Abstract
Purpose
To investigate the incidence, prevalence, and factors related to pterygium in Taiwan.
Study design
An ecological study
Methods
We analyzed a random sample of 1 million individuals in Taiwan drawn from the National Health Insurance Database (NHIRD), established in 2005, for the period 2000 to 2011. Patients with pterygium were identified using ICD-9-CM diagnostic codes. The prevalence and annual age- and gender-adjusted incidence of pterygium were calculated for each county in Taiwan. The risk factors including ultraviolet (UV) exposure, outdoor occupation, educational level, and average socioeconomic status of each county of each index year were identified. Univariate and backward elimination multivariate selection by the mixed-effects model were performed to identify significant risk factors related to the incidence of pterygium in Taiwan.
Results
A total of 22,063 individuals with pterygium (10,125 men and 11,938 women) were identified in this study. The prevalence of pterygium was 2.14% in the overall population and 3.48% in the population aged 40 years or older. The occurrence of pterygium was greater in women. In addition, this study demonstrated that UV exposure and low educational level are correlated with the age- and gender-adjusted incidence of pterygium.
Conclusion
Our study is the first to use the NHIRD to determine the prevalence (2.14%) and annual age- and gender-adjusted incidence of pterygium among the general population of Taiwan. The relationship of pterygium with UV exposure and educational level suggests a complex and multifactorial etiology for this disease.
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References
Liu L, Wu J, Geng J, Yuan Z, Huang D. Geographical prevalence and risk factors for pterygium: a systematic review and meta-analysis. BMJ Open. 2013;3:e003787. https://doi.org/10.1136/bmjopen-2013-003787.
Detorakis ET, Spandidos DA. Pathogenetic mechanisms and treatment options for ophthalmic pterygium: trends and perspectives (Review). Int J Mol Med. 2009;23:439–47.
Tomidokoro A, Miyata K, Sakaguchi Y, Samejima T, Tokunaga T, Oshika T. Effects of pterygium on corneal spherical power and astigmatism. Ophthalmology. 2000;107:1568–71.
Asokan R, Venkatasubbu RS, Velumuri L, Lingam V, George R. Prevalence and associated factors for pterygium and pinguecula in a South Indian population. Ophthalmic Physiol Opt. 2012;32:39–44.
Viso E, Gude F, Rodríguez-Ares M. Prevalence of pinguecula and pterygium in a general population in Spain. Eye. 2011;25:350–7.
Liang QF, Xu L, Jin XY, You QS, Yang XH, Cui TT. Epidemiology of pterygium in aged rural population of Beijing, China. Chin Med J (Engl). 2010;123:1699.
Cajucom-Uy H, Tong L, Wong TY, Tay WT, Saw SM. The prevalence of and risk factors for pterygium in an urban Malay population: the Singapore Malay Eye Study (SiMES). Br J Ophthalmol. 2010;94:977–81.
West S, Munoz B. Prevalence of pterygium in Latinos: Proyecto VER. Br J Ophthalmol. 2009;93:1287–90.
Shiroma H, Higa A, Sawaguchi S, Iwase A, Tomidokoro A, Amano S, et al. Prevalence and risk factors of pterygium in a southwestern island of Japan: the Kumejima Study. Am J Ophthalmol. 2009;148(766–71):e1.
Fotouhi A, Hashemi H, Khabazkhoob M, Mohammad K. Prevalence and risk factors of pterygium and pinguecula: the Tehran Eye Study. Eye. 2008;23:1125–9.
Durkin SR, Abhary S, Newland HS, Selva D, Aung T, Casson RJ. The prevalence, severity and risk factors for pterygium in central Myanmar: the Meiktila Eye Study. Br J Ophthalmol. 2008;92:25–9.
Nemesure B, Wu SY, Hennis A, Leske MC, Barbados Eye Studies Group. Nine-year incidence and risk factors for pterygium in the Barbados Eye Studies. Ophthalmology. 2008;115:2153–8.
Bradley JC, Yang W, Bradley RH, Reid TW, Schwab IR. The science of pterygia. Br J Ophthalmol. 2010;94:815–20.
Al-Bdour M, Al-Latayfeh MM. Risk factors for pterygium in an adult Jordanian population. Acta Ophthalmol Scand. 2004;82:64–7.
Threlfall TJ, English DR. Sun exposure and pterygium of the eye: a dose-response curve. Am J Ophthalmol. 1999;128:280–7.
Lu P, Chen X, Kang Y, Ke L, Wei X, Zhang W. Pterygium in Tibetans: a population-based study in China. Clin Exp Ophthalmol. 2007;35:828–33.
Lim CY, Kim SH, Chuck RS, Lee JK, Park CY. Risk factors for pterygium in Korea: The Korean National Health and Nutrition Examination Survey V, 2010–2012. Medicine. 2015;94:e1258. https://doi.org/10.1097/MD.0000000000001258.
Chen CL, Lai CH, Wu PL, Wu PC, Chou TH, Weng HH. The epidemiology of patients with pterygium in southern Taiwanese adults: the Chiayi survey. Taiwan J Ophthalmol. 2013;3:58–61.
Huang TL, Hsu SY, Tsai RK, Sheu MM. Etiology of ocular diseases in elderly Amis aborigines in Eastern Taiwan (The Amis Eye Study). Jpn J Ophthalmol. 2010;54:266–71.
Lin W, Wang SL, Wu HJ, Chang KH, Yeh P, Chen CJ, et al. Associations between arsenic in drinking water and pterygium in southwestern Taiwan. Environ Health Perspect. 2008;116:952.
Lin SF, Tsai RK, Tung IC, Sheu MM. An epidemiologic study of pterygium in middle-aged and elderly aboriginal populations of the Tao Tribe of Orchid Island in Taiwan. Tzu Chi Med J. 2006;18:283–6.
Chen YC, Chang SC, Pu C, Tang GJ. The impact of nationwide education program on clinical practice in sepsis care and mortality of severe sepsis: a population-based study in Taiwan. PloS One. 2013;8:e77414. https://doi.org/10.1371/journal.pone.0077414.
Wu CL, Wu JC, Huang WC, Wu HT, Chiou HJ, Liu L, et al. The risk of stroke after percutaneous vertebroplasty for osteoporosis: a population-based cohort study. PloS One. 2012;7:e31405. https://doi.org/10.1371/journal.pone.0031405.
Chien IC, Chou YJ, Lin CH, Bih SH, Chou P. Prevalence of psychiatric disorders among national health insurance enrollees in Taiwan. Psychiatr Serv. 2004;55:691–7.
Chien IC, Chou YJ, Lin CH, Bih SH, Chou P, Chang HJ. Prevalence and incidence of schizophrenia among national health insurance enrollees in Taiwan. Psychiatry Clin Neurosci. 2004;58:611–8.
Chen YC, Yeh HY, Wu JC, Haschler I, Chen TJ, Wetter T. Taiwan’s National Health Insurance Research Database: administrative health care database as study object in bibliometrics. Scientometrics. 2011;86:365–80.
Cheng CL, Kao YH, Lin SJ, Lee CH, Lai ML. Validation of the National Health Insurance Research Database with ischemic stroke cases in Taiwan. Pharmacoepidemiol Drug Safety. 2011;20:236–42.
Tan C, Lim T, Koh W, Liew G, Hoh S, Tan C, et al. Epidemiology of pterygium on a tropical island in the Riau Archipelago. Eye. 2006;20:908–12.
Li X, Dai Y, Xu W, Xu J. Essential role of ultraviolet radiation in the decrease of corneal endothelial cell density (ECD) caused by pterygium. Eye (Lond). 2018;32:1886–92.
Moran DJ, Hollows FC. Pterygium and ultraviolet radiation: a positive correlation. Br J Ophthalmol. 1984;68:343–6.
Luthra R, Nemesure BB, Wu S-Y, Xie SH, Leske MC. Frequency and risk factors for pterygium in the Barbados Eye Study. Arch Ophthalmol. 2001;119:1827.
Acknowledgements
We extend our deepest gratitude to Professor Hsu Kuang-Hung at Chang Gung University, Taiwan, and to Dr Bing-Yu Chen at the Department of Medical Research and Development, Chang Gung Memorial Hospital, Keelung, Taiwan, for their persistent assistance in reviewing our manuscript with the utmost care and for offering us invaluable advice and informative suggestions along the way regarding the statistical analysis. This study was supported by Grants (Nos. CLRPG2C0021-24 and CLRPG2G0081-82 to C.-C. Sun) from the Chang Gung Medical Research Foundation, Taiwan.
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Y.-H. Lin, None; C.-C. Sun, None; L. Yeung, None; Y.-W. Yu, None; M.-H. Sun, None; K.-J. Chen, None.
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Lin, YH., Sun, CC., Yeung, L. et al. Epidemiologic study of pterygium in Taiwan. Jpn J Ophthalmol 63, 297–303 (2019). https://doi.org/10.1007/s10384-019-00670-x
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DOI: https://doi.org/10.1007/s10384-019-00670-x