{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T06:03:22Z","timestamp":1792649002332,"version":"4.5.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,1,21]],"date-time":"2022-01-21T00:00:00Z","timestamp":1642723200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004391","name":"China Medical University Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004391","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p><jats:italic>Candida<\/jats:italic> infection is prevalent in patients with Sj\u00f6gren's syndrome (SjS), which usually takes years to reach diagnosis. Is the link a two-way street? The role of <jats:italic>Candida<\/jats:italic> infection before SjS has not been examined clearly. This study was conducted to provide epidemiological evidence regarding the relationship between the first acquisition of <jats:italic>Candida<\/jats:italic> infection and subsequent SjS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Totally, 23,494 individuals newly diagnosed with <jats:italic>Candida<\/jats:italic> infection were enrolled from 2000, to 2012. Controls (<jats:italic>N<\/jats:italic> = 93,976) were selected at a 1:4 ratio through propensity score matched (PSM) using the greedy algorithm. Exposure was defined according to the <jats:italic>International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)<\/jats:italic> codes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>SjS was recorded in the Registry for Catastrophic Illness Patients Database (RCIPD). Cox proportional hazard model was used to analyze the association and sensitivity analyses for cross-validation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 117,470 individuals (106,077 [89%] women), 23,494 individuals (20.0%) had <jats:italic>Candida<\/jats:italic> infection and 104 individuals (0.1%) developed SjS. The incidence of SjS was higher in the exposed group compared with the controls (1.92 vs. 0. 98 per 10,000 person-years) with adjusted hazard ratio (aHR) 1.90 (95% CI, 1.25\u20132.87). The aHRs in subgroups of aged 18\u201330 years, oral candidiasis and depression were 4.30 (95% CI, 1.60\u201311.55), 4.70 (4.70\u201313.93) and 6.34 (2.16\u201318.66). Sensitivity analyses yield consistent results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Residents in Taiwan with <jats:italic>Candida<\/jats:italic> infection have higher risk of SjS. For early diagnosis of SjS, clinicians are advised to take <jats:italic>Candida<\/jats:italic> infection into account in some situation.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2021.796324","type":"journal-article","created":{"date-parts":[[2022,1,21]],"date-time":"2022-01-21T06:55:00Z","timestamp":1642748100000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Candida Infection as an Early Sign of Subsequent Sj\u00f6gren's Syndrome: A Population-Based Matched Cohort Study"],"prefix":"10.3389","volume":"8","author":[{"given":"Chia-Lun","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang-Cherng","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao-Min","family":"Hung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei-Chia","family":"Chou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hei-Tung","family":"Yip","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renin","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James Cheng-Chung","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,1,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"16047","DOI":"10.1038\/nrdp.2016.47","article-title":"Sj\u00f6gren syndrome","volume":"2","author":"Brito-Zer\u00f3n","year":"2016","journal-title":"Nat Rev Dis Primers."},{"key":"B2","doi-asserted-by":"publisher","first-page":"706","DOI":"10.3899\/jrheum.100883","article-title":"Incidence and mortality of treated primary Sjogren's syndrome in Taiwan: a population-based study","volume":"38","author":"Weng","year":"2011","journal-title":"J Rheumatol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"10627","DOI":"10.1038\/s41598-020-67462-z","article-title":"Prevalence of Sj\u00f6gren's syndrome in the general adult population in Spain: estimating the proportion of undiagnosed cases","volume":"10","author":"Narv\u00e1ez","year":"2020","journal-title":"Sci Rep."},{"key":"B4","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1016\/j.mayocp.2017.01.020","article-title":"Incidence and Mortality of Physician-Diagnosed Primary Sj\u00f6gren Syndrome: Time Trends Over a 40-Year Period in a Population-Based US Cohort","volume":"92","author":"Maciel","year":"2017","journal-title":"Mayo Clin Proc."},{"key":"B5","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1007\/s00296-016-3474-7","article-title":"Estimating the incidence of connective tissue diseases and vasculitides in a defined population in Northern Savo area in 2010","volume":"36","author":"Elfving","year":"2016","journal-title":"Rheumatol Int."},{"key":"B6","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1002\/acr.23707","article-title":"The incidence and prevalence of adult primary Sj\u00f6gren's syndrome in New York County","volume":"71","author":"Izmirly","year":"2019","journal-title":"Arthritis Care Res (Hoboken)."},{"key":"B7","first-page":"98","article-title":"Sj\u00f6gren's syndrome: managed care data from a large United States population highlight real-world health care burden and lack of treatment options","volume":"35","author":"Birt","year":"2017","journal-title":"Clin Exp Rheumatol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1854","DOI":"10.1001\/jama.2013.278448","article-title":"Autoantibodies present before symptom onset in primary Sj\u00f6gren syndrome","volume":"310","author":"Jonsson","year":"2013","journal-title":"Jama."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1367","DOI":"10.1111\/odi.12896","article-title":"Silva R, de Figueiredo MAZ. 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