Annals of Epidemiology最新文献

{"title":"Leveraging mediation analysis as a tool to study mechanisms underlying health inequities.","authors":"Judith J M Rijnhart, Ryan J Bailey, Jessica Agbodo, Vishakha Agrawal, Valerie M Rodriguez-Olmo, Jason L Salemi","doi":"10.1016/j.annepidem.2025.07.002","DOIUrl":"10.1016/j.annepidem.2025.07.002","url":null,"abstract":"<p><strong>Purpose: </strong>To describe three statistical approaches that help gain a comprehensive understanding of mechanisms underlying health inequities: univariate regression analysis, effect modification analysis, and mediation analysis.</p><p><strong>Methods: </strong>We described how univariate regression analysis, effect modification analysis, and mediation analysis can be used to gain insight into mechanisms underlying health inequities. We demonstrated the application of these approaches using a motivating example from the Health and Retirement Study in which we studied the role of education in ethnic disparities in episodic memory.</p><p><strong>Results: </strong>Univariate regression analysis showed that Hispanic individuals on average had lower episodic memory scores compared to non-Hispanic individuals. Effect modification analysis showed that the beneficial effect of education on episodic memory was less strong in Hispanic individuals compared to non-Hispanic individuals. Mediation analysis showed that the ethnic disparity in episodic memory was not only driven by effect modification, but also by differences in the distribution of education years across ethnic groups.</p><p><strong>Conclusion: </strong>The combined study of effect modification and mediation provides a comprehensive understanding of the mechanisms that cause and sustain health inequities. Insight into these mechanisms is crucial to determine targets for interventions and policies aimed at eliminating health inequities.</p>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644079","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":"Race and neighborhood social determinants of premature cancer mortality in California adults, 2015–2021","authors":"Neil A. Maizlish ,&nbsp;Paul Simon ,&nbsp;Adrienne Damicis ,&nbsp;Tracy Delaney ,&nbsp;Helen Dowling","doi":"10.1016/j.annepidem.2025.07.012","DOIUrl":"10.1016/j.annepidem.2025.07.012","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate social determinants of cancer mortality and effect modification by race/ethnicity, age, sex, and Covid-19 pandemic period in Californian adults.</div></div><div><h3>Methods</h3><div>The Healthy Places Index (HPI) measures neighborhood socioeconomic and environmental conditions, and access to healthcare. We aggregated 224,997 cancer deaths to 2010 census tracts from death certificates and populations from U.S. census, 2015–2021. In this cross-sectional study, we age-adjusted death rates of HPI deciles and examined HPI dose-response with segmental regression.</div></div><div><h3>Results</h3><div>From 2015 to 2019, all-cancer mortality rates declined 5.1 % per HPI decile. The rate ratio between the 1st and 10th decile was 1.67 (CI_95 %: 1.58–1.77) for all cancers, 2.07 (1.81–2.37) for lung, 1.79 (1.49–2.16) for colorectal, 1.75 (1.28–2.37) for prostate, and 1.22 (1.01–1.48) for breast cancer. The HPI-all-cancer gradient in 2020–2021 was little changed from 2015 to 2019, but rates averaged 8 % lower. Disparities in death rates between race/ethnicity groups were comparable to those between HPI deciles within race/ethnicity groups. The site-specific HPI-attributable percent of mortality was: all cancers (27 %), lung (39 %), prostate (31 %), colorectal (29 %), and breast ((16 %).</div></div><div><h3>Conclusions</h3><div>Disparities in cancer mortality associated with social determinants of health were similar and large before and during the Covid-19 pandemic.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"109 ","pages":"Pages 73-82"},"PeriodicalIF":3.3,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627663","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":"Comparison of two measurement error–correction approaches for assessing the association between choline intake and coronary heart disease prevalence among US community-dwelling adults","authors":"Cuiqiong Huo ,&nbsp;Yuanyuan Luan ,&nbsp;Roger S. Zoh ,&nbsp;Nana Gletsu-Miller ,&nbsp;Stephen J. Carter ,&nbsp;Georgia Frey ,&nbsp;Hsien-Chang Lin ,&nbsp;Aurelian Bidulescu ,&nbsp;See Ling Loy ,&nbsp;Marwah Abdalla ,&nbsp;Carmen D. Tekwe","doi":"10.1016/j.annepidem.2025.07.011","DOIUrl":"10.1016/j.annepidem.2025.07.011","url":null,"abstract":"<div><h3>Purpose</h3><div>This study compared two measurement error–correction approaches—linear mixed-effects approach to measurement error–correction (MEM) and simulation–extrapolation (SIMEX)—for assessing the association between choline intake and coronary heart disease (CHD) prevalence among United States (US) community-dwelling adults.</div></div><div><h3>Methods</h3><div>Simulations were conducted to evaluate the performances of five estimation approaches: benchmark analysis, 1-day method, average method (AveMethod), MEM, and SIMEX. Data from the National Health and Nutrition Examination Survey (NHANES) were analyzed to determine the relationship between choline intake and CHD prevalence using these methods.</div></div><div><h3>Results</h3><div>Both MEM and SIMEX effectively corrected for measurement error–induced biases; MEM generally outperformed SIMEX except when the standard deviation of true exposure (<span><math><msub><mrow><mi>σ</mi></mrow><mrow><mi>X</mi></mrow></msub></math></span>) exceeded the standard deviation of random measurement error (<span><math><msub><mrow><mi>σ</mi></mrow><mrow><mi>U</mi></mrow></msub></math></span>). Analysis of NHANES data revealed that choline intake was significantly and inversely associated with CHD prevalence using the 1-day method (<span><math><mrow><mi>β</mi></mrow></math></span>= −0.39; 95 % confidence interval: −0.72, −0.05; odds ratio: 0.68). Other approaches did not reveal statistically significant associations.</div></div><div><h3>Conclusions</h3><div>MEM and SIMEX mitigated most measurement error–related biases in the simulations, although MEM demonstrated better overall performance. After correction for measurement error, choline intake was not significantly associated with CHD prevalence.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"109 ","pages":"Pages 65-72"},"PeriodicalIF":3.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621094","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 large language model analysis of global inequities in precision medicine research on diabetes","authors":"Aamna Soniwala ,&nbsp;Sophia Kim ,&nbsp;Jill Welkley ,&nbsp;Joyce C. Ho ,&nbsp;Jithin Sam Varghese","doi":"10.1016/j.annepidem.2025.06.021","DOIUrl":"10.1016/j.annepidem.2025.06.021","url":null,"abstract":"<div><h3>Purpose</h3><div>Although nearly 80 % of patients with diabetes live in low- and middle-income countries, it is currently unknown what proportion of precision medicine research is based on these populations. Manual screening of literature is time consuming and resource intensive. Our objective is to characterize the proportionality of diabetes burden and precision medicine research across ten geographic regions using a scalable large language model (LLM) enabled workflow.</div></div><div><h3>Methods</h3><div>An electronic search of PubMed identified titles and abstracts of studies related to precision medicine in diabetes from 2010 to 2023 (n = 129,154). Two reviewers independently labelled a random sub-sample and classified their source populations, and whether these were primary studies of precision medicine in diabetes. Using this labeled data (n = 2196), we developed prompts and selected hyperparameters for GPT-4o. We then used GPT-4o to classify the remaining studies and estimated the ratio of research output to disability adjusted life years [DALY] from the Global Burden of Disease [GBD] study 2021.</div></div><div><h3>Results</h3><div>Of the 15,507 studies identified as precision medicine in diabetes, 33.8 %, 20.9 % and 14.3 % were from North America, Western Europe, and East Asia respectively. The number of studies was the most proportionate to disease burden for North America (0.95 per 1000 DALYs) and Western Europe (0.78 per 1000 DALYs), and the least proportionate for Southeast Asia, South Asia, and Sub-Saharan Africa (0.02 each per 1000 DALYs).</div></div><div><h3>Conclusions</h3><div>Future research investments into omics-based research should prioritize regions outside Western Europe and North America for achieving global equity in diabetes care.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"109 ","pages":"Pages 25-30"},"PeriodicalIF":3.3,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571083","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":"Mortgage discrimination at the intersection of race and sexual orientation and its association with HIV incidence among sexual minority men in the U.S.","authors":"Kyle J. Moon ,&nbsp;Brian W. Weir ,&nbsp;Koichi Sakakibara ,&nbsp;Leslie M. Carson ,&nbsp;Marcus O. Reed ,&nbsp;Srija Dutta ,&nbsp;Daniel I. Alohan ,&nbsp;McKinsey Bullock ,&nbsp;Antonio Newman ,&nbsp;Samuel C.O. Opara ,&nbsp;Kamini Doraivelu ,&nbsp;Sophia A. Hussen ,&nbsp;Sabriya L. Linton","doi":"10.1016/j.annepidem.2025.06.020","DOIUrl":"10.1016/j.annepidem.2025.06.020","url":null,"abstract":"<div><h3>Purpose</h3><div>Structural racism and homonegativity influence access to housing and shape the HIV risk environment. We assess disparities in mortgage loan denial and evaluate the association of intersectional mortgage discrimination with HIV incidence among sexual minority men (SMM) across U.S. counties.</div></div><div><h3>Methods</h3><div>Using loan applications from 2018–2022, we conducted a decomposition analysis to measure national disparities in mortgage denial by race and sexual orientation. We then constructed a county-level measure of mortgage discrimination against Black same-sex male couples using mixed-effects logistic regression, and we evaluated its association with HIV incidence among SMM in 2022 using Poisson regression adjusted for county-level covariates.</div></div><div><h3>Results</h3><div>Mortgage loan denial was 14.9 percentage points higher among Black same-sex couples (22.0 %) than White heterosexual couples (7.1 %). HIV incidence rate among SMM was 26 % [95 % CI: 22, 30] higher in counties in the highest versus lowest tertile of intersectional mortgage discrimination.</div></div><div><h3>Conclusions</h3><div>Contemporary forces of structural racism and homonegativity continue to influence housing access, evidenced by higher loan denial for Black same-sex male couples versus White heterosexual couples. Such discrimination may contribute to the population-level burden of HIV. Anti-discrimination policies that increase access to housing for Black sexual minority men may aid in addressing HIV inequities.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"109 ","pages":"Pages 38-45"},"PeriodicalIF":3.3,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568046","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":"Recommendation on the use of viral load tests and exclusion of CD4 tests as proxies for HIV medical visits","authors":"Qiang Xia ,&nbsp;Mary K. Irvine ,&nbsp;Prima Manandhar-Sasaki ,&nbsp;Daniel Bertolino ,&nbsp;Faisal Abdelqader ,&nbsp;Meghan Peterson ,&nbsp;Denis Nash ,&nbsp;Lucia V. Torian","doi":"10.1016/j.annepidem.2025.06.017","DOIUrl":"10.1016/j.annepidem.2025.06.017","url":null,"abstract":"<div><h3>Objective</h3><div>Medical providers may order CD4 tests for people with HIV (PWH) without providing HIV care. We hypothesized that including CD4 tests as a proxy for HIV medical visits misclassifies PWH on linkage to, receipt of, and retention in care.</div></div><div><h3>Methods</h3><div>We used 2021 HIV surveillance data from New York City for analysis and compared 2 proxies for HIV medical visits—one included the presence of either CD4 or viral load tests and the other included viral load tests—to measure linkage to care among people newly diagnosed with HIV and receipt of and retention in care among PWH.</div></div><div><h3>Results</h3><div>In New York City in 2021, 1146 of 1399 people newly diagnosed with HIV (81.9 %) had timely linkage to care when either CD4 or viral load tests were used as proxies; 1118 of 1399 (79.9 %) people newly diagnosed with HIV had timely linkage to care when only viral load tests were used. A total of 69 982 of 76 338 PWH (91.7 %) were classified as having received HIV care in New York City in 2021 when either CD4 or viral load tests were used; 69 088 of 76 388 PWH (90.5 %) were classified as having received HIV care when only viral load tests were used.</div></div><div><h3>Conclusions</h3><div>Including CD4 tests as proxies for HIV medical visits misclassifies linkage to care among people newly diagnosed with HIV, and receipt of and retention in care among PWH. We recommend using viral load tests only as proxies to monitor progress toward goals of the National HIV/AIDS Strategy.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"109 ","pages":"Pages 46-51"},"PeriodicalIF":3.3,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568106","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":"Heart of the matter: Navigating trends and disparities in cardiovascular mortality among patients with amyloidosis in the United States (1999–2020)","authors":"Yong Hao Yeo ,&nbsp;Min Choon Tan ,&nbsp;Boon Jian San ,&nbsp;Reza Arsanjani ,&nbsp;Julie Rosenthal ,&nbsp;Kwan S. Lee","doi":"10.1016/j.annepidem.2025.07.001","DOIUrl":"10.1016/j.annepidem.2025.07.001","url":null,"abstract":"<div><h3>Background</h3><div>There is a growing recognition of the detrimental effects of amyloidosis disease on the cardiovascular system. This study sought to assess the longitudinal trends of cardiovascular deaths (CVDs) with amyloidosis as a contributing cause in the United States.</div></div><div><h3>Method</h3><div>We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database for cardiovascular mortality with amyloidosis as a contributing cause among patients aged 35 and above. Diseases of the circulatory system (ICD-10 I00-I99) were listed as the underlying cause of death, and amyloidosis (ICD-10 E85) as contributing cause of death. We calculated age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and determined the trends over time by estimating the annual percent change using the Joinpoint Regression Program.</div></div><div><h3>Results</h3><div>In the 22-year study period, 4145 CVDs with amyloidosis as a contributing cause in the United States were identified between 1999 and 2020. The AAMRs increased significantly from 0.69 (95 % CI, 0.56–0.85) per 1,000,000 individuals in 1999 to 2.13 (95 % CI, 1.93–2.33) per 1,000,000 individuals in 2020, with an annual percent increase of + 3.92. The AAMRs for the span of 22 years were higher in males than females (1.66 [95 % CI, 1.59–1.73] vs. 0.75 [95 % CI, 0.71–0.78]). When stratified by race, African American populations had the highest cumulative AAMR (2.34 [95 % CI, 2.18–2.51]) compared to other racial groups. In terms of urbanization, the AAMR was significantly higher in the urban regions compared to the rural areas (1.15 [95 % CI, 1.11–1.19] vs. 0.91 [95 % CI, 0.84–0.98]).</div></div><div><h3>Conclusion</h3><div>Our analysis revealed that the AAMR from CVDs with amyloidosis as a contributing cause has increased over the last two decades, with significant disparities seen in male and African-American individuals.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"109 ","pages":"Pages 22-24"},"PeriodicalIF":3.3,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557520","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":"Detecting co-occurring clusters of coronary heart disease and depression in New England neighborhoods","authors":"Theresa N. Faller ,&nbsp;Michael R. Desjardins","doi":"10.1016/j.annepidem.2025.06.022","DOIUrl":"10.1016/j.annepidem.2025.06.022","url":null,"abstract":"<div><h3>Background</h3><div>There is increasing evidence that coronary heart disease (CHD) patients with a mental health disorder have increased risk of cardiovascular mortality. Studying this relationship beyond the individual at the neighborhood level could lead to novel public health interventions.</div></div><div><h3>Methods</h3><div>Spatial scan statistics were used to detect potential co-occurring geographic clusters of CHD and depression among adults in the New England region of the United States during 2019. Negative binomial regression models were used to adjust cluster analyses for census-tract level estimates of relevant risk factors, including social vulnerability, urbanicity, walkability, greenspace, healthcare utilization, and access to mental health facilities.</div></div><div><h3>Results</h3><div>Nine significant adjusted clusters were identified, including six multivariate clusters and three univariate clusters for depression (none for CHD). The highest multivariate relative risk (RR) was seen in the cluster around Hartford County, CT (n=234 census tracts; Depression RR=1.06; CHD RR=1.06).</div></div><div><h3>Conclusions</h3><div>Clusters from adjusted analyses indicate clustering that is not explained by selected covariates alone, many of which were social determinants of health. Mixed-methods, longitudinal data, and individual-level approaches could help explain remaining clustering. The spatial methods employed in this study can more effectively identify high-risk areas where interventions, such as increasing mental health care utilization or enhancing health literacy, should be implemented for both conditions.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"109 ","pages":"Pages 52-58"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561875","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":"Psychological distress among stroke survivors in the US: An analysis of the National Health Interview Survey","authors":"Chaitali Dagli BHMS, MPH ,&nbsp;Pranali G. Patel BDS, MPH ,&nbsp;Katherine Gonzalez MD ,&nbsp;Mrudula Nair BDS, MPH ,&nbsp;Nada Al-Antary MD ,&nbsp;Chen Lin MD ,&nbsp;Eric Adjei Boakye PhD","doi":"10.1016/j.annepidem.2025.06.019","DOIUrl":"10.1016/j.annepidem.2025.06.019","url":null,"abstract":"<div><h3>Purpose</h3><div>We investigated the association between stroke diagnosis and psychological distress among adults in the United States.</div></div><div><h3>Methods</h3><div>This cross-sectional study utilized data from the 2021 National Health Interview Survey, including adults aged 18 years or older. The exposure variable was self-reported stroke diagnosis (yes/no). Propensity score matching (1:1) was performed to create a cohort of 947 stroke survivors and 947 controls. The outcome variable was psychological distress, assessed using the six-item Kessler Psychological Distress Scale and classified as none/low, moderate, or severe. Weighted multinomial logistic regression models were used to examine the associations between stroke diagnosis and psychological distress.</div></div><div><h3>Results</h3><div>A total of 1894 respondents were included in the study, 19.3 % and 6.4 % experienced moderate and severe psychological distress, respectively. Respondents who experienced a stroke diagnosis had more than twice the odds of experiencing moderate distress (aOR_moderate=2.16, 95 % CI: 1.59–2.93) and more than three times the odds of severe distress (aOR_severe=3.12, 95 % CI: 1.76–5.49) compared to respondents without stroke diagnosis.</div></div><div><h3>Conclusion</h3><div>This study addresses an important gap in understanding the emotional and psychological burden among stroke survivors. Future studies should focus on addressing psychological distress in stroke survivors to assess impact on quality of life and outcomes.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"109 ","pages":"Pages 8-13"},"PeriodicalIF":3.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144535923","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":"Implementation and assessment of SARS-CoV-2 prevention strategies in the 2022 Iditarod Trail Race – Alaska, United States","authors":"Jodie L. Guest ,&nbsp;E. Lisa Chung ,&nbsp;Coleman Cutchins ,&nbsp;Kristin Nelson ,&nbsp;Mark Nordman ,&nbsp;Chas St. George ,&nbsp;Rob Urbach ,&nbsp;Anne Zink ,&nbsp;Joseph McLaughlin","doi":"10.1016/j.annepidem.2025.06.018","DOIUrl":"10.1016/j.annepidem.2025.06.018","url":null,"abstract":"<div><h3>Objective</h3><div>This study evaluates public health prevention measures implemented during the COVID-19 pandemic for organizing a complex mass gathering event (MGE), and to identify practices applicable to future MGEs.</div></div><div><h3>Methods</h3><div>The study analyzed COVID-19 surveillance data from the 2022 Iditarod Trail Race alongside Alaska Department of Health COVID-19 reports to assess the effectiveness of a comprehensive prevention plan established to protect those involved with or near the race from COVID-19. This plan included a ‘bubble’ strategy to separate participants into designated groups, a multi-tiered daily testing approach (including pre-bubble testing), mandatory mask-wearing, vaccination requirements, and isolation of positive cases until two consecutive negative tests.</div></div><div><h3>Results</h3><div>Among the 622 participants, 18 (2.9 %) tested positive for COVID-19. Pre-arrival and pre-trail testing identified 17 (94 %) of cases, effectively preventing transmission on the trail. One case accounted for 67 % of the transmission in the headquarters bubble, while another asymptomatic case was detected on the trail during daily testing. No known transmission occurred from this case to community members or the trail bubble.</div></div><div><h3>Discussion</h3><div>Implementation of prevention strategies during the 2022 Iditarod—including the bubble strategy, daily testing, mask mandates, vaccination requirements, and isolation protocols— successfully prevented most transmission among race participants. The lack of sustained transmission combined with low community case counts provides evidence that the race did not increase transmission during this large-scale MGE, across 1000 miles and 23 communities. These findings demonstrate the effectiveness of combined strategies in protecting both participants and communities, while allowing a major sporting event to proceed.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"109 ","pages":"Pages 1-7"},"PeriodicalIF":3.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144535922","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}