{"title":"Authors' Response: Quasi-experiments rely on design choices: a reflection on Renson and Westreich's \"What makes a study design quasi-experimental?\"","authors":"Audrey Renson, Daniel Westreich","doi":"10.1093/ije/dyag227","DOIUrl":"https://doi.org/10.1093/ije/dyag227","url":null,"abstract":"","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"55 6","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193214","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":"Missed opportunities: lessons from Haitian AIDS patients and their relevance today.","authors":"Arthur E Pitchenik","doi":"10.1093/ije/dyag229","DOIUrl":"https://doi.org/10.1093/ije/dyag229","url":null,"abstract":"","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"55 6","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206738","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}
Frerik Smit, Farzaneh Boroumand, Peter W G Tennant, Kylie-Ann Mallitt, Arnaud Chiolero, Anita van Zwieten, Saman Khalatbari-Soltani
{"title":"Not always towards the null: reconsidering the direction of overadjustment bias","authors":"Frerik Smit, Farzaneh Boroumand, Peter W G Tennant, Kylie-Ann Mallitt, Arnaud Chiolero, Anita van Zwieten, Saman Khalatbari-Soltani","doi":"10.1093/ije/dyag215","DOIUrl":"https://doi.org/10.1093/ije/dyag215","url":null,"abstract":"Overadjustment bias occurs when adjusting for a variable increases rather than decreases bias. It commonly arises in studies estimating the total causal effect of an exposure on an outcome due to inappropriate adjustment for a mediator. While such inappropriate mediator adjustment can lead to bias in any direction (towards the null, away from the null, or reverse the direction of effect) even in the absence of other relevant unadjusted variables, this type of overadjustment bias is often described as acting towards the null. Using directed acyclic graphs and a simulated example of adjustment for smoking when estimating the total causal effect of education on the risk of breast cancer, we explain how inappropriately adjusting for a mediator can lead to overadjustment bias in any direction. Correspondingly, we provide general guidance to predict the likely direction of overadjustment bias based on the direction of effect of the relevant paths involved. In general, this bias will be away from the null or in the reverse direction when the mediated pathway being closed by inappropriate adjustment acts in the opposite direction to the combined effect of all remaining pathways between the exposure and the outcome. In contrast, this bias will be towards the null when the effects of these paths act in the same direction.","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"11 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149086550","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}
Chiara Minotti, Louise F Hill, Michelle N Clements, Wolfgang Stohr, Ann Sarah Walker, Julia A Bielicki
{"title":"Neonatal sepsis definitions for randomised-controlled trials: challenges and approaches.","authors":"Chiara Minotti, Louise F Hill, Michelle N Clements, Wolfgang Stohr, Ann Sarah Walker, Julia A Bielicki","doi":"10.1093/ije/dyag154","DOIUrl":"10.1093/ije/dyag154","url":null,"abstract":"","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"55 5","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792807","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":"When air pollution meets comorbidities: evidence on the causal effect of PM2.5 on COVID-19 hospitalizations and deaths.","authors":"Carla Morvan, Johanna Lepeule, Emmanuelle Lavaine","doi":"10.1093/ije/dyag152","DOIUrl":"https://doi.org/10.1093/ije/dyag152","url":null,"abstract":"<p><strong>Background: </strong>Despite growing evidence on the health effects of air pollution, few studies have examined its impact on COVID-19 hospitalizations and deaths, and none have explicitly accounted for preexisting comorbidities in a causal framework. This study addresses this gap by investigating the relationship between PM2.5 exposure and COVID-19 severity. We place particular emphasis on the role of comorbidities, which can increase vulnerability to COVID-19 and may interact with air pollution exposure.</p><p><strong>Methods: </strong>We use an exhaustive dataset covering the entire French territory over 2020-1, totaling more than 3.5 million weekly observations. The data include information on COVID-19 mortality and hospitalizations, disaggregated by age, sex, and municipality, along with detailed records on preexisting conditions. To address endogeneity, we employ a two-stage least squares approach, using wind direction as an instrument for local PM2.5 concentrations.</p><p><strong>Results: </strong>We find no significant effect of PM2.5 exposure on COVID-19 mortality or hospitalizations among individuals without preexisting conditions. However, when accounting for comorbidities, a 10 μg/m3 increase in PM 2.5 was associated with higher COVID-19 mortality rates (1.5 per 100 000, 95% CI: 0.8-2.2), particularly among patients with respiratory (0.9 per 100 000, 95% CI: 0.4-1.4), and cardiovascular diseases (0.6 per 100 000, 95% CI: 0.1-1.1).</p><p><strong>Conclusions: </strong>These findings underscore the importance of incorporating comorbidities when assessing the health effects of air pollution during a pandemic. Our results also show that the effects of PM2.5 are driven by the oldest age groups, who are both more vulnerable to COVID-19 and more likely to have comorbidities.</p>","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"55 5","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828013","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":"Air pollution and criminal behavior: a nationwide case-crossover analysis in China.","authors":"Dongyang Han, Yichen Guo, Yixuan Jiang, Yue Niu, Renjie Chen, Haidong Kan","doi":"10.1093/ije/dyag214","DOIUrl":"https://doi.org/10.1093/ije/dyag214","url":null,"abstract":"<p><strong>Background: </strong>Criminal activity is a major societal and public health concern. However, little is known about how exposure to ambient air pollution influences the incidence of crime. We aimed to examine the short-term associations between air pollution and criminal behavior.</p><p><strong>Methods: </strong>We used a nationwide time-stratified case-crossover design to analyse 483 718 crime events in China (2013-19). Conditional logistic regression models were employed to estimate associations between individual pollutants and crime, while weighted quantile sum (WQS) regression was used to assess joint effects. Stratified analyses were conducted by crime type, season, geographic region, and socioeconomic status. An Air Quality Score was constructed to facilitate interpretation.</p><p><strong>Results: </strong>All six examined pollutants, i.e. fine particulate matter, coarse particulate matter, nitrogen dioxide, carbon monoxide, sulfur dioxide, and ozone, were associated with increased crime incidence, with the largest estimates observed on the day of exposure. Each interquartile range increase corresponded to increases of 1.66%, 1.88%, 4.03%, 2.03%, 2.81%, and 1.30%, respectively. Associations were stronger in the cold season, northern regions, and lower-socioeconomic regions, with consistently stronger associations observed for violent crimes and theft across the examined pollutants. Moreover, a one-unit increase in the WQS index was associated with a 3.22% increase in crime incidence.</p><p><strong>Conclusion: </strong>Short-term exposure to air pollution is associated with increased crime incidence, as evidenced by both independent and joint-pollutant effects. These findings suggest that joint exposure to multiple pollutants may be relevant to crime incidence. Improving air quality may have potential co-benefits for public safety.</p>","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"55 5","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108923","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}
Phoebe S C Hui, Brooke L Devlin, David M Evans, Liang-Dar Hwang
{"title":"Comparing genome-wide significant and chemosensory variants as instruments for dietary patterns in Mendelian randomization.","authors":"Phoebe S C Hui, Brooke L Devlin, David M Evans, Liang-Dar Hwang","doi":"10.1093/ije/dyag186","DOIUrl":"10.1093/ije/dyag186","url":null,"abstract":"<p><strong>Background: </strong>Diet is a modifiable risk factor for cardiometabolic disease, yet establishing causality remains challenging. Mendelian randomization (MR) leverages genetic variants as instrumental variables (IVs) to enable causal inference.</p><p><strong>Method: </strong>Using two-sample MR, we assessed the causal effects of four principal component-derived dietary patterns (DPs)-Unhealthy, Healthy, Meat-based, Pescatarian-on cardiometabolic outcomes including body mass index, coronary artery disease, blood lipids, blood pressures, type 2 diabetes, fasting glucose and insulin, and glycated haemoglobin. Two sets of IVs were employed: conventional genome-wide significant variants associated with each DP, filtered for pleiotropy and directionality; and biologically informed variants in chemosensory receptor genes, given the role of taste and smell perception in food choice.</p><p><strong>Results: </strong>Using conventional IVs, the Pescatarian DP was associated with reduced fasting insulin (βIVW = -0.10 pmol/L per SD increase in the Pescatarian DP score, 95% confidence interval -0.15, -0.04; P = 1.19 × 10-3), surviving multiple sensitivity analyses. Associations between the Unhealthy DP and elevated blood pressure and glycated haemoglobin should be interpreted cautiously; one of the two filtered IVs was strongly associated with caffeine intake, limiting the attribution of these findings to the DP itself. Chemosensory Receptor IVs yielded null findings, reflecting insufficient power.</p><p><strong>Conclusion: </strong>Evidence for causal effects of DPs on cardiometabolic traits was limited, with the strongest support for a protective effect of the Pescatarian DP on fasting insulin. Chemosensory IVs demonstrated limited utility for DPs, likely reflecting the heterogeneous and complex sensory profiles of overall diets. Future efforts should consider guideline-based dietary indices to facilitate interpretability and translation.</p>","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"55 5","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919699","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}
Neil J Perkins, Siddharth Rawat, Elizabeth A DeVilbiss, Elizabeth H Scholl, Taylor Petty, Brian Kidd, Deepak Mav, Shyamal D Peddada, Jagteshwar Grewal
{"title":"Exposure to extreme temperatures may increase the risk of preterm birth: findings from a contemporary US cohort.","authors":"Neil J Perkins, Siddharth Rawat, Elizabeth A DeVilbiss, Elizabeth H Scholl, Taylor Petty, Brian Kidd, Deepak Mav, Shyamal D Peddada, Jagteshwar Grewal","doi":"10.1093/ije/dyag145","DOIUrl":"10.1093/ije/dyag145","url":null,"abstract":"<p><strong>Background: </strong>The frequency and severity of extreme temperatures have been increasing and are expected to continue to escalate in the coming decades. Relationships between extreme temperatures and early deliveries are not well understood.</p><p><strong>Methods: </strong>Data were obtained from 201 759 pregnancies with gestational age (GA) of >27 weeks in the Consortium on Safe Labor retrospective cohort study from 19 hospitals across the USA for 2002-8. Location-specific bulk temperatures were obtained from the Parameter-Elevation Regressions on Independent Slopes Model (4-km resolution), from which participants were linked to minimum, maximum, and mean daily temperatures across each day of pregnancy. Days were categorized for each site as cold (both minimum and maximum temperatures ≤ 20th percentile), hot (both minimum and maximum temperatures ≥ 80th percentile), or neither for each pregnancy. Cold and hot days were then analysed individually or as the proportion within specific pregnancy windows by using Cox regression and fetuses-at-risk logistic regression models.</p><p><strong>Results: </strong>Detrimental relations in fetuses-at-risk models were consistently observed between exposure to chronic cold and chronic heat and early delivery: odds ratio (ORcold)= 1.66, 1.40, and 1.16; ORheat = 1.20, 1.13, and 1.32 for early-preterm (GA < 34 weeks), preterm (34 ≤ GA < 37 weeks), and early-term (37 ≤ GA < 39), respectively. Associations for exposures in Trimesters 1 and 2 were mixed but clearly more detrimental in Trimester 1. The likelihood of early delivery increased with daily exposure to extreme temperatures after 27 weeks.</p><p><strong>Conclusion: </strong>Future work should seek to elucidate the underlying mechanisms and to validate these findings by using more recent diverse global data.</p>","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"55 5","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864865","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 lead time and overdiagnosis in cancer screening programmes: the MOCCI method.","authors":"Bor Vratanar, Maja Pohar Perme","doi":"10.1093/ije/dyag167","DOIUrl":"10.1093/ije/dyag167","url":null,"abstract":"<p><strong>Background: </strong>Cancer screening enables earlier cancer diagnosis and treatment. The interval between cancer diagnosis by screening and the symptomatic detection in the absence of screening is termed lead time. If a patient's tumour, detected by screening, would never surface clinically, the patient is considered overdiagnosed. Estimating these quantities is crucial for evaluating cancer screening programmes.</p><p><strong>Development: </strong>We developed MOCCI (Minimizing Observed and Counterfactual Cancer Incidence), a novel parametric method for estimating the lead time distribution. MOCCI compares age- and calendar-stratified cancer incidence between individuals invited to screening and those not invited and estimates the lead time distribution that minimizes the incidence difference between the two groups. The probability of overdiagnosis is then estimated by comparing the model-predicted lead time with the time to death from other causes.</p><p><strong>Application: </strong>In an application to the Slovenian breast cancer screening programme, we estimated that 30% (95% confidence interval [CI], 20% to 39%) of screen-detected cases were non-progressive and 33% (95% CI, 25% to 43%) were overdiagnosed; assuming an exponential lead time distribution for progressive cancers, the mean lead time was 1.8 years (95% CI, 1.3 to 2.9).</p><p><strong>Conclusions: </strong>This study proposes a new method for estimating lead time and overdiagnosis. The proposed method (a) can accommodate various lead time distributions, (b) yields a lead time distribution that is aligned with the observed excess incidence arising from screening, and (c) enables the separation of different sources of overdiagnosis. The method provides stable estimates when sample sizes are large and the assumed lead time model is simple.</p>","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"55 5","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13487635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792742","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}
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