European Journal of Epidemiology最新文献

{"title":"Effect of colonoscopy screening on risks of colorectal cancer and related death: instrumental variable estimation of per-protocol effects","authors":"Joy Shi, Magnus Løberg, Mette Kalager, Paulina Wieszczy, Nastazja D. Pilonis, Hans-Olov Adami, Michal F. Kaminski, Michael Bretthauer, Miguel A. Hernán","doi":"10.1007/s10654-025-01209-w","DOIUrl":"https://doi.org/10.1007/s10654-025-01209-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>We recently reported per-protocol estimates of colonoscopy screening on colorectal cancer incidence and mortality in NordICC, a large-scale randomized trial. Our results may be affected by residual confounding due to lack of detailed information on confounders. Here, we supplement our per-protocol analyses with instrumental variable (IV) estimates whose validity relies on an alternate set of assumptions but does not depend on the availability of confounder data. Individuals in the NordICC trial were randomized at a 1:2 ratio to receive either an invitation to a one-time screening colonoscopy (the invited group) or no invitation (the usual-care group). We used IV analyses to estimate bounds and point estimates of per-protocol effects of colonoscopy screening on colorectal cancer incidence and mortality after 10 years follow-up. Analyses included 28,220 participants in the invited group and 56,365 participants in the usual-care group. Participation in screening was 42%. In IV per-protocol analyses, the 10-year risk of colorectal cancer was 1.13% (95% confidence interval [CI]: 1.04, 1.23) with usual care and, depending on the assumptions, 0.66% (95% CI: 035, 0.95) to 0.74% (95% CI: 0.57, 0.95) in screened individuals (risk ratio of 0.59 [95% CI: 0.30, 0.98] to 0.65 [95% CI: 0.48, 0.87]). The risk of colorectal cancer mortality at 10 years was 0.29% (95% CI: 0.24, 0.33) in the usual-care group and 0.20 (95% CI: 0.09, 0.73) to 0.22% (95% CI: 0.08, 0.37) in the screened group (risk ratio of 0.71 [95% CI: 0.31, 2.89] to 0.79 [95% CI: 0.24, 1.42]). IV estimation of per-protocol effects suggests that colonoscopy screening reduces colorectal cancer incidence by 35 to 41% after 10 years.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"69 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The baseline examinations of the German National Cohort (NAKO): recruitment protocol, response, and weighting","authors":"Stefan Rach, Matthias Sand, Achim Reineke, Heiko Becher, Karin Halina Greiser, Kathrin Wolf, Kerstin Wirkner, Carsten Oliver Schmidt, Sabine Schipf, Karl-Heinz Jöckel, Lilian Krist, Wolfgang Ahrens, Hermann Brenner, Stefanie Castell, Sylvia Gastell, Volker Harth, Bernd Holleczek, Till Ittermann, Stefan Janisch-Fabian, André Karch, Thomas Keil, Carolina J. Klett-Tammen, Alexander Kluttig, Oliver Kuß, Michael Leitzmann, Wolfgang Lieb, Claudia Meinke-Franze, Karin B. Michels, Rafael Mikolajczyk, Ilais Moreno Velásquez, Nadia Obi, Cara Övermöhle, Annette Peters, Tobias Pischon, Susanne Rospleszcz, Börge Schmidt, Matthias B. Schulze, Andreas Stang, Henning Teismann, Christine Töpfer, Robert Wolff, Kathrin Günther","doi":"10.1007/s10654-025-01219-8","DOIUrl":"https://doi.org/10.1007/s10654-025-01219-8","url":null,"abstract":"<p>The German National Cohort (NAKO) is the largest population-based epidemiologic cohort study in Germany and investigates the causes of the most common chronic diseases. Between 2014 and 2019, a total of 1.3 million residents aged 20–69 years from 16 German regions were randomly selected from the general population and invited to participate following a highly standardized recruitment protocol. The overall response was 15.6% and differed considerably across study centers (7.6–30.7%). Females were more likely to participate than males (17.5% vs. 14.1%) and participation increased with age (10.2% in age group “ &lt; 29 years” up to 20.7% in age group “ &gt; 60 years”). Across all study regions, response was highest in rural areas (22.3%), followed by towns and suburbs (17.2%), and was lowest in cities (14.5%). Compared with the general population in the respective study regions, participants with low and medium education are underrepresented in the NAKO sample, while highly educated participants are overrepresented. Participants with non-German nationality and with a migration background are also underrepresented. Participants living in single households are underrepresented, while participants from larger households (2 or more persons) are overrepresented compared to the general population. Survey weights are made available to researchers along with the study data that account for the sampling design and adjust for differences in the distribution of age, sex, nationality (German vs. non-German), migration status, education, and household size.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"219 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When, why and how are estimated effects transported between populations? A scoping review of studies applying transportability methods","authors":"Fabian Manke-Reimers, Vincent Brugger, Till Bärnighausen, Stefan Kohler","doi":"10.1007/s10654-025-01217-w","DOIUrl":"https://doi.org/10.1007/s10654-025-01217-w","url":null,"abstract":"<p>Transportability methods can improve the external validity of estimated effects by accounting for effect heterogeneity due to differently distributed covariates between populations. This scoping review aims to provide an overview of when, why and how transportability methods have been applied. We systematically searched MEDLINE (Ovid), Embase, Web of Science, EconLit and Google Scholar for studies published between 2010 and December 18, 2024. Studies using transportability methods in a numerical application for at least partly non-overlapping source and target populations were included. We identified 3432 unique studies and included 64 studies applying transportability methods. Over two thirds of the included studies (44/64) introduced new methods. Less than one third of the included studies (20/64) were pure applications of transportability methods. Most applied studies (17/20) transported effect estimates from randomized controlled trials. Effects were transported to target populations with either complete (9/20) or no (9/20) treatment and outcome data or both (2/20). The most frequent aims of applied studies were to transport estimated effects to new populations (10/20) and to assess effect heterogeneity explainable by measured covariates (8/20). How transportability methods were applied varied widely between studies, for instance in the covariate selection approach and sensitivity analysis. Methodological studies with a transportability application presented new transportability estimators for randomized data (5/44), specific transportability applications (e.g., meta-analysis, mediation analysis; 21/44) and other methodological aspects (e.g., covariate selection, missing data handling; 18/44). Transportability methods are a useful tool for knowledge transfer between populations. More applications of transportability methods and guidance for their use are desirable.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"37 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143847273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Life satisfaction as compared with traditional risk factors in relation to incident cardiovascular diseases","authors":"Minghao Kou, Xiang Li, Hao Ma, Xuan Wang, Yoriko Heianza, JoAnn E. Manson, Lu Qi","doi":"10.1007/s10654-025-01225-w","DOIUrl":"https://doi.org/10.1007/s10654-025-01225-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Emerging evidence suggests a role of psychological well-being in the development of cardiovascular disease (CVD), but supportive data remain limited. This study assessed the prospective associations between life satisfaction and incident CVD, as well as the relative importance of life satisfaction compared to traditional risk factors.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>The study included 153,810 participants free of CVD at baseline, with measurements of life satisfaction on general happiness, personal health, family relationships, friendships, and financial situation, followed up until December 31, 2022. Cox proportional hazards models were used to estimate associations between life satisfaction and incident CVD. The relative importance of life satisfaction in predicting CVD was measured by explained R² values.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>During a median follow-up of 12.9 years, 14,370 incident CVD events occurred, including 10,070 CHD and 2,895 strokes. Individuals with low life satisfaction had an 80% higher risk of CVD compared to those with high life satisfaction (hazard ratio [95% confidence interval], 1.84 [1.63–2.07] for CVD, 1.83 [1.59–2.10] for CHD, and 1.74 [1.31–2.31] for stroke). Life satisfaction was ranked as the fourth-strongest CVD risk factor, following hypertension, race, and income. Low satisfaction with all individual aspects was significantly associated with higher risks of CVD and CHD (<i>P</i> &lt; 0.05), while satisfaction with personal health showing the strongest association.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>This study indicates that life satisfaction is robustly associated with incident CVD and may be considered one of the strongest predictors of CVD risk, alongside traditional risk factors. Our findings support the inclusion of life satisfaction in cardiovascular health metrics.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"37 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143798297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between aspirin use and the risk of incident nonalcoholic fatty liver disease","authors":"Hangkai Huang, Zhening Liu, Chengfu Xu","doi":"10.1007/s10654-025-01224-x","DOIUrl":"https://doi.org/10.1007/s10654-025-01224-x","url":null,"abstract":"<p>This study aimed to investigate the association between aspirin use and the incidence of nonalcoholic fatty liver disease (NAFLD). We included 53,490 participants from the Nurses’ Health Study II, a prospective US cohort study. Cox proportional hazard regression analyses were performed to assess the association between time-updated aspirin use and the risk of incident NAFLD. The exposure data included the status, duration, frequency and dosage of aspirin use. Data on the use of nonaspirin nonsteroidal anti-inflammatory drugs and acetaminophen were also collected. Over 1.1 million person-years of follow-up and 3,640 cases of incident NAFLD were documented. Compared with nonusers, current aspirin users had a significantly greater risk of NAFLD (HR: 1.17, 95% CI: 1.05 − 1.29). The current use of nonsteroidal nonaspirin anti-inflammatory drugs was also positively associated with NAFLD risk (HR: 1.29, 95% CI: 1.11 − 1.50). There were no significant associations with the use of acetaminophen. Aspirin use was associated with a modestly increased risk of incident NAFLD. These findings need to be confirmed in future studies.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"79 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Has the “obesity paradox” been resolved by semaglutide trials?","authors":"Zhu Liduzi Jiesisibieke, Mary Beth Terry, C. Mary Schooling","doi":"10.1007/s10654-025-01211-2","DOIUrl":"https://doi.org/10.1007/s10654-025-01211-2","url":null,"abstract":"","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"24 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence triangulation in health research","authors":"Sirena Gutierrez, M. Maria Glymour, George Davey Smith","doi":"10.1007/s10654-024-01194-6","DOIUrl":"https://doi.org/10.1007/s10654-024-01194-6","url":null,"abstract":"<p>For many important questions about influences on clinical and public health outcomes, no single study can provide a decisive answer. The perfect study—a large, diverse, well-conducted trial randomizing all relevant versions of a treatment and comprehensively tracking all relevant health outcomes—is never feasible. Instead, we must draw conclusions by piecing together evidence from multiple imperfect studies. A systematic framework for combining disparate, complementary sources of evidence is emerging. We introduce this framework, called evidence triangulation; summarize key approaches based on delineating likely biases due to confounding, measurement, and selection; and review some methods for combining evidence. We illustrate the issues using the example of estimating the effects of alcohol use on dementia. The central tenet of evidence triangulation is to identify the most important weaknesses for any given study approach (and for each specific study applying that approach) and, if necessary, to identify which new sources of evidence that do not share these weaknesses are required. Almost certainly, the new studies will have weaknesses, but when results are consistent across studies that rest on different assumptions, and for which biases should be unrelated, the conclusions are on much sturdier ground.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"72 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survey sampling design in wave 1 of the Global Flourishing Study","authors":"R. Noah Padgett, Richard G. Cowden, Manas Chattopadhyay, Ying Han, John Honohan, Zacc Ritter, Rajesh Srinivasan, Byron R. Johnson, Tyler J. VanderWeele","doi":"10.1007/s10654-024-01167-9","DOIUrl":"https://doi.org/10.1007/s10654-024-01167-9","url":null,"abstract":"<p>The Global Flourishing Study (GFS) is an international collaboration to develop a publicly accessible data resource to promote global research on human flourishing. These data include over 200,000 participants from 22 geographically and culturally diverse countries and one territory designed to be nationally representative of the adult population. The GFS is intended as a longitudinal panel study with recruitment and empanelment for Wave 1 occurring between April 2022 and December 2023. Future waves of data collection will invite participants to complete a survey annually. The annual survey covers a robust set of measures on well-being, health, social, economic, political, religious, spiritual, psychological and demographic variables. The current paper describes the sampling methodology and weighting approaches used to project the samples to be nationally representative. Details are provided on interviewer training and data collection, probability and non-probability samples, creating weights, design effects, and future data collection stages.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"27 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of salt substitution on cumulative blood pressure: a secondary analysis of the SSaSS","authors":"Xiaoxia Li, Liping Huang, Bo Zhou, Zhifang Li, Jixin Sun, Yan Yu, Hongyi Song, Maoyi Tian, Xuejun Yin, Bruce Neal, Yuhong Zhang, Yangfeng Wu, Yi Zhao","doi":"10.1007/s10654-025-01216-x","DOIUrl":"https://doi.org/10.1007/s10654-025-01216-x","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Abstract</h3><p>The effect of a potassium-enriched salt substitute on cumulative blood pressure (BP) remains unclear. This study aimed to assess the long-term effects of a potassium-enriched salt substitute versus regular salt on cumulative and conventional measures of systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP) and pulse pressure (PP). We analyzed data from the Salt Substitute and Stroke Study (SSaSS), a 5-year cluster randomized controlled trial in rural of China with 20,995 participants. The intervention used salt substitute; controls used regular salt. BP was measured for all participants at baseline, among subsamples at 12-month intervals, and for all alive at 60 months. Cumulative BP was calculated as the average between baseline and follow-up measures multiplied by the time between them (mmHg × year). Linear mixed models were used to assess the effects of salt substitution on BP outcomes at each follow-up visit. After a mean 4.74 years of follow-up, salt substitute compared to the regular salt lowered the cumulative SBP with a mean (SD) of 740 (85) vs. 750 (87) mmHg×year. Salt substitute also lowered cumulative MAP and PP, with means (SD) of 560 (58) vs. 566 (59) mmHg×year, and 306 (67) vs. 313 (68) mmHg×year, respectively. Similar beneficial effects of the salt substitute were observed for traditional measurements of SBP, MAP, and PP. There was no difference in either cumulative DBP (434 vs. 437 mmHg × year) or traditional DBP (85 vs. 86 mmHg). Salt substitute significantly reduced cumulative and traditional SBP, MAP, and PP, but not DBP.</p><h3 data-test=\"abstract-sub-heading\">Trial registration</h3><p>SSaSS ClinicalTrials.gov number: NCT0 2,092,090.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"37 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy in the Swedish national patient register: a review including diagnoses in the outpatient register","authors":"Åsa H. Everhov, Thomas Frisell, Mehdi Osooli, Hannah L. Brooke, Hanne K. Carlsen, Karin Modig, Karl Mårild, Jonathan Lindström, Karin Sköldin, Mona Heurgren, Jonas F. Ludvigsson, Ola Olén","doi":"10.1007/s10654-025-01221-0","DOIUrl":"https://doi.org/10.1007/s10654-025-01221-0","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>The Swedish National Patient Register (NPR) is an important source of data for epidemiological research. A review in 2010 described the validity of recorded diagnoses for inpatient care, but did not include specialised outpatient care.</p><h3 data-test=\"abstract-sub-heading\">Method</h3><p>Using systematic searches of medical literature databases (Embase, Medline), and reports from members of the Swedish Epidemiological Association, we aimed to identify all studies validating diagnoses and procedure codes in inpatient care since 2010 and all studies validating specialised outpatient care. In addition, we summarize findings from register validation work performed by the National Board of Health and Welfare.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The literature search and personal reports generated 3990 non-duplicate original studies, of which 89 were deemed relevant. Compared to data in patient charts (reference), the median positive predictive value (PPV) for diagnostic codes in the NPR was 84% (interquartile range 72–93%), but with clear differences between types of diagnoses. The median PPV for surgical procedures was 97% (86–99%). The median sensitivity of diagnoses and procedures compared to other registers and cohorts was 73% (45–80%). The completeness of the register has improved over time. Missingness originates mainly from underreporting of procedures performed by private healthcare providers, and for certain variables, e.g. medication codes.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>The NPR has good diagnostic accuracy for most diagnoses and very good for surgical procedures. The sensitivity is lower. Longitudinal comparisons of incidence or prevalence are affected by changes in completeness. Missingness is low, although it is higher among private healthcare providers and for specific variables such as drug administration.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"22 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}