Epidemiology and Health

Original Articles

Comparison of all-cause mortality associated with non-alcoholic fatty liver disease and metabolic dysfunction-associated fatty liver disease in Taiwan MJ cohort: Wei-Chun Cheng, Hua-Fen Chen, Hsiu-Chi Cheng, Chung-Yi Li; Epidemiol Health. 2024;46:e2024024. Published online January 21, 2024; DOI: https://doi.org/10.4178/epih.e2024024

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Abstract

OBJECTIVES
The global burden of non-alcoholic fatty liver disease (NAFLD) is rising. An alternative term, metabolic dysfunction-associated fatty liver disease (MAFLD), instead highlights the associated metabolic risks. This cohort study examined patient classifications under NAFLD and MAFLD criteria and their associations with all-cause mortality.

METHODS

Participants who attended a paid health check-up (2012-2015) were included. Hepatic steatosis (HS) was diagnosed ultrasonographically. NAFLD was defined as HS without secondary causes, while MAFLD involved HS with overweight/obesity, type 2 diabetes mellitus, or ≥2 metabolic dysfunctions. Mortality was tracked via the Taiwan Death Registry until November 30, 2022.

RESULTS

Of 118,915 participants, 36.9% had NAFLD, 40.2% had MAFLD, and 32.9% met both definitions. Participants with NAFLD alone had lower mortality, and those with MAFLD alone had higher mortality, than individuals with both conditions. After adjustment for potential confounders, the hazard ratios (HRs) for all-cause mortality were 1.08 (95% confidence interval [CI], 0.78 to 1.48) for NAFLD alone and 1.26 (95% CI, 1.09 to 1.47) for MAFLD alone, relative to both conditions. Advanced fibrosis conferred greater mortality risk, with HRs of 1.93 (95% CI, 1.44 to 2.58) and 2.08 (95% CI, 1.61 to 2.70) for advanced fibrotic NAFLD and MAFLD, respectively. Key mortality risk factors for NAFLD and MAFLD included older age, unmarried status, higher body mass index, smoking, diabetes mellitus, chronic kidney disease, and advanced fibrosis.

CONCLUSIONS

All-cause mortality in NAFLD and/or MAFLD was linked to cardiometabolic covariates, with risk attenuated after multivariable adjustment. A high fibrosis-4 index score, indicating fibrosis, could identify fatty liver disease cases involving elevated mortality risk.

Summary

Key Message
In a cohort study involving 118,915 Taiwanese participants in a paid health check-up program, approximately one-third met both NAFLD (non-alcoholic fatty liver disease) and MAFLD (metabolic dysfunction-associated fatty liver disease) criteria. All-cause mortality associated with NAFLD and/or MAFLD correlated with cardiometabolic factors, though the risk attenuated following multivariable adjustment. A high fibrosis-4 index score, suggestive of liver fibrosis, was predictive of increased mortality risk in FLD (fatty liver disease) cases.

Citations

Citations to this article as recorded by

Assessing Mortality Disparities Among Non-Alcoholic Fatty Liver Disease Metabolic Dysfunction Fatty Liver Disease and Metabolic Dysfunction-Associated Liver Disease: A Comprehensive Meta-Analysis
Fahad Lakhdhir, Agha Syed Muhammad, Ahmed Nasir Qureshi, Imran A Shaikh, Imran Joher, Jawaria Majeed, Javaria Khan
Cureus.2024;[Epub] CrossRef

Overall and cause-specific mortality in patients with dementia: a population-based cohort study in Taiwan: Chia-Lun Kuo, Pei-Chen Lee, Li-Jung Elizabeth Ku, Yu Sun, Tsung-Hsueh Lu, Muhammad Atoillah Isfandiari, Chung-Yi Li; Epidemiol Health. 2023;45:e2023082. Published online August 31, 2023; DOI: https://doi.org/10.4178/epih.e2023082

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Information regarding the underlying causes of death (UCODs) and standardized mortality ratio (SMR) of dementia is instrumental in formulating medical strategies to prolong life in persons with dementia (PWD). We examined the leading UCODs among PWD and estimated the overall and cause-specific SMRs in relation to dementia in Taiwan.

METHODS

Data were retrieved from 2 national datasets: the Taiwan Death Registry and the medical claim datasets of the National Health Insurance program. The observed person-years for each study participant were counted from the date of cohort enrollment to either the date of death or the final day of 2016. Sex-specific and age-specific SMRs were then calculated.

RESULTS

The leading UCOD was circulatory disease, accounting for 26.0% of total deaths (n=3,505), followed by respiratory disease at 21.3% (n=2,875). PWD were at significantly increased risk of all-cause mortality (SMR, 2.01), with SMR decreasing with advancing age. A cause-specific analysis revealed that the highest SMRs were associated with nervous system diseases (SMR, 7.58) and mental, behavioral, and neurodevelopmental disorders (SMR, 4.80). Age appeared to modify SMR, suggesting that younger age at cohort enrollment was linked to higher SMRs for nearly all causes of mortality.

CONCLUSIONS

Circulatory and respiratory diseases were the leading UCODs among PWD. The particularly elevated mortality due to nervous system diseases and mental disorders suggests that allocating more resources to neurological and psychiatric services is warranted. The elevated SMRs of various UCODs among younger PWD underscore the need for clinicians to pay particular attention to the medical care provided to these patients.

Summary

Key Message
Circulatory diseases were the leading causes of death in patients with dementia (PWD) in Taiwan, which accounted for 26% of the total deaths, followed by diseases of the respiratory system (21.32%). PWD were at a significantly increased risk of all-cause mortality (SMR: 2.01). A greater increase in cause specific SMR was noted for nervous system diseases (SMR: 7.58) and mental, behavioral and neurodevelopmental disorders (SMR: 4.80). Age tended to modify the SMRs in PWD, which indicated the younger the age of cohort enrollment was, the higher the SMRs of nearly all causes of mortality were.

Citations

Citations to this article as recorded by

Trends in incidence, mortality, dynamic needs and rapid evolution of healthcare in dementia
Ke-Zong Ma, Chaur-Jong Hu
Archives of Gerontology and Geriatrics.2024; 121: 105389. CrossRef
Associations of cognitive impairment and functional limitation with all-cause mortality risk in older adults: A population-based study from the National Health and Nutrition Examination Survey
Wenxiu Zhu, Xuyan Zhao, Qingqin Xu, Yun Xue
Applied Neuropsychology: Adult.2024; : 1. CrossRef

Type 2 diabetes mellitus increases the severity of non-fatal injuries, but not the risk of fatal injuries, among driver victims of motor vehicle crashes in Taiwan: I-Lin Hsu, Wen-Hsuan Hou, Ya-Hui Chang, Chung-Yi Li; Epidemiol Health. 2022;44:e2022076. Published online September 16, 2022; DOI: https://doi.org/10.4178/epih.e2022076

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Limited information is available on whether diabetes increases the severity of injuries from motor vehicle crashes (MVCs). This study aimed to investigate the association of type 2 diabetes with injury severity among driver victims of MVCs.
METHODS
This cohort study involved 75,737 adult driver victims with type 2 diabetes from Taiwan’s Police-Reported Traffic Accident Registry in 2015-2017, along with 150,911 sex-, age-, and calendar year-matched controls. The severity level of non- fatal injuries was derived from the International Classification of Diseases Programs for Injury Categorization based on the diagnostic codes of National Health Insurance claims within 3 days after an MVC. Information on fatal injuries within 3 days after an MVC was obtained from the Taiwan Death Registry. Logistic regression models were used to estimate the odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) of injury severity in association with type 2 diabetes.
RESULTS
After adjusting for potential confounders, driver victims with type 2 diabetes experienced significantly higher risks of mild and severe non-fatal injuries than their counterparts without diabetes, with covariate-adjusted ORs of 1.08 (95% CI, 1.05 to 1.11) and 1.28 (95% CI, 1.20 to 1.37), respectively. By contrast, the adjusted OR for fatal injuries was not significantly elevated, at 1.02 (95% CI, 0.89 to 1.18). Similar results were found when car and scooter driver victims were analyzed separately.
CONCLUSIONS
Type 2 diabetes was found to moderately increase the severity of non-fatal injuries from MVCs among car and scooter driver victims.; Summary

Key Message
With 75,737 driver victims with diabetes and 150,911 matched controls, this study showed an 8% and 28% increase in mild and severe non-fatal injury, respectively among driver victims with diabetes. Such increase in risk was equally applied to both car and scooter drivers. No increase in risk of 3-day mortality after crash was found.

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