiasis (with or without baseline), with or without baseline), osteoporosis (with or without baseline). All analyzes were performed in SAS version 9.4 (SAS Institute Inc., NC, USA) and STATA version 16 (StataCorp LLC, TX, USA) using two-tailed tests. Statistical significance levels were set as follows: p< 0.05.

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