International journal of epidemiology最新文献

{"title":"Illustrating the structures of bias from immortal time using directed acyclic graphs","authors":"Guoyi Yang, Stephen Burgess, Catherine Mary Schooling","doi":"10.1093/ije/dyae176","DOIUrl":"https://doi.org/10.1093/ije/dyae176","url":null,"abstract":"Background Immortal time is a period of follow-up during which death or the study outcome cannot occur by design. Bias from immortal time has been increasingly recognized in epidemiological studies. However, the fundamental causes and structures of bias from immortal time have not been explained systematically. Methods We use an example ‘Does winning a Nobel Prize prolong lifespan?’ for illustration. We illustrate how immortal time arises and present structures of bias from immortal time using directed acyclic graphs that specify time-varying variables. We further explore the structures of bias with the exclusion of immortal time and with the presence of competing risks. We discuss how these structures are shared by different study designs in pharmacoepidemiology and provide solutions, where possible, to address the bias. Results The fundamental cause of immortal time is misalignment of exposure allocation and eligibility. Specifically, immortal time arises from using post-eligibility information to define exposure or using post-exposure information to define eligibility. The structures of bias from immortal time are confounding by survival until exposure allocation or selection bias from selecting on survival until eligibility. Excluding immortal time from follow-up does not fully address this confounding or selection bias, and the presence of competing risks can worsen the bias. Bias from immortal time may be avoided by aligning baseline, exposure allocation and eligibility, and by excluding individuals with prior exposure. Conclusions Understanding bias from immortal time in terms of confounding or selection bias helps researchers identify and thereby avoid or ameliorate this bias.","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"28 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935931","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":"Changes in traffic-related air pollution exposures and associations with adverse birth outcomes over 20 years in Texas","authors":"Perry Hystad, Elaine L Hill, Andrew Larkin, David Schrank, Max Harleman, Evan Volkin, Erin J Campbell, John Molitor, Lena Harris, Beate R Ritz, Mary D Willis","doi":"10.1093/ije/dyae178","DOIUrl":"https://doi.org/10.1093/ije/dyae178","url":null,"abstract":"Background Billions of dollars have been spent implementing regulations to reduce traffic-related air pollution (TRAP) from exhaust pipe emissions. However, few health studies have evaluated the change in TRAP emissions and associations with infant health outcomes. We hypothesize that the magnitude of association between vehicle exposure measures and adverse birth outcomes has decreased over time, parallelling regulatory improvements in exhaust pipe emissions. Methods Using birth records in Texas from 1996 to 2016, we calculated residential exposure measures related to TRAP: nitrogen dioxide (NO2, a marker of the TRAP mixture), vehicle miles travelled within 500 m of homes (VMT500), a measure of traffic volume, and highway proximity. Using an accountability study framework, our analysis examined term birthweight, term low birthweight (TLBW) (<2500 g), preterm birth (PTB) (<37 weeks) and very preterm birth (VPTB) (<32 weeks). We implemented linear and logistic regression models to examine overall and time-stratified associations, including trends by race/ethnicity and socioeconomic groups. Results Among exposures for 6 158 518 births, NO2 exposures decreased 59% over time but VMT500 remained relatively stable. TRAP-related exposure measures were persistently associated with harmful birth outcomes [e.g. OR1996-2016 of 1.07 (95% CI: 1.04, 1.08) for TLBW comparing the highest vs lowest NO2 quintile]. The magnitude of associations decreased for total VMT500 and TLBW (-60%, OR1996: 1.08 to OR2016: 1.03 for the highest vs lowest quintile) and PTB (-65%) and VTPT (-61%), but not for term birthweight. Conclusions We observed evidence of small improvements in birth outcomes associated with reductions in exhaust pipe emissions over a 20-year period in Texas.","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"7 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934918","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":"Associations between breastfeeding and breast cancer risk through mammographic breast density in a cohort of Korean women.","authors":"Soyeoun Kim, Thi Xuan Mai Tran, Mi Kyung Kim, Min Sung Chung, Eun Hye Lee, Woojoo Lee, Boyoung Park","doi":"10.1093/ije/dyae165","DOIUrl":"https://doi.org/10.1093/ije/dyae165","url":null,"abstract":"<p><strong>Background: </strong>Mammographic breast density has been suggested to play a role as a mediator between the risk factors for breast cancer (BC) and BC risk. We investigated the extent to which never breastfeeding is a risk factor for BC and how this risk is further mediated by increased mammographic breast density.</p><p><strong>Methods: </strong>This retrospective cohort study included 4 136 723 women aged ≥40 years who underwent mammographic screening between 2009 and 2010 and were followed up until 31 December 2020. Breastfeeding information was obtained by using a self-administered questionnaire. Mammographic breast density was extracted from national BC screening results, which were assessed by trained radiologists and categorized into dense and fatty breasts. We estimated the hazard ratios (HRs) and the proportion of the associations between breastfeeding and BC risk mediated by breast density.</p><p><strong>Results: </strong>The HR of never breastfeeding on BC risk was 1.34 (95% CI, 1.32-1.37) when adjusted for only parity, body mass index and smoking status, which were selected as covariates through a directed acyclic graph and 1.21 (95% CI, 1.19-1.23) when breast density was additionally adjusted. The proportion of the association between never breastfeeding and BC risk mediated by breast density in total, pre- and post-menopausal women was 35.48%, 17.86% and 24.0%, respectively (all P < 0.001). The HR of never breastfeeding on BC risk was 1.10 (95% CI, 1.08-1.12) when adjusted for nine known breast cancer risk factors and 1.09 (95% CI, 1.07-1.12) when breast density was additionally adjusted. The proportion of the association between never breastfeeding and BC risk mediated by breast density in the total, pre- and post-menopausal women was 7.50%, 3.71% and 12.21%, respectively (all P < 0.001).</p><p><strong>Conclusions: </strong>Our findings suggest that the association between never breastfeeding and BC risk may be mediated by breast density. However, the HR and proportion of medications varied according to the adjusted covariates, highlighting that variables for adjustment should be selected based on directed acyclic graphs.</p>","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"54 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885586","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":"Cohort Profile: Healthy Finland Survey.","authors":"Katri Sääksjärvi, Hanna M Elonheimo, Jonna Ikonen, Lara Lehtoranta, Suvi Parikka, Tommi Härkänen, Terhi Vihervaara, Päivi Sainio, Tuija Jääskeläinen, Anna Liisa Suominen, Ulla Harjunmaa, Pia Mäkelä, Jouni Lahti, Niina E Kaartinen, Seppo Koskinen, Annamari Lundqvist","doi":"10.1093/ije/dyae166","DOIUrl":"10.1093/ije/dyae166","url":null,"abstract":"","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"54 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881765","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 proteogenomic analysis of the adiposity colorectal cancer relationship identifies GREM1 as a probable mediator.","authors":"Matthew A Lee, Charlie A Hatcher, Emma Hazelwood, Lucy J Goudswaard, Konstantinos K Tsilidis, Emma E Vincent, Richard M Martin, Karl Smith-Byrne, Hermann Brenner, Iona Cheng, Sun-Seog Kweon, Loic Le Marchand, Polly A Newcomb, Robert E Schoen, Ulrike Peters, Marc J Gunter, Bethany Van Guelpen, Neil Murphy","doi":"10.1093/ije/dyae175","DOIUrl":"10.1093/ije/dyae175","url":null,"abstract":"<p><strong>Background: </strong>Adiposity is an established risk factor for colorectal cancer (CRC). The pathways underlying this relationship, and specifically the role of circulating proteins, are unclear.</p><p><strong>Methods: </strong>Utilizing two-sample univariable Mendelian randomization (UVMR), multivariable Mendelian randomization (MVMR), and colocalization, based on summary data from large sex-combined and sex-specific genetic studies, we estimated the univariable associations between: (i) body mass index (BMI) and waist-hip ratio (WHR) and overall and site-specific (colon, proximal colon, distal colon, and rectal) CRC risk, (ii) BMI and WHR and circulating proteins, and (iii) adiposity-associated circulating proteins and CRC risk. We used MVMR to investigate the potential mediating role of adiposity- and CRC-related circulating proteins in the adiposity-CRC association.</p><p><strong>Results: </strong>BMI and WHR were positively associated with CRC risk, with similar associations by anatomical tumor site. In total, 6591 adiposity-protein (2628 unique circulating proteins) and 33 protein-CRC (7 unique circulating proteins) associations were identified using UVMR and colocalization. One circulating protein, GREM1, was associated with BMI (only) and CRC outcomes in a manner that was consistent with a potential mediating role in sex-combined and female-specific analyses. In MVMR, adjusting the BMI-CRC association for GREM1, effect estimates were attenuated-suggestive of a potential mediating role-most strongly for the BMI-overall CRC association in women.</p><p><strong>Conclusion: </strong>Results highlight the impact of adiposity on the plasma proteome and of adiposity-associated circulating proteins on the risk of CRC. Supported by evidence from UVMR and colocalization analyses using cis-single-nucleotide polymorphisms, GREM1 was identified as a potential mediator of the BMI-CRC association, particularly in women.</p>","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"54 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023490","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":"Cohort Profile Update: The Danish Nurse Cohort.","authors":"Mette Kildevæld Simonsen, Berit Lilienthal Heitmann, Dorthe Boe Danbjærg, Christoffer Johansen, Maria Kristiansen, Ola Ekholm","doi":"10.1093/ije/dyae168","DOIUrl":"https://doi.org/10.1093/ije/dyae168","url":null,"abstract":"","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"54 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881746","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":"Increased risk of subsequent antiphospholipid syndrome in patients with endometriosis.","authors":"Zhiyong Chen, Ran Cui, Shiow-Ing Wang, Hua Zhang, Miao Chen, Qian Wang, Qiang Tong, James Cheng-Chung Wei, Sheng-Ming Dai","doi":"10.1093/ije/dyae167","DOIUrl":"10.1093/ije/dyae167","url":null,"abstract":"<p><strong>Background: </strong>Although autoimmune abnormalities are common in patients with endometriosis, it is unknown whether patients with endometriosis have a higher risk of developing antiphospholipid syndrome (APS).</p><p><strong>Methods: </strong>We conducted a retrospective cohort study by using the multi-institutional research network TriNetX from 1 January 2012 to 31 December 2021. A total of 13 131 782 women aged 20-60 years from networks within the USA were included. The risks of APS were compared between an endometriosis cohort and a non-endometriosis cohort in subgroup analyses by age, obesity and systemic lupus erythematosus (SLE), and the sensitivity analysis was stratified by the presence or absence of a history of surgery of the uterus.</p><p><strong>Results: </strong>After 1:1 propensity score matching, the endometriosis and non-endometriosis cohorts each included 50 078 participants. Compared to individuals without endometriosis, patients with endometriosis had a higher risk of incident APS (log-rank test, P < 0.001). The hazard ratios (HRs) ranged from 1.82 [APS within 30 days to 1 year after the index date, 95% confidence intervals (CIs) 1.40-2.53] to 2.44 (APS within 30 days to any time after the index date, 95% CI 1.65-3.61). In the subgroup analyses, an increased risk of APS was observed in all ages, White race, and subgroups without smoking, obesity, asthma, inflammatory bowel disease and SLE (HR range 1.85-2.84). Sensitivity analyses revealed that the risk of APS increased in patients without surgery history of the uterus.</p><p><strong>Conclusions: </strong>Patients with endometriosis had a higher risk (2.84-fold) of developing APS. Future large-scale prospective studies are warranted to confirm our results.</p>","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"54 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846428","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":"Acute coronary syndrome rates by age and sex before and during the COVID-19 pandemic in Israel: nationwide study","authors":"Alexander Kagan, Donna R Zwas, Ziona Haklai, Hagai Levine","doi":"10.1093/ije/dyae164","DOIUrl":"https://doi.org/10.1093/ije/dyae164","url":null,"abstract":"Background There have been reports of sharp declines in acute coronary syndrome (ACS) during the COVID-19 pandemic. The study aims to assess nationwide ACS emergency department (ED) visit rates across age and sex subgroups and the general population, with a comparison before and throughout the pandemic’s various phases. Methods A multiple interrupted time series analysis was used to assess 61 349 ACS nationwide hospital visits from January 2018 to December 2021 at monthly intervals. The study period was divided into three periods: January 2018–February 2020 (pre-pandemic period); March 2020–January 2021 (early-pandemic period); February 2021–December 2021 (late-pandemic period). Segmented regression with a seasonally adjusted autoregressive moving average structure was used to build predictive models with an estimated reference trendline (counterfactual). Results Over 11 months of the early-pandemic period (lockdowns), the largest decrease in visits was seen in women aged 65 and above, of 18.4% [incidence rate ratio (IRR) 0.82; 95% confidence interval (CI) 0.77–0.86]. The lowest decrease was observed in men aged 25–64, of 7.2% (IRR 0.93; 0.91–0.94). During the late-pandemic period, which included high vaccination coverage and no lockdowns, the largest further decrease was in women aged 25–64 of 20.1% (IRR 0.80; 0.75–0.84) on average. Conclusions The pandemic influenced ACS ED visits variably, with substantial declines during phases of high COVID-19 morbidity and mortality. Older individuals, particularly women, demonstrated the largest decrease in ACS ED visits, highlighting the need for tailored public health strategies to maintain public confidence in access to critical care during future health emergencies.","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"30 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142832266","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":"Cohort Profile: The Performance Monitoring for Action (PMA) panel surveys.","authors":"Aisha Siewe, Meagan E Byrne, Dana Sarnak, Saifuddin Ahmed, Scott Radloff, Win Brown, Linnea A Zimmerman, Amy Tsui, Yoonjoung Choi, Elizabeth Gummerson, Caroline Moreau, Carolina Cardona, Shannon Wood, Celia Karp, Suzanne O Bell, Georges Guiella, Rosine Mosso, Fassassi Raïmi, Pierre Akilimali, Anoop Khanna, Peter Gichangi, Mary Thiongo, Souleymane Alzouma, Sani Oumarou, Elizabeth Omoluabi, Funmilola M OlaOlorun, Musa Sani Zakirai, Frederick Makumbi, Simon Peter Sebina Kibira, Philip Anglewicz","doi":"10.1093/ije/dyae180","DOIUrl":"https://doi.org/10.1093/ije/dyae180","url":null,"abstract":"","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"54 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931705","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":"Data Resource Profile: Harmonized health survey data for 240 cities across 11 countries in Latin America: the SALURBAL project.","authors":"Kari Moore, Mariana Lazo, Ana Ortigoza, D Alex Quistberg, Brisa Sanchez, Binod Acharya, Tania Alfaro, Maria Fernanda Kroker-Lobos, Mariana Carvalho De Menezes, Olga Lucia Sarmiento, Amanda C de Souza Andrade, Carolina Perez Ferrer, Akram Hernandez Vasquez, Waleska Teixeira Caiaffa, Ana V Diez Roux","doi":"10.1093/ije/dyae171","DOIUrl":"https://doi.org/10.1093/ije/dyae171","url":null,"abstract":"","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"54 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948355","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}