Annals of Epidemiology最新文献

{"title":"Associations of early life body size and pubertal timing with breast density and postmenopausal breast cancer risk: A mediation analysis","authors":"Dorthe C. Pedersen ,&nbsp;Dan Hameiri-Bowen ,&nbsp;Julie Aarestrup ,&nbsp;Britt W. Jensen ,&nbsp;Anne Tjønneland ,&nbsp;Lene Mellemkjær ,&nbsp;My von Euler-Chelpin ,&nbsp;Ilse Vejborg ,&nbsp;Zorana J. Andersen ,&nbsp;Jennifer L. Baker","doi":"10.1016/j.annepidem.2025.01.004","DOIUrl":"10.1016/j.annepidem.2025.01.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Whether breast density mediates associations between early life body size and pubertal timing with postmenopausal breast cancer is underexplored.</div></div><div><h3>Methods</h3><div>We studied 33,939 Danish women attending the Capital Mammography Screening Program at ages 50–69 years. Early life anthropometry and pubertal timing information came from the Copenhagen School Health Records Register. Postmenopausal breast cancer information came from the Danish Breast Cancer Group database (n = 833). Breast density (BI-RADS) was categorized as low (n = 25,464; 75 %) or high. Risk ratios (RR) and hazard ratios (HR) were estimated using generalized linear regression and Cox proportional hazards analyses. Counterfactual mediation analyses were conducted.</div></div><div><h3>Results</h3><div>Evidence was limited for associations between birthweight and pubertal timing with breast density or breast cancer. Childhood BMI was inversely associated with high breast density (age 13y, RR=0.77 [0.72–0.81] for a <em>z</em>-score of 0.6 versus 0) and breast cancer (HR=0.90 [0.83–0.96] per <em>z</em>-score). Breast density mediated 37 % (17–170 %) of this association. Although childhood height was associated with breast density and breast cancer, there were few indications of mediation by breast density.</div></div><div><h3>Conclusions</h3><div>Breast density may partially explain the inverse association between childhood BMI and postmenopausal breast cancer, but not the positive association between childhood height and postmenopausal breast cancer.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"102 ","pages":"Pages 68-74"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Duration of exposure to eviction moratoria in the early COVID-19 pandemic and perinatal outcomes: A population-level analysis of US births conceived in March-May 2020","authors":"Kaitlyn K. Stanhope PhD ,&nbsp;Sara Markowitz PhD ,&nbsp;Michael R. Kramer PhD","doi":"10.1016/j.annepidem.2025.01.001","DOIUrl":"10.1016/j.annepidem.2025.01.001","url":null,"abstract":"<div><h3>Objective</h3><div>To estimate associations between the length of state-level eviction moratoria enacted in March and April 2020 in the United States and perinatal outcomes.</div></div><div><h3>Methods</h3><div>We used data from natality files, 2020–2021 to identify individuals with Medicaid or no insurance who conceived in March-May 2020. The exposure was the number of months exposed to a moratorium (0 (referent, no state-level moratoria), 1–2, 3–4, 5 or more). Outcomes included preterm birth (PTB, &lt; 37 weeks gestation), very preterm birth (VPTB, &lt; 32 weeks gestation), low birthweight (LBW, &lt; 2500 g), very low birthweight (VLBW, &lt; 1500 g), primary cesarean, or maternal morbidity. We estimated risk ratios (RRs) using log-binomial regression, including individual, county, and state-level confounders. We conducted several sensitivity analyses to rule out residual state-level confounding including a negative control analysis of 2019 conceptions and difference-in-difference analysis.</div></div><div><h3>Results</h3><div>We included 375,821 births. Following adjustment, having a moratorium in place for 5 or more months was associated with slightly reduced risk of PTB (RR: 0.95, 95 % CI: 0.88, 1.02), VPTB (RR: 0.90, 95 % CI: 0.8–1.01), LBW (RR: 0.95, 95 % CI: 0.9–1.01), and VLBW (RR: 0.91, 95 % CI: 0.81–1.02) compared to states without a moratorium. There was no association with cesarean or maternal morbidity. Sensitivity analyses showed that all or most of the observed associations may be explained by residual state-level confounding.</div></div><div><h3>Conclusions</h3><div>State-level eviction moratoria were associated with improved birth outcomes, yet it is likely that all or most of the observed association is due to other policy actions or characteristics of enacting states.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"102 ","pages":"Pages 48-54"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973140","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":"Machine learning in public health informatics: Evidence that complex sampling structures may not be needed for prediction models with imbalanced outcomes","authors":"Zhengye Si,&nbsp;Jinpu Li,&nbsp;Emily Leary Ph.D.","doi":"10.1016/j.annepidem.2024.12.016","DOIUrl":"10.1016/j.annepidem.2024.12.016","url":null,"abstract":"<div><h3>Purpose</h3><div>The objective of this study is to investigate the predictive ability of machine learning models for imbalanced outcomes from national survey data without the use of sampling weights.</div></div><div><h3>Methods</h3><div>We evaluated the predictive performance of machine learning models on imbalanced outcomes from the US National Health and Nutrition Examination Survey (USNHANES) without using sampling weights. Four machine learning models (support vector machine, random forest, least absolute shrinkage and selection operator regression, and deep neural network) were compared with a logistic model that incorporates the survey's complex sampling design. Three resampling methods (oversampling, undersampling, and combined) were used to address class imbalance during the model training process.</div></div><div><h3>Results</h3><div>For all models, the balanced accuracy was similar (ranging from 0.72 to 0.76) and the specificity was smaller than sensitivity except for random forest. The support vector machine and neural networks performed best with sensitivity (ranging from 0.79 to 0.83), while the random forest had the largest specificity (ranging from 0.86 to 0.96), with one exception. PR-AUC scores and Brier scores were low ranging from 0.2529 to 0.3313 (lower scores worse) and 0.1005–0.3245 (lower scores better), respectively</div></div><div><h3>Conclusions</h3><div>The machine learning models had overall similar predictive capacity to the recommended methods which integrate the complex sampling design for the prediction of osteoarthritis occurrence with USNHANES.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"102 ","pages":"Pages 75-80"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973141","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":"Calculation of lifetime relative risks from summary cohort data and application to calculation of attributable fractions","authors":"John Ferguson","doi":"10.1016/j.annepidem.2025.01.008","DOIUrl":"10.1016/j.annepidem.2025.01.008","url":null,"abstract":"<div><div>In cohort studies, relative risks are estimated by comparing eventual disease risk in individuals exposed to the risk factor at baseline with similar unexposed individuals. However, such relative risk estimates intrinsically depend on how many of the unexposed individuals develop exposure after baseline and on the ages at which the exposed individuals developed exposure prior to baseline. These factors pertain to the distribution of risk factor incidence in the population, rather than to the causal effect the risk factor has on disease. As such, these cohort relative risk estimates have no straightforward causal interpretation, even after adjustment for confounding. Here, we instead consider initial exposure to the risk factor at differing ages as differing treatments, with corresponding potential outcomes. Subsequently, we define lifetime relative risk as the relative probability of eventual disease comparing initial exposure to the risk factor at differing ages to lifetime non-exposure. We describe a procedure to approximate lifetime relative risks using summary data from published cohort studies, and detail conditions under which such estimation is valid. In addition to being of independent interest, lifetime relative risks are useful in estimating population attributable fractions (PAF)s. In our applied example, we illustrate this connection via application of estimated lifetime relative risks to assess the PAF for incident vascular dementia due to hypertension in the United Kingdom.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"102 ","pages":"Pages 102-113"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043295","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":"Clinical outcomes after transcatheter aortic valve implantation in nonagenarian patients: A retrospective population-based cohort study","authors":"Matteo Franchi ,&nbsp;Marco Gennari ,&nbsp;Gaia Severgnini ,&nbsp;Fausto Biancari ,&nbsp;Alice Bonomi ,&nbsp;Federico De Marco ,&nbsp;Gianluca Polvani ,&nbsp;Marco Agrifoglio","doi":"10.1016/j.annepidem.2025.01.005","DOIUrl":"10.1016/j.annepidem.2025.01.005","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the overall survival and the risk of all-cause and heart failure-specific hospitalization in nonagenarian patients hospitalized for symptomatic severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI) or conservative treatment.</div></div><div><h3>Methods</h3><div>Population-based retrospective cohort study based on healthcare utilization databases of the Italian region of Lombardy. The cohort included all nonagenarians hospitalized for AS between 2017 and 2021, who underwent TAVI within 90 days from first diagnosis or conservative treatment. The association between TAVI and clinical outcomes was assessed through Cox or Fine&amp;Grey regression models. High-dimensional propensity score matching was used to reduce the heterogeneity between groups.</div></div><div><h3>Results</h3><div>Overall, 16,848 nonagenarians hospitalized for AS were identified. Among these, 320 patients underwent TAVI, of which 193 were matched to as many control patients. The 2-year survival rates were 76.0 % and 37.7 %, respectively, in TAVI and control patients, corresponding to an HR of 0.24 (95 % CI 0.15–0.37). The 2-year cumulative incidence of rehospitalization for heart failure was 11.1 % and 26.5 %, respectively, corresponding to an HR of 0.64 (95 % CI 0.40–0.99).</div></div><div><h3>Conclusions</h3><div>This study further supports the usefulness of TAVI in nonagenarians, as it showed to improve their survival rate, reduce their risk of rehospitalization, and likely increase their quality of life.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"102 ","pages":"Pages 81-85"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"School neighborhood deprivation is associated with a higher prevalence of hypertension","authors":"Elizabeth A. Onugha MD MSCI ,&nbsp;Ankona Banerjee MS ,&nbsp;Kenneth J. Nobleza MS ,&nbsp;Duc T. Nguyen MD, PhD ,&nbsp;Omar Rosales MS ,&nbsp;Abiodun Oluyomi PhD ,&nbsp;Jayna M. Dave PhD ,&nbsp;Joshua Samuels MD, MPH","doi":"10.1016/j.annepidem.2025.01.010","DOIUrl":"10.1016/j.annepidem.2025.01.010","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine the association between socioeconomic characteristics of school neighborhoods and the prevalence of hypertension in adolescents.</div></div><div><h3>Study design</h3><div>We performed a secondary data analysis of over 21,000 adolescents who participated in a school BP surveillance program between 2000 and 2017. BP status was confirmed by BP measurements on up to 3 occasions to diagnose sustained hypertension according to standard pediatric hypertension guidelines. We assessed school neighborhood socioeconomic status (SES) via the area deprivation index (ADI), a composite measure of area-level socioeconomic deprivation and categorized into quartiles. Q1 represented schools in neighborhoods with the least social deprivation while Q4 represented neighborhood with the most socioeconomic deprivation. We performed a cross-sectional analysis using both univariate and multivariable regression analyses.</div></div><div><h3>Results</h3><div>Of 21,392 children included in our analysis, the prevalence of sustained hypertension was 2.6 %. Hispanics and African Americans were overrepresented in the schools in more deprived neighborhoods. The highest sustained hypertension rate was observed among students attending Q3 (5.5 %) and Q4 (4.2 %) schools compared to Q1 (2.7 %) and Q2 (2.0 %) schools (p &lt; 0.001). Multivariable regression analysis showed that being male, obese, and attending school in a disadvantaged neighborhood were significantly associated with an increased prevalence of hypertension.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that school neighborhood deprivation measured by ADI may be a risk factor for hypertension and may contribute to the racial/ ethnic disparities observed in hypertension prevalence in adolescents.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"103 ","pages":"Pages 9-15"},"PeriodicalIF":3.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082005","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":"Electronic cigarette use and heavy metal exposure: Evidence from the Korea National Health and Nutrition Examination Survey","authors":"Bo Ram Yang ,&nbsp;Seung-Mi Lee","doi":"10.1016/j.annepidem.2025.01.011","DOIUrl":"10.1016/j.annepidem.2025.01.011","url":null,"abstract":"<div><h3>Purpose</h3><div>This study investigated the association between electronic cigarette (e-cigarette) use and serum concentrations of heavy metals (lead, mercury, and cadmium) in the Korean population, utilizing data from the Korea National Health and Nutrition Examination Survey (KNHANES), a nationally representative cross-sectional survey.</div></div><div><h3>Methods</h3><div>Data from KNHANES 2013, 2016, and 2017 were analyzed. Participants were classified as e-cigarette users (individuals who had ever used e-cigarettes, including dual users who had also used conventional cigarettes), conventional smokers (individuals who had smoked at least 100 conventional cigarettes [5 packs], but not e-cigarettes, in their lifetime), and non-smokers (individuals who had never used e-cigarettes and either never smoked conventional cigarettes or smoked fewer than 100 cigarettes). Linear regression models were employed to evaluate the association between smoking status and heavy metal concentrations, adjusting for covariates including age, sex, income, education, and health behaviors. Subgroup analyses were performed based on sex, age, and obesity status.</div></div><div><h3>Results</h3><div>E-cigarette users exhibited significantly higher serum concentrations of heavy metals than non-smokers. Lead levels were 10.0 % higher (exponentiated β = 1.100; p &lt; 0.001), mercury levels were 13.7 % higher (β = 1.137; p &lt; 0.001), and cadmium levels were 61.4 % higher (β = 1.614; p &lt; 0.001). Conventional smokers demonstrated elevated levels of these metals compared to non-smokers, but generally lower levels than e-cigarette users. Subgroup analyses revealed stronger associations among younger participants, males, and individuals with obesity, particularly for cadmium.</div></div><div><h3>Conclusions</h3><div>Dual use of e-cigarettes and conventional cigarettes is associated with elevated exposure to heavy metals compared to exclusive smoking cigarettes. These findings highlight the need for targeted public health interventions and stricter regulatory standards to address the risks associated with e-cigarette use.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"103 ","pages":"Pages 1-8"},"PeriodicalIF":3.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076451","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":"Gender diversity and daily steps: Findings from the Adolescent Brain Cognitive Development Study","authors":"Jason M. Nagata M.D., M.Sc. ,&nbsp;Shirley Sui ,&nbsp;Angela E. Kim M.Phil. ,&nbsp;Iris Yuefan Shao M.P.H., Ph.D. ,&nbsp;Christopher D. Otmar Ph.D. ,&nbsp;Kyle T. Ganson Ph.D., M.S.W. ,&nbsp;Alexander Testa Ph.D. ,&nbsp;Erin E. Dooley M.S., Ph.D. ,&nbsp;Holly C. Gooding M.D., MS.c. ,&nbsp;Fiona C. Baker Ph.D. ,&nbsp;Kelley Pettee Gabriel M.S., Ph.D.","doi":"10.1016/j.annepidem.2024.11.004","DOIUrl":"10.1016/j.annepidem.2024.11.004","url":null,"abstract":"<div><h3>Purpose</h3><div>To examine the association between multiple dimensions of gender diversity and physical activity (daily steps) in a diverse national sample of early adolescents in the United States.</div></div><div><h3>Methods</h3><div>This study analyzed Year 2 data from the Adolescent Brain Cognitive Development (ABCD) Study (<em>N</em> = 6038, <em>M</em>_<em>age</em>=12.0 years). Linear regression models were used to estimate the associations of gender diversity across multiple measures (transgender identity, felt gender, gender expression, gender non-contentedness) with daily step count measured by wrist-worn Fitbit devices.</div></div><div><h3>Results</h3><div>In this sample of early adolescents, 49.7 % were assigned female at birth, 39.4 % were from racial/ethnic minority groups, and 1 % to 16.9 % identified as gender diverse, depending on the measure used. Transgender identity was associated with 1394 (95 % confidence interval 284–2504) fewer steps per day compared to cisgender identity after adjusting for all covariates. Greater gender diversity, as measured by felt gender and gender non-contentedness, was also associated with lower daily steps.</div></div><div><h3>Conclusions</h3><div>Transgender and gender-diverse adolescents engage in less physical activity than their cisgender peers. This research has important implications for public health and policies focused on supporting physical activity among transgender and gender-diverse early adolescents.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"101 ","pages":"Pages 1-6"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National trends in drug overdose mortality among Asian American, Native Hawaiian, and Pacific Islander populations","authors":"David T. Zhu ,&nbsp;Andrew Park","doi":"10.1016/j.annepidem.2024.12.005","DOIUrl":"10.1016/j.annepidem.2024.12.005","url":null,"abstract":"<div><h3>Purpose</h3><div>To analyze drug overdose mortality trends among Asian American and Native Hawaiian/Pacific Islander (AANHPI) populations.</div></div><div><h3>Methods</h3><div>We obtained data on drug overdose deaths and population totals from CDC WONDER and the American Community Survey (2018–2022). Crude mortality rates per 100,000 were calculated overall and by sex, U.S. Census Division, and drug type. Disaggregated analyses included six Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) and three NHPI subgroups (Native Hawaiian, Guamanian, and Samoan).</div></div><div><h3>Results</h3><div>In 2022, Asian Americans had 1226 drug overdose deaths and NHPI individuals had 154. The mortality rate for NHPI individuals (17.52 [95 % CI: 14.76–20.29] per 100,000) tripled that of Asian Americans (5.85 [95 % CI: 5.52–6.18] per 100,000). Fentanyl was the leading drug-related death among Asian Americans (3.17 [95 % CI: 2.93–3.41] per 100,000), while methamphetamine led for NHPI individuals (11.38 [95 % CI: 9.15–13.61] per 100,000). Disaggregated mortality rates were highest for Korean Americans (9.06 [95 % CI: 8.88–9.24] per 100,000) and Guamanians (43.16 [95 % CI: 39.05–48.24] per 100,000) among the Asian American and NHPI subgroups, respectively.</div></div><div><h3>Conclusions</h3><div>AANHPI populations experience distinct overdose mortality patterns, with NHPI individuals and specific ethnic subgroups disproportionately affected, warranting targeted public health interventions.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"101 ","pages":"Pages 36-41"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873372","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 impact of COVID-19 on breast cancer mortality trends in Brazil: A time-series study","authors":"Adriano Hyeda ,&nbsp;Élide Sbardellotto Mariano da Costa ,&nbsp;Sérgio Cândido Kowalski","doi":"10.1016/j.annepidem.2024.12.001","DOIUrl":"10.1016/j.annepidem.2024.12.001","url":null,"abstract":"<div><h3>Background</h3><div>There is a lack of research on whether COVID-19 disruptions in breast cancer screening, diagnosis, and treatment affected mortality rates over time.</div></div><div><h3>Method</h3><div>This ecological time series study, covering the period between 2013 and 2023, utilizes the inflection point regression model and calculates the Annual Percentage Change (APC). The study used open-access data from the Brazilian Mortality Information System. The dependent variables measured were mortality rates due to breast cancer as an underlying cause and contributing cause in women aged 20 and over. The double exponential smoothing method was applied to predict mortality rates for 2020–2023.</div></div><div><h3>Results</h3><div>During the study period, the mortality rate due to breast cancer as a contributing cause increased approximately tenfold compared to mortality as an underlying cause (APC 6.9 % vs. 0.7 %). On average, 12 % of breast cancer-related deaths were attributed to the disease as a contributing cause. Breast cancer deaths as an underlying cause declined in 2020 and 2021, remaining below the 95 % predicted interval (95 % PI), but showed recovery until 2023. Mortality due to breast cancer as a contributing cause increased early in the pandemic, with deaths related to COVID-19 as an underlying cause comprising 39.6 % of cases in 2021. Breast cancer-related deaths, both as an underlying and contributing cause, showed an upward trend until 2021 and remained within the 95 % PI until 2023.</div></div><div><h3>Conclusion</h3><div>During the pandemic, deaths due to breast cancer as an underlying cause decreased while contributing deaths increased, with total mortality remaining within the predicted range.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"101 ","pages":"Pages 7-13"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792722","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}