European Journal of Epidemiology最新文献

{"title":"Cohort profile: the Guangzhou older longitudinal dynamic health (GOLD-Health) cohort.","authors":"Hui Liu,Xiaojie Wang,Weiquan Lin,Ge Chen,Jiamin Chen,Zilong Zhang,Qin Zhou,Yin Yang,Xiangyi Liu,Junguo Zhang,Yingying Fang,Liying Luo,Hualiang Lin,Zhoubin Zhang","doi":"10.1007/s10654-025-01254-5","DOIUrl":"https://doi.org/10.1007/s10654-025-01254-5","url":null,"abstract":"The Guangzhou Older Longitudinal Dynamic Health (GOLD-Health) Cohort is a prospective population-based cohort study aimed at investigating the risk factors associated with non-communicable diseases (NCDs) among adult individuals in Guangzhou, one of China's most developed and densely populated cities. From 1 Jan 2018 until 31 Dec 2020, 737,863 participants (mean age = 71.8 years, 58.9% were female) completed baseline data collection, among which approximately 92.1% donated blood samples. Baseline data collection comprises various factors, including general characteristics, socio-economic factors, lifestyle habits, cooking fuel usage and living standards, and medical history of chronic diseases. Additionally, physical and biochemical indicator examinations are conducted by trained medical staff. Two complementary follow-up approaches are utilized to validate and enrich the outcome information on mortality and non-communicable disease outcomes, ensuring its reliability and comprehensiveness. First, routine linkage with the Guangzhou Municipal Health Commission's electronic records provides continuous monitoring of mortality events and participants' inpatient and outpatient hospital visits. Second, periodic follow-up is conducted through telephone interviews and regular face-to-face surveys to collect detailed information on health status, lifestyle changes, newly diagnosed conditions, and self-reported events not captured in hospital records. This combined approach ensures both the completeness and accuracy of the cohort data. This cohort may serve as a decision-making tool for chronic disease management and contributes to the evaluation of scientific findings under real-world conditions.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"51 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144370088","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":"Recent trends in self-reported utilization of colonoscopy and fecal occult blood test in Europe: analysis of the European Health Interview Surveys 2013-2015 and 2018-2020.","authors":"Idris Ola,Rafael Cardoso,Michael Hoffmeister,Hermann Brenner","doi":"10.1007/s10654-025-01247-4","DOIUrl":"https://doi.org/10.1007/s10654-025-01247-4","url":null,"abstract":"Despite increasing implementation of colorectal cancer (CRC) screening programs in Europe, utilization of screening tests has varied significantly over the years. We examined recent trends in the utilization of colonoscopy and fecal occult blood test (FOBT), the primary tests recommended for CRC screening, across European countries with various screening programs. Population-based data from the second and third waves of the European Health Interview Survey (EHIS) were analyzed to determine changes in utilization of fecal occult blood test within the preceding 2 years or colonoscopy within the preceding 10 years among people aged 50-74 years between 2013-2015 and 2018-2020. Absolute percentage changes (APC) in screening test use were calculated in each country and subgroup meta-analyses were conducted using random effects models to estimate the pooled APCs and their 95% confidence intervals across different categories of screening offers. A total of 234,251 respondents across 28 European countries were included in the analysis. The increase in use of either test was highest among countries which fully rolled out nationwide organized screening programs with fecal tests between 2013-2015 and 2018-2020 (increases ranging from 19.1% units in Belgium to 46.3% units in The Netherlands) and was lowest among countries with opportunistic offering of fecal test, colonoscopy or flexible sigmoidoscopy (from - 3% units in Germany to + 12.2% units in Slovakia). Changes in screening programs were strongly associated with higher rates of utilization of colonoscopy and fecal occult blood test across all screening offers. Our findings highlight that well-organized and dynamic population screening strategies can rapidly and sustainably increase utilization of CRC screening tests in Europe.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"12 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311466","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":"How hazard ratios can mislead and why it matters in practice.","authors":"Elise Dumas, Mats J Stensrud","doi":"10.1007/s10654-025-01250-9","DOIUrl":"10.1007/s10654-025-01250-9","url":null,"abstract":"<p><p>Hazard ratios are routinely reported as effect measures in clinical trials and observational studies. However, many methodological works have raised concerns about the interpretation of hazard ratios as causal effects. These concerns are often related to three points: (i) depletion of susceptible individuals leads to selection bias and complicates the causal interpretation of the hazard ratio, (ii) the hazard ratio is not collapsible, and (iii) the conventional proportional hazards assumption rarely holds in medical studies. We discuss the relation between these three points. We ground our presentation on an example about effect of endocrine therapy in reducing the risk of recurrence or death in a population of patients with breast cancer. We also describe why survival curves and risk differences do not exhibit any of the undesirable properties of hazard ratios.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":" ","pages":"603-609"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to: Aspirin use and risk of nonalcoholic fatty liver disease.","authors":"Hangkai Huang, Zhening Liu, Chengfu Xu","doi":"10.1007/s10654-025-01253-6","DOIUrl":"10.1007/s10654-025-01253-6","url":null,"abstract":"","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":" ","pages":"737"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293570","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":"All-cause and cause-specific mortality in individuals with COPD in China: a 16-year follow-up cohort study.","authors":"Yalei Ke, Yuxuan Zhao, Dianjianyi Sun, Pei Pei, Huaidong Du, Yiping Chen, Ling Yang, Xiaoming Yang, Yalin Chen, Junshi Chen, Zhengming Chen, Jun Lv, Liming Li, Canqing Yu","doi":"10.1007/s10654-025-01252-7","DOIUrl":"10.1007/s10654-025-01252-7","url":null,"abstract":"<p><p>The prevalence of chronic obstructive pulmonary disease (COPD) is rising in China, yet population-based evidence on COPD-related mortality risk remains limited. This study examined the association between prevalent COPD and all-cause and cause-specific mortality in a large Chinese cohort. 484,301 adults aged 30 to 79 years who received spirometry at the baseline of the China Kadoorie Biobank Study (2004-2008) were included. COPD was defined as FEV₁/ FVC < 0.7. Mortality data were tracked via local death registries and national health insurance systems over a median follow-up period of 16.0 years. Cox proportional hazard models and competing risk regression were used to estimate hazard ratios (HRs) and subdistribution HRs (SHRs), respectively. The COPD group had higher all-cause and cause-specific mortality, with adjusted HR (95%CI) for all-cause mortality of 1.44 (1.41-1.47), and adjusted SHR (95%CI) of 1.09 (1.05-1.13), 1.06 (1.01-1.11), 3.30 (3.12-3.49), 1.45 (1.16-1.81), for circulatory disease, neoplasms, respiratory disease, and infectious disease mortality, respectively. Specifically, young COPD (aged < 50 years) showed a stronger mortality association than those aged ≥ 50 years. Moreover, individuals with preserved ratio impaired spirometry (PRISm) had a 1.4-fold higher risk of all-cause mortality compared with non-COPD participants. COPD is associated with a significantly elevated risk of mortality from all causes, circulatory disease, neoplasms, respiratory disease, and infectious disease in the Chinese population. Additionally, young COPD and those with PRISm faced significant mortality burdens.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":" ","pages":"681-691"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215263","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":"Prenatal and childhood infections and risk of epilepsy.","authors":"Yi-Jiun Pan, Mei-Chen Lin, Chi-Fung Cheng, Chi-Shin Wu, Chia-Lin Liu, Pei-Chun Chen, Wesley K Thompson, Chun-Chieh Fan, Shi-Heng Wang","doi":"10.1007/s10654-025-01256-3","DOIUrl":"10.1007/s10654-025-01256-3","url":null,"abstract":"<p><p>Infections in utero and early childhood are associated with an increased epilepsy risk; however, confounding by familial predisposition has not been adequately accounted for in previous studies. We aimed to assess the epilepsy risk attributable to infections in utero and early childhood by performing population-based and sibling-comparison analyses to account for residual and unmeasured familial confounding factors. This nationwide birth cohort study included 2,609,289 individuals born 2001-2016 in Taiwan. Maternal infection during pregnancy and early childhood infection during the first year of life were defined. Maternal pre-pregnancy infection was used as negative control. In the population analyses, offspring exposed to any maternal infection during pregnancy had an increased epilepsy risk (hazard ratio (HR) = 1.36, 95% confidence interval (CI):1.27-1.45). However, the association with maternal infection was attenuated to the null (HR = 1.11, 95% CI:0.98-1.27), except for maternal infection in sepsis (HR = 2.54, 95% CI:1.74-3.70) and central nervous system (HR = 24.59, 95% CI:3.28-184.23), in the sibling analyses. The association of maternal pre-pregnancy infection with offspring epilepsy was observed in the population analyses, but not in the sibling analyses. Individuals exposed to childhood infection had an increased epilepsy risk (HR = 1.49, 95% CI:1.45-1.54) in the population analyses; the association was still observed in the sibling analyses (HR = 1.31, 95% CI:1.23-1.40). The association between maternal infection during pregnancy and epilepsy risk in the offspring appears largely because of familial confounding factors. Infections during early childhood may play a causal role in the subsequent epilepsy risk.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":" ","pages":"693-704"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215295","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":"Non-linear Mendelian randomization: evaluation of effect modification in the residual and doubly-ranked methods with simulated and empirical examples.","authors":"Fergus W Hamilton, David A Hughes, Tianyuan Lu, Zoltán Kutalik, Apostolos Gkatzionis, Kate Tilling, Fernando P Hartwig, George Davey Smith","doi":"10.1007/s10654-025-01208-x","DOIUrl":"10.1007/s10654-025-01208-x","url":null,"abstract":"<p><p>Non-linear Mendelian randomisation (NLMR) is a relatively recently developed approach to estimate the causal effect of an exposure on an outcome where this is expected to be non-linear. Two commonly used techniques-based on stratifying the exposure and performing Mendelian randomisation (MR) within each strata-are the residual and doubly-ranked methods. The residual method is known to be biased in the presence of genetic effect heterogeneity-where the effect of the genotype on the exposure varies between individuals. The doubly-ranked method is considered to be less sensitive to genetic effect heterogeneity. In this paper, we simulate genetic effect heterogeneity and confounding of the exposure and outcome and identify that both methods are susceptible to likely unpredictable bias in this setting. Using UK Biobank, we identify empirical evidence of genetic effect heterogeneity and show via simulated outcomes that this leads to biased MR estimates within strata, whilst conventional MR across the full sample remains unbiased. We suggest that these biases are highly likely to be present in other empirical NLMR analyses using these methods and urge caution in current usage. Simulated outcome analyses may represent a useful test to identify if genetic effect heterogeneity is likely to bias NLMR estimates in future analyses.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":" ","pages":"631-647"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postdiagnosis physical activity and dietary inflammatory and insulinemic potential with overall survival in men with nonmetastatic prostate cancer.","authors":"Dong Hoon Lee, Leandro F M Rezende, Gerson Ferrari, Yiwen Zhang, Qiao-Li Wang, Hannah Oh, NaNa Keum, Jinbo Hu, Justin Y Jeon, Lorelei A Mucci, Edward L Giovannucci","doi":"10.1007/s10654-025-01240-x","DOIUrl":"10.1007/s10654-025-01240-x","url":null,"abstract":"<p><p>Inflammation and insulin resistance are associated with increased mortality in the general population. However, it remains unclear how physical activity and proinflammatory/hyperinsulinemic diets influence overall survival in prostate cancer patients. We analyzed 4779 men with nonmetastatic prostate cancer from the Health Professionals Follow-up Study. Postdiagnosis physical activity and diet were assessed using validated self-reported questionnaires. We used the validated dietary scores to empirically assess the anti-inflammatory (rEDIP) and anti-insulinemic (rEDIH) potential of dietary patterns based upon specific combinations of food groups. Cox regression model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During a median of 15 years of follow-up, we identified 2282 deaths. Compared to men with < 3 MET-h/week of postdiagnosis physical activity, multivariable-adjusted HRs (95% CI) were 0.80 (0.68-0.95) for 9-< 24 MET-h/week, 0.63 (0.53-0.75) for 24-< 48 MET-hours/week and 0.61 (0.51-0.73) for ≥ 48 MET-hours/week in relation to all-cause mortality (P-trend < 0.001). Both vigorous and non-vigorous activities after diagnosis were associated with lower all-cause mortality (P-trend < 0.001). Moreover, post-diagnosis rEDIP and rEDIH scores were inversely associated with all-cause mortality (HR per 1-SD increase: 0.93 (0.89-0.99) for rEDIP; 0.91 (0.86-0.96) for rEDIH). In joint analyses, men with high physical activity and high rEDIP (or rEDIH) score showed approximately 30-36% lower risks of all-cause mortality, compared to those with low physical activity and low diet scores. In conclusion, high physical activity and low proinflammatory and hyperinsulinemic diets were independently associated with decreased risk of all-cause mortality in men with prostate cancer. Men with both high physical activity and low proinflammatory and hyperinsulinemic diets after diagnosis have the lowest mortality rate.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":" ","pages":"669-679"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157505","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":"Cancer risk after in utero exposure to diethylstilbestrol.","authors":"Naomi B Boekel, Janneke Verloop, Hester H van Boven, Elisabeth J M van Erp, Lieske Schrijver, Matti A Rookus, Flora E van Leeuwen","doi":"10.1007/s10654-025-01234-9","DOIUrl":"10.1007/s10654-025-01234-9","url":null,"abstract":"<p><p>In utero exposure to diethylstilbestrol (DES) is associated with increased risk of clear cell adenocarcinoma (CCAC) of the vagina or cervix. It is not clear whether these risks remain increased at older ages, and if the risks of other cancer sites, including breast cancer, are increased. This nationwide cohort study included 12,249 DES-exposed women and 2,070 unexposed sisters. Hormone-related risk factors and medical history were assessed through questionnaires, and cancer incidence through linkages with nationwide registries. Comparison with general population rates showed no difference in overall cancer risk (SIR = 0.98, 95%CI 0.93-1.04) or breast cancer risk (SIR = 1.03, 95%CI 0.96-1.11) for DES-exposed women. The rate of vaginal cancer was strongly increased for DES-exposed women (SIR = 10.5, 95%CI 5.72-17.6) and was increased in all age categories, including age 60-69 years (SIR = 8.3, 95%CI 1.00-29.9). Risks of both CCAC (SIR = 49.1, 95%CI 21.2-96.8) and squamous cell carcinoma (SCC; SIR = 5.86, 95%CI 2.15-12.8) of the vagina were significantly elevated. When comparing DES-exposed women with DES-unexposed sisters, overall cancer risk and risk of breast cancer were similar (HR = 0.93, 95%CI 0.78-1.11 and HR = 0.97, 95%CI 0.76-1.23, respectively). Apart from the established increased risk of vaginal cancer, women exposed to DES in utero do not seem to be at increased risk of cancer, including breast cancer. The risk of vaginal cancer remains increased also for women in their fifties/sixties. Moreover, the increased risk of vaginal cancer was seen for both subtypes CCAC and SCC. Screening for vaginal cancer up to higher ages than currently recommended (< 60 years) should be considered.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":" ","pages":"659-668"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157547","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":"Search for common genetic variants to allow reliable Mendelian randomization investigations into ketone metabolism.","authors":"Zhu Liduzi Jiesisibieke, Héléne Toinét Cronjé, C Mary Schooling, Stephen Burgess","doi":"10.1007/s10654-025-01246-5","DOIUrl":"10.1007/s10654-025-01246-5","url":null,"abstract":"<p><p>Ketogenic diets are popular among people aiming for weight management. Ketone supplementation has been linked to improved cognitive performance and increased risk of insulin resistance. We aim to identify common genetic variants that allow Mendelian randomization investigations into further potential effects of ketone metabolism. We set four premises that we believe any valid instrument for ketone metabolism should satisfy. These are: (1) location in a gene region relevant to ketone metabolism, (2) association with all three primary ketone bodies (acetone, acetoacetate, and beta-hydroxybutyrate), (3) no pleiotropic associations, (4) associations with positive control variables (cognitive performance, two-hour glucose, and insulin fold change). We considered gene regions containing variants previously associated with acetone. Four of these regions had biological relevance to ketone metabolism. Lead variants for three of these four regions (SLC2A4, HMGCS2, OXCT1) were associated with all three primary ketone bodies. One region (SLC2A4) was associated with two-hour glucose and insulin fold change; however, this region had strong pleiotropic associations with blood pressure. One region (OXCT1) showed an association with cognitive performance, and thus satisfied all our premises to be a valid instrument for ketone metabolism. In a complementary agnostic approach considering all genome-wide significant predictors of the three primary ketone bodies in turn, genetically predicted acetoacetate based on seven variants was associated with improved cognitive performance. However, several variants selected in this approach were not located in biologically relevant gene regions and were pleiotropic. Causal claims from Mendelian randomization will be most reliable when the instrumental variable assumptions are plausibly satisfied. We illustrate a framework to identify candidate instruments based on biological considerations.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":" ","pages":"649-657"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}