Epidemiology Study and Evaluation of Prevention Strategies on Liver Diseases Using Database and Serum Samples Collected from Community-Based Comprehensive Screenings in Taiwan during 2003 to 2013 (II)

The original protocol of this study is a 3-year study including activating a large health database (1st year), epidemiological study on liver dieases (2nd year) and evaluation of prevention stratagem for liver disease. However, only the 1st year project was proven in 2014. For achieve academic outcomes after database cleaning and activation, we plan to conduct this 1-year continuous protocol on both both epidemiological and prevention stratagem evaluation. During 2003 and 2013, around 370,000 residents have been checked under comprehensive health screening program in Tainan. Not only their health data was computerized, but also a serum bank was established. Even calling for projects, the valuable health resource has not been used in academic research. There are some barriers, such as validation of the database, ethical consideration and linkage with national database. In this year, we handle the raw database with 376,867subjects, and created two valide and eazy-to-use datasets, one is for cross-sectional study which includes only information in the first visit of 190,954 participants and the other will be for longitudinal study which includes information of 78,404 participants with 219,661 repeated measurements. After these two datasets established, we will analyze these decoded databases as an academic researcher. For the outcomes or health events, we will link the datasets to national databases of overall mortality, cancer registration, and anti-viral treatment of chronic hepatitis B and C. In the continuous project, we will conduct epidemiological studies of liver disease, including REVEAL-like study, differentiation between cohort effect and age effect in hepatitis B and C infections and health effects of series changes of blood biochemical tests. In addition to REVEAL study, we can include non-invasive serological markers for hepatic fibrosis and metablic syndrome, and we also have enough cases to study “non-B, non C” and “B+C” hepatocellular carcinoma. For cost-effect considerations, nested case-control study will be an adequate design. Selected serum samples will be tests for viral loads of HBV and HCV. The seldom database included the wide age range as 11 years in a same birth cohort. It should be quite a good material for study differentiation between cohort effect and age effect in hepatitis B and C infections. Using trajectory analysis, datasets with repeated measurement samples can be objectively divided into different patterns. This study will explore that relation between health events and series pattern of biochemical tests rather than a single time spot. At the same time, we will evaluate the effects of preventive strategies of liver diseases, including a national strategy as anti-viral treatment of hepatitis B and C; countywide strategies as repeated hepatitis markers screening, ultrasonographic screening for hepatocellular carcinoma on the high risk groups, and further management of detected hepatitis cases with elevated ALT; and a local strategy as establishment of an assessable hepatology clinic in a country-side townships Yujing and Guantian. We will calculate the reduction incidence and mortality of liver diseases as academic studies. We will further try to find gaps between public health screening to NHI reimbursed medical care. In conclusion, this continuous project willconduct epidemiology study of liver disease in current status as well as evaluate the ongoing national and local preventive strategies of liver disease using an activated mass health data and serum bank. It should be a particle projects.

Project ID:PC10408-1966
External Project ID:MOST104-2314-B182-014