Journal of Epidemiology最新文献

{"title":"Changes in Alcohol Consumption During and After the Covid-19 Pandemic From 2020 to 2023 in a Prospective Cohort of Italian Adults.","authors":"Sonia Cerrai, Giulia Carreras, Filippo Monti, Chiara Stival, Alessandra Lugo, Cristina Bosetti, Silvia Biagioni, Tiziana Fanucchi, Giuseppe Gorini, Andrea Amerio, Luisa Mastrobattista, Claudia Mortali, Anna Odone, Sabrina Molinaro, Luc Smits, Silvano Gallus","doi":"10.2188/jea.JE20230340","DOIUrl":"10.2188/jea.JE20230340","url":null,"abstract":"<p><strong>Background: </strong>The lockdowns imposed by the government during coronavirus disease 2019 (COVID-19) pandemic have had a significant impact on the Italian population habits.</p><p><strong>Methods: </strong>LOckdown and lifeSTyles in Italy and in Tuscany studies collected data on a representative sample of the Italian adult population in 2020 (n = 6,003) followed up through 2023 via four additional surveys (3,000 ≤ n ≤ 6,600) through an online self-administered questionnaire. The Alcohol Use Disorders Identification Test-Concise was used to identify at-risk drinkers. Considering the cohort of individuals who took part to the first and at least one other wave (n = 5,378), a multilevel logistic model was used to derive odds ratios (ORs) and corresponding 95% confidence intervals (CIs) of being at-risk drinkers.</p><p><strong>Results: </strong>The prevalence of at-risk drinkers was 26.4% before, 23.4% during the first lockdown, and stabilized around 30.0% thereafter. Being at-risk alcohol consumers decreased with decreasing economic status (P for trend <0.001), was less frequent among middle-aged compared to younger (OR 0.73; 95% CI, 0.60-0.89) and among divorced/separated (OR 0.77; 95% CI, 0.60-0.99) or single (OR 0.75; 95% CI, 0.64-0.89) compared to married individuals. It was more frequent among individuals with anxiety or depressive symptoms (OR 1.24; 95% CI, 1.12-1.37), those using psychotropic drugs (OR 1.99; 95% CI, 1.69-2.35) and users of conventional and/or alternative nicotine products (OR 3.67; 95% CI, 3.00-4.48).</p><p><strong>Conclusion: </strong>The long-term trends in alcohol consumption after the COVID-19 pandemic are unfavorable in Italy. The results point to an increased vulnerability for at-risk alcohol consumption among younger individuals, women with higher economic status, and married individuals. At-risk drinking is strongly related to mental health symptoms and nicotine consumption.</p>","PeriodicalId":15799,"journal":{"name":"Journal of Epidemiology","volume":" ","pages":"63-70"},"PeriodicalIF":3.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854303","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":"Association Between Maternal Physical Activity From Pre-pregnancy to Child-rearing and Their Children's Physical Activity in Early Childhood Among Japanese.","authors":"Aya Yamada, Haruki Momma, Nozomi Tatsuta, Kunihiko Nakai, Takahiro Arima, Chiharu Ota, Nobuo Yaegashi, Ryoichi Nagatomi","doi":"10.2188/jea.JE20240041","DOIUrl":"10.2188/jea.JE20240041","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to determine the association between cumulative maternal physical activity level and their children's physical activity in early childhood. We also compared the influence of each maternal physical activity on children's physical activity in early childhood.</p><p><strong>Methods: </strong>We analyzed the data from 1,067 Japanese mother-child pairs. Maternal physical activity was assessed using the International Physical Activity Questionnaire. Cumulative physical activity level in mothers was computed based on the categories (low, moderate, and high) of physical activity from five time points (pre-pregnancy, during pregnancy, 1.5, 3.5, and 5.5 years postpartum). Children's physical activity level was measured at age 5.5 years using the WHO Health Behaviour School-aged Children questionnaire and defined as engaging in physical activity for at least 60 minutes per day for more than 5 days. Logistic regression analysis was used to determine the association between maternal and children's physical activity levels.</p><p><strong>Results: </strong>The results showed the positive association between cumulative maternal physical activity and children's physical activity level (P for trend < 0.001). Furthermore, maternal physical activity during pregnancy (P for trend = 0.031) and 5.5 years postpartum (P for trend < 0.001) was positively associated with children's physical activity.</p><p><strong>Conclusion: </strong>A positive association was observed between the cumulative maternal physical activity level and the physical activity level of their children at 5.5 years of age. Furthermore, maternal physical activity during pregnancy and at 5.5 years postpartum were positively associated with the level of children's physical activity.</p>","PeriodicalId":15799,"journal":{"name":"Journal of Epidemiology","volume":" ","pages":"81-89"},"PeriodicalIF":3.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734278","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":"Association between informal caregiving and changes in cardiovascular-related health behaviors among middle-aged and older adults in Japan: A 15-year panel survey.","authors":"Yuta Taniguchi, Atsushi Miyawaki, Masao Iwagami, Takehiro Sugiyama, Taeko Watanabe, Tomoko Ito, Nanako Tamiya","doi":"10.2188/jea.JE20240197","DOIUrl":"https://doi.org/10.2188/jea.JE20240197","url":null,"abstract":"<p><p>BackgroundStudies have shown that informal caregiving is associated with an increased risk of cardiovascular diseases. However, there is limited evidence on the mechanisms involved. To fill this knowledge gap, we investigated the association of informal caregiving with changes in health-related behaviors.MethodsWe analyzed a nationally representative sample aged 50-59 years as of 2005 using fifteen waves of the Longitudinal Survey of Middle-Aged and Older Adults, conducted between 2005-2019. We investigated the association between the change in informal caregiving status and the change in health-related behaviors, including (1) heavy drinking, (2) smoking, (3) no exercise habits, and (4) no attendance at annual health checkups. We used multivariable logistic regression models with correlated random effects, adjusting for individual-level time-invariant characteristics.ResultsAmong 268,165 observations from 30,530 participants (median age 55 [interquartile range 52-57] at baseline; 51.6% women), 32,164 (12.0%) observations from 10,224 individuals provided informal care. After adjusting for potential confounders, informal caregiving was associated with higher probabilities of deteriorating health-related behaviors, including heavy drinking (adjusted odds ratio [aOR] 1.16; 95% confidence interval [CI] 1.03-1.32; adjusted p=0.032) and no exercise habits (aOR 1.09; 95%CI 1.04-1.15; adjusted p<0.001). We observed similar patterns for smoking (aOR 1.12; 95%CI 1.001-1.26; adjusted p=0.053) and no attendance at health checkups (aOR 1.05; 95%CI 0.999-1.10; adjusted p=0.053).ConclusionThis study showed that the transition into informal caregiving was associated with deteriorating cardiovascular-related health behaviors in Japan. These findings highlighted the importance of continued efforts to prevent the deterioration of caregivers' health-related behaviors.</p>","PeriodicalId":15799,"journal":{"name":"Journal of Epidemiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047093","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 Wako Cohort Study: Design and Profile of Participants at Baseline.","authors":"Yuri Yokoyama, Yu Nofuji, Takumi Abe, Kumiko Nonaka, Yumi Ozone, Yuka Nakamura, Shiina Chiaki, Takumi Suda, Naoko Saito, Mai Takase, Hidenori Amano, Susumu Ogawa, Hiroyuki Suzuki, Hiroshi Murayama","doi":"10.2188/jea.JE20240288","DOIUrl":"10.2188/jea.JE20240288","url":null,"abstract":"<p><strong>Background: </strong>We launched the Wako Cohort Study in 2023 to identify individual and socio-environmental factors related to the extension of healthy life expectancy and the reduction of health disparities among community-dwelling adults and to develop health promotion and care prevention strategies. This study profile aims to describe the study design and participants' profile at baseline.</p><p><strong>Methods: </strong>The Wako Cohort Study is a prospective study of community-dwelling adults aged ≥ 40 years living in Wako City, Saitama Prefecture, Japan. The Wako Cohort Study consists of two surveys: a mail-in survey for persons aged ≥ 40 years and a face-to-face assessment (on-site survey) for those aged ≥ 65 years. The survey items were designed considering the following points: 1) life course perspective (transition from middle to old age in the life course), 2) health indifference, and 3) employment in older age.</p><p><strong>Results: </strong>A total of 8,824 individuals participated in the mail-in survey (2,395 persons aged 40-64 years and 6,429 aged ≥ 65 years). Of those aged ≥ 65 years who returned the mail survey, 1,004 participated in the subsequent on-site survey. Men aged ≥ 65 years tended to have higher health interests than those aged 40-64 years; however, this was not true for women. In the mail-in survey, 30.4 % of those aged ≥ 65 years were employed.</p><p><strong>Conclusions: </strong>The Wako Cohort Study is expected to provide new insights into the development of strategies to extend healthy life expectancy and reduce health disparities in Japan.</p>","PeriodicalId":15799,"journal":{"name":"Journal of Epidemiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047095","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":"Number of teeth and incidence of hip fracture in older adults aged ≥75 years: the OHSAKA study.","authors":"Naoko Otsuki, Tomoaki Mameno, Yuya Kanie, Masahiro Wada, Maki Shinzawa, Kazunori Ikebe, Ryohei Yamamoto","doi":"10.2188/jea.JE20240165","DOIUrl":"10.2188/jea.JE20240165","url":null,"abstract":"<p><strong>Background: </strong>Several studies reported an association between the number of teeth and the incidence of hip fractures in observational studies, mainly in middle-aged adults. This retrospective cohort study aimed to clarify the association between the number of teeth and the incidence of hip fractures.</p><p><strong>Methods: </strong>In this retrospective cohort study, a total of 256,772 participants aged 75 years or older who underwent public dental checkups in Japan were evaluated. Exposure in this study was the number of teeth, with a maximum number of 28, excluding third molars. Outcome measures were the incidence of hip fractures needing surgery, using the Japanese procedure codes in medical claims.</p><p><strong>Results: </strong>A total of 190,998 participants met the inclusion criteria and were available for analysis. Adjusted Fine and Gray models identified a significant association between the number of teeth, including sound, filled, and decayed teeth, and the incidence of hip fractures among women but not for men. The continuous net reclassification improvement (NRI) of the sound and filled teeth count model increased by 0.078 compared with that of the sound, filled, and decayed teeth count model among women.</p><p><strong>Conclusions: </strong>The number of sound and filled teeth predicted the risk of hip fractures in women, whereas no association was observed between the number of teeth and hip fractures in men.</p>","PeriodicalId":15799,"journal":{"name":"Journal of Epidemiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047094","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":"Comprehensive assessment of the impact of blood pressure, body mass index, smoking, and diabetes on healthy life expectancy in Japan: NIPPON DATA90.","authors":"Rumi Tsukinoki, Yoshitaka Murakami, Takehito Hayakawa, Aya Kadota, Akiko Harada, Yoshikuni Kita, Akira Okayama, Katsuyuki Miura, Tomonori Okamura, Hirotsugu Ueshima","doi":"10.2188/jea.JE20240298","DOIUrl":"https://doi.org/10.2188/jea.JE20240298","url":null,"abstract":"<p><strong>Background: </strong>Healthy life expectancy (HLE) is a population health indicator that is widely used in developed countries, but little is known about its relationships with combinations of non-communicable disease risk factors. This study was conducted to examine HLE at age 65 according to combinations of blood pressure levels, body mass index, smoking status, and diabetes mellitus (DM) in a Japanese population.</p><p><strong>Methods: </strong>In a nationwide cohort study (NIPPON DATA90), data on these risk factors were obtained from participants in 1990 through physical examinations, blood tests, interviews, and questionnaires. Subsequently, participants aged ≥65 years underwent surveys on activities of daily living in 1995 and 2000, and multistate life tables were used to calculate combination-specific HLEs and their 95% confidence intervals (CIs).</p><p><strong>Results: </strong>The study population comprised 6,569 participants (men: 2,797; women: 3,772) who were followed-up until 2010. HLE at age 65 in men with grade II/III hypertension, obesity, current smoker status, and DM (HLE: 12.9 years, 95% CIs: 12.9-13.0 years) was 9.7 years shorter than men without these risk factors (HLE: 22.6 years, 95% CIs: 22.4-22.8 years). Similarly, HLE at age 65 in women with grade II/III hypertension, obesity, current smoker status, and DM (HLE: 16.2 years, 95% CIs: 15.9-16.5 years) was 10.1 years shorter than women without these risk factors (HLE: 26.3 years, 95% CIs: 26.3-26.3 years).</p><p><strong>Conclusion: </strong>The large discrepancies in HLEs underscore the impact of non-communicable disease risk factors, which should be considered when formulating health interventions to improve HLE in Japanese older adults.</p>","PeriodicalId":15799,"journal":{"name":"Journal of Epidemiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978853","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":"Validity of Self-reported Participation in Cancer Screenings and Health Checkups in Japan.","authors":"Isao Muraki, Tomotaka Sobue, Kazumasa Yamagishi, Shoichiro Tsugane, Norie Sawada, Hiroyasu Iso","doi":"10.2188/jea.JE20240090","DOIUrl":"10.2188/jea.JE20240090","url":null,"abstract":"<p><strong>Background: </strong>The participation rate for screening is regarded as a useful indicator for preventing cancer and cardio-metabolic disease. However, the validity of self-reported screening participation has not yet been thoroughly evaluated in Japan. We aimed to examine its validity using the municipal screening records among the Japanese population.</p><p><strong>Methods: </strong>We included 3,060 men and 3,860 women insured by the National Health Insurance for residents aged <75 years or the Medical Care System for the Elderly aged ≥75 years in the Chikusei area of the Japan Public Health Center-based Prospective Study for the Next Generation. They were asked about their participation in cancer screenings and health checkups during the previous year. We compared their responses to the municipal records and calculated the sensitivity and specificity of self-reported screening participation.</p><p><strong>Results: </strong>The sensitivity and specificity of self-reported participation were 0.49 and 0.86 for lung cancer screening, 0.67 and 0.85 for colorectal cancer screening, 0.77 and 0.79 for stomach cancer screening, and 0.86 and 0.65 for health checkup, respectively. Among women, the sensitivity and specificity were 0.83 and 0.81 for breast cancer and 0.85 and 0.90 for cervical cancer, respectively.</p><p><strong>Conclusion: </strong>Self-reported cancer screening participation for colorectal, stomach, breast, and cervical cancers had moderate-to-high sensitivity and specificity. Self-reported participation, especially for lung cancer screening and health checkups, should be carefully interpreted when assessing the performance of preventive measures.</p>","PeriodicalId":15799,"journal":{"name":"Journal of Epidemiology","volume":" ","pages":"47-52"},"PeriodicalIF":3.7,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442854","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 Principal Component Analysis of Metabolome and Cognitive Decline Among Japanese Older Adults: Cross-sectional Analysis Using Tohoku Medical Megabank Cohort Study Data.","authors":"Sakura Kiuchi, Kumi Nakaya, Upul Cooray, Kenji Takeuchi, Ikuko N Motoike, Naoki Nakaya, Yasuyuki Taki, Seizo Koshiba, Shunji Mugikura, Ken Osaka, Atsushi Hozawa","doi":"10.2188/jea.JE20240099","DOIUrl":"10.2188/jea.JE20240099","url":null,"abstract":"<p><strong>Background: </strong>Dementia is the leading cause of disability and imposes a significant burden on society. Previous studies have suggested an association between metabolites and cognitive decline. Although the metabolite composition differs between Western and Asian populations, studies targeting Asian populations remain scarce.</p><p><strong>Methods: </strong>This cross-sectional study used data from a cohort survey of community-dwelling older adults aged ≥60 years living in Miyagi, Japan, conducted by Tohoku Medical Megabank Organization between 2013 and 2016. Forty-three metabolite variables quantified using nuclear magnetic resonance spectroscopy were used as explanatory variables. Dependent variable was the presence of cognitive decline (≤23 points), assessed by the Mini-Mental State Examination. Principal component (PC) analysis was performed to reduce the dimensionality of metabolite variables, followed by logistic regression analysis to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for cognitive decline.</p><p><strong>Results: </strong>A total of 2,940 participants were included (men: 49.0%, mean age: 67.6 years). Among them, 1.9% showed cognitive decline. The first 12 PC components (PC1-PC12) accounted for 71.7% of the total variance. Multivariate analysis showed that PC1, which mainly represented essential amino acids, was associated with lower odds of cognitive decline (OR 0.89; 95% CI, 0.80-0.98). PC2, which mainly included ketone bodies, was associated with cognitive decline (OR 1.29; 95% CI, 1.11-1.51). PC3, which included amino acids, was associated with lower odds of cognitive decline (OR 0.81; 95% CI, 0.66-0.99).</p><p><strong>Conclusion: </strong>Amino acids are protectively associated with cognitive decline, whereas ketone metabolites are associated with higher odds of cognitive decline.</p>","PeriodicalId":15799,"journal":{"name":"Journal of Epidemiology","volume":" ","pages":"39-46"},"PeriodicalIF":3.7,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554945","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":"Income Dynamics and Risk of Colorectal Cancer in Individuals With Type 2 Diabetes: A Nationwide Population-based Cohort Study.","authors":"Yong-Moon Mark Park, Benjamin C Amick Iii, Pearl A McElfish, Clare C Brown, Mario Schootman, Marie-Rachelle Narcisse, Seong-Su Lee, Yoon Jin Choi, Kyungdo Han","doi":"10.2188/jea.JE20230310","DOIUrl":"10.2188/jea.JE20230310","url":null,"abstract":"<p><strong>Background: </strong>Individuals with type 2 diabetes mellitus (T2DM) have increased colorectal cancer (CRC) risk, but it is unknown whether income dynamics are associated with CRC risk in these individuals. We examined whether persistent low- or high-income and income changes are associated with CRC risk in non-elderly adults with T2DM.</p><p><strong>Methods: </strong>Using nationally representative data from the Korean Health Insurance Service database, 1,909,492 adults aged 30 to 64 years with T2DM and no history of cancer were included between 2009 and 2012 (median follow-up of 7.8 years). We determined income levels based on health insurance premiums and assessed annual income quartiles for the baseline year and the four preceding years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated after adjusting for sociodemographic factors, CRC risk factors, and diabetes duration and treatment.</p><p><strong>Results: </strong>Persistent low income (ie, lowest income quartile) was associated with increased CRC risk (HR_{5 years vs 0 years} 1.11; 95% CI, 1.04-1.18; P for trend = 0.004). Income declines (ie, a decrease ≥25% in income quantile) were also associated with increased CRC risk (HR_{≥2 vs 0 declines} 1.10; 95% CI, 1.05-1.16; P for trend = 0.001). In contrast, persistent high income (ie, highest income quartile) was associated with decreased CRC risk (HR_{5 years vs 0 years} 0.81; 95% CI, 0.73-0.89; P for trend < 0.0001), which was more pronounced for rectal cancer (HR 0.64; 95% CI, 0.53-0.78) and distal colon cancer (HR 0.70; 95% CI, 0.57-0.86).</p><p><strong>Conclusion: </strong>Our findings underscore the need for increased public policy awareness of the association between income dynamics and CRC risk in adults with T2DM.</p>","PeriodicalId":15799,"journal":{"name":"Journal of Epidemiology","volume":" ","pages":"30-38"},"PeriodicalIF":3.7,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554948","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":"Methodological Tutorial Series for Epidemiological Studies: Confounder Selection and Sensitivity Analyses to Unmeasured Confounding From Epidemiological and Statistical Perspectives.","authors":"Kosuke Inoue, Kentaro Sakamaki, Sho Komukai, Yuri Ito, Atsushi Goto, Tomohiro Shinozaki","doi":"10.2188/jea.JE20240082","DOIUrl":"10.2188/jea.JE20240082","url":null,"abstract":"<p><p>In observational studies, identifying and adjusting for a sufficient set of confounders is crucial for accurately estimating the causal effect of the exposure on the outcome. Even in studies with large sample sizes, which typically benefit from small variances in estimates, there is a risk of producing estimates that are precisely inaccurate if the study suffers from systematic errors or biases, including confounding bias. To date, several approaches have been developed for selecting confounders. In this article, we first summarize the epidemiological and statistical approaches to identifying a sufficient set of confounders. Particularly, we introduce the modified disjunctive cause criterion as one of the most useful approaches, which involves controlling for any pre-exposure covariate that affects the exposure, outcome, or both. It then excludes instrumental variables but includes proxies for the shared common cause of exposure and outcome. Statistical confounder selection is also useful when dealing with a large number of covariates, even in studies with small sample sizes. After introducing several approaches, we discuss some pitfalls and considerations in confounder selection, such as the adjustment for instrumental variables, intermediate variables, and baseline outcome variables. Lastly, as it is often difficult to comprehensively measure key confounders, we introduce two statistics, E-value and robustness value, for assessing sensitivity to unmeasured confounders. Illustrated examples are provided using the National Health and Nutritional Examination Survey Epidemiologic Follow-up Study. Integrating these principles and approaches will enhance our understanding of confounder selection and facilitate better reporting and interpretation of future epidemiological studies.</p>","PeriodicalId":15799,"journal":{"name":"Journal of Epidemiology","volume":" ","pages":"3-10"},"PeriodicalIF":3.7,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554947","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}