Epidemiology最新文献

{"title":"Does Adjusting for Causal Intermediate Confounders Resolve the Perinatal Crossover Paradox?","authors":"Wen Wei Loh, Cande V Ananth","doi":"10.1097/EDE.0000000000001848","DOIUrl":"10.1097/EDE.0000000000001848","url":null,"abstract":"<p><strong>Background: </strong>Mediation analyses of the preeclampsia-perinatal outcome association through preterm birth (PTB) have produced paradoxical findings. For example, preeclamptic births at preterm gestations show a lower risk of adverse outcomes than normotensive births. These results have been explained by unmeasured baseline confounding between PTB and outcomes, with PTB as the sole mediator. However, other intermediate variables, such as placental abruption, small for gestational age (SGA) births, and chorioamnionitis, are confounders yet are excluded because they occur after preeclampsia.</p><p><strong>Methods: </strong>Using data from the Consortium on Safe Labor (2002-2008; ), we utilized interventional indirect effects to examine whether adjusting for causal intermediates mitigates confounding bias to resolve the perinatal paradox. We compared two approaches to handle intermediate confounding by abruption, SGA, and chorioamnionitis when PTB is the focal mediator: as exposure-induced confounders or as multiple mediators. We developed bias formulas to assess unmeasured confounding for interventional effects.</p><p><strong>Results: </strong>When PTB was the sole mediator, the estimated protective direct effect of preeclampsia (risk ratio = 0.60; 95% confidence interval = 0.52, 0.71) was in line with previous paradoxical findings. The estimated protective effect persisted even after adjusting for intermediate confounders. Sensitivity analyses suggested an unmeasured confounder must strongly influence the outcome to resolve the paradox.</p><p><strong>Conclusion: </strong>Adjusting for causal intermediates such as abruption, SGA, and chorioamnionitis is inadequate to eliminate unmeasured PTB-perinatal mortality confounding. The paradox of preeclampsia's protective direct effect on mortality remains unresolved. Sensitivity analyses to unmeasured confounding are effective in bolstering conclusions from causal mediation analyses and should be more widely applied.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"350-362"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491350","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":"Advancing Reproducible Research Through Version Control Technology.","authors":"Ghassan B Hamra, Ian D Buller, Corinne A Riddell, Lauren B Wilner, Audrey Brown, Nathaniel S MacNell","doi":"10.1097/EDE.0000000000001845","DOIUrl":"10.1097/EDE.0000000000001845","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":"36 3","pages":"344-349"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964525","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":"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 on 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":"374-380"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","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}

{"title":"Influenza Activity and Preterm Birth in the Atlanta Metropolitan Area: A Time-Series Analysis from 2010 to 2017.","authors":"Xiaping Zheng, Tingyu Wang, Hua Hao, Rohan R D'Souza, Matthew J Strickland, Joshua L Warren, Lyndsey A Darrow, Howard H Chang","doi":"10.1097/EDE.0000000000001819","DOIUrl":"10.1097/EDE.0000000000001819","url":null,"abstract":"<p><strong>Background: </strong>Annual influenza epidemics lead to a substantial public health burden, and pregnant people are vulnerable to severe outcomes. Influenza during pregnancy is hypothesized to increase the risk of adverse birth outcomes, but population-based epidemiologic evidence remains limited and inconsistent.</p><p><strong>Methods: </strong>We conducted a time-series analysis to estimate short-term associations between community-level seasonal influenza activity and daily counts of preterm births in Atlanta, United States from October 17, 2010 to July 10, 2017. We defined weekly influenza exposures four ways: (1) percent test-positive from virologic surveillance, (2) percent of patients with symptoms of influenza-like illness (ILI) in outpatient settings, (3) a composite measure of percent test-positive and ILI, and (4) influenza hospitalization rates. We used Poisson log-linear models to estimate associations, adjusting for time-varying confounders and ongoing at-risk pregnancies. We further examined associations by influenza type and exposure lags and effect modification by maternal characteristics.</p><p><strong>Results: </strong>We studied a total of 316,253 births. We found consistent positive associations between influenza activity and preterm birth across different exposure measures and exposure lags. An interquartile range increase in a composite measure of ILI activity and percent test-positive was associated with a 1.014 (95% confidence interval: 1.001-1.027) increase in preterm birth during the same week. In stratified analyses, associations were more pronounced among married, non-Black, and Hispanic pregnant people.</p><p><strong>Conclusion: </strong>Periods of high influenza activity were associated with an increased risk of preterm birth.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"141-148"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11785485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715605","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":"Association of Early-life Trauma With Gestational Diabetes and Hypertensive Disorders of Pregnancy.","authors":"Sharonda M Lovett, Jennifer M P Woo, Katie M O'Brien, Samantha E Parker, Dale P Sandler","doi":"10.1097/EDE.0000000000001817","DOIUrl":"10.1097/EDE.0000000000001817","url":null,"abstract":"<p><strong>Background: </strong>Early-life trauma (before age of 18 years) is hypothesized to increase the risk for adverse pregnancy outcomes through stress pathways, yet epidemiologic findings are mixed.</p><p><strong>Methods: </strong>Sister Study participants (US women aged 35-74 years enrolled 2003-2009) completed an adapted Brief Betrayal Trauma Survey at the first follow-up visit. Lifetime history of gestational diabetes mellitus (GDM) or hypertensive disorders of pregnancy (HDP: pregnancy-related high blood pressure, pre-eclampsia/toxemia, or eclampsia) in pregnancies lasting ≥20 weeks was self-reported. We used log-binomial regression to estimate relative risks (RR) and 95% confidence intervals (CIs) for the association between early-life trauma (modeled using conventional measures [e.g., any experience, substantive domains, individual types] and latent classes of co-occurring traumas) and GDM or HDP among 34,879 parous women.</p><p><strong>Results: </strong>Approximately, 4% of participants reported GDM and 11% reported HDP. Relative to no early-life trauma, the RRs for any were 1.1 (95% CI = 1.0, 1.3) for GDM and 1.2 (95% CI = 1.2, 1.3) for HDP. Women reporting physical trauma had the highest risk of GDM and HDP in comparison to other substantive domains. In analyses using latent classes of early-life trauma, high trauma was associated with an elevated risk of both GDM (RR = 1.9, 95% CI = 1.5, 2.6) and HDP (RR = 1.7, 95% CI = 1.4, 2.0) compared with low trauma.</p><p><strong>Conclusions: </strong>Women experiencing high levels of trauma in early life were at higher risk of GDM and HDP, adding to a growing evidence base for this association.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"149-159"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909369","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":"Back to Basics: What Descriptive Epidemiology Can Teach Us About the Recent Rise in Firearm Homicide.","authors":"Veronica A Pear, Julia P Schleimer","doi":"10.1097/EDE.0000000000001827","DOIUrl":"10.1097/EDE.0000000000001827","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"183-185"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817364","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":"Erratum: Natural effects with a recanting witness: non-identifiability or meaningless estimand?","authors":"","doi":"10.1097/EDE.0000000000001806","DOIUrl":"10.1097/EDE.0000000000001806","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":"36 2","pages":"e4"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064266","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":"Socioeconomic Status, Smoking, and Lung Cancer: Mediation and Bias Analysis in the SYNERGY Study.","authors":"Jan Hovanec, Benjamin Kendzia, Ann Olsson, Joachim Schüz, Hans Kromhout, Roel Vermeulen, Susan Peters, Per Gustavsson, Enrica Migliore, Loredana Radoi, Christine Barul, Dario Consonni, Neil E Caporaso, Maria Teresa Landi, John K Field, Stefan Karrasch, Heinz-Erich Wichmann, Jack Siemiatycki, Marie-Elise Parent, Lorenzo Richiardi, Lorenzo Simonato, Karl-Heinz Jöckel, Wolfgang Ahrens, Hermann Pohlabeln, Guillermo Fernández-Tardón, David Zaridze, John R McLaughlin, Paul A Demers, Beata Świątkowska, Jolanta Lissowska, Tamás Pándics, Eleonora Fabianova, Dana Mates, Miriam Schejbalova, Lenka Foretova, Vladimír Janout, Paolo Boffetta, Francesco Forastiere, Kurt Straif, Thomas Brüning, Thomas Behrens","doi":"10.1097/EDE.0000000000001807","DOIUrl":"10.1097/EDE.0000000000001807","url":null,"abstract":"<p><strong>Background: </strong>Increased lung cancer risks for low socioeconomic status (SES) groups are only partially attributable to smoking habits. Little effort has been made to investigate the persistent risks related to low SES by quantification of potential biases.</p><p><strong>Methods: </strong>Based on 12 case-control studies, including 18 centers of the international SYNERGY project (16,550 cases, 20,147 controls), we estimated controlled direct effects (CDE) of SES on lung cancer via multiple logistic regression, adjusted for age, study center, and smoking habits and stratified by sex. We conducted mediation analysis by inverse odds ratio weighting to estimate natural direct effects and natural indirect effects via smoking habits. We considered misclassification of smoking status, selection bias, and unmeasured mediator-outcome confounding by genetic risk, both separately and by multiple quantitative bias analyses, using bootstrap to create 95% simulation intervals (SI).</p><p><strong>Results: </strong>Mediation analysis of lung cancer risks for SES estimated mean proportions of 43% in men and 33% in women attributable to smoking. Bias analyses decreased the direct effects of SES on lung cancer, with selection bias showing the strongest reduction in lung cancer risk in the multiple bias analysis. Lung cancer risks remained increased for lower SES groups, with higher risks in men (fourth vs. first [highest] SES quartile: CDE, 1.50 [SI, 1.32, 1.69]) than women (CDE: 1.20 [SI: 1.01, 1.45]). Natural direct effects were similar to CDE, particularly in men.</p><p><strong>Conclusions: </strong>Bias adjustment lowered direct lung cancer risk estimates of lower SES groups. However, risks for low SES remained elevated, likely attributable to occupational hazards or other environmental exposures.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"245-252"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460886","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 Authors Respond.","authors":"Guilin Li, Miguel A Hernán, Barbra A Dickerman","doi":"10.1097/EDE.0000000000001813","DOIUrl":"10.1097/EDE.0000000000001813","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"e1-e2"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11785474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946625","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 Association Between Ambient Particulate Matter Exposure and Anemia in HIV/AIDS Patients.","authors":"Wei Liang, Aojing Han, Dong Hou, Ruihan Li, Qilin Hu, Huanfeng Shen, Yalei Jin, Hao Xiang","doi":"10.1097/EDE.0000000000001825","DOIUrl":"10.1097/EDE.0000000000001825","url":null,"abstract":"<p><strong>Background: </strong>Anemia is common among HIV/AIDS patients, impacting prognosis. Particulate matter (PM) exposure is an understudied, potentially modifiable risk factor in this group.</p><p><strong>Methods: </strong>We gathered 36,266 hemoglobin (Hb) measurements from 6808 HIV/AIDS patients from the HIV/AIDS Comprehensive Response Information Management System from 1 January 2004 to 31 December 2021. We evaluated the relationship between Hb levels and short-term PM exposure using linear mixed-effects models. We used logistic regression to estimate the association of long-term PM exposure with baseline anemia prevalence and time-varying Cox models to estimate the association of long-term PM exposure with follow-up incidence of anemia. Mediation analysis explored the role of chronic kidney disease (CKD) in the association between PM exposure and anemia.</p><p><strong>Results: </strong>For every 5 µg/m³ increase in 28-day average PM 1 , Hb levels decreased by 0.43 g/l. For a 10 µg/m³ increase in PM 2.5 , Hb decreased by 0.55 g/l; for the same increase in PM 10, Hb decreased by 0.35 g/l. A 5 µg/m³ increase in 1-year average PM 1 corresponded to a 7% higher prevalence of anemia at baseline, a 10 µg/m³ increase in PM 2.5 to 8% higher prevalence, and a 10 µg/m³ increase in PM 10 to 6% higher prevalence. These rises in average PM concentrations during follow-up were associated with increased incident anemia by 54% (PM 1 ), 72% (PM 2.5 ), and 51% (PM 10 ). CKD partially mediated the positive associations between PM exposure and the incidence of anemia.</p><p><strong>Conclusion: </strong>PM exposure was associated with lower Hb levels and higher incidence of anemia in HIV/AIDS patients and CKD with mediating estimated effects in PM-induced anemia.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"216-226"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909285","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}