Epidemiology最新文献

{"title":"Is leaving the house a protective factor against early death? Informing interventions demands more specific exposures.","authors":"Jonathan Y Huang","doi":"10.1097/EDE.0000000000001847","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001847","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078990","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":"Incidental infections and the probability of necessity.","authors":"Bronner P Gonçalves","doi":"10.1097/EDE.0000000000001833","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001833","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064630","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":"A Latent Trait-based Measure as a Data Harmonization and Missing Data Solution Applied to the Environmental Influences on Child Health Outcomes Cohort.","authors":"Emily A Knapp, Amii M Kress, Ronel Ghidey, Tyler J Gorham, Brendan Galdo, Stephen A Petrill, Izzuddin M Aris, Theresa M Bastain, Carlos A Camargo, Michael A Coccia, Nicholas Cragoe, Dana Dabelea, Anne L Dunlop, Tebeb Gebretsadik, Tina Hartert, Alison E Hipwell, Christine C Johnson, Margaret R Karagas, Kaja Z LeWinn, Luis Enrique Maldonado, Cindy T McEvoy, Hooman Mirzakhani, Thomas G O'Connor, T Michael O'Shea, Zhu Wang, Rosalind J Wright, Katherine Ziegler, Yeyi Zhu, Christopher W Bartlett, Bryan Lau","doi":"10.1097/EDE.0000000000001832","DOIUrl":"10.1097/EDE.0000000000001832","url":null,"abstract":"<p><strong>Background: </strong>Collaborative research consortia provide an efficient method to increase sample size, enabling evaluation of subgroup heterogeneity and rare outcomes. In addition to missing data challenges faced by all cohort studies like nonresponse and attrition, collaborative studies have missing data due to differences in study design and measurement of the contributing studies.</p><p><strong>Methods: </strong>We extend ROSETTA, a latent variable method that creates common measures across datasets collecting the same latent constructs with only partial overlap in measures, to define a common measure of socioeconomic status (SES) across cohorts with varying indicators in the Environmental influences on Child Health Outcomes Cohort, a consortium of pregnancy and pediatric cohorts.</p><p><strong>Results: </strong>Starting with 52 indicators of prenatal SES from 39,372 participants across 53 cohorts, ROSETTA created three factors representing key domains of SES: income and education, insurance and poverty, and unemployment. At least one factor score was available for 34,528 participants; two factors were available for more participants than any single indicator. Factors fit the data well, had content validity, and were correlated with alternative measures of SES (for income & education factor, r= 0.40-0.89). Higher SES as measured by the factor scores was associated with lower odds of prenatal smoking:OR income & education 0.42 (95% CI 0.38, 0.45). Missing data were reduced compared to most methods, except for multiple imputation.</p><p><strong>Conclusions: </strong>ROSETTA aids in pooled analysis of individual participant data by creating measures on a common scale and maximizing data in the presence of missing and mismatched measures.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064615","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 Effects of Hospital Delivery Volume and Travel Time on Perinatal Mortality and Delivery in Transit: Causal Inference with Triangulation.","authors":"Andreas Asheim, Sara Marie Nilsen, Signe Opdahl, Kari Risnes, Elisabeth Balstad Magnussen, Fredrik Carlsen, Neil Martin Davies, Johan Håkon Bjørngaard","doi":"10.1097/EDE.0000000000001840","DOIUrl":"10.1097/EDE.0000000000001840","url":null,"abstract":"<p><strong>Background: </strong>Hospital regionalization involves balancing hospital volume and travel time. We investigated how hospital volume and travel time affect perinatal mortality and the risk of delivery in transit using three different study designs.</p><p><strong>Methods: </strong>This nationwide cohort study used data from the Medical Birth Registry of Norway (1999-2016) and Statistics Norway. We compared estimates across three designs: (1) Observed confounder adjustment: Comparing women giving birth at hospitals of different sizes and travel times (1,066,332 births), (2) Sibling comparison: Comparing women who moved between hospital catchment areas between births (203,464 births), (3) Neighbor comparison: comparing women living in neighboring municipalities, but in different hospital catchment areas (460,776 births).</p><p><strong>Results: </strong>The study population included 5080 (0.48%) perinatal deaths and 7063 deliveries in transit (0.66%). For hospitals with 2000 compared with 500 births/year, observed confounder adjustment showed 1.81 times higher perinatal mortality (95% confidence interval [CI] 1.21-2.73). However, sibling and neighbor comparisons showed a factor 0.64 (95% CI 0.43-0.97) and 0.61% (95% CI 0.43-0.88) lower perinatal mortality, respectively. Increased travel time was strongly associated with higher perinatal mortality using observed confounder adjustment, but this was not supported by the other designs. Longer travel time was consistently linked to an increased risk of delivery in transit.</p><p><strong>Conclusions: </strong>Perinatal mortality was higher in high-volume hospitals when adjusting for observed confounders. However, triangulating inferences from the other designs suggested the opposite, estimating that observed confounder control was insufficient. This supports the idea that access to higher-volume hospitals could improve perinatal outcomes at the population level.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058404","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":"HELICOBACTER PYLORI ERADICATION TREATMENTS AND RISK OF ALZHEIMER DISEASE: A CASE-CONTROL STUDY NESTED IN THE FINNISH POPULATION.","authors":"Emmi Keränen, Jaana Rysä, Miia Tiihonen, Sirpa Hartikainen, Anna-Maija Tolppanen","doi":"10.1097/EDE.0000000000001831","DOIUrl":"10.1097/EDE.0000000000001831","url":null,"abstract":"<p><strong>Background: </strong>Helicobacter pylori (H. pylori) has been inconsistently associated with risk of Alzheimer disease. The exposure assessment period has often overlapped with the prodromal time of Alzheimer disease. Cognitive disorders might increase vulnerability to infectious pathogens, complicating the ascertainment of temporal relationship between H. pylori infection and Alzheimer disease.</p><p><strong>Methods: </strong>This Finnish nested case-control study included 70,520 persons with incident Alzheimer disease diagnosed between 2005-2011 and 281,233 age-, sex-, and region of residence-matched controls. We obtained information on comorbidities and drug use from the national healthcare registers. We identified dispensed H. pylori eradication treatments from the Prescription register. We considered exposure at least 5 years before Alzheimer disease diagnosis in the main analysis. We compared risk of Alzheimer disease between H. pylori eradication treatment users and nonusers using confounder-adjusted (comorbidities and other drug use) conditional logistic regression. We assessed cumulative exposure by calculating the number of eradication treatments.</p><p><strong>Results: </strong>The prevalence of exposure to H. pylori eradication treatment at least 5 years before the outcome was 4.1% in cases and 3.9% in controls. The odds ratio (95% confidence interval) was 1.06 (1.02-1.11) in the crude and 1.03 (0.99-1.07) in the confounder-adjusted model. We observed no association between cumulative exposure and risk of Alzheimer disease.</p><p><strong>Conclusion: </strong>Our results, reflecting diagnosed and treated H. pylori infection late in life, do not support the hypothesis of H. pylori as an independent risk factor for Alzheimer disease. The previously reported association may be explained by reverse association and confounding.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046034","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":"Estimating prevalence of opioid misuse in North Carolina counties from 2016-2021: An integrated abundance model approach.","authors":"David M Kline, Brian N White, Kathryn E Lancaster, Kathleen L Egan, Eva Murphy, William C Miller, Staci A Hepler","doi":"10.1097/EDE.0000000000001838","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001838","url":null,"abstract":"<p><strong>Background: </strong>The overdose epidemic remains largely driven by opioids, but county-level prevalence of opioid misuse is unknown. Without this information, public health and policy responses are limited by a lack of knowledge on the scope of the problem.</p><p><strong>Methods: </strong>Using an integrated abundance model, we estimate annual county-level prevalence of opioid misuse for counties in North Carolina from 2016 to 2021. The model integrates county-level observed counts of illicit opioid overdose deaths, people receiving prescriptions for buprenorphine, and people served by treatment programs. It also incorporates state-level survey estimates of misuse prevalence. County-level social and environmental covariates are also accounted for in the model. Data are integrated through a Bayesian hierarchical model to estimate posterior distributions of the parameters.</p><p><strong>Results: </strong>In general, the estimated prevalence of misuse was decreasing over the study period. Estimated prevalence was above average in the western and southeastern parts of the state. We also estimated that the proportion of people who misuse opioids who fatally overdosed increased sharply over the study period as the median estimated proportion in 2021 was more than 8 times greater than 2016. The proportion of people who misuse opioids who received buprenorphine and were served by treatment programs increased over the study period.</p><p><strong>Conclusions: </strong>Estimates from our integrated abundance model fill an important gap in public health knowledge about the local prevalence of people who misuse opioids and can be used to inform an adequate and equitable allocation of resources to communities across the state.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037432","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":"Industrial air emissions and breast cancer incidence in a United States-wide prospective cohort.","authors":"Jennifer L Ish, Jessica M Madrigal, John L Pearce, Alexander P Keil, Jared A Fisher, Rena R Jones, Dale P Sandler, Alexandra J White","doi":"10.1097/EDE.0000000000001837","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001837","url":null,"abstract":"<p><strong>Background: </strong>We evaluated air emissions of industrial compounds, many of which have carcinogenic or endocrine disrupting properties, in relation to breast cancer incidence.</p><p><strong>Methods: </strong>Using the United States Environmental Protection Agency's Toxics Release Inventory, we quantified air emissions of 28 compounds near Sister Study participants' residences during the 10 years leading up to study enrollment (2003-2006; n=46,150). We used Cox proportional hazards regression to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for associations of residential emission levels of single pollutants with incident breast cancer. We assessed pollutant mixtures using an Exposure Continuum Mapping (ECM) framework and characterized associations using a joint-exposure response function.</p><p><strong>Results: </strong>During follow-up (median=13.4 years), we identified 4,155 breast cancer cases. We observed non-monotonic but elevated associations with breast cancer for emissions within 3km of the residence for nickel compounds (HRquintile5vs.none = 1.3; 95% CI 1.0, 1.6) and trichloroethylene (HRquintile5vs.none = 1.3; 95% CI 1.0, 1.6). ECM identified 25 mixture profiles that explained 72% of the variance in emissions patterns, with most participants experiencing relatively low emissions profiles. The joint-exposure response function suggested that higher incidence of breast cancer occurred among individuals with relatively rare, high emissions profiles; however, the overall trend was not associated with breast cancer (p=0.09).</p><p><strong>Conclusions: </strong>In our study, breast cancer incidence was associated with air emissions of certain industrial carcinogens. Although the overall emissions mixture did not show a trend related to breast cancer, this may not reflect the importance of individual compounds or specific emissions sources.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037434","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":"Causal Estimands for Analyses of Averted and Avertible Outcomes due to Infectious Disease Interventions.","authors":"Katherine M Jia, Christopher B Boyer, Jacco Wallinga, Marc Lipsitch","doi":"10.1097/EDE.0000000000001839","DOIUrl":"10.1097/EDE.0000000000001839","url":null,"abstract":"<p><p>During the coronavirus disease (COVID-19) pandemic, researchers attempted to estimate the number of averted and avertible outcomes due to vaccination campaigns to quantify public health impact. However, the estimands used in these analyses have not been previously formalized. It is also unclear how these analyses relate to the broader framework of direct, indirect, total, and overall causal effects under interference. Here, using potential outcome notation, we adjust the direct and overall effects to accommodate analyses of averted and avertible outcomes. We use this framework to interrogate the commonly held assumption that vaccine-averted outcomes via direct impact among vaccinated individuals (or vaccine-avertible outcomes via direct impact among unvaccinated individuals) is a lower bound on vaccine-averted (or -avertible) outcomes overall. To do so, we describe a susceptible-infected-recovered-death model stratified by vaccination status. When vaccine efficacies wane, the lower bound fails for vaccine-avertible outcomes. When transmission or fatality parameters increase over time, the lower bound fails for both vaccine-averted and -avertible outcomes. Only in the simplest scenario where vaccine efficacies, transmission, and fatality parameters are constant over time, outcomes averted via direct impact among vaccinated individuals (or outcomes avertible via direct impact among unvaccinated individuals) is a lower bound on overall impact. In conclusion, the lower bound can fail under common violations to assumptions on time-invariant vaccine efficacy, pathogen properties, or behavioral parameters. In real data analyses, estimating what seems like a lower bound on overall impact through estimating direct impact may be inadvisable without examining the directions of indirect effects.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037412","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":"A quasi-experimental study of general practices' referral to mammography in the post-trials treatment era.","authors":"Mette Lise Lousdal, Timothy L Lash, W Dana Flanders, M Alan Brookhart, Ivar Sønbø Kristiansen, Peter Vedsted, Henrik Støvring","doi":"10.1097/EDE.0000000000001841","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001841","url":null,"abstract":"<p><strong>Background: </strong>Improvements in breast cancer therapy since the randomized controlled trials of mammography screening might have reduced the screening benefit. Most observational studies of mammography effectiveness would be confounded by these improvements and other factors. Using a design resistant to this confounding, we evaluated whether mammography in asymptomatic women reduces breast cancer mortality during the treatment era succeeding the trials.</p><p><strong>Methods: </strong>We designed a quasi-experimental cohort study in regions of Denmark without organized screening. We predicted the number of expected mammograms for each general practice based on observed numbers of mammograms and individual risk factors. Regardless of a woman's individual exposure to mammography, we assigned her the ratio of observed to expected mammograms of her general practice as her instrumental variable. We employed this potential instrumental variable as mammography exposure status and followed women from January 1, 2006 until death, emigration, or December 31, 2014, whichever came first.</p><p><strong>Results: </strong>We included 169,197 women aged 50-66 from 738 general practices and without previous breast cancer as of January 1, 2006. Women affiliated with a practice referring more women than expected, compared with less, had a lower hazard of breast cancer death (hazard ratio 0.80, 95% confidence interval 0.68, 0.95). Negative control associations were near null, suggesting no confounding bias.</p><p><strong>Conclusions: </strong>This quasi-experimental study estimated a continued protective effect of mammography in women where most were presumably asymptomatic. In contrast to conventional observational studies, the use of practice referral ratio as an instrumental variable may avoid bias from uncontrolled confounding.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037133","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":"Effect modification in settings with \"truncation by death\".","authors":"Bronner P Gonçalves, Etsuji Suzuki","doi":"10.1097/EDE.0000000000001834","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001834","url":null,"abstract":"<p><p>Epidemiologic studies recruiting individuals with higher-than-population-average mortality can be affected by \"truncation by death\", whereby the outcome of interest (e.g. quality of life) is considered not to be defined for individuals who die before the end of follow-up. Here, we use the potential outcomes framework and principal stratification to derive conditions under which the survivor average causal effect, an estimand defined for the \"always-survivors\" stratum, is modified by a variable that represents a possible common cause of survival and the outcome of interest, and by a variable that only affects survival. Further, we show that this principal effect can be expressed as a weighted average of this treatment effect for individuals with each level of these variables, and that these weights depend not only on the relative frequencies of the levels in the total population, but also in the \"always-survivors\" principal stratum. We also discuss the implications of this work for the transportability of the survivor average causal effect.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037423","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}