Department of Ophthalmology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Am J Ophthalmol. 2021 Mar;223:140-148. doi: 10.1016/j.ajo.2020.09.040. Epub 2020 Sep 29.
The aim of this study was to determine the sociodemographic and risk factors for keratoconus (KC) patients with a nationwide Asian database.
Population-based matched case-control study.
We performed a secondary data analysis of the Taiwan National Health Insurance Research Database (NHIRD). Cases were patients with newly diagnosed KC in 1998-2015. Controls were patients without KC and matched 4:1 with the KC cases by age, sex, and index date. Comorbidities diagnosed before KC included diabetes mellitus (DM), asthma, allergic rhinitis, mitral valve prolapse, collagen vascular disease, aortic aneurysm, Down syndrome, sleep apnea, depression, hyperlipidemia, astigmatism, and myopia. Conditional logistic regression with forward selection were used to obtain risk factors for KC.
A total of 5,055 patients with KC were matched with 20,220 controls. The average age at KC first diagnosis was 29.76 years. Individuals who lived in suburban and rural area had lower odds ratio of KC (adjusted odds ratio [OR] 0.86, 95% confidence interval [CI] 0.80-0.94; and 0.73, 95% CI 0.67-0.79; respectively) when comparing with those who lived in urban area. Multivariate analysis revealed that Down syndrome, astigmatism, myopia, allergic rhinitis, and asthma were positively associated with KC with adjusted odds ratios (adjusted OR 8.69, 95% CI 3.74-20.19; 6.23, 95% CI 5.35-7.24; 2.99, 95% CI 2.70-3.32; 1.22, 95% CI 1.14-1.32; and 1.18, 95% CI 1.07-1.30, respectively). On the other hand, hyperlipidemia, depression, and DM (uncomplicated and complicated) were negatively associated with KC (adjusted OR 0.67, 95% CI 0.59-0.77; 0.58, 95% CI 0.48-0.71; 0.77, 95% CI 0.64-0.93; and 0.61, 95% CI 0.44-0.86, respectively).
Our study found that patients with hyperlipidemia, depression, or DM were less likely to have KC, and patients with asthma, allergic rhinitis, astigmatism, myopia, or Down syndrome had higher odds ratio of KC.
本研究旨在通过一个全国性的亚洲数据库，确定圆锥角膜（KC）患者的社会人口学和危险因素。
基于人群的匹配病例对照研究。
我们对台湾全民健康保险研究数据库（NHIRD）进行了二次数据分析。病例组为 1998 年至 2015 年间新诊断为 KC 的患者。对照组为无 KC 且按年龄、性别和索引日期与 KC 病例组以 4:1 匹配的患者。KC 前诊断出的合并症包括糖尿病（DM）、哮喘、过敏性鼻炎、二尖瓣脱垂、胶原血管疾病、主动脉瘤、唐氏综合征、睡眠呼吸暂停、抑郁症、高血脂、散光和近视。采用向前选择的条件逻辑回归来确定 KC 的危险因素。
共纳入 5055 例 KC 患者，匹配 20220 例对照组。KC 首次诊断的平均年龄为 29.76 岁。与居住在城市地区的患者相比，居住在郊区和农村地区的患者 KC 的比值比（调整比值比 [OR]，95%置信区间 [CI] 0.80-0.94；0.73，95%CI 0.67-0.79）较低。多变量分析显示，唐氏综合征、散光、近视、过敏性鼻炎和哮喘与 KC 呈正相关，调整比值比（调整 OR 8.69，95%CI 3.74-20.19；6.23，95%CI 5.35-7.24；2.99，95%CI 2.70-3.32；1.22，95%CI 1.14-1.32；1.18，95%CI 1.07-1.30）。另一方面，高血脂、抑郁症和 DM（单纯和复杂）与 KC 呈负相关（调整 OR 0.67，95%CI 0.59-0.77；0.58，95%CI 0.48-0.71；0.77，95%CI 0.64-0.93；0.61，95%CI 0.44-0.86）。
本研究发现，高血脂、抑郁症或 DM 患者发生 KC 的可能性较小，而哮喘、过敏性鼻炎、散光、近视或唐氏综合征患者 KC 的比值比较高。
