Global Epidemiology最新文献

{"title":"Adjustment for sparse data bias in odds ratios: Significance to appraisal of risk of diabetes due to occupational trichlorfon insecticide exposure","authors":"Igor Burstyn ,&nbsp;David Miller","doi":"10.1016/j.gloepi.2024.100154","DOIUrl":"https://doi.org/10.1016/j.gloepi.2024.100154","url":null,"abstract":"<div><h3>Background</h3><p>Bias away from the null in odds ratios (OR), aggravated by low power, is a well-known phenomenon in statistics (sparse data bias). Such bias increases in presence of selection of “significant” results on the basis of null hypothesis testing (effect size magnification, ESM).</p></div><div><h3>Objectives</h3><p>We seek to illustrate these issues and adjust for suspected sparse data bias in the context of a reported more than doubling of the odds of new onset type 2 diabetes in presence of occupational trichlorfon insecticide exposure reported in the Agricultural Health Study.</p></div><div><h3>Methods</h3><p>We performed ESM analysis on the crude ORs extracted from the contingency table in the published report, which is done by simulating selected OR given a posited true OR. Next, we applied easily accessible methods that adjust for sparse data bias to the extracted contingency tables, including data augmentation, bootstrap, Firth's regression, and Bayesian methods with weakly informative priors.</p></div><div><h3>Results</h3><p>During the ESM analysis, we observed that there was a reasonable chance that a “statistically significant” OR of around 2.5–2.6 would be observed for true OR of 1.2. Adjustment for sparse data bias revealed that Bayesian methods outperformed alternative approaches in terms of yielding more precise inference, while not making unjustified distributional assumptions about estimates of OR. The OR in the original paper of about 2.5–2.6 was reduced on average to OR of 1.9 to 2.2, with 95% (Bayesian) credible intervals that included the null.</p></div><div><h3>Discussion</h3><p>It is reasonable to adjust ORs for sparse data bias when the reported association has societal importance, because policy must be informed by the least biased estimates of the effect. We think that such adjustment would lead to a more appropriate evaluation of the extent of evidence on the contribution of occupational exposure to trichlorfon pesticide to risk of new onset diabetes.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100154"},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000208/pdfft?md5=6bc5348dadb703f37ca792175093dac0&pid=1-s2.0-S2590113324000208-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141594043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conceptual frameworks for the integration of genetic and social epidemiology in complex diseases","authors":"Diane Xue ,&nbsp;Anjum Hajat ,&nbsp;Alison E. Fohner","doi":"10.1016/j.gloepi.2024.100156","DOIUrl":"https://doi.org/10.1016/j.gloepi.2024.100156","url":null,"abstract":"<div><p>Uncovering the root causes of complex diseases requires complex approaches, yet many studies continue to isolate the effects of genetic and social determinants of disease. Epidemiologic efforts that under-utilize genetic epidemiology methods and findings may lead to incomplete understanding of disease. Meanwhile, genetic epidemiology studies are often conducted without consideration of social and environmental context, limiting the public health impact of genomic discoveries. This divide endures despite shared goals and increases in interdisciplinary data due to a lack of shared theoretical frameworks and differing language. Here, we demonstrate that bridging epidemiological divides does not require entirely new ways of thinking. Existing social epidemiology frameworks including Ecosocial theory and Fundamental Cause Theory, can both be extended to incorporate principles from genetic epidemiology. We show that genetic epidemiology can strengthen, rather than detract from, efforts to understand the impact of social determinants of health. In addition to presenting theoretical synergies, we offer practical examples of how genetics can improve the public health impact of epidemiology studies across the field. Ultimately, we aim to provide a guiding framework for trainees and established epidemiologists to think about diseases and complex systems and foster more fruitful collaboration between genetic and traditional epidemiological disciplines.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100156"},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000221/pdfft?md5=67c278baa8f2f590eea2db907fbebf6d&pid=1-s2.0-S2590113324000221-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141606924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital outcomes for young adults with COVID-19","authors":"Brian S. Williams ,&nbsp;Thomas M. Piasecki ,&nbsp;Michael C. Fiore ,&nbsp;Karen L. Conner ,&nbsp;Wendy S. Slutske","doi":"10.1016/j.gloepi.2024.100155","DOIUrl":"https://doi.org/10.1016/j.gloepi.2024.100155","url":null,"abstract":"<div><h3>Background</h3><p>Older adults are at higher risk of severe outcomes from COVID-19 with comorbidities increasing such risk. Much less is known about the outcomes of young adults with COVID-19 despite their having had high infection rates.</p></div><div><h3>Objectives</h3><p>Our objective was to determine outcomes of hospitalized young adults with COVID-19 infection including rates of oxygen use, mortality, ICU admission, intubation, duration of hospitalization, and factors associated with adverse outcomes.</p></div><div><h3>Study design</h3><p>This retrospective cohort study included EHR data from 21 health systems in the United States on 18–29-year-olds hospitalized with COVID-19 from March 1, 2020 – January 31, 2022. Oxygen need was used to identify symptomatic COVID-19. Rates for mortality, ICU admission, and intubation were calculated for the symptomatic and asymptomatic groups. Effects of demographic and health characteristics on outcomes were assessed as were changes in hospital outcomes over time.</p></div><div><h3>Results</h3><p>Our sample included 9871 young adults hospitalized with COVID-19; 35% required oxygen. Of those who required oxygen, 53.5% were female, 23.7% had an anxiety disorder, 2.6% died (<em>n</em> = 89), 27.7% were admitted to the ICU (<em>n</em> = 955), and 15.8% were intubated (<em>n</em> = 547). A past-year history of any cancer was associated with a 2.1 times increased odds of death. Vaccination was associated with a &gt;40% reduction in the odds of ICU admission. Mortality rates did not change significantly across the study period.</p></div><div><h3>Conclusions</h3><p>COVID-19 caused significant morbidity and mortality in hospitalized young adults who required oxygen. A cancer history was associated with increased risk of death. Vaccination appeared to have had a protective effect on illness severity.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100155"},"PeriodicalIF":0.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259011332400021X/pdfft?md5=22c6125a8d246f8d56024cecadf2f928&pid=1-s2.0-S259011332400021X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141594041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to editor regarding: “Moral controversies and academic public health: Notes on navigating and surviving academic freedom challenges” by professor VanderWeele","authors":"Robert Litwack ,&nbsp;Victor DeGruttola","doi":"10.1016/j.gloepi.2024.100152","DOIUrl":"https://doi.org/10.1016/j.gloepi.2024.100152","url":null,"abstract":"","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100152"},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259011332400018X/pdfft?md5=489c6363e84ae7c2bc52b1993400fa5f&pid=1-s2.0-S259011332400018X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141543047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: Letter by Litwack and DeGruttola regarding “Moral controversies and academic public health: Notes on navigating and surviving academic freedom challenges”","authors":"Tyler J. VanderWeele","doi":"10.1016/j.gloepi.2024.100153","DOIUrl":"https://doi.org/10.1016/j.gloepi.2024.100153","url":null,"abstract":"","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100153"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000191/pdfft?md5=361b89dd2baf33bf5100df18f05dec44&pid=1-s2.0-S2590113324000191-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141594042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"For a proper use of frequentist inferential statistics in public health","authors":"Alessandro Rovetta ,&nbsp;Mohammad Ali Mansournia ,&nbsp;Alessandro Vitale","doi":"10.1016/j.gloepi.2024.100151","DOIUrl":"10.1016/j.gloepi.2024.100151","url":null,"abstract":"<div><p>As widely noted in the literature and by international bodies such as the American Statistical Association, severe misinterpretations of <em>P</em>-values, confidence intervals, and statistical significance are sadly common in public health. This scenario poses serious risks concerning terminal decisions such as the approval or rejection of therapies. Cognitive distortions about statistics likely stem from poor teaching in schools and universities, overly simplified interpretations, and – as we suggest – the reckless use of calculation software with predefined standardized procedures. In light of this, we present a framework to recalibrate the role of frequentist-inferential statistics within clinical and epidemiological research. In particular, we stress that statistics is only a set of rules and numbers that make sense only when properly placed within a well-defined scientific context beforehand. Practical examples are discussed for educational purposes. Alongside this, we propose some tools to better evaluate statistical outcomes, such as multiple compatibility or surprisal intervals or tuples of various point hypotheses. Lastly, we emphasize that every conclusion must be informed by different kinds of scientific evidence (e.g., biochemical, clinical, statistical, etc.) and must be based on a careful examination of costs, risks, and benefits.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100151"},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000178/pdfft?md5=4fe0b244a01cff2d2b827052b4f73448&pid=1-s2.0-S2590113324000178-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141398894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability of a short diet and vitamin supplement questionnaire for retrospective collection of maternal nutrient intake","authors":"Rebecca J. Schmidt ,&nbsp;Amanda J. Goodrich ,&nbsp;Lauren Granillo ,&nbsp;Yunru Huang ,&nbsp;Paula Krakowiak ,&nbsp;Adrianne Widaman ,&nbsp;J. Erin Dienes ,&nbsp;Deborah H. Bennett ,&nbsp;Cheryl K. Walker ,&nbsp;Daniel J. Tancredi","doi":"10.1016/j.gloepi.2024.100150","DOIUrl":"10.1016/j.gloepi.2024.100150","url":null,"abstract":"<div><h3>Background</h3><p>Gestational nutrition can protect against adverse neurodevelopmental outcomes.</p></div><div><h3>Objectives</h3><p>We developed a short tool for collecting maternal nutritional intake during pregnancy to facilitate research in this area and compared its retrospective use to prospectively-collected food frequency questionnaires (FFQ).</p></div><div><h3>Methods</h3><p>Maternal nutritional intake was retrospectively assessed using three versions (full interview, full self-administered online, and shortened interview) of the Early Life Exposure Assessment Tool (ELEAT) among participants of the MARBLES pregnancy cohort study of younger siblings of autistic children. Retrospective responses were compared with responses to supplement questions and the validated 2005 Block FFQ prospectively collected in MARBLES during pregnancies 2–7 years prior. ELEAT nutrient values were calculated using reported food intake frequencies and nutrient values from the USDA nutrient database. Correlations between retrospectively- and prospectively-reported intake were evaluated using Kappa coefficients, Youden's J, and Spearman Rank Correlation Coefficients (r_s).</p></div><div><h3>Results</h3><p>MARBLES FFQ dietary intakes were compared among 54 women who completed the ELEAT full form including 12 online, and among 23 who completed the ELEAT short form. Correlations across most foods were fair to moderate. Most ELEAT quantified nutrient values were moderately correlated (r_s = 0.3–0.6) with those on the Block FFQ. Supplement questions in both MARBLES and the ELEAT were completed by 114 women. Kappas were moderate for whether or not supplements were taken, but modest for timing. Correlations varied by version and child diagnosis or concerns, and were higher when mothers completed the ELEAT when their child was 4 years old or younger.</p></div><div><h3>Conclusions</h3><p>With recall up to several years, ELEAT dietary and supplement module responses were modestly to moderately reliable and produced nutrient values moderately correlated with prospectively-collected measures. The ELEAT dietary and vitamin supplements modules can be used to rank participants in terms of intake of several nutrients relevant for neurodevelopment.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100150"},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000166/pdfft?md5=0d583c28cdbaddd85aaf42f8850125cc&pid=1-s2.0-S2590113324000166-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141412256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the prevalence of risk factors, clinical presentations and severity of coronary artery diseases (CAD) in patients with very early and premature CAD are different from mature CAD patients?: A registry- based cross-sectional study","authors":"Mohammad Haji Aghajani ,&nbsp;Niloufar Taherpour ,&nbsp;Mohammad Parsa Mahjoob ,&nbsp;Naser Kachoueian ,&nbsp;Milad Alipour ,&nbsp;Saman Ghorbani","doi":"10.1016/j.gloepi.2024.100148","DOIUrl":"10.1016/j.gloepi.2024.100148","url":null,"abstract":"<div><h3>Introduction</h3><p>The present study aims to compare the risk factors, clinical presentation, and severity of coronary artery involvement in young compared to elderly CAD patients to assess the cardiovascular health status for better disease management and control of these specific patients.</p></div><div><h3>Methods</h3><p>This registry-based cross-sectional study was conducted using Coronary Angiography and Angioplasty Registry (CAAR) patients in east of Tehran, Iran. The data were extracted from 330 patients with confirmed CAD recorded by the CAAR during July 2021 to August 2023.</p></div><div><h3>Results</h3><p>The majority of patients in MCAD (68.2%) and VECAD (80%) were male, while the majority of PCAD patients were female (51.8%). Among PCAD patients, the prevalence of diabetes (38.1%) was higher than in other groups. The presence of IHD history in the father (38.1%) and mother (26.3%) was higher in the VECAD group. The mean total cholesterol, LDL, and LDL/HDL ratio were higher in the VECAD group. Among MCAD group (75.4%) compared to PCAD (58.1%) and VECAD (47.2%) groups, the multi-vessel disease was more common.MCAD patients had the highest median Gensini score compared to PCAD and VECAD patients. Also, in male compared to female the mean Gensini score was higher by 8 units (ß = 8.26, 95%CI = 0.24, 16.28).</p></div><div><h3>Conclusion</h3><p>Modifiable risk factors in young CAD patients are common. High LDL-C levels and smoking were the common modifiable CVD risk factors in young patients, indicating the significant role of these traditional risk factors in early atherosclerosis development alongside inheritable risk-factors such as positive family history that were more common in young CAD patients. While, the severity of coronary artery involvement in individuals with MCAD was higher, but the priority of involvement based on the type of vessel was almost the same in all CAD groups.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100148"},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000142/pdfft?md5=abe42c31a4a75ea8cf00cddec3f6bc30&pid=1-s2.0-S2590113324000142-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141400678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SARS-CoV-2 infection prevalence, risk factors, and outcomes among non-clinical-related service providers in a national healthcare system","authors":"Moza Aishaq ,&nbsp;Hanaa Nafady-Hego ,&nbsp;Fatma Ben Abid ,&nbsp;Jameela Ali Al Ajmi ,&nbsp;Wedad S. Hamdi ,&nbsp;Suni Vinoy ,&nbsp;Anil George Thomas ,&nbsp;Saddam Alrwashdh ,&nbsp;Mohamed Shaheen ,&nbsp;Tintu Elizabeth Mathew ,&nbsp;Mohamed Elgendy ,&nbsp;Sam Joseph ,&nbsp;Christymol Thomas ,&nbsp;Anju K. Alex ,&nbsp;Asmaa Nafady ,&nbsp;Peter V. Coyle ,&nbsp;Hamed Elgendy","doi":"10.1016/j.gloepi.2024.100149","DOIUrl":"10.1016/j.gloepi.2024.100149","url":null,"abstract":"<div><p>Health care workers (HCWs) may be at a variable risk of SARS-CoV2 infection. Regardless of their involvement in providing direct clinical treatment, most of the prior research had included all HCWs. Understanding infection rates, risk factors and outcomes among different subgroups of HCWs is crucial. From February 28, 2020 to January 1, 2022, we conducted a retrospective analysis encompassing all full-time non-clinical staff (NCS) subcontracted with Hamad Medical Corporation (HMC) facilities. To determine current or previous SARS-CoV2 infection, all personnel underwent RT-PCR and/or serology testing. To identify the demographic factors linked to the risk of infection, we utilized Cox-Hazard regression analysis. Herein 3158/6231 (50.7%) subcontracted NCS tested positive for SARS-CoV-2 by RT-PCR or serology during the research period. The median age was 30 years (IQR 25,35), 69.8% of the population were males, 82.4% were from South Asia, 86.6% did not have any concomitant conditions. 6032 (96.8%) of the population lived in shared housing, while 4749 (76.2%) had low to median levels of education. While infection (PCR positive with or without seropositive results) was independently predicted by male gender, working in the catering, laundry, and security sectors and being intermediate (7–12 years of education), lower (0–6 years of education), higher (exposure to confirmed case), and having symptoms. Male gender, working in the security sectors and being intermediate (7–12 years of education) were independently associated with accidently detected cases (PCR negative and seropositive). 299 (4.8%) required hospitalization, of them 3 cases were severe pneumonia and one required ICU admission without mechanical ventilation, with no deaths reported. In conclusion Infection rates among NCS are high. The majority are asymptomatic and may contribute to ongoing illness spread in the public or in healthcare facilities. During a pandemic, routine screening of this population is crucial and may aid in containing the spread of infection.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100149"},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000154/pdfft?md5=9fe8a5c698ef406b3d33d25b12143840&pid=1-s2.0-S2590113324000154-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141410673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An analysis of paediatric clinical presentations in Northwest Syria and the effect of forced displacement, 2018–2022","authors":"Vinay Kampalath ,&nbsp;Ms Maia C. Tarnas ,&nbsp;Ms Vaibhavee Patel ,&nbsp;Mohamed Hamze ,&nbsp;Randa Loutfi ,&nbsp;Bachir Tajaldin ,&nbsp;Ahmad Albik ,&nbsp;Ayman Kassas ,&nbsp;Anas Khashata ,&nbsp;Aula Abbara","doi":"10.1016/j.gloepi.2024.100146","DOIUrl":"10.1016/j.gloepi.2024.100146","url":null,"abstract":"<div><h3>Background</h3><p>One in six children worldwide lives in a region exposed to armed conflict. In conflicts, children are among the most vulnerable, and at risk of adverse health outcomes. We sought to describe trends in child and adolescent morbidity in northwest Syria (NWS) and understand how forced displacement affects clinical utilisation during the Syrian conflict.</p></div><div><h3>Methods</h3><p>Retrospective data between January 2018 and December 2022 were obtained from the Syrian American Medical Society (SAMS), a non-governmental organisation that operates health facilities in NWS. After initial descriptive analyses were completed, we performed a seasonal-trend decomposition to estimate the seasonality of clinical presentations. We subsequently employed a multivariate regression model incorporating age, gender, residency status, season, and a random district-level intercept to measure the association between the odds of clinical consultation and forced displacement.</p></div><div><h3>Findings</h3><p>Across 51 reporting SAMS facilities, 2,687,807 clinical consultations were studied over a five-year period. Seasonality was demonstrated for every clinical consultation category. Higher levels of forced displacement were associated with increased odds of consultations for nutrition, trauma, NCDs and mental health and decreased odds of consultation for communicable diseases. Aside from traumatic injury, internally displaced persons (IDPs) had higher AORs of clinical consultations compared to host populations.</p></div><div><h3>Interpretation</h3><p>Forced displacement differentially impacts clinical utilisation among children in northwest Syria, and the effects of displacement persist for at least six months. Clinical needs vary by host/IDP status, sex, age, and season. This study can assist policymakers in forecasting the health needs of children in northwest Syria.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100146"},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000129/pdfft?md5=b2d42f6ebc1c79281f0f8ae3397e2798&pid=1-s2.0-S2590113324000129-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141276215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}