Annals of Epidemiology最新文献

{"title":"Changed epidemiology of influenza and RSV hospitalizations after the emergence of SARS-CoV-2 in Norway, 2017 - 2024.","authors":"Håkon Bøås, Elina Seppälä, Lamprini Veneti, Jeanette Stålcrantz, Jacob Dag Berild, Jesper Dahl, Trine Hessevik Paulsen","doi":"10.1016/j.annepidem.2025.06.010","DOIUrl":"https://doi.org/10.1016/j.annepidem.2025.06.010","url":null,"abstract":"<p><strong>Background: </strong>Many countries reported missing and atypical influenza and RSV seasons during the COVID-19 pandemic. Here we describe the incidence and seasonality of COVID-19, influenza, and RSV hospitalizations in Norway between 2017-2024, and the disease burden between 2022-2024.</p><p><strong>Methods: </strong>Using nationwide data on ICD-10 discharge codes, procedure codes and laboratory results, we calculate the incidence of COVID-19, influenza, and RSV hospitalizations, by age group, week and surveillance year between January 2017 to April 2024, and report proportions receiving intensive care, deaths and length of stay between 2022-2024.</p><p><strong>Results: </strong>The transmission of influenza and RSV was interrupted the first year of the COVID-19 pandemic and reemerged with epidemics outside of the normal seasonality in 2021/2022, after COVID-19 restrictions were removed. Between 2022-2024, COVID-19 was a greater contributor to hospitalizations than influenza and RSV, with higher mortality rate within two weeks of admission. The use of ventilatory support/intensive care admission was highest among patients hospitalized with RSV.</p><p><strong>Conclusion: </strong>The transmission of influenza and RSV was interrupted during the first year of the COVID-19 pandemic, followed by an unusual seasonality. Although many hospitalizations are caused by RSV and influenza, COVID-19 was the largest contributor of these three to hospital burden in the first years with co-circulation.</p>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340603","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":"A pluralistic approach to interpreting surveillance data: The likely decline in the occurrence of invasive pneumococcal disease in Japan during the COVID-19 pandemic","authors":"Reiko Shimbashi ,&nbsp;Yuzo Arima ,&nbsp;Koji Yahara ,&nbsp;Maki Masutani ,&nbsp;Ayu Kasamatsu ,&nbsp;Munehisa Fukusumi ,&nbsp;Toshiki Kajihara ,&nbsp;Takeshi Arashiro ,&nbsp;Takuri Takahashi ,&nbsp;Miyako Otsuka ,&nbsp;Yusuke Kobayashi ,&nbsp;Katsuhiro Komase ,&nbsp;Yuuki Tsuchihashi ,&nbsp;Bin Chang ,&nbsp;Junko Amemura-Maekawa ,&nbsp;Tomimasa Sunagawa ,&nbsp;Motoi Suzuki ,&nbsp;Yukihiro Akeda","doi":"10.1016/j.annepidem.2025.06.008","DOIUrl":"10.1016/j.annepidem.2025.06.008","url":null,"abstract":"<div><h3>Purpose</h3><div>To systematically investigate whether the decline in invasive pneumococcal disease (IPD; caused by <em>Streptococcus pneumoniae</em>) notifications during the COVID-19 pandemic, based on Japan’s national infectious disease surveillance system, was due to a reduction in incidence.</div></div><div><h3>Methods</h3><div>Considering potential surveillance biases from changes in healthcare-seeking, testing/diagnosis, or reporting, we compared the following for the 12-month period before vs. after the state of emergency declaration (week 15, 2020): notification rates of IPD, invasive <em>Haemophilus influenzae</em> disease (IHD), and legionellosis (clinically similar bacterial diseases, but unlike IPD/IHD, legionellosis is not transmitted person-to-person and serves as a negative control); surveillance timeliness indicators; notifications restricted to severe cases; and <em>S. pneumoniae</em> detections accounting for test frequency.</div></div><div><h3>Results</h3><div>Following the declaration, IPD notifications decreased by 60 % (notification rate ratio = 0.39, 95 %CI = 0.37–0.42). While IHD also decreased markedly (0.37, 0.31–0.44), legionellosis declined little (0.83, 0.78–0.88). None of the diseases showed delays in timeliness. Restricted to severe cases, respectively similar trends were observed for IPD, IHD, and legionellosis, with respectively similar death trends in census data. Additionally, decrease in <em>S. pneumoniae</em> detections greatly exceeded that in test counts, substantially decreasing test positivity.</div></div><div><h3>Conclusions</h3><div>Based on our pluralistic approach, reduced IPD notifications could not be explained by surveillance biases and was likely due to decreased incidence.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"108 ","pages":"Pages 63-70"},"PeriodicalIF":3.3,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318578","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 Relationship Between Living in Poverty and Youth COVID-19 Testing in Underserved Populations.","authors":"Emily M D'Agostino, Derek D Cyr, Lisa Wruck, Maria Victoria Ferraris, Lisa Gwynn, Ryan J Coller, Dana Keener Mast, Jennifer E Schuster, Jennifer L Goldman, Corinne McDaniels-Davidson, Susan M Kiene, Eyal Oren, Krista M Perreira","doi":"10.1016/j.annepidem.2025.06.006","DOIUrl":"https://doi.org/10.1016/j.annepidem.2025.06.006","url":null,"abstract":"<p><strong>Background: </strong>Children living in poverty face particular risk for pandemic-related adverse health events. Place-based pandemic-related health inequities may vary for children living in poverty due to social and environmental factors. We aimed to examine the association between living in low-income households and COVID-19 testing in youth across several regions of the United States.</p><p><strong>Methods: </strong>This cross-sectional study drew data from three Rapid Acceleration of Diagnostics-Underserved Populations projects (2021-2023). The association between living in low-income households and COVID-19 testing was analyzed by project using logistic regression adjusted for age, sex assigned at birth, race and ethnicity, and household member job loss.</p><p><strong>Findings: </strong>Participants (n=2,934; median [IQR] age, 12 [11-13] years; sex, 52% male; race, 56% White, 21% other; ethnicity, 48% Hispanic, Latino, or Spanish Origin; income, 18% living in a low-income household) were included. Overall, 83·5% of the participants had prior COVID-19 testing. Youth participants living in low-income households had 39% lower adjusted odds of prior testing for COVID-19 compared to those not living in low-income households (0·61; 95% CI, 0·42-0·88).</p><p><strong>Interpretation: </strong>Youth living in low-income households had lower odds of prior testing for COVID-19 compared to those not living in low-income households.</p>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310776","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":"Outpatient insurance data indicate increased numbers of Parvovirus B19 infections and -associated miscarriages during the 2024 epidemic in the German federal state Saarland","authors":"Anna Sternjakob ,&nbsp;Florian Bub ,&nbsp;Martin Giesen ,&nbsp;Alexandra Schanzenbach ,&nbsp;Thomas Rehlinger ,&nbsp;Harry Derouet ,&nbsp;Martin Enders ,&nbsp;Sigrun Smola ,&nbsp;Fabian K. Berger","doi":"10.1016/j.annepidem.2025.06.007","DOIUrl":"10.1016/j.annepidem.2025.06.007","url":null,"abstract":"<div><h3>Objectives</h3><div>Parvovirus B19 (B19V) infection usually causes mild diseases such as <em>Erythema infectiosum</em> in immunocompetent individuals. During pregnancy, however, it can lead to fetal anemia, hydrops fetalis or fetal death. To date, neither B19V infections nor attributable complications are notified in Germany. At the beginning of 2024, we observed an increased number of B19V infections in pregnant women at Saarland University Hospital.</div></div><div><h3>Study design and methods</h3><div>To investigate this further, we analyzed retrospective ICD-10-coded aggregated outpatient health insurance data over the last 10 years in the German federal state Saarland on B19V infections, stratified by sex and age groups, and on B19V infection-associated pregnancies and miscarriages.</div></div><div><h3>Results</h3><div>The first B19V epidemic after the SARS-CoV-2 pandemic began in the third quarter of 2023, peaked in the first quarter of 2024 and remained stable in the second quarter of 2024. Compared to the last two pre-pandemic B19V epidemics in 2017 and 2018, the number of infections were 14 and 6 times higher respectively. In pregnant women, the number of B19V infections increased 17.5-fold in the first quarter of 2024 and by more than 60 % in the second quarter, which was accompanied by a marked increase in miscarriages.</div></div><div><h3>Conclusions</h3><div>These are the first objective data documenting an unusually strong B19V epidemic in a German federal state after the SARS-CoV-2 pandemic, with a steep rise of B19V infections in pregnant women and associated miscarriages. The establishment of early warning systems should be considered to prevent dramatic consequences of future B19V epidemics.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"108 ","pages":"Pages 71-76"},"PeriodicalIF":3.3,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303426","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":"Towards robust real-time surveillance of severe acute respiratory infections: Exploring the potential of an existing national intensive care unit registry","authors":"Christine G.J.I. van Straten ,&nbsp;Jordy Gaspersz ,&nbsp;Nicolette F. de Keizer ,&nbsp;Cornelis H. van Werkhoven ,&nbsp;Arianne B. van Gageldonk-Lafeber ,&nbsp;Dylan W. de Lange ,&nbsp;Dave A. Dongelmans ,&nbsp;Ferishta Bakhshi- Raiez ,&nbsp;Liselotte van Asten","doi":"10.1016/j.annepidem.2025.06.005","DOIUrl":"10.1016/j.annepidem.2025.06.005","url":null,"abstract":"<div><h3>Objectives</h3><div>Although many countries lack Severe Acute Respiratory Infections (SARI) surveillance, establishing such systems is crucial for pandemic preparedness. Adjusting existing registries designed for other purposes may be viable. We investigated the potential of the Dutch National Intensive Care Evaluation (NICE) registry, originally designed to monitor intensive care unit (ICU) care quality, for near real-time SARI surveillance by determining data timeliness.</div></div><div><h3>Study design</h3><div>A descriptive study was performed with retrospective ICU admissions (2012–2019).</div></div><div><h3>Methods</h3><div>The lag time between SARI admissions and their data upload was determined. Incident SARI cases, SARI proportion relative to all medical admissions, and SARI patient mortality were examined at various lag times and compared to the complete data.</div></div><div><h3>Results</h3><div>ICUs uploaded data at varying intervals. The Spearman correlation coefficient between the complete and incomplete ICU incident cases increased the most between 2 and 6 weeks of lag time and increased further with longer lag time. Data uploaded within two weeks fluctuated, with no uploaded data in 13 % of the weeks.</div></div><div><h3>Conclusion</h3><div>The current uploading delays render the NICE registry unsuitable for near real-time SARI surveillance. Investing in timely and preferably automated data exchange mechanisms can enhance existing registry purposes. This may benefit other countries as well.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"108 ","pages":"Pages 47-55"},"PeriodicalIF":3.3,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263434","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":"Health inequity learning module: Zadeh et al (2023), Epidemiological approaches to multivariable models of health inequity: A study of race, rurality, and occupation during the COVID-19 pandemic","authors":"Jeb Jones PhD, MPH, MS, Associate Professor","doi":"10.1016/j.annepidem.2025.04.007","DOIUrl":"10.1016/j.annepidem.2025.04.007","url":null,"abstract":"<div><div>Educational Engagement Modules (EEMs) are teaching materials for educators and students that facilitate a deeper understanding of key epidemiological methods and concepts. Each EEM poses a series of questions using a recently published paper in Annals to further understanding of a specific study design and to encourage critical thinking and careful evaluation. This EEM focuses on methods for studying health inequity and references the following article: Zadeh H, Curran M, Del Castillo N, Morales C, Dukes K, Martinez D, Salinas JL, Bryant R, Bojang M, Carvour ML. Epidemiological approaches to multivariable models of health inequity: A study of race, rurality, and occupation during the COVID-19 pandemic. Ann Epidemiol. 2024 Jun;94:42–48. doi: 10.1016/j.annepidem.2024.04.008. Epub 2024 Apr 19. PMID: 38642626; PMCID: PMC11326713.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"107 ","pages":"Pages 68-70"},"PeriodicalIF":3.3,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254291","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 definition of treatment assignment in observational emulations of target trials – an empirical examination in the Swedish Primary Care Cardiovascular Database","authors":"Anna B.C. Humphreys ,&nbsp;Anthony A. Matthews ,&nbsp;Jessica C. Young ,&nbsp;Anita Berglund ,&nbsp;Bertil Lindahl ,&nbsp;Björn Wettermark ,&nbsp;Issa J. Dahabreh ,&nbsp;Thomas Kahan ,&nbsp;Miguel A. Hernán","doi":"10.1016/j.annepidem.2025.06.003","DOIUrl":"10.1016/j.annepidem.2025.06.003","url":null,"abstract":"<div><h3>Background</h3><div>In randomized trials, the intention-to-treat effect is the effect of assignment to treatment strategies. The concept of assignment may not be clearly defined when using observational data to emulate a target trial.</div></div><div><h3>Aims</h3><div>We aimed to assess the practical implications of using data on prescription versus dispensation as analogues of treatment assignment in observational analyses.</div></div><div><h3>Methods</h3><div>We used the primary care-derived Swedish Primary Care Cardiovascular Database of individuals with newly diagnosed hypertension between 2006 and 2014 and linked registers. We compared the effect of two antihypertensive drug classes on the five-year risk of cancer and ischemic heart disease. Treatment assignment was first mapped using prescription data, and then dispensation data. With unique confounding structures, we sequentially adjusted for different classes of risk factor due to uncertainty over the choice of relevant confounders for prescription vs. dispensation.</div></div><div><h3>Results</h3><div>7770 individuals were eligible when assignment was defined using prescription compared with 5964 when defined using dispensation. For both cancer and ischemic heart disease outcomes, both higher and lower relative risks of the outcome were consistent with our data. Effect estimates did not vary with the choice of prescription or dispensation data as analogues of assignment, nor with sequential adjustment for class of risk factor.</div></div><div><h3>Conclusion</h3><div>The mapping of prescription or dispensation data to treatment assignment influences the size and characteristics of the study population and the structure of confounding. However, we found no clear numerical differences in effect estimates in this study. Further investigation is required in other settings.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"108 ","pages":"Pages 56-62"},"PeriodicalIF":3.3,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286953","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":"Prematurity at birth and risk of self-injury, overdose or death in adolescence and early adulthood: A population-based cohort study","authors":"Joel G. Ray MD MSc ,&nbsp;Neda Pirouzmand BHSc ,&nbsp;Alison L. Park MSc ,&nbsp;Peter C. Austin PhD ,&nbsp;Simone Vigod MD MSC ,&nbsp;Sonia Grandi PhD ,&nbsp;Howard Berger MD ,&nbsp;Eyal Cohen MD MSc","doi":"10.1016/j.annepidem.2025.06.002","DOIUrl":"10.1016/j.annepidem.2025.06.002","url":null,"abstract":"<div><h3>Background</h3><div>Preterm birth may adversely affect cortical brain development, and subsequent cognition in childhood and adolescence. Such abnormalities in brain development are correlated with suicidal and non-suicidal self-injury and persistent substance use, and to unintentional injury as well.</div></div><div><h3>Objective</h3><div>To evaluate the risk of self-injury, overdose, and all-cause mortality among adolescents and young adults – each in relation to preterm birth.</div></div><div><h3>Design</h3><div>Population-based cohort study in Ontario, Canada, where there is universal healthcare for all.</div></div><div><h3>Setting</h3><div>All of Ontario, Canada, where there is universal healthcare.</div></div><div><h3>Participants</h3><div>All youths born in Ontario from 1992 to 2012, and alive at age 10 years.</div></div><div><h3>Exposures</h3><div>Degree of prematurity in 2-week earlier increments, as well as preterm birth &lt; 37 weeks’ gestation.</div></div><div><h3>Outcomes</h3><div>i) Primary composite of an ED visit or hospitalization for intentional self-injury, poisoning or overdose, or all-cause mortality; and ii) co-primary composite of intentional self-injury, poisoning or overdose – each assessed between ages 10–24 years.</div></div><div><h3>Results</h3><div>Among 2352,563 youths in the cohort, 151,182 (6.4 %) were born preterm. Adjusted hazard ratios (aHR) for i) self-injury, overdose, or all-cause mortality was 1.03 (95 % CI 1.01–1.05) per 2-week earlier gestational age at birth; and ii) 1.01 (95 % CI 0.99–1.03) for self-injury or overdose. Compared to term births, preterm birth &lt; 37 weeks’ gestation was associated with a higher aHR for i) self-injury, overdose or all-cause mortality (1.09, 95 % CI 1.05–1.12); and ii) self-injury or overdose (1.06, 95 % CI 1.02–1.10).</div></div><div><h3>Conclusion</h3><div>Preterm birth may be associated with a slightly higher risk of all-cause mortality and, possibly, self-injury and overdose among adolescents and young adults. Ongoing efforts might focus on the health of youths who were born prematurely as they enter their adolescent years.</div></div><div><h3>Primary funding source</h3><div><span>Canadian Institutes of Health Research</span>.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"108 ","pages":"Pages 34-42"},"PeriodicalIF":3.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144242027","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 the epidemiology of extended-spectrum beta-lactamase-producing Enterobacterales – Boulder County, Colorado, 2020–2022","authors":"Alyssa Beck ,&nbsp;Jennifer Driscoll ,&nbsp;Karlie Hoetzer ,&nbsp;Deborah Hindman ,&nbsp;Keith Rawls ,&nbsp;Janell ,&nbsp;Helen Johnston ,&nbsp;Christopher A. Czaja","doi":"10.1016/j.annepidem.2025.06.001","DOIUrl":"10.1016/j.annepidem.2025.06.001","url":null,"abstract":"<div><h3>Purpose</h3><div>Extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) are serious antibiotic resistance threats. We describe trends in epidemiological and clinical characteristics of ESBL-E cases in Boulder County, Colorado from 2020 to 2022.</div></div><div><h3>Methods</h3><div>The Colorado Department of Public Health and Environment (CDPHE) and Boulder County Public Health conduct population-based surveillance for ESBL-E as part of the Emerging Infections Program-Healthcare-Associated Infections Community Interface. Trained epidemiologists abstracted data from patient medical records from the year prior to incident specimen collection through 30 days after.</div></div><div><h3>Results</h3><div>There were 1036 ESBL-E cases. Annual case counts increased from 2020 to 2022 (256, 316, and 464, respectively). The rate of ESBL-E infections per 100,000 population increased (77.4 in 2020, 96.6 in 2021, and 141.7 in 2022). Most samples were collected from outpatient settings (n = 812, 92.2 %) and <em>Escherichia coli</em> was the most common organism identified (n = 789, 89.6 %). Most case-patients had a lower urinary tract infection (UTI) (n = 757, 85.9 %), which increased by year (p = 0.03).</div></div><div><h3>Conclusions</h3><div>ESBL-E counts and incidence rates in Boulder County increased from 2020 to 2022. Cases most commonly presented with <em>E. coli</em> urinary tract infections in the outpatient setting. Strategies to combat antibiotic resistance should target ESBL-E in community settings.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"108 ","pages":"Pages 43-46"},"PeriodicalIF":3.3,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227482","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":"Geographical distribution disparities and prediction of health satisfaction among middle-aged and elderly adults in China: An analysis based on national data","authors":"Na Dong ,&nbsp;Xiaohan Yi ,&nbsp;Lijun Mao ,&nbsp;Biying Wang ,&nbsp;Manoj Sharma ,&nbsp;Lei Si ,&nbsp;Guoqun Xie ,&nbsp;Xianglong Xu","doi":"10.1016/j.annepidem.2025.05.012","DOIUrl":"10.1016/j.annepidem.2025.05.012","url":null,"abstract":"<div><h3>Background</h3><div>Health satisfaction among middle-aged and elderly adults has become a critical public health concern in China's aging society. Understanding geographical disparities in health satisfaction and developing prediction models are essential for targeted healthcare interventions and resource allocation.</div></div><div><h3>Methods</h3><div>Our study conducted a cross-sectional analysis of 16,231 participants aged 45 and above from the China Health and Retirement Longitudinal Study 2015. We analysed the provincial spatial distribution of health satisfaction in China. We developed conventional logistic regression (LR), random forest (RF), gradient boosting machine (GBM), XGBoost, and a stacking ensemble model (SEM) to predict health satisfaction and investigate social and biological determinants. We used the SHapley Additive exPlanation (SHAP) method to interpret our machine learning predictive models.</div></div><div><h3>Results</h3><div>Our analysis revealed significant geographical disparities in health satisfaction. The health satisfaction rate was 74.0 %, with regional variations: high in Xinjiang and Shanghai (&gt;80 %), low in some provinces (60–70 %), and moderate in the remaining provinces and municipalities (70–80 %). The AUCs of LR, RF, GBM, XGBoost, and SEM were all around 0.8. SHAP analysis revealed demographics (e.g., age), behavioural factors (e.g., night sleep duration), health-related factors (e.g., troubling body pain, self-expectations of health status, depression, heart problems and stomach or other digestive system diseases) and biological factors (e.g., self-reported distance vision status, self-reported near vision status, self-reported hearing status and MCV) as important predictors of health satisfaction in middle-aged and elderly adults.</div></div><div><h3>Conclusion</h3><div>The findings highlight substantial geographical inequalities in health satisfaction among middle-aged and elderly Chinese adults. The predictive models developed in this study can help policymakers identify high-risk populations, enabling more targeted interventions to improve health satisfaction levels across different regions.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"108 ","pages":"Pages 16-25"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144203882","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}