Epidemiology最新文献

{"title":"BARS: An empirical Bayes method for summarizing pregnancy history to predict later health outcomes.","authors":"Mary V Díaz-Santana, Molly Rogers, Clarice R Weinberg","doi":"10.1097/EDE.0000000000001880","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001880","url":null,"abstract":"<p><p>Reproductive complications tend to recur. The risk of gestational diabetes is much higher in the second pregnancy if it occurred in the first. Such recurrence risks are regarded as reflecting heterogeneity among couples in their inherent risk. Pregnancy complications not only predict their own recurrence but have been shown to be associated with different later health problems like hypertension and heart disease. Epidemiologically considering reproductive history as a risk factor has been challenging, however, because women vary in their number of pregnancies and there's no obvious way to account for both prior occurrences and prior non-occurrences. We propose a simple empirical Bayes approach, the Beta Approach for Risk Summarization (BARS). We apply BARS to retrospective data reported at enrollment in a large cohort, the Sister Study, to estimate propensity to gestational diabetes, and use that to predict subsequent occurrences of gestational diabetes based on successively updated pregnancy histories. We assess the calibration of our predictive model for gestational diabetes and demonstrate that it works well. We then apply the method to prospective data from the Sister Study, revisiting an earlier paper that linked gestational diabetes to risk of breast cancer, but now using BARS and additional person time.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156695","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":"10.1097/EDE.0000000000001833","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"e6-e7"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","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":"Adjusting Adjustments: Using External Data to Estimate the Impact of Different Confounder Sets on Published Associations.","authors":"Thomas P Ahern, Lindsay J Collin, Richard F MacLehose, Benjamin Littenberg, Laura Haines, Michaela Bonnett, Fanny Børne Asmussen, Jennifer Chen, Timothy L Lash","doi":"10.1097/EDE.0000000000001821","DOIUrl":"10.1097/EDE.0000000000001821","url":null,"abstract":"<p><strong>Background: </strong>A 2013 meta-analysis observed a protective association between overweight body mass index (BMI) (vs. normal BMI) and all-cause mortality that was particularly strong in people aged ≥65. Estimates informing this meta-analysis were highly heterogeneous, and critics raised insufficient or inappropriate confounder adjustment in many studies as an explanation for the protective summary association. Using this topic as an example, we demonstrate a novel approach for external adjustment of individual studies for a uniform and sufficient confounder set before meta-analysis.</p><p><strong>Methods: </strong>We abstracted summary data on the 33 associations comprising the age ≥65 stratum of the 2013 meta-analysis. Using an external dataset (NHANES III), we derived covariates used in each study's multivariable model of the overweight-mortality association. We then calculated a bias factor to quantify the direction and magnitude of displacement of the ratio measure of association after changing from the original adjustment set to a sufficient adjustment set. After applying bias factors to adjust original associations, we compared summary results from random-effects meta-analyses with and without such adjustment.</p><p><strong>Results: </strong>We reproduced the original meta-analysis of overweight-mortality estimates among older participants and found a protective association similar to that reported in 2013 (summary relative risk = 0.88; 95% confidence interval: 0.84, 0.92; I 2 = 38.4%). After we simulated uniform adjustment of all 33 associations for a minimally sufficient confounder set (age, sex, and smoking status), the meta-analysis showed a similar summary association (summary relative risk = 0.90; 95% confidence interval: 0.86, 0.94), but with reduced heterogeneity (I 2 = 34.6%).</p><p><strong>Conclusion: </strong>Simulated uniform adjustment for a sufficient confounder set may improve rigor and promote consensus in meta-analysis.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"381-390"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11991891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686091","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 to 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":"10.1097/EDE.0000000000001838","url":null,"abstract":"<p><strong>Background: </strong>The overdose epidemic remains largely driven by opioids, but the 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 the 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 in 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":"310-318"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11991883/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Activity Participation on the Risk of Mortality and Hospitalizations in Danish Men and Women: Insights from REGLINK-SHAREDK.","authors":"Linda Juel Ahrenfeldt, Jens Søndergaard, McKinsley Laro, Sören Möller, Tobias Anker Stripp","doi":"10.1097/EDE.0000000000001835","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001835","url":null,"abstract":"<p><strong>Background: </strong>Previous evidence shows that religious service attendance is associated with lower mortality among women and fewer hospitalizations among men. However, it is unclear if similar associations exist for other activities.</p><p><strong>Methods: </strong>This cohort study examines the associations between various activities and their engagement levels on mortality and hospitalizations among 2987 Danes aged 40+ years, interviewed in SHARE from 2004 to 2007. The study followed individuals in the Danish registers until 2018. We estimated relative and absolute risks of mortality at age 90 and used negative binomial regressions for hospitalizations, including adjustment for several potential confounders.</p><p><strong>Results: </strong>Overall, activity participation was associated with lower mortality. Specifically, individuals participating in voluntary or charity work (relative risks [RR] = 0.85; 95% CI = 0.76, 0.95; risk differences [RD] = -0.11; 95% CI = -0.18, -0.04), helping others (RR = 0.88; 95% CI = 0.82, 0.95; RD = -0.09; 95% CI = -0.14, -0.04), or participating in sports or social clubs (RR = 0.89; 95% CI = 0.81, 0.98; RD = -0.09; 95% CI = -0.15, -0.03) exhibited lower mortality. We found lower mortality among women who took part in a religious organization. Our results showed fewer hospitalizations for men who engaged in 3+ activities, and for men who took part in a religious organization. For some activities, the strength of associations varied with activity frequency; for example, caring for the sick was associated with fewer hospitalizations but only when done less than once a week.</p><p><strong>Conclusions: </strong>Several activities were associated with lower mortality, particularly among women. However, the reduced hospitalizations observed among men attending religious services did not extend to other activities.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":"36 3","pages":"297-305"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975242","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":"Plant-Capture Methods for Estimating Homeless Population Size From Uncertain Plant Captures.","authors":"Yiran Wang, Martin Lysy, Audrey Béliveau","doi":"10.1097/EDE.0000000000001836","DOIUrl":"10.1097/EDE.0000000000001836","url":null,"abstract":"<p><p>Plant-capture is a specialized variant of traditional capture-recapture methods used to estimate the size of a population. In epidemiologic literature, a notable application of this method is the estimation of the size of homeless populations through point-in-time street surveys. With this approach, decoys referred to as \"plants\" are introduced into the population to estimate the capture probability. Previous plant-capture studies have not systematically accounted for uncertainty in the capture status of individual plants. To address this, we propose three increasingly complex hierarchical modeling approaches to formally incorporate uncertainty into the plant-capture model arising from the capture status of plants and heterogeneity between survey sites. We then apply our methods to estimate the size of the homeless population in large US cities in the context of the \"S-Night\" study conducted by the US Census Bureau. Details on the frequentist and Bayesian implementations of our models, along with empirical evaluations of their statistical performance, are provided in the supplementary materials.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"319-326"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390548","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":"Thanks to Our Reviewers.","authors":"","doi":"10.1097/EDE.0000000000001850","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001850","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":"36 3","pages":"436-437"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959439","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":"Long-term Economic Distress and Growing Educational Inequity in Life Expectancy.","authors":"Arline T Geronimus, Timothy A Waidmann, John Bound, Vincent Pancini, Meifeng Yang","doi":"10.1097/EDE.0000000000001843","DOIUrl":"10.1097/EDE.0000000000001843","url":null,"abstract":"<p><strong>Background: </strong>The nature and timing of increasing educational inequity in US life expectancy before the coronavirus disease 2019 pandemic suggest that long-term adverse labor market conditions secondary to globalization and technological change played a role for less-educated workers, but this has not been tested.</p><p><strong>Methods: </strong>We exploit spatiotemporal variation in mortality and long-term economic conditions at the year and commuting zone level to estimate the relationship between macroeconomic restructuring and diverging mortality trends, 1990-2017, by race, sex, and education. Our measure of macroeconomic restructuring is based on the baseline industrial mix of an area, a measure that is plausibly exogenous to mortality.</p><p><strong>Results: </strong>Mortality trends were substantially worse in commuting zones experiencing long-term economic stagnation than in others. For both White and Black adults, this relationship was strongest in the lowest quartile of the education distribution. Residence in commuting zones in the top quartile of our measure of economic conditions was associated with an additional 1-2 years lived between ages 25 and 84 compared with living in a commuting zone in the bottom quartile. The primary mediators of these divergent mortality trends were cancer, cardiovascular and metabolic diseases, and diseases of other internal body systems. Deaths from suicide or substance abuse did not contribute importantly toward accounting for the estimated impact of long-term economic stagnation on mortality.</p><p><strong>Conclusion: </strong>In our study, diverging trends in US life expectancy were associated with macroeconomic changes witnessed over the last half-century. The causes of death mediating this link were largely found in rates of death from stress-related internal diseases.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"287-296"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390547","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":"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":"363-373"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","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":"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), and (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 of 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":"425-435"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","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}