title: Acute Anticholinesterase Pesticide Poisoning Caused a Long-Term Mortality Increase: A Nationwide Population-Based Cohort Study.
abstract: Acute anticholinesterase pesticide (organophosphate and carbamate) poisoning (ACPP) often produces severe complications, and sometimes death. We investigated the long-term mortality of patients with ACPP because it is not sufficiently understood. In this retrospective nationwide population-based cohort study, 818 patients with ACPP and 16,360 healthy comparisons from 1999 to 2010 were selected from Taiwan's National Health Insurance Research Database. They were followed until 2011. Ninety-four (11.5%) ACPP patients and 793 (4.9%) comparisons died (P < 0.01) during follow-up. The incidence rate ratios (IRRs) of death were 2.5 times higher in ACPP patients than in comparisons (P < 0.01). The risk of death was particularly high in the first month after ACPP (IRR: 92.7; 95% confidence interval [CI]: 45.0-191.0) and still high for ~6 months (IRR: 3.8; 95% CI: 1.9-7.4). After adjusting for age, gender, selected comorbidities, geographic area, and monthly income, the hazard ratio of death for ACPP patients was still 2.4 times higher than for comparisons. Older age (≥35 years), male gender, diabetes mellitus, coronary artery disease, hypertension, stroke, mental disorder, and lower monthly income also predicted death. ACPP significantly increased long-term mortality. In addition to early follow-up after acute treatment, comorbidity control and socioeconomic assistance are needed for patients with ACPP.
authors.affiliation: From the Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan (H-SH, C-C Hsu, H-JL, C-C Huang); Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan (H-SH, S-BS, C-C Huang); Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan (C-C Hsu, H-JL); Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan (S-FW, J-JW); Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan (S-FW); Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan (H-JL); Department of Leisure, Recreation, and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan (S-BS); Department of Medical Research, Chi Mei Medical Center, Liouying, Tainan, Taiwan (S-BS); Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C-C Huang, H-RG); Department of Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan (C-C Huang); Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan (C-C Huang); Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan (H-RG).
authors.forename: Hung-Sheng
authors.initials: HS
authors.lastname: Huang
authors.forename: Chien-Chin
authors.initials: CC
authors.lastname: Hsu
authors.forename: Shih-Feng
authors.initials: SF
authors.lastname: Weng
authors.forename: Hung-Jung
authors.initials: HJ
authors.lastname: Lin
authors.forename: Jhi-Joung
authors.initials: JJ
authors.lastname: Wang
authors.forename: Shih-Bin
authors.initials: SB
authors.lastname: Su
authors.forename: Chien-Cheng
authors.initials: CC
authors.lastname: Huang
authors.forename: How-Ran
authors.initials: HR
authors.lastname: Guo
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002800:Cholinesterase Inhibitors / Q000506:poisoning*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D062025:Organophosphate Poisoning / Q000453:epidemiology*; D010575:Pesticides / Q000506:poisoning*; D011159:Population Surveillance / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D002800:Cholinesterase Inhibitors; D010575:Pesticides