Epidemiology最新文献

{"title":"Impact of the first nirsevimab immunization campaign on infant RSV-related emergency department visits and hospitalizations in Québec, Canada.","authors":"Amandine Bemmo, Élise Fortin, Patrick Fortin, Radhouene Doggui, Charles-Antoine Guay, Rachid Amini, Sara Carazo, Jesse Papenburg, Rodica Gilca","doi":"10.1097/EDE.0000000000002050","DOIUrl":"https://doi.org/10.1097/EDE.0000000000002050","url":null,"abstract":"<p><strong>Objectives: </strong>During the 2024-2025 respiratory syncytial virus (RSV) season, a universal nirsevimab infant immunization program was implemented in the province of Québec. We evaluated its population-level impact on RSV-related emergency department (ED) visits and hospitalizations in 0-5-month-old infants, using both active surveillance and administrative health data.</p><p><strong>Methods: </strong>Study population included all Québec children <18 years old. We calculated incidence rates of RSV-confirmed hospitalizations, RSV-associated hospitalizations and ED visits linked to a positive RSV test, and acute bronchiolitis ED visits for nirsevimab-eligible (0-5 months old) and non-eligible (6-11 months and 1-17 years old) age groups during the 2024-2025 season. We also compared these 2024-2025 figures to previous seasons using varying lookback periods. Using difference-in-differences and constant proportion of admissions counterfactual approaches, pre-/post-intervention variations in 0-5-month-olds were adjusted for any time trends occurring in non-targeted age groups.</p><p><strong>Results: </strong>Decreases of 59% (95% CI: 49-70) and 66% (95% CI: 58-71) were observed in RSV-confirmed and RSV-associated hospitalizations, respectively. Acute bronchiolitis ED visits decreased by 35% (95% CI: 28-41), and RSV-associated ED visits by 60% (95% CI: 56-65). In the 2024-25 season, ED visits and hospitalizations were less frequent than expected (i.e. without nirsevimab) in 0-5-month-old infants, suggesting that between 323 and 746 hospitalizations may have been prevented.</p><p><strong>Conclusion: </strong>The 2024-2025 nirsevimab campaign was associated with a two-thirds reduction in RSV-related hospitalizations and RSV-associated ED visits in Québec among 0-5-month-old infants. ED visits for acute bronchiolitis were also reduced by a third.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent Interplay of Adversity and Risk: An Ising Network Analysis of the 2023 Youth Risk Behavior Survey.","authors":"Diego A Díaz-Faes, Sonali Rajan, Charles C Branas","doi":"10.1097/EDE.0000000000002045","DOIUrl":"https://doi.org/10.1097/EDE.0000000000002045","url":null,"abstract":"<p><p>Adolescents may experience multiple early adversities alongside mental and behavioral challenges whose inter-relationships are not well captured by traditional conceptual models. Network analysis examines the conditional associations among indicators, offering new insights into how these experiences and behaviors cluster and interconnect. Drawing on a nationally representative sample of U.S. adolescents, we estimated an Ising network of 26 items from the 2023 national Youth Risk Behavior Survey (YBRS, N = 20,103) across five domains: adverse childhood experiences (ACEs), victimization, suicidal behaviors, substance use, and violence. We examined node and bridge centrality and assessed network invariance through the Network Comparison Test by sex (female vs. male), sexual orientation (heterosexual vs. sexual minorities and bisexuals separately), and race/ethnicity, comparing White respondents to Black/African American, Hispanic/Latino, Asian, American Indian/Alaska Native, and Multiracial respondents. The network was stable with substantial overall connectivity. Three variables showed the highest centrality (as measured by node strength z-scores): suicidal ideation (1.8), caregiver emotional abuse (1.8), and hopelessness (1.7). The strongest between-domain connectors (bridge strength z-scores) were hopelessness (2.2), physical fighting (2.0), and gun carrying (1.6). Hopelessness emerged as the most important variable in the network. Caregiver emotional abuse was the most relevant node within the ACEs. Physical fights and gun carrying were key in connecting violence to other domains. Exploratory subgroup comparisons suggested broadly similar network structure and global strength across sex, sexual orientation, and most racial/ethnic comparisons, with the strongest evidence of structural differences for Black/African American versus White respondents. These findings offer new directions for future research by identifying potential indicators of risk or cascade processes that may inform hypotheses about whether the observed associations reflect causal pathways.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between high fat, sugar, and sodium diet and adverse pregnancy outcomes, modified by fruit and vegetable intake density.","authors":"Ya-Hui Yu, Lisa M Bodnar, Sharon I Kirkpatrick, Sara M Parisi, Ashley I Naimi","doi":"10.1097/EDE.0000000000002047","DOIUrl":"10.1097/EDE.0000000000002047","url":null,"abstract":"<p><strong>Background: </strong>We aimed to examine whether fruit and vegetable intake densities modify the association between a periconceptional high-fat, sugar, and sodium diet and adverse pregnancy outcomes.</p><p><strong>Methods: </strong>We analyzed data from 8,259 participants in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (2010-2013). Periconceptional diet was assessed via food frequency questionnaire. The outcome was a composite of preeclampsia, gestational diabetes, preterm birth, or small-for-gestational-age birth; individual outcomes were also examined. Effect modification by vegetable and fruit intake densities was evaluated using a doubly robust learner with ensemble machine learning.</p><p><strong>Results: </strong>Approximately 23% of participants experienced an adverse outcome, and 29% consumed a high-fat, sugar, and sodium diet. This dietary pattern was associated with 1.0-2.9 excess cases per 100 pregnancies for the composite outcome and most individual outcomes (except preterm birth), compared with other diets. For the composite outcome, associations varied across levels of vegetable but not fruit intake density, although estimates were imprecise. For example, risk differences decreased from 3.7 (95% CI, -0.7 to 8.0) to 2.6 (95% CI, -1.4 to 6.6) excess cases per 100 pregnancies at 0.5 versus 1.25 cups of vegetables per 1,000 kcal. Attenuation of risk at higher vegetable intake was slightly greater when combined with higher fruit intake density, but estimates remained imprecise, limiting interpretation of joint effect modification. Patterns of associations differed across individual outcomes.</p><p><strong>Conclusions: </strong>We did not find evidence that the risk of adverse pregnancy outcomes associated with a high-fat, sugar, and sodium dietary pattern was meaningfully different across vegetable and/or fruit intake densities.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding potential collider bias in external validity analysis depending on types of effect measure modifiers.","authors":"Fabian Manke-Reimers, Vincent Brugger, Michael Webster-Clark","doi":"10.1097/EDE.0000000000002048","DOIUrl":"https://doi.org/10.1097/EDE.0000000000002048","url":null,"abstract":"<p><p>Covariate selection is a challenging part of estimating effects, whether accounting for confounding or improving external validity by addressing different distributions of effect measure modifiers between a study and target population. However, current recommendations on covariate selection for external validity analyses might be misleading. We investigate how directions of causal relationships between sample membership, types of effect measure modification, and collider bias impact sufficient adjustment sets for external validity analysis. We provide a simulated example to underpin the theoretical results and examine how impacts of collider bias depend on the colliders' associations, strength of interactions and sample size. When sample membership is caused by effect measure modifiers (e.g., when sociodemographics have an effect on the probability of trial participation), conditioning on effect measure modifiers (regardless of type) does not bias target population estimates. However, in the converse scenario where effect measure modifiers are caused by sample membership (e.g., under trial engagement effects), conditioning on some types of effect measure modifiers can be problematic. This is because sample membership can become an effect measure modifier by collider conditioning. We term adjustment sets that differ in their sufficiency according to the specific causal relationships between effect measure modifiers and sample membership \"selection dependent\" (s-dependent) sets. It is important to note, however, that weak interactions and collider-parent associations may not be sufficient to generate substantial collider bias. Nevertheless, we argue that researchers should consider the direction of the relationships between sample membership and effect measure modifiers to avoid inducing collider bias in external validity analyses.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Separate and Joint Associations of Own and Spousal Depression with Mortality in Couples: Does Spousal Depression Contribute to Mortality Hazard?","authors":"Toshiaki Komura, Säde Stenlund, Laura D Kubzansky","doi":"10.1097/EDE.0000000000001993","DOIUrl":"10.1097/EDE.0000000000001993","url":null,"abstract":"<p><strong>Background: </strong>Depression causes a substantial burden on a person's health and well-being. However, evidence is limited regarding whether the depression of one person in a marital relationship may affect the other partner's health. We assessed whether depression in one partner within a married couple might contribute to the other partner's mortality hazard, also considering whether only one or both partners have depression.</p><p><strong>Methods: </strong>We examined a nationally representative sample comprising 8442 older US adults within 4225 couples from the Health and Retirement Study. Using the Center for Epidemiologic Studies Depression Scale, we characterized depression status as follows: (1) no depression in either partner, (2) depression in the respondent only, (3) depression in the spouse only, and (4) depression in the respondent and their spouse. Associations between couples' depression status on individuals' mortality hazards over 11 years were estimated using Cox proportional hazards models adjusted for 27 characteristics of the individual, their spouse, and their household.</p><p><strong>Results: </strong>We observed a higher mortality hazard when only the respondent had depression (hazard ratio [HR]: 1.44 [95% confidence interval (CI): 1.26, 1.66]), as well as a modestly elevated hazard when only their spouse exhibited depression (HR: 1.18 [95% CI: 1.01, 1.39]). When both partners had depression, we observed a jointly elevated mortality hazard (HR: 1.53 [95% CI: 1.26, 1.86]).</p><p><strong>Conclusions: </strong>Results suggest the harmful effects of depression could extend beyond the individual to spouses' physical health. Future studies on the health effects of depression should incorporate familial contexts.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"688-697"},"PeriodicalIF":4.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smart Meter-derived Air Conditioning Penetration Rate Modifies the Association Between Ambient Temperature and Emergency Department Visits.","authors":"Xiaping Zheng, McKenna Peplinski, Diego Ramos Aguilera, Kelly T Sanders, Stefanie Ebelt, Noah Scovronick, Peter Kalmus, Howard H Chang","doi":"10.1097/EDE.0000000000002006","DOIUrl":"10.1097/EDE.0000000000002006","url":null,"abstract":"<p><strong>Background: </strong>Air conditioning data are typically available only at coarse spatial resolutions. We examined modifications of heat-morbidity relationships using finer spatial resolution - specifically, ZIP code-level air conditioning penetration rates derived from household-level smart meter electricity records in southern California (2015-2019).</p><p><strong>Methods: </strong>We first estimated ZIP code-specific relative risk (RR) between heat-related emergency department visits and 4-day lagged temperatures at the 95th to 50th temperature quantile. Meta-regression was used to estimate effect modification, as measured by the ratio of RR.</p><p><strong>Results: </strong>Air conditioning penetration rates ranged from 23% to 96% (median = 79%). Among non-coastal regions, a 10% increase in air conditioning penetration was associated with lower heat and emergency department visit risk: ratio of RR = 0.79 (95% confidence interval: 0.68, 0.91) for dry bulb temperature and 0.80 (95% confidence interval: 0.70, 0.92) for wet bulb temperature. Air conditioning penetration did not modify heat-morbidity associations in coastal regions.</p><p><strong>Conclusion: </strong>Our results indicate that neighborhoods with higher air conditioning penetration rates were associated with lower heat-related health risks in noncoastal regions.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":"37 5","pages":"719-723"},"PeriodicalIF":4.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Be Wary of Age-stratum Aging in Early-onset Cancer Trends.","authors":"Axelle Braggion, Stéphane Cullati, Arnaud Chiolero","doi":"10.1097/EDE.0000000000001998","DOIUrl":"10.1097/EDE.0000000000001998","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"e14-e16"},"PeriodicalIF":4.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Estimators in Partially Identified Models.","authors":"Richard F MacLehose, Timothy L Lash, Lindsay J Collin, Thomas P Ahern, Paul Gustafson","doi":"10.1097/EDE.0000000000002014","DOIUrl":"10.1097/EDE.0000000000002014","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"575-577"},"PeriodicalIF":4.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Demographic Predictors of Increased Nonfatal Opioid Overdose Risk Among New York State Medicaid Enrollees After the COVID-19 Pandemic: An Analysis of Heterogeneous Treatment Effects.","authors":"John R Pamplin, Katherine Wheeler-Martin, Allison Perry, Zachary Mannes, Noa Krawczyk, Stephen Crystal, Deborah S Hasin, Silvia S Martins, Ravi Shroff, Magdalena Cerdá, Daniel B Neill","doi":"10.1097/EDE.0000000000001992","DOIUrl":"10.1097/EDE.0000000000001992","url":null,"abstract":"<p><strong>Background: </strong>Overdose rates in the United States rose dramatically during the coronavirus disease 2019 (COVID-19) pandemic. Well-documented racial and sociodemographic inequities in the impact of the pandemic suggest the potential for similar inequities for overdose. Our objective was to identify subgroups of New York State Medicaid enrollees who experienced the greatest increases in nonfatal opioid overdose risk after the onset of the COVID-19 pandemic.</p><p><strong>Methods: </strong>Data are from a retrospective cohort of 1,021,889 people enrolled in New York State Medicaid from 2019 to 2020. To identify subgroups with the greatest increased risk of nonfatal overdose after the onset of the COVID-19 pandemic, we used a Heterogeneous Treatment Effect-Scan, a novel machine learning method developed for accurate and computationally efficient discovery of heterogeneous treatment effects in complex data.</p><p><strong>Results: </strong>In the total sample, the risk of nonfatal opioid overdose increased 22% after the onset of the pandemic. We also identified two subgroups with elevated risk relative to the total sample: subgroup 1 (Black and Hispanic males aged 45-64 years old with no baseline documentation of opioid use disorder (OUD); N = 53,065) and subgroup 2 (people aged 45-64 years old with documented aged/blind/disabled status and no baseline documentation of OUD; N = 73,694). These subgroups experienced a 54% and 57% increase in nonfatal overdose risk, respectively.</p><p><strong>Conclusion: </strong>We estimated heterogeneous effects of the onset of the COVID-19 pandemic on nonfatal overdose, with elevated risks estimated for older working-aged, structurally disadvantaged adults without documented OUD. These findings illustrate the importance of structural factors in driving heterogeneous risk of overdose after complex social events.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"640-650"},"PeriodicalIF":4.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13308939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147671523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Excess Adiposity among US and Canadian Adults with and without BMI-defined Obesity.","authors":"Laura N Anderson, Nuha Anver Mohamed Rizan, Rachel A Lipson, Alexandra J Mayhew, Lauren E Griffith","doi":"10.1097/EDE.0000000000002010","DOIUrl":"10.1097/EDE.0000000000002010","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"e16-e18"},"PeriodicalIF":4.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147986995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}