Annals of Epidemiology最新文献

{"title":"The rising predictive power of LGBT identity in mental health: An analysis of variable importance.","authors":"Masanori Kuroki","doi":"10.1016/j.annepidem.2025.09.022","DOIUrl":"https://doi.org/10.1016/j.annepidem.2025.09.022","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the changing predictive importance of lesbian, gay, bisexual, and transgender (LGBT) status on mental health outcomes between 2014 and 2023.</p><p><strong>Methods: </strong>We utilized data from the Behavioral Risk Factor Surveillance System (BRFSS) and employed two ensemble methods-random forests and gradient boosting-as well as traditional logistic regression, to analyze the predictive power of various factors, including LGBT status, on frequent mental distress. Frequent mental distress was defined as experiencing poor mental health for 14 or more days during the previous 30 days.</p><p><strong>Results: </strong>Our analysis revealed a significant and consistent increase in the predictive importance of LGBT status on frequent mental distress across all three modeling approaches. Specifically, LGBT status consistently rose from the 8th or 13th most important predictor in 2014 to the 3rd or 5th most important in 2023, depending on the model. This trend demonstrates that SOGI has become one of the most influential factors for predicting mental health challenges in recent years.</p><p><strong>Conclusions: </strong>These findings highlight the growing importance of sexual orientation and gender identity (SOGI) as a risk factor for mental health challenges.</p>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Migration and cardiovascular disease: A comparative study of prevalence and risk factor profiles in resettlers from the German National Cohort (NAKO)\" [Ann Epidemiol 111 (2025) 14-23].","authors":"Glenna Walther, Tilman Brand, Nico Dragano, Claudia Meinke-Franze, Amand Führer, Karin Halina Greiser, Olga Hovardovska, Jamin Kiekert, Lilian Krist, Michael Leitzmann, Wolfgang Lieb, Rafael Mikolajczyk, Ute Mons, Fiona Niedermayer, Nadia Obi, Cara Övermöhle, Marvin Reuter, Börge Schmidt, Ilais Moreno Velasquez, Henry Völzke, Kerstin Wirkner, Hajo Zeeb, Till Bärnighausen, Beate Fischer, Lena Koch-Gallenkamp, Volker Harth, André Karch, Berit Lange, Annette Peters, Tobias Pischon, Henning Teismann, Heiko Becher, Volker Winkler","doi":"10.1016/j.annepidem.2025.09.020","DOIUrl":"https://doi.org/10.1016/j.annepidem.2025.09.020","url":null,"abstract":"","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"111 ","pages":"87"},"PeriodicalIF":3.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping access to prenatal care: Geographic disparities in West Virginia's rural communities.","authors":"Madelin Coyne, Brian Hendricks, Amna Umer, Toni Rudisill, Candice Lefeber, Collin John, Christa Lilly","doi":"10.1016/j.annepidem.2025.09.021","DOIUrl":"10.1016/j.annepidem.2025.09.021","url":null,"abstract":"<p><strong>Introduction: </strong>Adequate prenatal care (PNC) is essential to the overall health of mother and her infant. Previous research has demonstrated that rural areas have a higher risk of inadequate PNC compared to their urban counterparts. No studies to date have applied spatial statistical modeling to understand community level factors related to PNC inadequacy.</p><p><strong>Purpose: </strong>To identify communities where the adjusted rate of PNC inadequacy is high, and the insurance type and drive time driving these geographic differences.</p><p><strong>Methods: </strong>Data were obtained from Project WATCH/Birth Score Program for WV zip codes from May 2018 to March 2022. Stratified spatial regression analyses were conducted for women with public and private insurance to understand the extent to which predictors affected risk of PNC inadequacy, and whether relationships differed depending on insurance type.</p><p><strong>Results: </strong>For both insurance types, 30-minute drive time from a birthing facility had a statistically significant association with risk of inadequate PNC (public IRR:3.83, CI:(2.85,5.18)) (private IRR:4.31, CI:(3.17,5.88). Hot spots of model adjusted inadequate PNC risk were clustered in the mid-eastern and southern parts of WV. Importantly, communities with highest risk of inadequate PNC were located further than 30-minutes from a birthing center.</p><p><strong>Discussion: </strong>This study identified strong associations between restricted access to birthing facilities and inadequacy of PNC for women with public and private insurance. Differences in hotspot locations between public and private insurance groups suggest these groups experience different barriers, such as lack of public transportation and drive time.</p>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":" ","pages":"88-93"},"PeriodicalIF":3.0,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Campus climate and intersectional inequities in eating disorders among U.S. college students: A multilevel analysis of individual heterogeneity and discriminatory accuracy.","authors":"Ariel L Beccia, Vivienne M Hazzard, Rachel F Rodgers, Dougie Zubizarreta, Lauren M Schaefer, Natasha L Burke","doi":"10.1016/j.annepidem.2025.09.014","DOIUrl":"10.1016/j.annepidem.2025.09.014","url":null,"abstract":"<p><strong>Purpose: </strong>To advance understanding of how contextual factors explain eating disorder (ED) inequities among college students, we examined associations between campus climate - i.e., the extent to which a given school is hostile vs. friendly to students of diverse social/cultural backgrounds - and ED prevalence across intersections of gender, sexual, and racialized identity.</p><p><strong>Method: </strong>Cross-sectional data came from 15,544 students at colleges/universities that participated in the 2018/2019 Healthy Minds Study. We conducted a Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) by grouping participants into 35 intersectional social strata defined by gender, sexual, and racialized identity and fitting multilevel models to obtain stratum-specific prevalence estimates of probable EDs across the range of campus climate ratings (1 = \"very hostile\" to 5 = \"very friendly\").</p><p><strong>Results: </strong>Campus climate was inversely associated with probable EDs; specifically, for every 1-unit increase in ratings (i.e., more friendly climates), odds decreased by 8 %. There were differences in the magnitude of this association across strata, such that multiply marginalized students experienced the largest benefits from attending \"very friendly\" campuses, and especially those who were cisgender women and/or LGBQ+.</p><p><strong>Conclusions: </strong>Results reveal a complex social patterning of EDs among college students across campus climate ratings and provide preliminary evidence suggesting that hostile campus climates may function as a driver of intersectional inequities in this population.</p>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":" ","pages":"94-101"},"PeriodicalIF":3.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Conditions, Disability, and COVID-19 Testing and Vaccination: A National Rapid Acceleration of Diagnostics-Underserved Populations Analysis.","authors":"Haley R Fonseca, Elizabeth Lydon, Troy A Stefano, Eileen Fluney, Lisa Wruck, Susanna Stevens, Krista M Perreira, David R Brown, Wensong Wu, Marianna K Baum","doi":"10.1016/j.annepidem.2025.09.019","DOIUrl":"https://doi.org/10.1016/j.annepidem.2025.09.019","url":null,"abstract":"<p><strong>Purpose: </strong>We investigated the impact of chronic conditions on COVID-19 testing, vaccination, and related challenges, with a focus on the interaction effect of disability.</p><p><strong>Methods: </strong>This cross-sectional, cross-consortium analysis was conducted as part of the National Institutes of Health Rapid Acceleration of Diagnostics-Underserved Population (RADx-UP) initiative. Data were self-reported via standardized RADx-UP common data elements. Multivariable generalized estimating equation models with a logit link adjusted for sociodemographic variables, health insurance, health status, housing, and United States region were utilized.</p><p><strong>Results: </strong>Participants were from 28 states (n=8,813), enrolled between February 2021-March 2022 with a mean age of 49 years, 60.4% female, 30.8% Hispanic, and 25.5% Black, non-Hispanic. Over 30% were living with three or more chronic conditions and 22.1% reported some type of disability. Odds of COVID-19 testing (aOR:1.95; 95%CI:1.75, 2.17), vaccination (aOR:1.63; 95%CI:1.31, 2.03), food insecurity (aOR:1.43; 95%CI:1.21, 1.68), housing insecurity (aOR:1.42; 95%CI:1.10, 1.82), healthcare access challenges (aOR:1.60; 95%CI:1.38, 1.86) and transportation challenges (aOR:1.48; 95%CI:1.21, 1.81) increased as number of chronic conditions increased. The effect of chronic conditions on probability of COVID-19 testing (p=0.157) and vaccination (p=0.147) did not differ by disability, but the effect on probability of experiencing COVID-19-related challenges did differ by disability (p<0.001). For those with functional and employment disability, the more chronic conditions one had, the more likely they were to experience food insecurity (aOR:1.94; 95%CI:1.33, 2.82) and issues accessing healthcare (aOR:2.21; 95%CI:1.19, 4.14) and transportation (aOR:2.33; 95%CI:1.11, 4.89).</p><p><strong>Conclusions: </strong>Testing and vaccination sites may have been accessible to various populations and/or adults with chronic conditions may have had heightened awareness of potential vulnerability to COVID-19, which could have led to similar testing and vaccination behaviors across different disability statuses. However, disability may still exacerbate daily-life challenges in those living with chronic conditions during public health crises.</p>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term risk of all-cause mortality and major adverse cardiovascular events in hip osteoarthritis patients after total hip replacement","authors":"Nai-Chen Shih MD, PhD ,&nbsp;Han-Wei Yeh MD ,&nbsp;Shun-Fa Yang PhD ,&nbsp;Jing-Yang Huang PhD ,&nbsp;Ping-Kun Tsai MD, PhD ,&nbsp;Chao-Bin Yeh MD, PhD","doi":"10.1016/j.annepidem.2025.09.018","DOIUrl":"10.1016/j.annepidem.2025.09.018","url":null,"abstract":"<div><h3>Introduction</h3><div>To evaluate the long-term effects of total hip replacement (THR) on all-cause mortality and major adverse cardiovascular events (MACEs) among patients with hip osteoarthritis (OA).</div></div><div><h3>Methods</h3><div>A retrospective cohort study utilizing data from the TriNetX US Collaborative Network, a multicenter electronic health record database. We identified adult patients diagnosed with hip OA between January 1, 2012, and December 31, 2020. Propensity score matching (PSM) was employed to generate 16,893 matched pairs of patients who underwent THR and those who did not. Outcomes included all-cause mortality and incidence of MACEs, analyzed using Kaplan–Meier survival curves and Cox proportional hazards models. Subgroup analyses were conducted stratified by age, sex, race, and body mass index (BMI).</div></div><div><h3>Results</h3><div>Following PSM, patients receiving THR demonstrated a significantly 41 % lower risk of all-cause mortality (hazard ratio [HR], 0.59; 95 % confidence interval [CI], 0.54–0.64) and a 41 % lower risk of MACEs (HR, 0.59; 95 % CI, 0.56–0.62) compared with those not undergoing THR. Subgroup analysis revealed sex-based heterogeneity in mortality benefit (HR, 0.61; 95 % CI, 0.54–0.69 in males vs. HR, 0.75; 95 % CI, 0.66–0.87 in females). Age-stratified analyses for MACE risk showed a diminishing protective effect with increasing age (HR, 0.48 for 50–59 years; HR, 0.58 for 60–69 years; HR, 0.66 for 70–79 years).</div></div><div><h3>Conclusions</h3><div>Total hip replacement is associated with a substantial reduction in long-term all-cause mortality and cardiovascular events among patients with hip OA, corresponding to approximately 40 % lower risks compared with non-surgical patients. These associations appear to be modified by sex and age. The observed benefits may reflect improved mobility, enhanced physical activity, and better cardiovascular health following surgical intervention.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"111 ","pages":"Pages 65-73"},"PeriodicalIF":3.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications of case definition selection on traumatic brain injury trends: A controlled interrupted time-series analysis of North Carolina emergency department data.","authors":"Lucas M Neuroth, Yuni Tang, Anna E Waller, Katherine J Harmon","doi":"10.1016/j.annepidem.2025.09.017","DOIUrl":"10.1016/j.annepidem.2025.09.017","url":null,"abstract":"<p><strong>Background: </strong>In 2015, the CDC removed unspecified head injuries from its TBI surveillance case definition, complicating the investigation of long-term morbidity trends. We examined the long-term impact of this change on quantifying statewide TBI incidence.</p><p><strong>Methods: </strong>North Carolina emergency department (ED) visit records were obtained from 2012 to 2024 and classified based on the presence (S09.90+) or absence (S09.90-) of the ICD-10-CM code for \"head injury, unspecified\". Segmented Poisson regression was used to compare slope- and level-changes in monthly TBI visit counts.</p><p><strong>Results: </strong>From January 2012 through September 2015, TBI visits increased at a rate of 14.9 visits per month. TBI visits dropped at the onset of COVID-19, and then rebounded after the relaxation of the state's stay-at-home-order; however, this trend was diminished under the S09.90- definition, with a difference of 75.9 (57.2-94.6) visits per month between the two definitions.</p><p><strong>Conclusions: </strong>The presence of unspecified head injuries in the TBI surveillance case definition substantially altered statewide trends and their inclusion may better reflect injury burden.</p>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":" ","pages":"82-86"},"PeriodicalIF":3.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association of preterm birth and small for gestational age with recurrent multisite musculoskeletal pain during early and middle adulthood — The Northern Finland Birth Cohort 1966 Study","authors":"Sandra-Sofia Nieminen ,&nbsp;Jaro Karppinen ,&nbsp;Eero Kajantie ,&nbsp;Paulo Ferreira ,&nbsp;Eveliina Heikkala","doi":"10.1016/j.annepidem.2025.09.011","DOIUrl":"10.1016/j.annepidem.2025.09.011","url":null,"abstract":"<div><h3>Purpose</h3><div>Musculoskeletal (MSK) pain is a leading cause of disability and commonly affects multiple locations. Identifying early-life risk factors could enable targeted prevention of multisite MSK pain. This study investigated associations of preterm birth (&lt;37 weeks) and small for gestational age (SGA) with recurrent multisite MSK pain during early and middle adulthood.</div></div><div><h3>Methods</h3><div>Participants in the NFBC1966 were prospectively followed from gestation to 46 years. Exposure data were based on delivery records; the outcome was self-reported. Multinomial logistic regression estimated odds ratios (ORs) and 95 % confidence intervals (CIs) both unadjusted and adjusted [a] for sex, maternal age at birth, pregnancy disorder, maternal smoking, family socioeconomic status, and parity.</div></div><div><h3>Results</h3><div>Among participants, 12 % born prematurely and 16 % born at term reported recurrent multisite MSK pain between 31 and 46 years (aOR 0.79, 95 % CI 0.43–1.46). Using continuous gestational age, a statistically significant association was observed (aOR 1.07, 95 % CI 1.00–1.14). SGA showed no association (aOR 0.94, 95 % CI 0.84–1.04). No associations were found for onset or resolved multisite MSK pain.</div></div><div><h3>Conclusion</h3><div>Preterm birth and SGA were not negatively associated with adult multisite MSK pain. A protective association appeared with continuous gestational age, but small sample sizes warrant cautious interpretation.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"111 ","pages":"Pages 58-64"},"PeriodicalIF":3.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body mass index inequities among adults in Spain: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy of age, sex/gender, immigration status, and education","authors":"Luisa N. Borrell ,&nbsp;Julia Díez ,&nbsp;Nerea Lanborena ,&nbsp;Sara Yago-Gonzalez ,&nbsp;Elena Rodriguez-Alvarez","doi":"10.1016/j.annepidem.2025.09.013","DOIUrl":"10.1016/j.annepidem.2025.09.013","url":null,"abstract":"<div><h3>Purpose</h3><div>We aimed to examine intersectional BMI inequities across age, sex/gender, immigration status, and education among adults in Spain.</div></div><div><h3>Methods</h3><div>We analyzed data from 61,844 adults aged ≥ 18 years from the 2014 and 2020 European Health Interview Surveys in Spain and the 2017 Spanish National Health Survey. Using intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (I-MAIHDA) via linear mixed models, we examined BMI inequities across 180 intersectional strata, defined by age, sex/gender, immigration status, education, and survey year, and quantified the contribution of their intersections to BMI inequities.</div></div><div><h3>Results</h3><div>The intersectional strata explained 9.6 % of BMI inequities, with 87.1 % of the between-strata variance explained by age, sex/gender, immigration status, education, and survey year. On average, BMI was higher in older adults, immigrants, and those with lower education but lower in women. Interaction effects revealed that immigrant women had a higher predicted BMI than Spanish-born women. BMI inequities between immigrant and Spanish-born women were greatest for those aged 55–64 with middle and high education.</div></div><div><h3>Conclusion</h3><div>Although most BMI inequities were explained by the social factors considered as inequity axes, interaction effects were present. The latter calls for a universal public health intervention proportionate to the needs of specific groups in the population. I-MAIHDA revealed complex patterns of BMI inequities in Spain, which may inform the interventions needed to address weight-related outcomes.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"111 ","pages":"Pages 74-81"},"PeriodicalIF":3.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in orofacial cleft prevalence and the effect of prenatal detection on pregnancy outcomes in Northern Netherlands","authors":"Sofia Anania MD ,&nbsp;Marian K. Bakker PhD ,&nbsp;Jorieke E.H. Bergman MD PhD ,&nbsp;Leonie K. Duin MD PhD ,&nbsp;Mike Ruettermann MD PhD ,&nbsp;Dieuwke C. Broekstra PhD","doi":"10.1016/j.annepidem.2025.09.012","DOIUrl":"10.1016/j.annepidem.2025.09.012","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe trends in total and live birth (LB) prevalence of orofacial clefts (OFCs) and investigate the effect of prenatal diagnosis on its LB prevalence in the Northern Netherlands (NNL) over a 21-year period.</div></div><div><h3>Study design</h3><div>Cases with OFCs were selected from Eurocat NNL, a population-based registry of congenital anomalies. Aggregated denominator data (controls) was derived from Statistics Netherlands. We categorized OFCs into cleft lip with or without palate (CL±P) and cleft palate (CP). We analyzed trends in prevalence and temporal patterns in prenatal detection rates and birth type by calculating the annual percentage change (APC) using Joinpoint regression or the <em>X²</em> test for linear trends.</div></div><div><h3>Results</h3><div>The total prevalence of CL±P decreased non-significantly from 1.65/1000 births in 2001 to 1.17/1000 births in 2021 (APC=-0.82 [95 %CI: −2.18, 0.55]), whereas the LB prevalence decreased significantly from 1.57/1000 births in 2001 to 0.93/1000 births in 2021 (APC=-1.65 [95 %CI −3.03, −0.25]). The total and LB prevalence of CP did not show significant decreasing trends.</div><div>The prenatal detection rate of CL±P increased from 15 % to 71 % between 2001 and 2007 (APC=34.38 [95 %CI 24.27, 52.26]), followed by a slower increase, reaching 94 % in 2021 (APC=3.57 [95 %CI 0.59, 6.08]). The percentage of induced abortions increased from 3.2 % to 12.7 % between 2001 and 2021 (<em>X</em>^<em>2</em> for trend P &lt; 0.001), with most induced abortions occurring in the CL±P associated with genetic/syndromic or other congenital anomalies.</div></div><div><h3>Conclusions</h3><div>The LB prevalence of CL±P decreased, which may be associated with better prenatal detection and increasing pregnancy terminations due to unfavorable prognosis</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"111 ","pages":"Pages 44-50"},"PeriodicalIF":3.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}