title: Association of chronic obstructive pulmonary disease and hemorrhoids: A nationwide cohort study.
abstract: According to traditional Chinese medicine (TCM) theory, a specific physiological and pathological relationship exists between the lungs and the large intestine. The aim of this study is to delineate the association of chronic obstructive pulmonary disease (COPD) and hemorrhoids in order to verify the "interior-exterior" relationship between the lungs and the large intestine. A retrospective cohort study is conceived from the National Health Insurance Research Database, Taiwan. The 2 samples (COPD cohort and non-COPD cohort) were selected from the 2000 to 2003 beneficiaries of the NHI, representing patients age 20 and older in Taiwan, with the follow-up ending on December 31, 2011. The COPD cohort (n = 51,506) includes every patient newly diagnosed as having Chronic Obstructive Pulmonary Disease (COPD, ICD-9-CM: 490-492, 494, 496), who have made at least 2 confirmed visits to the hospital/clinic. The non-COPD cohort (n = 103,012) includes patients without COPD and is selected via a 1:2 (COPD: non-COPD) matching by age group (per 5 years), gender, and index date (diagnosis date of COPD for the COPD cohort). Compared with non-COPD cohorts, patients with COPD have a higher likelihood of having hemorrhoids and the age-, gender- and comorbidies-adjusted hazard ratio (HR) for hemorrhoids is 1.56 (95% confidence intervals [CI]:1.50-1.62). The adjusted HR of hemorrhoids for females is 0.79 (95% CI: 0.77-0.83), which is significantly less than that for males. The elderly groups, 40 to 59 years and aged 60 or above, have higher adjusted HRs than younger age groups (20-39 years), 1.19 (95% CI: 1.14-1.26), and 1.18 (95% CI: 1.12-1.24), respectively. Patients with COPD may have a higher likelihood to have hemorrhoids in this retrospective cohort study. This study verifies the fundamental theorem of TCM that there is a definite pathogenic association between the lungs and large intestine.
authors.affiliation: Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung Division of Chinese Medicine, An Nan Hospital, China Medical University, Tainan Departments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital Department of Urology, Taichung Veterans General Hospital Department of Psychology, College of Medical and Health Science, Asia University, Taichung Division of Chinese Medicine, China Medical University Beigang Hospital, Yunlin Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Lih-Hwa
authors.initials: LH
authors.lastname: Lin
authors.forename: Justin Ji-Yuen
authors.initials: JJ
authors.lastname: Siu
authors.forename: Po-Chi
authors.initials: PC
authors.lastname: Liao
authors.forename: Jen-Huai
authors.initials: JH
authors.lastname: Chiang
authors.forename: Pei-Chi
authors.initials: PC
authors.lastname: Chou
authors.forename: Huey-Yi
authors.initials: HY
authors.lastname: Chen
authors.forename: Tsung-Jung
authors.initials: TJ
authors.lastname: Ho
authors.forename: Ming-Yen
authors.initials: MY
authors.lastname: Tsai
authors.forename: Yung-Hsiang
authors.initials: YH
authors.lastname: Chen
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Chen
mesh_terms: D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006484:Hemorrhoids / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008516:Medicine, Chinese Traditional; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult