title: Systemic sclerosis and the risk of tuberculosis.
abstract: OBJECTIVE
  Pulmonary involvement is common in patients with systemic sclerosis (SSc), and this condition causes substantial morbidity and mortality. Disrupted immunity from the disease or associated medication may render such patients subject to tuberculosis (TB) infection. However, the relationship between SSc and TB has not yet been investigated.
  
  
  METHODS
  Using the Taiwan National Health Insurance Research Database, 838 patients with SSc diagnosed in Taiwan during 2000-2006 were identified and followed for emergence of TB infection. Incidence rate ratios (IRR) of TB compared to 8380 randomly selected age-, sex-, and comorbidity-matched controls without SSc were calculated. The Cox proportional hazards model was used for multivariate adjustment to identify independent risk factors for TB infection.
  
  
  RESULTS
  The risk of TB infection was higher in the SSc cohort than in controls (IRR 2.81, 95% CI 1.36-5.37; p = 0.004), particularly for pulmonary TB (IRR 2.53, 95% CI 1.08-5.30; p = 0.022). Other independent risk factors for TB infection in patients with SSc were age ≥ 60 years [hazard ratio (HR) 3.52, 95% CI 1.10-11.33; p = 0.035] and pulmonary hypertension (PH; HR 6.06, 95% CI 1.59-23.17; p = 0.008). Mortality did not differ for SSc patients with or without TB.
  
  
  CONCLUSIONS
  In this nationwide study, the incidence of TB infection was significantly higher among patients with SSc than in controls without SSc. Special care should be taken in managing patients with SSc who are at high risk for TB, especially those aged ≥ 60 years or who also have PH.
authors.affiliation: From the Division of Nephrology, the Division of Hematology and Oncology, and the Division of Gastroenterology, Department of Medicine, the Department of Neurology, Neurological Institute, the Department of Chest Medicine, and the Department of Family Medicine, Taipei Veterans General Hospital, Taipei; Division of Chest Medicine, Da-Chien General Hospital, Miaoli; School of Medicine, Institute of Clinical Medicine, Institute of Public Health, and Department of Internal Medicine, National Yang-Ming University; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Department of Medicine, Taipei City Hospital Heping Fuyou Branch; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.S-M. Ou, MD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; W-C. Fan, MD, Division of Chest Medicine, Da-Chien General Hospital, and School of Medicine, National Yang-Ming University; K-T. Cho, MD, Institute of Clinical Medicine, National Yang-Ming University, and Department of Chest Medicine, Taipei Veterans General Hospital; C-M. Yeh, MS, School of Medicine, National Yang-Ming University, and Department of Family Medicine, Taipei Veterans General Hospital; V.Y-F. Su, MD, Department of Chest Medicine, Taipei Veterans General Hospital; M-H. Hung, MD, Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital; Y-S. Chang, MD, School of Medicine, National Yang-Ming University, and Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Y-J. Lee, MD, School of Medicine, National Yang-Ming University, and Department of Neurology, Neurological Institute, Taipei Veterans General Hospital; Y-T. Chen, MD, Division of Nephrology, Department of Medicine, Taipei Vete
authors.forename: Shuo-Ming
authors.initials: SM
authors.lastname: Ou
authors.affiliation: From the Division of Nephrology, the Division of Hematology and Oncology, and the Division of Gastroenterology, Department of Medicine, the Department of Neurology, Neurological Institute, the Department of Chest Medicine, and the Department of Family Medicine, Taipei Veterans General Hospital, Taipei; Division of Chest Medicine, Da-Chien General Hospital, Miaoli; School of Medicine, Institute of Clinical Medicine, Institute of Public Health, and Department of Internal Medicine, National Yang-Ming University; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Department of Medicine, Taipei City Hospital Heping Fuyou Branch; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.S-M. Ou, MD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; W-C. Fan, MD, Division of Chest Medicine, Da-Chien General Hospital, and School of Medicine, National Yang-Ming University; K-T. Cho, MD, Institute of Clinical Medicine, National Yang-Ming University, and Department of Chest Medicine, Taipei Veterans General Hospital; C-M. Yeh, MS, School of Medicine, National Yang-Ming University, and Department of Family Medicine, Taipei Veterans General Hospital; V.Y-F. Su, MD, Department of Chest Medicine, Taipei Veterans General Hospital; M-H. Hung, MD, Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital; Y-S. Chang, MD, School of Medicine, National Yang-Ming University, and Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Y-J. Lee, MD, School of Medicine, National Yang-Ming University, and Department of Neurology, Neurological Institute, Taipei Veterans General Hospital; Y-T. Chen, MD, Division of Nephrology, Department of Medicine, Taipei Vete
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Fan
authors.affiliation: From the Division of Nephrology, the Division of Hematology and Oncology, and the Division of Gastroenterology, Department of Medicine, the Department of Neurology, Neurological Institute, the Department of Chest Medicine, and the Department of Family Medicine, Taipei Veterans General Hospital, Taipei; Division of Chest Medicine, Da-Chien General Hospital, Miaoli; School of Medicine, Institute of Clinical Medicine, Institute of Public Health, and Department of Internal Medicine, National Yang-Ming University; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Department of Medicine, Taipei City Hospital Heping Fuyou Branch; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.S-M. Ou, MD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; W-C. Fan, MD, Division of Chest Medicine, Da-Chien General Hospital, and School of Medicine, National Yang-Ming University; K-T. Cho, MD, Institute of Clinical Medicine, National Yang-Ming University, and Department of Chest Medicine, Taipei Veterans General Hospital; C-M. Yeh, MS, School of Medicine, National Yang-Ming University, and Department of Family Medicine, Taipei Veterans General Hospital; V.Y-F. Su, MD, Department of Chest Medicine, Taipei Veterans General Hospital; M-H. Hung, MD, Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital; Y-S. Chang, MD, School of Medicine, National Yang-Ming University, and Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Y-J. Lee, MD, School of Medicine, National Yang-Ming University, and Department of Neurology, Neurological Institute, Taipei Veterans General Hospital; Y-T. Chen, MD, Division of Nephrology, Department of Medicine, Taipei Vete
authors.forename: Kun-Ta
authors.initials: KT
authors.lastname: Chou
authors.affiliation: From the Division of Nephrology, the Division of Hematology and Oncology, and the Division of Gastroenterology, Department of Medicine, the Department of Neurology, Neurological Institute, the Department of Chest Medicine, and the Department of Family Medicine, Taipei Veterans General Hospital, Taipei; Division of Chest Medicine, Da-Chien General Hospital, Miaoli; School of Medicine, Institute of Clinical Medicine, Institute of Public Health, and Department of Internal Medicine, National Yang-Ming University; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Department of Medicine, Taipei City Hospital Heping Fuyou Branch; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.S-M. Ou, MD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; W-C. Fan, MD, Division of Chest Medicine, Da-Chien General Hospital, and School of Medicine, National Yang-Ming University; K-T. Cho, MD, Institute of Clinical Medicine, National Yang-Ming University, and Department of Chest Medicine, Taipei Veterans General Hospital; C-M. Yeh, MS, School of Medicine, National Yang-Ming University, and Department of Family Medicine, Taipei Veterans General Hospital; V.Y-F. Su, MD, Department of Chest Medicine, Taipei Veterans General Hospital; M-H. Hung, MD, Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital; Y-S. Chang, MD, School of Medicine, National Yang-Ming University, and Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Y-J. Lee, MD, School of Medicine, National Yang-Ming University, and Department of Neurology, Neurological Institute, Taipei Veterans General Hospital; Y-T. Chen, MD, Division of Nephrology, Department of Medicine, Taipei Vete
authors.forename: Kun-Ta
authors.initials: KT
authors.lastname: Cho
authors.affiliation: From the Division of Nephrology, the Division of Hematology and Oncology, and the Division of Gastroenterology, Department of Medicine, the Department of Neurology, Neurological Institute, the Department of Chest Medicine, and the Department of Family Medicine, Taipei Veterans General Hospital, Taipei; Division of Chest Medicine, Da-Chien General Hospital, Miaoli; School of Medicine, Institute of Clinical Medicine, Institute of Public Health, and Department of Internal Medicine, National Yang-Ming University; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Department of Medicine, Taipei City Hospital Heping Fuyou Branch; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.S-M. Ou, MD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; W-C. Fan, MD, Division of Chest Medicine, Da-Chien General Hospital, and School of Medicine, National Yang-Ming University; K-T. Cho, MD, Institute of Clinical Medicine, National Yang-Ming University, and Department of Chest Medicine, Taipei Veterans General Hospital; C-M. Yeh, MS, School of Medicine, National Yang-Ming University, and Department of Family Medicine, Taipei Veterans General Hospital; V.Y-F. Su, MD, Department of Chest Medicine, Taipei Veterans General Hospital; M-H. Hung, MD, Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital; Y-S. Chang, MD, School of Medicine, National Yang-Ming University, and Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Y-J. Lee, MD, School of Medicine, National Yang-Ming University, and Department of Neurology, Neurological Institute, Taipei Veterans General Hospital; Y-T. Chen, MD, Division of Nephrology, Department of Medicine, Taipei Vete
authors.forename: Chiu-Mei
authors.initials: CM
authors.lastname: Yeh
authors.affiliation: From the Division of Nephrology, the Division of Hematology and Oncology, and the Division of Gastroenterology, Department of Medicine, the Department of Neurology, Neurological Institute, the Department of Chest Medicine, and the Department of Family Medicine, Taipei Veterans General Hospital, Taipei; Division of Chest Medicine, Da-Chien General Hospital, Miaoli; School of Medicine, Institute of Clinical Medicine, Institute of Public Health, and Department of Internal Medicine, National Yang-Ming University; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Department of Medicine, Taipei City Hospital Heping Fuyou Branch; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.S-M. Ou, MD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; W-C. Fan, MD, Division of Chest Medicine, Da-Chien General Hospital, and School of Medicine, National Yang-Ming University; K-T. Cho, MD, Institute of Clinical Medicine, National Yang-Ming University, and Department of Chest Medicine, Taipei Veterans General Hospital; C-M. Yeh, MS, School of Medicine, National Yang-Ming University, and Department of Family Medicine, Taipei Veterans General Hospital; V.Y-F. Su, MD, Department of Chest Medicine, Taipei Veterans General Hospital; M-H. Hung, MD, Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital; Y-S. Chang, MD, School of Medicine, National Yang-Ming University, and Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Y-J. Lee, MD, School of Medicine, National Yang-Ming University, and Department of Neurology, Neurological Institute, Taipei Veterans General Hospital; Y-T. Chen, MD, Division of Nephrology, Department of Medicine, Taipei Vete
authors.forename: Vincent Yi-Fong
authors.initials: VY
authors.lastname: Su
authors.affiliation: From the Division of Nephrology, the Division of Hematology and Oncology, and the Division of Gastroenterology, Department of Medicine, the Department of Neurology, Neurological Institute, the Department of Chest Medicine, and the Department of Family Medicine, Taipei Veterans General Hospital, Taipei; Division of Chest Medicine, Da-Chien General Hospital, Miaoli; School of Medicine, Institute of Clinical Medicine, Institute of Public Health, and Department of Internal Medicine, National Yang-Ming University; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Department of Medicine, Taipei City Hospital Heping Fuyou Branch; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.S-M. Ou, MD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; W-C. Fan, MD, Division of Chest Medicine, Da-Chien General Hospital, and School of Medicine, National Yang-Ming University; K-T. Cho, MD, Institute of Clinical Medicine, National Yang-Ming University, and Department of Chest Medicine, Taipei Veterans General Hospital; C-M. Yeh, MS, School of Medicine, National Yang-Ming University, and Department of Family Medicine, Taipei Veterans General Hospital; V.Y-F. Su, MD, Department of Chest Medicine, Taipei Veterans General Hospital; M-H. Hung, MD, Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital; Y-S. Chang, MD, School of Medicine, National Yang-Ming University, and Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Y-J. Lee, MD, School of Medicine, National Yang-Ming University, and Department of Neurology, Neurological Institute, Taipei Veterans General Hospital; Y-T. Chen, MD, Division of Nephrology, Department of Medicine, Taipei Vete
authors.forename: Man-Hsin
authors.initials: MH
authors.lastname: Hung
authors.affiliation: From the Division of Nephrology, the Division of Hematology and Oncology, and the Division of Gastroenterology, Department of Medicine, the Department of Neurology, Neurological Institute, the Department of Chest Medicine, and the Department of Family Medicine, Taipei Veterans General Hospital, Taipei; Division of Chest Medicine, Da-Chien General Hospital, Miaoli; School of Medicine, Institute of Clinical Medicine, Institute of Public Health, and Department of Internal Medicine, National Yang-Ming University; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Department of Medicine, Taipei City Hospital Heping Fuyou Branch; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.S-M. Ou, MD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; W-C. Fan, MD, Division of Chest Medicine, Da-Chien General Hospital, and School of Medicine, National Yang-Ming University; K-T. Cho, MD, Institute of Clinical Medicine, National Yang-Ming University, and Department of Chest Medicine, Taipei Veterans General Hospital; C-M. Yeh, MS, School of Medicine, National Yang-Ming University, and Department of Family Medicine, Taipei Veterans General Hospital; V.Y-F. Su, MD, Department of Chest Medicine, Taipei Veterans General Hospital; M-H. Hung, MD, Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital; Y-S. Chang, MD, School of Medicine, National Yang-Ming University, and Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Y-J. Lee, MD, School of Medicine, National Yang-Ming University, and Department of Neurology, Neurological Institute, Taipei Veterans General Hospital; Y-T. Chen, MD, Division of Nephrology, Department of Medicine, Taipei Vete
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Chang
authors.affiliation: From the Division of Nephrology, the Division of Hematology and Oncology, and the Division of Gastroenterology, Department of Medicine, the Department of Neurology, Neurological Institute, the Department of Chest Medicine, and the Department of Family Medicine, Taipei Veterans General Hospital, Taipei; Division of Chest Medicine, Da-Chien General Hospital, Miaoli; School of Medicine, Institute of Clinical Medicine, Institute of Public Health, and Department of Internal Medicine, National Yang-Ming University; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Department of Medicine, Taipei City Hospital Heping Fuyou Branch; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.S-M. Ou, MD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; W-C. Fan, MD, Division of Chest Medicine, Da-Chien General Hospital, and School of Medicine, National Yang-Ming University; K-T. Cho, MD, Institute of Clinical Medicine, National Yang-Ming University, and Department of Chest Medicine, Taipei Veterans General Hospital; C-M. Yeh, MS, School of Medicine, National Yang-Ming University, and Department of Family Medicine, Taipei Veterans General Hospital; V.Y-F. Su, MD, Department of Chest Medicine, Taipei Veterans General Hospital; M-H. Hung, MD, Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital; Y-S. Chang, MD, School of Medicine, National Yang-Ming University, and Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Y-J. Lee, MD, School of Medicine, National Yang-Ming University, and Department of Neurology, Neurological Institute, Taipei Veterans General Hospital; Y-T. Chen, MD, Division of Nephrology, Department of Medicine, Taipei Vete
authors.forename: Yi-Jung
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: From the Division of Nephrology, the Division of Hematology and Oncology, and the Division of Gastroenterology, Department of Medicine, the Department of Neurology, Neurological Institute, the Department of Chest Medicine, and the Department of Family Medicine, Taipei Veterans General Hospital, Taipei; Division of Chest Medicine, Da-Chien General Hospital, Miaoli; School of Medicine, Institute of Clinical Medicine, Institute of Public Health, and Department of Internal Medicine, National Yang-Ming University; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Department of Medicine, Taipei City Hospital Heping Fuyou Branch; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.S-M. Ou, MD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; W-C. Fan, MD, Division of Chest Medicine, Da-Chien General Hospital, and School of Medicine, National Yang-Ming University; K-T. Cho, MD, Institute of Clinical Medicine, National Yang-Ming University, and Department of Chest Medicine, Taipei Veterans General Hospital; C-M. Yeh, MS, School of Medicine, National Yang-Ming University, and Department of Family Medicine, Taipei Veterans General Hospital; V.Y-F. Su, MD, Department of Chest Medicine, Taipei Veterans General Hospital; M-H. Hung, MD, Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital; Y-S. Chang, MD, School of Medicine, National Yang-Ming University, and Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Y-J. Lee, MD, School of Medicine, National Yang-Ming University, and Department of Neurology, Neurological Institute, Taipei Veterans General Hospital; Y-T. Chen, MD, Division of Nephrology, Department of Medicine, Taipei Vete
authors.forename: Yung-Tai
authors.initials: YT
authors.lastname: Chen
authors.affiliation: From the Division of Nephrology, the Division of Hematology and Oncology, and the Division of Gastroenterology, Department of Medicine, the Department of Neurology, Neurological Institute, the Department of Chest Medicine, and the Department of Family Medicine, Taipei Veterans General Hospital, Taipei; Division of Chest Medicine, Da-Chien General Hospital, Miaoli; School of Medicine, Institute of Clinical Medicine, Institute of Public Health, and Department of Internal Medicine, National Yang-Ming University; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Department of Medicine, Taipei City Hospital Heping Fuyou Branch; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.S-M. Ou, MD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; W-C. Fan, MD, Division of Chest Medicine, Da-Chien General Hospital, and School of Medicine, National Yang-Ming University; K-T. Cho, MD, Institute of Clinical Medicine, National Yang-Ming University, and Department of Chest Medicine, Taipei Veterans General Hospital; C-M. Yeh, MS, School of Medicine, National Yang-Ming University, and Department of Family Medicine, Taipei Veterans General Hospital; V.Y-F. Su, MD, Department of Chest Medicine, Taipei Veterans General Hospital; M-H. Hung, MD, Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital; Y-S. Chang, MD, School of Medicine, National Yang-Ming University, and Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Y-J. Lee, MD, School of Medicine, National Yang-Ming University, and Department of Neurology, Neurological Institute, Taipei Veterans General Hospital; Y-T. Chen, MD, Division of Nephrology, Department of Medicine, Taipei Vete
authors.forename: Pei-Wen
authors.initials: PW
authors.lastname: Chao
authors.affiliation: From the Division of Nephrology, the Division of Hematology and Oncology, and the Division of Gastroenterology, Department of Medicine, the Department of Neurology, Neurological Institute, the Department of Chest Medicine, and the Department of Family Medicine, Taipei Veterans General Hospital, Taipei; Division of Chest Medicine, Da-Chien General Hospital, Miaoli; School of Medicine, Institute of Clinical Medicine, Institute of Public Health, and Department of Internal Medicine, National Yang-Ming University; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Department of Medicine, Taipei City Hospital Heping Fuyou Branch; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.S-M. Ou, MD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; W-C. Fan, MD, Division of Chest Medicine, Da-Chien General Hospital, and School of Medicine, National Yang-Ming University; K-T. Cho, MD, Institute of Clinical Medicine, National Yang-Ming University, and Department of Chest Medicine, Taipei Veterans General Hospital; C-M. Yeh, MS, School of Medicine, National Yang-Ming University, and Department of Family Medicine, Taipei Veterans General Hospital; V.Y-F. Su, MD, Department of Chest Medicine, Taipei Veterans General Hospital; M-H. Hung, MD, Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital; Y-S. Chang, MD, School of Medicine, National Yang-Ming University, and Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Y-J. Lee, MD, School of Medicine, National Yang-Ming University, and Department of Neurology, Neurological Institute, Taipei Veterans General Hospital; Y-T. Chen, MD, Division of Nephrology, Department of Medicine, Taipei Vete
authors.forename: Wu-Chang
authors.initials: WC
authors.lastname: Yang
authors.affiliation: From the Division of Nephrology, the Division of Hematology and Oncology, and the Division of Gastroenterology, Department of Medicine, the Department of Neurology, Neurological Institute, the Department of Chest Medicine, and the Department of Family Medicine, Taipei Veterans General Hospital, Taipei; Division of Chest Medicine, Da-Chien General Hospital, Miaoli; School of Medicine, Institute of Clinical Medicine, Institute of Public Health, and Department of Internal Medicine, National Yang-Ming University; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Department of Medicine, Taipei City Hospital Heping Fuyou Branch; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.S-M. Ou, MD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; W-C. Fan, MD, Division of Chest Medicine, Da-Chien General Hospital, and School of Medicine, National Yang-Ming University; K-T. Cho, MD, Institute of Clinical Medicine, National Yang-Ming University, and Department of Chest Medicine, Taipei Veterans General Hospital; C-M. Yeh, MS, School of Medicine, National Yang-Ming University, and Department of Family Medicine, Taipei Veterans General Hospital; V.Y-F. Su, MD, Department of Chest Medicine, Taipei Veterans General Hospital; M-H. Hung, MD, Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital; Y-S. Chang, MD, School of Medicine, National Yang-Ming University, and Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Y-J. Lee, MD, School of Medicine, National Yang-Ming University, and Department of Neurology, Neurological Institute, Taipei Veterans General Hospital; Y-T. Chen, MD, Division of Nephrology, Department of Medicine, Taipei Vete
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.affiliation: From the Division of Nephrology, the Division of Hematology and Oncology, and the Division of Gastroenterology, Department of Medicine, the Department of Neurology, Neurological Institute, the Department of Chest Medicine, and the Department of Family Medicine, Taipei Veterans General Hospital, Taipei; Division of Chest Medicine, Da-Chien General Hospital, Miaoli; School of Medicine, Institute of Clinical Medicine, Institute of Public Health, and Department of Internal Medicine, National Yang-Ming University; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Department of Medicine, Taipei City Hospital Heping Fuyou Branch; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.S-M. Ou, MD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; W-C. Fan, MD, Division of Chest Medicine, Da-Chien General Hospital, and School of Medicine, National Yang-Ming University; K-T. Cho, MD, Institute of Clinical Medicine, National Yang-Ming University, and Department of Chest Medicine, Taipei Veterans General Hospital; C-M. Yeh, MS, School of Medicine, National Yang-Ming University, and Department of Family Medicine, Taipei Veterans General Hospital; V.Y-F. Su, MD, Department of Chest Medicine, Taipei Veterans General Hospital; M-H. Hung, MD, Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital; Y-S. Chang, MD, School of Medicine, National Yang-Ming University, and Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Y-J. Lee, MD, School of Medicine, National Yang-Ming University, and Department of Neurology, Neurological Institute, Taipei Veterans General Hospital; Y-T. Chen, MD, Division of Nephrology, Department of Medicine, Taipei Vete
authors.forename: Wei-Shu
authors.initials: WS
authors.lastname: Wang
authors.affiliation: From the Division of Nephrology, the Division of Hematology and Oncology, and the Division of Gastroenterology, Department of Medicine, the Department of Neurology, Neurological Institute, the Department of Chest Medicine, and the Department of Family Medicine, Taipei Veterans General Hospital, Taipei; Division of Chest Medicine, Da-Chien General Hospital, Miaoli; School of Medicine, Institute of Clinical Medicine, Institute of Public Health, and Department of Internal Medicine, National Yang-Ming University; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Department of Medicine, Taipei City Hospital Heping Fuyou Branch; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.S-M. Ou, MD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; W-C. Fan, MD, Division of Chest Medicine, Da-Chien General Hospital, and School of Medicine, National Yang-Ming University; K-T. Cho, MD, Institute of Clinical Medicine, National Yang-Ming University, and Department of Chest Medicine, Taipei Veterans General Hospital; C-M. Yeh, MS, School of Medicine, National Yang-Ming University, and Department of Family Medicine, Taipei Veterans General Hospital; V.Y-F. Su, MD, Department of Chest Medicine, Taipei Veterans General Hospital; M-H. Hung, MD, Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital; Y-S. Chang, MD, School of Medicine, National Yang-Ming University, and Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Y-J. Lee, MD, School of Medicine, National Yang-Ming University, and Department of Neurology, Neurological Institute, Taipei Veterans General Hospital; Y-T. Chen, MD, Division of Nephrology, Department of Medicine, Taipei Vete
authors.forename: Hsuan-Ming
authors.initials: HM
authors.lastname: Tsao
authors.affiliation: From the Division of Nephrology, the Division of Hematology and Oncology, and the Division of Gastroenterology, Department of Medicine, the Department of Neurology, Neurological Institute, the Department of Chest Medicine, and the Department of Family Medicine, Taipei Veterans General Hospital, Taipei; Division of Chest Medicine, Da-Chien General Hospital, Miaoli; School of Medicine, Institute of Clinical Medicine, Institute of Public Health, and Department of Internal Medicine, National Yang-Ming University; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Department of Medicine, Taipei City Hospital Heping Fuyou Branch; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.S-M. Ou, MD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; W-C. Fan, MD, Division of Chest Medicine, Da-Chien General Hospital, and School of Medicine, National Yang-Ming University; K-T. Cho, MD, Institute of Clinical Medicine, National Yang-Ming University, and Department of Chest Medicine, Taipei Veterans General Hospital; C-M. Yeh, MS, School of Medicine, National Yang-Ming University, and Department of Family Medicine, Taipei Veterans General Hospital; V.Y-F. Su, MD, Department of Chest Medicine, Taipei Veterans General Hospital; M-H. Hung, MD, Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital; Y-S. Chang, MD, School of Medicine, National Yang-Ming University, and Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Y-J. Lee, MD, School of Medicine, National Yang-Ming University, and Department of Neurology, Neurological Institute, Taipei Veterans General Hospital; Y-T. Chen, MD, Division of Nephrology, Department of Medicine, Taipei Vete
authors.forename: Li-Fu
authors.initials: LF
authors.lastname: Chen
authors.affiliation: From the Division of Nephrology, the Division of Hematology and Oncology, and the Division of Gastroenterology, Department of Medicine, the Department of Neurology, Neurological Institute, the Department of Chest Medicine, and the Department of Family Medicine, Taipei Veterans General Hospital, Taipei; Division of Chest Medicine, Da-Chien General Hospital, Miaoli; School of Medicine, Institute of Clinical Medicine, Institute of Public Health, and Department of Internal Medicine, National Yang-Ming University; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Department of Medicine, Taipei City Hospital Heping Fuyou Branch; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.S-M. Ou, MD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; W-C. Fan, MD, Division of Chest Medicine, Da-Chien General Hospital, and School of Medicine, National Yang-Ming University; K-T. Cho, MD, Institute of Clinical Medicine, National Yang-Ming University, and Department of Chest Medicine, Taipei Veterans General Hospital; C-M. Yeh, MS, School of Medicine, National Yang-Ming University, and Department of Family Medicine, Taipei Veterans General Hospital; V.Y-F. Su, MD, Department of Chest Medicine, Taipei Veterans General Hospital; M-H. Hung, MD, Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital; Y-S. Chang, MD, School of Medicine, National Yang-Ming University, and Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Y-J. Lee, MD, School of Medicine, National Yang-Ming University, and Department of Neurology, Neurological Institute, Taipei Veterans General Hospital; Y-T. Chen, MD, Division of Nephrology, Department of Medicine, Taipei Vete
authors.forename: Fa-Yauh
authors.initials: FY
authors.lastname: Lee
authors.affiliation: From the Division of Nephrology, the Division of Hematology and Oncology, and the Division of Gastroenterology, Department of Medicine, the Department of Neurology, Neurological Institute, the Department of Chest Medicine, and the Department of Family Medicine, Taipei Veterans General Hospital, Taipei; Division of Chest Medicine, Da-Chien General Hospital, Miaoli; School of Medicine, Institute of Clinical Medicine, Institute of Public Health, and Department of Internal Medicine, National Yang-Ming University; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Department of Medicine, Taipei City Hospital Heping Fuyou Branch; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.S-M. Ou, MD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; W-C. Fan, MD, Division of Chest Medicine, Da-Chien General Hospital, and School of Medicine, National Yang-Ming University; K-T. Cho, MD, Institute of Clinical Medicine, National Yang-Ming University, and Department of Chest Medicine, Taipei Veterans General Hospital; C-M. Yeh, MS, School of Medicine, National Yang-Ming University, and Department of Family Medicine, Taipei Veterans General Hospital; V.Y-F. Su, MD, Department of Chest Medicine, Taipei Veterans General Hospital; M-H. Hung, MD, Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital; Y-S. Chang, MD, School of Medicine, National Yang-Ming University, and Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital; Y-J. Lee, MD, School of Medicine, National Yang-Ming University, and Department of Neurology, Neurological Institute, Taipei Veterans General Hospital; Y-T. Chen, MD, Division of Nephrology, Department of Medicine, Taipei Vete
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000150:complications* / Q000401:mortality; D013624:Taiwan / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology* / Q000401:mortality
keywords: PULMONARY FIBROSIS; PULMONARY HYPERTENSION; SYSTEMIC SCLEROSIS; TUBERCULOSIS