International journal of epidemiology最新文献

{"title":"Estimating and presenting non-linear associations with restricted cubic splines.","authors":"Andrea Discacciati,Michael G Palazzolo,Jeong-Gun Park,Giorgio E M Melloni,Sabina A Murphy,Andrea Bellavia","doi":"10.1093/ije/dyaf088","DOIUrl":"https://doi.org/10.1093/ije/dyaf088","url":null,"abstract":"Most of the regression models commonly used in epidemiology-including logistic regression and methods for time-to-event outcomes such as Cox regression-define the relationship between a set of covariates and the outcome of interest using linear functions, thus making implicit assumptions of linearity for continuous covariates. Categorizing continuous covariates, which represents a common option to address non-linearities, introduces additional assumptions and has recognized limitations in terms of results interpretation. Restricted cubic splines (RCS) offer a flexible alternative tool that can improve the model fit in the presence of non-linear associations, overcoming many of the limitations of categorical approaches and providing information on the shape of the exposure-outcome relationship. Including RCS transformations in regression models, however, is not straightforward analytically and presents challenges in terms of interpretation and graphical presentation of the exposure-outcome association. In this paper, we provide an introduction to the application of RCS in regression modeling for assessing non-linear exposure-outcome associations in epidemiological studies. We present RCS as a flexible extension of categorization and describe the two key steps of integrating RCS in regression: model fitting and graphical presentation. We detail key considerations that can guide the choice of RCS transformations, the interpretation of regression output, and the translation of regression results into graphical displays of the exposure-outcome association. To accompany this presentation, we also provide a set of functions and examples in R, Stata, and SAS, thereby providing a comprehensive set of tools for flexibly and robustly incorporating continuous covariates into regression modeling.","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"100 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311464","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":"Risk of stroke, myocardial infarction, coronary intervention, and atrial fibrillation or flutter in individuals experiencing typical migraine aura without headache: a Danish registry-based cohort study.","authors":"Elena Dudukina, Dávid Nagy, Cecilia Hvitfeldt Fuglsang, Erzsébet Horváth-Puhó, Henrik Toft Sørensen, Vera Ehrenstein, Flemming Winther Bach, Jan Paul Vandenbroucke","doi":"10.1093/ije/dyaf079","DOIUrl":"https://doi.org/10.1093/ije/dyaf079","url":null,"abstract":"<p><strong>Background: </strong>Migraine aura without headache was previously described as a benign condition. We investigated an association between migraine aura without headache and risks of stroke, myocardial infarction (MI) or percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), atrial fibrillation or flutter, and composite outcome (MI, PCI, and CABG).</p><p><strong>Methods: </strong>We conducted a nationwide, registry-based cohort study in Denmark in 2003-18, which included 755 individuals with typical aura without headache, 11 420 individuals who experience migraine with aura, 13 415 individuals who experience migraine without aura, 12 000 individuals with unspecified migraine, and a comparison cohort of 702 755 individuals aged 15-80 years randomly sampled from the general population. We computed incidence rates (IRs) per 1000 person-years (PYs) of the outcomes and hazard ratios (aHRs) adjusted for age, sex, calendar year, and pre-existing chronic conditions in Cox proportional-hazards regression analyses.</p><p><strong>Results: </strong>The IR per 1000 PYs among individuals experiencing aura without headache were 4.58 (2.09-7.07) for stroke, 2.10 (0.42-3.79) for MI or PCI, 0.69 (0.00-1.66) for CABG, and 4.95 (2.35-7.54) for atrial fibrillation or flutter. Individuals who experience aura without headache versus the comparator had increased risks of stroke [aHR: 2.58, 95% confidence interval (CI): 1.49-4.44] and atrial fibrillation or flutter (aHR: 2.22, 1.31-3.75). Associations with MI or PCI (aHR: 1.56, 0.70-3.47), CABG (aHR: 2.66, 0.66-10.65), and composite outcome (aHR: 1.65, 95% CI: 0.79-3.46) were in the same direction, but lacked precision.</p><p><strong>Conclusion: </strong>Aura without headache was associated with increased risks of stroke and atrial fibrillation or flutter; associations with remaining outcomes could not be ruled out.</p>","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"54 4","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527925","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":"School opening associated with lower test-adjusted COVID-19 case rates in children.","authors":"Ambarish Chandra, Tracy B Høeg","doi":"10.1093/ije/dyaf113","DOIUrl":"10.1093/ije/dyaf113","url":null,"abstract":"<p><strong>Background: </strong>There is conflicting evidence from prior studies on the relationship between in-person schooling and transmission of SARS-CoV-2 among children. This may be due to multiple confounders in estimating this relationship, including the decision to close schools, community rates of infection, and rates of testing.</p><p><strong>Methods: </strong>Regression-based observational study to estimate the relationship between school openings and COVID-19 case rates among children, while accounting for potential confounders including community case rates, mitigations in schools, and rates of testing among schoolchildren. The setting is US school districts in the Fall of 2021, from 3 weeks prior through 12 weeks after school opening, using restricted data obtained from the Centers for Disease Control and Prevention. Data were available for school districts in 2592 counties, containing 86% of the US population.</p><p><strong>Results: </strong>School openings were associated with a brief rise in cases among children relative to adults, with a peak of 39.3 [37.7, 40.9] additional cases per 100 000 per week. However, children were tested at higher rates when schools were in session. After adjusting for testing rates, case rates among children were significantly lower after schools reopened by 4.7 cases per 100 000 compared with over summer break.</p><p><strong>Conclusion: </strong>School reopening in the USA in the 2021-22 academic year was accompanied by an increase in SARS-CoV-2 testing in children and a brief rise in pediatric cases. When testing rates are accounted for, school reopening was associated with a decrease in COVID-19 cases among children relative to adults. A lower threshold for testing in the school setting may be an important confounder in studies of SARS-CoV-2 transmission.</p>","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"54 4","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527926","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":"Commentary: To bioRxiv or not to bioRxiv?","authors":"Soo Ji Lee, Joohon Sung","doi":"10.1093/ije/dyaf090","DOIUrl":"https://doi.org/10.1093/ije/dyaf090","url":null,"abstract":"","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"54 4","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583870","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 relationship between polyunsaturated fatty acids and inflammation: evidence from cohort and Mendelian randomization analyses.","authors":"Daisy C P Crick, Sarah L Halligan, George Davey Smith, Golam M Khandaker, Hannah J Jones","doi":"10.1093/ije/dyaf065","DOIUrl":"10.1093/ije/dyaf065","url":null,"abstract":"<p><strong>Background: </strong>Omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acids (PUFAs) are thought to have anti- and pro-inflammatory roles, respectively, and influence the risk of various chronic diseases. However, it is unclear whether these associations are causal.</p><p><strong>Methods: </strong>We examined the associations of dietary polyunsaturated FAs with biomarkers of systemic inflammation: C-reactive protein (CRP), glycoprotein acetyls (GlycA), and interleukin 6 (IL-6) in two cohort datasets-Avon Longitudinal Study of Parents and Children (N = 2802) and UK Biobank (N = 12 401)-by using multivariable analyses. We investigated causality by using two-sample Mendelian randomization (MR). In addition to the inverse-variance weighted (IVW) method, we used sensitivity analyses to strengthen the causal inference. We conducted multivariable MR (MVMR) to investigate the causal effects of n-3 and n-6 on inflammation, accounting for the low-density lipoprotein (LDL) cholesterol, triglycerides, monounsaturated FAs, and saturated FAs.</p><p><strong>Results: </strong>Cohort analyses show a positive association between the n-6:n-3 ratio and each biomarker. Total n-3 and n-6 PUFAs were associated with higher GlycA levels [mean difference = 0.33; 95% confidence interval (CI) = 0.29, 0.36, and 0.52; 95% CI = 0.48, 0.55, respectively]. The MR results suggest that total n-3 FAs cause higher circulating CRP (IVW = 0.09; 95% CI = 0.03, 0.16) and GlycA levels (0.12; 95% CI = 0.04, 0.21). The positive association between n-3 FAs and GlycA remained in the MVMR analysis after accounting for LDL cholesterol, triglycerides, monounsaturated FAs, and saturated FAs.</p><p><strong>Conclusion: </strong>We find no convincing evidence of a simple pro- and anti-inflammatory dichotomy regarding the function of n-6 and n-3 PUFAs. Further research is needed to better understand the mechanisms underlying the effects of PUFAs on specific immune biomarkers.</p>","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"54 4","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475056","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: Bambasi Health and Demographic Surveillance System (Bambasi HDSS).","authors":"Mulatu Agajie Amentie, Muluwas Amentie Zelka, Wagari Kelbessa Gibina, Merga Dheresa Aga, Feyisa Abebe Gelashe, Gezahegn Mengesha, Bizuhan Gelaw, Abebe Folla, Tiyese Chimuna, John N Cranmer, Abebe Gebremariam Gobezayeu, Tamiru Kassa, Gurmesa Tura Debelew","doi":"10.1093/ije/dyaf131","DOIUrl":"10.1093/ije/dyaf131","url":null,"abstract":"","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"54 4","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835063","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":"Statins and the risk of gynecological cancer: a Norwegian population-based cohort study.","authors":"Leif Lukas Löfling, Nathalie C Støer, Edoardo Botteri, Renée Turzanski Fortner","doi":"10.1093/ije/dyaf133","DOIUrl":"10.1093/ije/dyaf133","url":null,"abstract":"<p><strong>Background: </strong>Endometrial, ovarian, and cervical cancers are the most common gynecological cancers, with 1.4 million diagnoses worldwide in 2022. Statins are widely used for cardiovascular conditions and have been studied for their association with gynecological cancer risk, but results to date have been inconclusive.</p><p><strong>Methods: </strong>We conducted a population-based cohort study including data from the Norwegian Prescription Database and the Cancer Registry of Norway, and followed women aged ≥50 years from 2004 to 2018. We examined the association between statin use overall and by type (lipophilic, hydrophilic), and the risk of endometrial, ovarian, and cervical cancers overall and by age groups and histologic subgroup using Cox proportional hazard models.</p><p><strong>Results: </strong>The cohort study included 1 083 629 women. During a median follow-up of 11.6 years, 334 582 (31%) used statins at least once. There were 7709 cases of endometrial, 4415 cases of ovarian, and 1603 cases of cervical cancers. Statin use was associated with reduced risk of endometrial cancer [current use hazard ratio (HR) = 0.90, 95% confidence interval (CI): 0.85-0.96; past use HR = 0.79, 95% CI: 0.71-0.88]; associations were observed only for the lipophilic statins, and with similar associations by age groups and for type I and II endometrial cancer. No consistent associations were found for ovarian or cervical cancers. We found no trends for cumulative defined daily doses of current use or time since cessation for any cancer type.</p><p><strong>Conclusion: </strong>Statin use was associated with a reduced risk of endometrial cancer but not with the risk of ovarian cancer or cervical cancer.</p>","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"54 4","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12296387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717901","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 Mendelian randomization study of the effect of body mass index on 52 causes of death among 125 000 Mexican adults with admixed ancestry.","authors":"Louisa Gnatiuc Friedrichs, Pablo Kuri-Morales, Eirini Trichia, Natalie Staplin, Jason Torres, Jesus Alegre-Díaz, Paulina Baca, Adrián Garcilazo-Ávila, Carlos González-Carballo, Raul Ramirez-Reyes, Fernando Rivas, Diego Aguilar-Ramirez, Fiona Bragg, Robert Clarke, William G Herrington, Michael Hill, Tianshu Liu, Alejandra Vergara-Lope, Rachel Wade, Rory Collins, Richard Peto, Jaime Berumen, Roberto Tapia-Conyer, Jonathan R Emberson","doi":"10.1093/ije/dyaf110","DOIUrl":"10.1093/ije/dyaf110","url":null,"abstract":"<p><strong>Background: </strong>Persistent hyperglycaemia in diabetes can cause weight loss, distorting the association of adiposity with mortality. We estimated the lifelong associations of genetically predicted body mass index (BMI) with 52 causes of death among 125 003 Mexican adults, in whom persistent hyperglycaemia in diabetes was common.</p><p><strong>Methods: </strong>A trans-ancestry genetic instrument for BMI (from 724 BMI-associated single-nucleotide polymorphisms) estimated the causal relevance of BMI to mortality before age 75 years, stratified by sex and adjusted for age and underlying ancestry structure, using a one-sample Mendelian randomization (MR) approach. Two-sample MR and other sensitivity analyses were also performed.</p><p><strong>Results: </strong>The genetic instrument explained 3% of the BMI variation and predicted BMI similarly in men and women. Each 5-kg/m2 higher genetically predicted BMI was associated with nearly a doubling in the risk of all-cause mortality at ages 35-74 years [13 066 deaths; hazard ratio (HR) 1.80, 95% confidence interval (CI) 1.63-2.00]. Hazard ratios were greater for vascular-metabolic (n =  7111; HR 2.15, 95% CI 1.87-2.48) than for non-vascular-metabolic causes (n =  5955; HR 1.47, 95% CI 1.27-1.71) and particularly strong for renal (n =  2034; HR 3.59, 95% CI 2.76-4.67), acute diabetic crises (n =  557; HR 2.70, 95% CI 1.64-4.44), and infective deaths (n =  811; HR 2.61, 95% CI 1.73-3.92). For all-cause mortality, HRs were somewhat greater at younger ages compared with older ages, and slightly larger in those with a higher proportion of Indigenous American ancestry. The strength of the association with mortality was reduced by more than half after simple adjustment for genetic predisposition to diabetes. Sensitivity analyses supported the main conclusions.</p><p><strong>Conclusion: </strong>In this Mexican population, genetically predicted lifelong BMI was strongly related to mortality and mediated substantially through diabetes.</p>","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"54 4","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144617418","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":"Data Resource Profile: Paediatric Regional Healthcare Information Platform in Halland, Sweden.","authors":"Awais Ashfaq, Kerstin Albertsson Wikland, Lars Gelander, Ola Lövenvald, Ulf Strömberg, Josefine Roswall, Gerd Almquist Tangen, Aldina Pivodic, Björn Agvall, Håkan Nilsson, Markus Lingman, Anton Holmgren","doi":"10.1093/ije/dyaf119","DOIUrl":"10.1093/ije/dyaf119","url":null,"abstract":"","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"54 4","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682542","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":"Associations between commuting modes and risk of 16 site-specific cancers in the UK Biobank.","authors":"Win Thu, Alana Cavadino, Alistair Woodward, Sandar Tin Tin","doi":"10.1093/ije/dyaf117","DOIUrl":"10.1093/ije/dyaf117","url":null,"abstract":"<p><strong>Background: </strong>The choice of transport mode may influence cancer risk by affecting physical activity level, sedentary behaviour, and exposure to environmental pollution. This study investigated the associations between commuting modes and 16 site-specific cancers in the UK Biobank.</p><p><strong>Methods: </strong>The UK Biobank is a prospective cohort study involving about 500 000 participants. Information on transport modes was collected at recruitment, and incident cancer cases were identified through linkage to national cancer registries. Multivariable Cox proportional hazards models were used.</p><p><strong>Results: </strong>There were 252 334 employed participants included, and 15 828 incident cancer cases were identified over a median follow-up of 11.7 years. Compared to the car-only mode, cycling (exclusively or combined with any other modes) was associated with a lower risk of colon [hazard ratio (HR): 0.72; 95% confidence interval: 0.53-0.96], renal (HR: 0.60; 0.38-0.96), and stomach (HR: 0.27; 0.10-0.71) cancers. Walking (exclusively or combined with any motorized mode) was associated with a lower risk of renal (HR: 0.67; 0.49-0.92) and liver (HR: 0.55; 0.31-0.98) cancers. Public transport users were less engaged in other physical activities, and its use was associated with a higher risk of bladder cancer (HR: 1.39; 1.01-1.90).</p><p><strong>Conclusions: </strong>Active commuting, even combined with motorized modes, is associated with a lower risk of some common cancers.</p>","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"54 4","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591200","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}