ORIGINAL ARTICLE
Subsequent risk of nasopharyngeal carcinoma among patients with allergic rhinitis: A nationwide population-based cohort study Kuen-Tze Lin, MD,1 Wen-Yen Huang, MD,1,2 Che-Chen Lin, MSc,3 Yee-Min Jen, MD, PhD,1 Chun-Shu Lin, MD,1 Cheng-Hsiang Lo, MD,1 Chia-Hung Kao, MD4,5* 1
Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, 2Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, 3Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan, 4Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan, 5Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Accepted 10 January 2014 Published online 9 April 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/hed.23617
ABSTRACT: Background. The purpose of this study was to examine the risk of nasopharyngeal carcinoma (NPC) after a diagnosis of allergic rhinitis. Methods. We identified 67,532 patients with allergic rhinitis (allergic rhinitis cohort) and a 135,064 control cohort with the same mean age and sex ratio by using a Taiwan Longitudinal Health Insurance Database (LHID) sample from 2000 to 2005. Results. After adjusting for the possible confounding factors of the study, the allergic rhinitis cohort had a 2.33-fold higher risk of developing NPC than did the comparison cohort. The frequency of allergic rhinitis visits was correlated with the risk of subsequent NPC. Patients with 4 or more
allergic rhinitis visits per year were significantly associated with increasingly developing NPC risk. Conclusion. Patients with allergic rhinitis might be associated with subsequent NPC in Taiwan. Those who had repeated visits for allergic rhinitis had even higher risk for NPC. Physicians should be aware of the link C 2014 Wiley Periodicals, when assessing patients with allergic rhinitis. V Inc. Head Neck 37: 413–417, 2015
INTRODUCTION
the world but common in Southern China, Hong Kong, and Taiwan.8,9 Based on the 2009 cancer registry annual report released by the Taiwan Department of Health, the incidence of NPC was 9.99 per 100,000 for men and 2.98 per 100,000 for women. Thus, in Taiwan, NPC is the 11th most common cause of cancer-related death for men and the 16th for women. Because allergic rhinitis is such a common condition, any association between allergic rhinitis and an increased risk of NPC is a public health concern in Taiwan. Previous studies have shown that the risk of NPC is higher in patients with chronic local infection/inflammation of the aerodigestive tract in the head and neck, such as sinusitis, otitis media, and tonsillitis.10–13 However, the association between allergic rhinitis and subsequent NPC is less known and even less studied. Taiwan initiated its National Health Insurance (NHI) program in 1996, and 97% of the hospitals and clinics throughout Taiwan were under contract with the system by the end of 1996. By 1998, the NHI provided health care for nearly 99% of the population of Taiwan.14 The NHI has made the Taiwan National Health Insurance Research Database (NHIRD) available to researchers in Taiwan, and this database has been extensively used in epidemiologic studies.11,15,16 In this research, we conducted a large nationwide retrospective cohort study to examine the risk of NPC after diagnosis of allergic rhinitis.
Allergic rhinitis is the most common chronic disorder of the respiratory tract and includes symptoms of sneezing, rhinorrhea, nasal obstruction, nasal itching, postnasal drip, and cough.1,2 The economic burden of allergic rhinitis and its complications are considerable.3,4 Allergic rhinitis is also associated with a lower quality of life.5,6 The prevalence of allergic rhinitis varies worldwide. The prevalence of allergic rhinitis is extremely high (24.2% to 43.0%) and continues to increase in Taiwan,1,7,8 which is an island country with a population of approximately 23 million, the majority of whom are ethnic Chinese.7 Nasopharyngeal cancer (NPC) is a malignant tumor of the nasopharynx, the narrow tubular passage behind the nasal cavity. The incidence of NPC demonstrates a marked geographic variation. It is rare in most parts of
*Corresponding author: C.-H. Kao, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 404, Taiwan. E-mail: [email protected] Contract grant sponsor: This study was supported in part by the study projects of DMR-103-012, DMR-103-018; Taiwan Ministry of Health and Welfare Clinical Trial and Research Center for Excellence (DOH102-TD-B-111-004), Taiwan Ministry of Health and Welfare Cancer Research Center for Excellence (MOHW103-TD-B-111-03); and International Research-Intensive Centers of Excellence in Taiwan (I-RiCE; NSC101-2911-I-002-303). The role of study sponsors in the study was in the collection of data from the Taiwan National Health Insurance Research Database (NHIRD).
KEY WORDS: nasopharyngeal carcinoma, allergic rhinitis, cohort study, National Health Insurance, National Health Insurance Research Database
HEAD & NECK—DOI 10.1002/HED
MARCH 2015
413
LIN ET AL.
TABLE 1. Baseline demographic status and comorbidity compared between the comparison and allergic rhinitis cohorts. No. (%) by cohort†
Variables
Age, y (SD)*
Subsequent risk of nasopharyngeal carcinoma among patients with allergic rhinitis: A nationwide population-based cohort study Kuen-Tze Lin, MD,1 Wen-Yen Huang, MD,1,2 Che-Chen Lin, MSc,3 Yee-Min Jen, MD, PhD,1 Chun-Shu Lin, MD,1 Cheng-Hsiang Lo, MD,1 Chia-Hung Kao, MD4,5* 1
Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, 2Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, 3Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan, 4Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan, 5Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Accepted 10 January 2014 Published online 9 April 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/hed.23617
ABSTRACT: Background. The purpose of this study was to examine the risk of nasopharyngeal carcinoma (NPC) after a diagnosis of allergic rhinitis. Methods. We identified 67,532 patients with allergic rhinitis (allergic rhinitis cohort) and a 135,064 control cohort with the same mean age and sex ratio by using a Taiwan Longitudinal Health Insurance Database (LHID) sample from 2000 to 2005. Results. After adjusting for the possible confounding factors of the study, the allergic rhinitis cohort had a 2.33-fold higher risk of developing NPC than did the comparison cohort. The frequency of allergic rhinitis visits was correlated with the risk of subsequent NPC. Patients with 4 or more
allergic rhinitis visits per year were significantly associated with increasingly developing NPC risk. Conclusion. Patients with allergic rhinitis might be associated with subsequent NPC in Taiwan. Those who had repeated visits for allergic rhinitis had even higher risk for NPC. Physicians should be aware of the link C 2014 Wiley Periodicals, when assessing patients with allergic rhinitis. V Inc. Head Neck 37: 413–417, 2015
INTRODUCTION
the world but common in Southern China, Hong Kong, and Taiwan.8,9 Based on the 2009 cancer registry annual report released by the Taiwan Department of Health, the incidence of NPC was 9.99 per 100,000 for men and 2.98 per 100,000 for women. Thus, in Taiwan, NPC is the 11th most common cause of cancer-related death for men and the 16th for women. Because allergic rhinitis is such a common condition, any association between allergic rhinitis and an increased risk of NPC is a public health concern in Taiwan. Previous studies have shown that the risk of NPC is higher in patients with chronic local infection/inflammation of the aerodigestive tract in the head and neck, such as sinusitis, otitis media, and tonsillitis.10–13 However, the association between allergic rhinitis and subsequent NPC is less known and even less studied. Taiwan initiated its National Health Insurance (NHI) program in 1996, and 97% of the hospitals and clinics throughout Taiwan were under contract with the system by the end of 1996. By 1998, the NHI provided health care for nearly 99% of the population of Taiwan.14 The NHI has made the Taiwan National Health Insurance Research Database (NHIRD) available to researchers in Taiwan, and this database has been extensively used in epidemiologic studies.11,15,16 In this research, we conducted a large nationwide retrospective cohort study to examine the risk of NPC after diagnosis of allergic rhinitis.
Allergic rhinitis is the most common chronic disorder of the respiratory tract and includes symptoms of sneezing, rhinorrhea, nasal obstruction, nasal itching, postnasal drip, and cough.1,2 The economic burden of allergic rhinitis and its complications are considerable.3,4 Allergic rhinitis is also associated with a lower quality of life.5,6 The prevalence of allergic rhinitis varies worldwide. The prevalence of allergic rhinitis is extremely high (24.2% to 43.0%) and continues to increase in Taiwan,1,7,8 which is an island country with a population of approximately 23 million, the majority of whom are ethnic Chinese.7 Nasopharyngeal cancer (NPC) is a malignant tumor of the nasopharynx, the narrow tubular passage behind the nasal cavity. The incidence of NPC demonstrates a marked geographic variation. It is rare in most parts of
*Corresponding author: C.-H. Kao, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 404, Taiwan. E-mail: [email protected] Contract grant sponsor: This study was supported in part by the study projects of DMR-103-012, DMR-103-018; Taiwan Ministry of Health and Welfare Clinical Trial and Research Center for Excellence (DOH102-TD-B-111-004), Taiwan Ministry of Health and Welfare Cancer Research Center for Excellence (MOHW103-TD-B-111-03); and International Research-Intensive Centers of Excellence in Taiwan (I-RiCE; NSC101-2911-I-002-303). The role of study sponsors in the study was in the collection of data from the Taiwan National Health Insurance Research Database (NHIRD).
KEY WORDS: nasopharyngeal carcinoma, allergic rhinitis, cohort study, National Health Insurance, National Health Insurance Research Database
HEAD & NECK—DOI 10.1002/HED
MARCH 2015
413
LIN ET AL.
TABLE 1. Baseline demographic status and comorbidity compared between the comparison and allergic rhinitis cohorts. No. (%) by cohort†
Variables
Age, y (SD)*
