Journal of Epidemiology and Community Health最新文献

{"title":"Ghost gun recovery and firearm deaths in California, 2014-2023.","authors":"Jemar R Bather, Amanda I Mauri, Zoe Lindenfeld, Saba Rouhani, Runhan Chen, Jinrui Fang, José A Pagán, Diana Silver, Melody S Goodman","doi":"10.1136/jech-2025-225202","DOIUrl":"10.1136/jech-2025-225202","url":null,"abstract":"<p><strong>Background: </strong>We investigated whether ghost gun recovery rates are significantly associated with firearm mortality rates in the following year across California's 58 counties from 2014 to 2023.</p><p><strong>Methods: </strong>We obtained yearly county-level data on ghost guns recovered in California from The Trace's Gun Violence Data Hub. County-level firearm death counts (total, suicide and homicide) were pulled from the Centers for Disease Control and Prevention's Restricted-Use Vital Statistics Data. Spatiotemporal models quantified the covariate-adjusted associations between ghost gun recoveries per capita and firearm death rates (total, suicide and homicide) in the following year. Secondary analyses examined suicide and homicide models stratified by sex and race/ethnicity. RESULTS : For every 20 ghost guns recovered per 100 000 population, there was an associated 6.4% increase in firearm suicide rate (adjusted incidence rate ratio (aIRR): 1.064, 95% credible interval (CrI) 1.019 to 1.111) in the following year. We found no evidence of a significant ghost gun recovery association with total firearm death rate (aIRR: 1.036, 95% CrI 0.999 to 1.075) and firearm homicide rates (aIRR: 1.002, 95% CrI 0.946 to 1.064). Stratified models for firearm suicide rates suggested variations across sex and racial/ethnic groups, with significant positive associations observed for male (6.5% increase; aIRR: 1.065, 95% CrI 1.017 to 1.115), non-Hispanic white (6.2% increase; aIRR: 1.062, 95% CrI 1.005 to 1.122) and Hispanic (12.6% increase; aIRR: 1.126, 95% CrI 1.031 to 1.230) individuals. A different pattern emerged for firearm homicide death rates, where associations across demographic groups were not statistically significant.</p><p><strong>Conclusions: </strong>Practitioners concentrating on suicide prevention efforts should be advised about the threat that ghost guns may present.</p>","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":" ","pages":"388-392"},"PeriodicalIF":3.7,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Children's views of obesity, body size and weight: systematic review of UK qualitative evidence.","authors":"Theo Lorenc, Helen Burchett, Rosa Mendizabal-Espinosa, Claire Stansfield, Katy Sutcliffe, Amanda Sowden","doi":"10.1136/jech-2025-225045","DOIUrl":"10.1136/jech-2025-225045","url":null,"abstract":"<p><strong>Background: </strong>Understanding views about body size and weight is key to addressing both obesity and weight stigma. The views of younger children are not well understood and may differ in important ways from those of adults and young people. This review aimed to fill this gap.</p><p><strong>Methods: </strong>Systematic review of qualitative evidence. We searched 19 database sources in February 2025 and included qualitative studies from the UK published since 2008 reporting data on children's (4-12 years) views of obesity, body size, body shape or weight. We assessed study quality using the Critical Appraisal Skills Programme checklist and conducted a thematic synthesis of the data.</p><p><strong>Results: </strong>We included 34 studies. Study quality overall was fairly high. Children reported a range of perceived impacts of body weight, including health impacts, limitations on activities, bullying and teasing, which generated negative perceptions of overweight and fear of fatness. Ideas about body shape may be influenced by family members and by media or social media content. Children identified diet and physical activity as the main influences on body weight. There may be differences in views between girls and boys at older ages, although both are concerned about weight. We found very little data on differences relating to ethnicity or socioeconomic status. Children with overweight or obesity reported a pervasive experience of negative attitudes and bullying, which could be a barrier to participating in activities.</p><p><strong>Conclusion: </strong>Children, including very young children, generally hold very negative views of overweight and obesity. Overweight is seen to be linked with unhealthiness, limited agency and with being bullied. These links may influence how children understand messages about weight and health.</p><p><strong>Prospero registration number: </strong>CRD42025650306.</p>","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":" ","pages":"416-422"},"PeriodicalIF":3.7,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scalable regionalised quality improvement model for ACS management in resource-limited primary healthcare facilities.","authors":"Zongbin Wang, Yan Zhang, Long Zhang, Siwei Xie, Sidney Smith, Zhi-Jie Zheng, Dingcheng Xiang, Yinzi Jin, Yong Huo, Shuduo Zhou","doi":"10.1136/jech-2025-225229","DOIUrl":"10.1136/jech-2025-225229","url":null,"abstract":"<p><strong>Background: </strong>Prehospital delays remain critical barriers to timely acute coronary syndrome (ACS) care, particularly for patients referred from resource-constrained primary healthcare to hospitals with percutaneous coronary intervention (PCI) capabilities. This study evaluated the associations between China Chest Pain Unit (CPU) programme, with prehospital delays, management and in-hospital outcomes for ACS patients.</p><p><strong>Methods: </strong>This retrospective cohort study used registry data from the Chinese Cardiovascular Association Database. We included patients diagnosed with ACS who were referred from primary healthcare facilities to chest pain centres (CPCs). The CPU-referral group received standardised triage and referral protocols; the non-CPU-referral group received routine referral. All patients were treated at CPCs. Primary outcomes included in-hospital heart failure, in-hospital mortality, door-in-door-out (DIDO) time and time from onset to CPC door. Secondary outcomes included time from onset to first medical contact, door-to-balloon time, discharge medication use, length of stay and total hospital expenditure. Propensity score matching and generalised linear mixed models were used to evaluate the associations.</p><p><strong>Results: </strong>A cohort consisting of 8834 patients was constructed by propensity score matching among 119 723 eligible referred ACS patients (5000 CPU-referrals and 114 723 non-CPU-referrals). CPU referral was associated with lower odds of in-hospital heart failure (OR 0.16, 95% CI 0.08 to 0.30) and in-hospital mortality (OR 0.68, 95% CI 0.50 to 0.92), shorter DIDO time (β=-0.33, 95% CI -0.40 to -0.25) and shorter times from onset to arrival at the CPC door (β=-0.19, 95% CI -0.27 to -0.11). CPU referral was also associated with shorter time to first medical contact and door-to-balloon time, improved adherence to guideline-recommended discharge medications, reduced length of stay and lower total hospital expenditure.</p><p><strong>Conclusions: </strong>The regionalised quality improvement programme for CPUs was associated with reduced prehospital delays, lower in-hospital heart failure and mortality, better care quality and lower costs among referred ACS patients.</p>","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":" ","pages":"371-378"},"PeriodicalIF":3.7,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extending multilevel analysis of individual heterogeneity and discriminatory accuracy to time-to-event outcomes: an application of survival MAIHDA to Korean health data.","authors":"Jin-Hwan Kim, Woojoo Lee","doi":"10.1136/jech-2025-224939","DOIUrl":"10.1136/jech-2025-224939","url":null,"abstract":"<p><strong>Background: </strong>Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) is a leading quantitative approach for intersectionality-informed health research, but most applications analyse binary or cross-sectional outcomes, ignoring event timing. We applied a multilevel survival (shared frailty) model within the MAIHDA framework to examine intersectional disparities in time-to-diagnosis of hypertension.</p><p><strong>Methods: </strong>Using 2019 Korean Community Health Survey data (n=228 632), we defined intersectional strata by sex, education, income and residential area. Three survival specifications were implemented: accelerated failure time (AFT), parametric proportional hazards (PHs) and semi-parametric Cox PH models, each with stratum-level random intercepts (shared frailty terms). Between-stratum variance was summarised with the variance partition coefficient (VPC) where estimable and proportional change in variance quantified fixed-effect contributions. Stratum-specific random effects were compared across model types to assess ranking stability.</p><p><strong>Results: </strong>Between-stratum variance was small overall (AFT VPC: 1.8%), but several strata deviated markedly from the grand mean. Strata with low education and low income were diagnosed earlier than average, while high-education, low-income strata were diagnosed later. Geographic context modified these effects. Time-to-diagnosis patterns often diverged from prevalence patterns. Across models, random effect estimates and ranks were highly correlated (Spearman's <i>ρ</i>>0.97), though some middle-ranked strata shifted by up to six positions.</p><p><strong>Conclusions: </strong>Applying a multilevel survival (shared frailty) model within MAIHDA enables examination of when disparities emerge, not just whether they exist. This approach retains MAIHDA's interpretability while leveraging time-to-event data, offering advantages in settings with incomplete follow-up or irregular observation windows.</p>","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":" ","pages":"444-451"},"PeriodicalIF":3.7,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel population data-driven approach to quantifying feasibility of recruitment during the study planning stage: lessons learnt from an e-cigarette pilot study.","authors":"Rana Jaber, Michael J Blaha, Andrew DeFilippis, Khurram Nasir, Jonathan Fialkow","doi":"10.1136/jech-2025-225639","DOIUrl":"https://doi.org/10.1136/jech-2025-225639","url":null,"abstract":"","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpreting educational inequalities in site-specific cancer mortality: statistical significance versus public health relevance.","authors":"Chenchen Jiang","doi":"10.1136/jech-2026-226267","DOIUrl":"10.1136/jech-2026-226267","url":null,"abstract":"","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dyadic associations of depressive symptoms and cardiovascular health trajectories in middle-aged and older couples.","authors":"Yenee Soh, Richard Norman Jones, Izzuddin M Aris, Ichiro Kawachi, Henning Tiemeier","doi":"10.1136/jech-2025-225333","DOIUrl":"https://doi.org/10.1136/jech-2025-225333","url":null,"abstract":"<p><strong>Background: </strong>Depressive symptoms can contribute to poor cardiovascular health (CVH) but prior research largely focused on individual-based studies. Yet, health behaviours and outcomes are interlinked within social relationships, particularly in spouses. This study examined how depressive symptoms in opposite-sex spouses may jointly and uniquely impact CVH over time.</p><p><strong>Methods: </strong>We analysed 4360 opposite-sex spousal dyads in the Health and Retirement Study-a prospective cohort of middle-aged and older adults (2004-2016). Depressive symptoms were measured at baseline (2004/2006) using the 8-item Center for Epidemiologic Studies-Depression scale. CVH scores (range: 0-100; higher scores=better CVH), based on body mass index, blood pressure, fasting glucose, total cholesterol and smoking were assessed across three follow-up waves (2006/2008-2014/2016; 8-year follow-up period). We used the Actor-Partner Interdependence Model and latent growth curve modelling to examine how both spouses' depressive symptoms were associated with subsequent CVH, adjusting for sociodemographics and prior cardiovascular disease.</p><p><strong>Results: </strong>In wives, a one-unit increment in depressive symptoms at baseline was associated with lower CVH scores (β=-1.25; 95% CI -1.60 to -0.91) at Wave 2. Similar associations were observed in husbands (β=-1.19; 95% CI -1.58 to -0.81). Wives' depressive symptoms were also associated with lower husbands' CVH scores (β=-0.39; 95% CI -0.70 to -0.07), while husbands' depressive symptoms were associated with faster CVH decline in wives over time (β=-0.08; 95% CI -0.14 to -0.03). No other significant spousal effects were found.</p><p><strong>Conclusion: </strong>Depressive symptoms in both spouses may contribute to one's own and one's partner's CVH, with distinct gender-specific patterns. These results may inform targeted dyadic interventions to optimise CVH in middle-aged and older opposite-sex couples.</p>","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preterm birth in a conflict-affected setting: prevalence and determinants in the West Bank, Palestine.","authors":"Amani Saleem Salim, Ewa-Lena Bratt, Kawther Elissa","doi":"10.1136/jech-2026-225948","DOIUrl":"https://doi.org/10.1136/jech-2026-225948","url":null,"abstract":"<p><strong>Background: </strong>Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality worldwide, with heightened risks in conflict-affected settings. In the West Bank, political instability and healthcare barriers may increase adverse birth outcomes but hospital-based evidence remains limited. This study estimated hospital-based PTB prevalence in selected public hospitals and identified maternal, household and healthcare determinants.</p><p><strong>Methods: </strong>A cross-sectional study was conducted between April and August 2025 in purposively selected governmental hospitals across the northern, central and southern West Bank. Women delivering singleton live births were approached consecutively within 24-48 hours post partum. Data were collected using a structured interviewer-administered questionnaire and medical record abstraction. PTB was defined as birth before 37 completed weeks. Multivariable logistic regression estimated adjusted ORs (aORs) and 95% CIs.</p><p><strong>Results: </strong>Among 1235 eligible women, 174 had PTBs, yielding a hospital-based prevalence of 14.1% (95% CI 12.1% to 16.3%). Higher odds of PTB were observed among women aged 19-24 years (aOR 1.90, 95% CI 1.07 to 3.37) and 25-34 years (aOR 1.72, 95% CI 1.06 to 2.79), households with <three members (aOR 2.40, 95% CI 1.20 to 4.80) and residents of the northern West Bank (aOR 3.67, 95% CI 2.07 to 6.52). Reporting safe access to healthcare was associated with lower odds of PTB (aOR 0.67, 95% CI 0.46 to 0.98).</p><p><strong>Conclusion: </strong>PTB is highly prevalent in selected public hospitals in the West Bank, influenced by structural, social and geographic factors. Policies improving healthcare access and addressing regional disparities are essential to reduce PTB in conflict-affected settings.</p>","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of active travel interventions in the UK on disadvantaged population groups and their potential to reduce health inequalities: systematic review.","authors":"Gareth J Hollands, Wendy Macdowall, Helen Ed Burchett, Irene Kwan, Preethy D'Souza, Michelle Richardson, Claire Stansfield, David Ogilvie, Jenna Panter, James Thomas, Amanda J Sowden, Katy Sutcliffe","doi":"10.1136/jech-2026-225997","DOIUrl":"https://doi.org/10.1136/jech-2026-225997","url":null,"abstract":"<p><strong>Background: </strong>Differential impacts of active travel interventions on disadvantaged population groups have been under-studied. A review of evidence from the UK was commissioned to inform the development of government policy and support the implementation of equitable and effective interventions.</p><p><strong>Methods: </strong>Systematic review, identifying studies via searching 31 electronic databases. Eligible studies evaluated active travel interventions in the UK and reported quantitative data on active travel behaviours and/or linked health outcomes for population subgroups defined by sex/gender, ethnicity, age or socioeconomic status. Two reviewers screened reports, extracted data and assessed risk of bias. Outcome data were summarised in relation to directions of intervention effects for population subgroups.</p><p><strong>Results: </strong>We included 18 study reports collectively evaluating five interventions. Evidence suggests that interventions are more likely to increase than decrease active travel among females and may also be more likely to benefit females relative to males. Interventions are also more likely to increase than decrease active travel among older adults, but there is no clear evidence that they will benefit this group relative to younger adults. Available evidence gives no clear indication of likely positive or negative impacts on groups defined by ethnicity or socioeconomic status.</p><p><strong>Conclusion: </strong>There is some evidence that active travel interventions improve outcomes and may reduce inequalities in relation to sex, and improve outcomes among older adults. The available evidence for differential impacts of active travel interventions is otherwise largely inconclusive, but importantly provides no clear indication that implementing active travel interventions will widen inequalities.</p>","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who is the expert? A process guide to incorporate lived/living experience into directed acyclic graphs: an applied example from HIV research.","authors":"Megan E Marziali, Kathleen Inglis, Peggy Frank, Wayne Campbell, Sandy Lambert, Patience Magagula, Valerie Nicholson, Michael Budu, Melanie C M Murray, Silvia Guillemi, Catherine Worthington, Robert S Hogg","doi":"10.1136/jech-2025-224787","DOIUrl":"https://doi.org/10.1136/jech-2025-224787","url":null,"abstract":"<p><strong>Aim: </strong>Causal inference relies on correct background knowledge, which epidemiologists generally understand to come from academic experts. Our community-engaged study augments scientific domain knowledge with lived/living experience to co-construct the directed acyclic graph (DAG) underpinning our team's research question about ageing and HIV. We outline our team's process for co-creating the community-based DAG and describe qualitative reflections from team members regarding these methods. Our overarching goal was to expand expert knowledge to include community expertise by engaging peer researchers in DAG co-development.</p><p><strong>Methods: </strong>We assembled a team of quantitative and qualitative researchers, including a diverse group of peer researchers living with HIV. The team co-constructed a DAG, illustrated by a peer researcher-artist, combining the lived/living experience of peer researchers with subject-matter expertise from academic researchers. The DAG was refined with input from epidemiologists. Qualitative researchers transcribed DAG co-development sessions to understand how peer researchers engaged with this tool.</p><p><strong>Results: </strong>Qualitative reflections allowed the study team to critically analyse our process. Peer researchers found drawing the DAG intuitive. Having a visual representation of causal relationships led to active discussion and greater understanding. The complexity of the DAG enmeshed with temporal ordering humanised the research; seeing the web of covariates resonated as a reflection of a person's life journey. One peer researcher found that incorporating diverse perspectives meant upholding unique expertise and not only platforming academic expertise.</p><p><strong>Conclusions: </strong>Co-constructing DAGs incorporating lived/living experience is reasonable and possible. Co-constructing DAGs may strengthen epidemiologic studies by reconceptualising the traditional epidemiologic definition of expert knowledge.</p>","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}