title: Significant social events and increasing use of life-sustaining treatment: trend analysis using extracorporeal membrane oxygenation as an example.
abstract: BACKGROUND
  Most studies have examined the outcomes of patients supported by extracorporeal membrane oxygenation as a life-sustaining treatment. It is unclear whether significant social events are associated with the use of life-sustaining treatment. This study aimed to compare the trend of extracorporeal membrane oxygenation use in Taiwan with that in the world, and to examine the influence of significant social events on the trend of extracorporeal membrane oxygenation use in Taiwan.
  
  
  METHODS
  Taiwan's extracorporeal membrane oxygenation uses from 2000 to 2009 were collected from National Health Insurance Research Dataset. The number of the worldwide extracorporeal membrane oxygenation cases was mainly estimated using Extracorporeal Life Support Registry Report International Summary July 2012. The trend of Taiwan's crude annual incidence rate of extracorporeal membrane oxygenation use was compared with that of the rest of the world. Each trend of extracorporeal membrane oxygenation use was examined using joinpoint regression.
  
  
  RESULTS
  The measurement was the crude annual incidence rate of extracorporeal membrane oxygenation use. Each of the Taiwan's crude annual incidence rates was much higher than the worldwide one in the same year. Both the trends of Taiwan's and worldwide crude annual incidence rates have significantly increased since 2000. Joinpoint regression selected the model of the Taiwan's trend with one joinpoint in 2006 as the best-fitted model, implying that the significant social events in 2006 were significantly associated with the trend change of extracorporeal membrane oxygenation use following 2006. In addition, significantly social events highlighted by the media are more likely to be associated with the increase of extracorporeal membrane oxygenation use than being fully covered by National Health Insurance.
  
  
  CONCLUSIONS
  Significant social events, such as a well-known person's successful extracorporeal membrane oxygenation use highlighted by the mass media, are associated with the use of life-sustaining treatment such as extracorporeal membrane oxygenation.
authors.forename: Yen-Yuan
authors.initials: YY
authors.lastname: Chen
authors.forename: Likwang
authors.initials: L
authors.lastname: Chen
authors.forename: Tien-Shang
authors.initials: TS
authors.lastname: Huang
authors.forename: Wen-Je
authors.initials: WJ
authors.lastname: Ko
authors.forename: Tzong-Shinn
authors.initials: TS
authors.lastname: Chu
authors.affiliation: Department of Pediatrics, National Taiwan University College of Medicine, No, 1, Road Ren-Ai sec, 1, Taipei 100, Taiwan. yhni@ntu.edu.tw.
authors.forename: Yen-Hsuan
authors.initials: YH
authors.lastname: Ni
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000941:ethics / Q000706:statistics & numerical data* / Q000639:trends; D005197:Famous Persons; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008020:Life Support Care / Q000706:statistics & numerical data* / Q000639:trends*; D008297:Male; D008402:Mass Media / Q000941:ethics; D011639:Public Opinion; D012042:Registries; D013624:Taiwan; D016896:Treatment Outcome