title: Survival and complication rates in patients with thalassemia major in Taiwan.
abstract: While transfusion and iron chelation therapy for thalassemia major (TM) has improved dramatically in recent years, the consequences of this improvement (current rates of survival and TM-related complications) remain unknown.
  
  
  
  This nationwide population-based cohort study analyzed 2007-2011 data obtained from the Taiwanese National Health Insurance Research Database.
  
  
  
  After excluding those patients receiving hematopoietic stem cell transplantation, we enrolled 454 patients with TM who received transfusion and chelation therapy (median age, 17.2 years). Among these patients, the mortality rate was 2.9% in 2007, 2.3% in 2008, 2.9% in 2009, 2.6% in 2010, and 0.7% in 2011. Heart was the most common target organ of TM-related complications. There were 80 patients (17.6%) with arrhythmia and 86 patients (18.9%) with congestive heart failure. Dysfunction of endocrine organs was common, and the most common endocrinopathy was hypogonadism (23.1%), followed by diabetes (21.2%). There were 75 patients (16.5%) with liver cirrhosis and 79 patients (17.4%) with osteoporosis.
  
  
  
  Adequate red blood cell transfusion and iron chelation is available to all patients with TM in Taiwan under the universal health insurance system, and has resulted in reduction of TM-related mortality to very low levels. As these patients get older, early detection of complications and adequate intervention are important to quality-of-life improvement.
authors: Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Han-Ping
authors: HP
authors: Wu
authors: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.|College of Medicine, China Medical University, Taichung, Taiwan.
authors: Cheng-Li
authors: CL
authors: Lin
authors: Division of Pediatric Hematology-Oncology, Children's Hospital, China Medical University, Taichung, Taiwan.
authors: Yin-Chen
authors: YC
authors: Chang
authors: Division of Pediatric Hematology-Oncology, Children's Hospital, China Medical University, Taichung, Taiwan.|School of Post-Baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
authors: Kang-Hsi
authors: KH
authors: Wu
authors: Department of Nursing, College of Medicine and Nursing, Hungkuang University, Taichung, Taiwan.
authors: Rouh-Lih
authors: RL
authors: Lei
authors: Division of Pediatric Hematology-Oncology, Children's Hospital, China Medical University, Taichung, Taiwan.|Department of Biotechnology and Bioinformatics, Asia University, Taichung, Taiwan.
authors: Ching-Tien
authors: CT
authors: Peng
authors: Division of Pediatric Hematology-Oncology, Children's Hospital, China Medical University, Taichung, Taiwan.
authors: Tefu
authors: T
authors: Weng
authors: Division of Pediatric Hematology-Oncology, Children's Hospital, China Medical University, Taichung, Taiwan.
authors: Yu-Man
authors: YM
authors: Tai
authors: Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan.|School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors: Yu-Hua
authors: YH
authors: Chao
mesh_terms: D000293:Adolescent; D000328:Adult; D015913:Chelation Therapy / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D017707:Erythrocyte Transfusion / Q000401:mortality*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult; D017086:beta-Thalassemia / Q000150:complications* / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy
keywords: Taiwan; complication; national health insurance; survival; thalassemia major