BMJ public health最新文献

Introduction: High-impact chronic pain (HICP) significantly affects the quality of life for millions of U.S. adults, imposing substantial economic/healthcare burdens. Disproportionate effects are observed among racial/ethnic minorities and older adults.

Methods: We leveraged the National Health Interview Survey (NHIS) from 2016 (n=32,980), 2017 (n=26,700), and 2021 (n=28,740) to validate and develop analytical models for HICP. Initial models (2016 NHIS data) identified correlates associated with HICP, including hospital stays, diagnosis of specific diseases, psychological symptoms, and employment status. We assessed the models' generalizability and drew comparisons across time. We constructed five validation scenarios to account for variations in the availability of predictor variables across datasets and different time frames for pain assessment questions. We used logistic regression with LASSO and random forest techniques. We assessed model discrimination, calibration, and overall performance using metrics such as area under the curve (AUC), calibration slope, and Brier score.

Results: Scenario 1, validating the NHIS 2016 model against 2017 data, demonstrated excellent discrimination with an AUC of 0.89 (95% CI: 0.88-0.90) for both LASSO and random forest models. Subgroup-specific performance varied, with the lowest AUC among adults aged ≥65 years (0.81, 95% CI: 0.78-0.82) and the highest among Hispanic respondents (0.91, 95% CI: 0.88-0.94). Model calibration was generally robust, although underfitting was observed for Hispanic respondents (calibration slope: 1.31). Scenario 3, testing the NHIS 2016 model on 2021 data, showed reduced discrimination (AUC: 0.82, 95% CI: 0.81-0.83) and overfitting (calibration slopes < 1). De novo models based on 2021 data showed comparable discrimination (AUC: 0.86, 95% CI: 0.85-0.87) but poorer calibration when validated against older datasets.

Conclusion: These findings underscore the potential of these models to guide personalized medicine strategies for HICP, aiming for more preventive rather than reactive healthcare. However, the model's broader applicability requires further validation in varied settings and global populations.

Background: Racially minoritised groups tend to have poorer cardiovascular health (CVH) than non-Hispanic (NH)-White adults and are generally more likely to work in labourer or support service positions where job strain-associated with cardiovascular disease-is often high. Yet, few studies have included racially/ethnically diverse samples.

Methods: Using 2004-2018 National Health Interview Survey cross-sectional data, we investigated standardised occupational classifications in relation to 'ideal' CVH using a modified 'ideal' CVH (mICVH) metric among US adults (n=230 196) by race/ethnicity, sex/gender, age, and income. mICVH was defined as a report of 'yes' to the following: never smoked/former smoker; body mass index (≥18.5-25 kg/m²); physical activity (≥150-300 min/week moderate or ≥75-150 min/week vigorous); sleep duration (7-9 hours/night); and no prior diagnosis of dyslipidaemia, hypertension, or diabetes/pre-diabetes. Adjusting for sociodemographic, clinical factors, and health behaviour confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% CIs of mICVH overall and by race/ethnicity and performed Wald tests for interaction.

Results: Latinx (53%) and NH-Black (37%) adults were more likely than NH-White adults (29%) to report labourer positions and had the lowest prevalence of mICVH (5.2% (Latinx) and 3.9% (NH-Black)). Labourer versus professional/management occupational class positions were associated with a lower mICVH prevalence among NH-Asian (PR=0.60 (0.46-0.79)), NH-White (PR=0.80 (0.74-0.87)) and NH-Black (PR=0.77 (0.58-1.01)), but with no evidence of an association among Latinx (PR=0.94 (0.78-1.14) adults; p interaction <0.001).

Conclusions: In conclusion, working in labourer versus professional/management positions was associated with lower mICVH, except among Latinx adults. Given the higher likelihood of labourer occupations and lower prevalence of mICVH among minoritised racial/ethnic groups, social determinants related to occupational class should be considered in future studies of racial and ethnic disparities in CVH.

Objective: Hypertension and dyslipidemia are established risk factors for cardiovascular disease (CVD), but are often insufficient alone in predicting CVD. Inflammation also contributes to CVD, but research on the co-occurrence of inflammation, hypertension, and dyslipidemia and CVD risk is limited. Knowledge of inflammatory status in addition to other risk factors is vital for clinicians to correctly evaluate patients for CVD risk.

Methods: Prospective data from the Health and Retirement Study, a representative cohort of US adults over 50 years of age (n = 7895) were used. The average participant age was 68.8 years, and 54.9% were female. 80.7% were Non-Hispanic White, 10.1% were Non-Hispanic Black, and 9.2% were Hispanic. Hypertension, dyslipidemia, and elevated C-reactive protein (CRP) were used to create a CVD risk score: low (0-1 factors), medium (2 factors), or high (all 3 factors). Measurement and definition guidelines for these variables are thoroughly explained in the methods section. Weighted logistic regression models estimated the odds ratio (OR) of 1) prevalent and incident CVD for medium and high-risk groups versus the low-risk group and 2) 4-year mortality adjusting for covariates.

Results: Cross-sectionally, high-risk participants (n=1706) had significantly higher odds of CVD prevalence compared to participants with low-risk (n=3107) (adjusted OR = 1.54, 95% CI: [1.29 - 1.84]). Medium-risk (n=3082) participants had higher odds of CVD prevalence, though this did not reach significance. Prospectively, medium and high-risk participants had significantly higher odds of 4-year CVD incidence (medium-risk adjusted OR = 1.57, 95% CI: [1.18 - 2.09]; high-risk adjusted OR = 1.67, 95% CI: [1.19 - 2.36]) compared to those with low-risk. Risk of 4-year mortality was higher in high-risk (OR = 2.12, 95% CI: [1.60 - 2.8]) participants vs. low-risk, and non-significantly elevated in medium-risk participants.

Conclusions: Co-occurrence of hypertension, dyslipidemia, and elevated CRP was strongly associated with increased CVD prevalence, higher incident CVD, and elevated 4-year mortality in older US adults, emphasizing the importance of multifactor screening for CVD risk.

Introduction: Micronutrient deficiencies are common among women of reproductive age (WRA) and children in Senegal. Large-scale food fortification (LSFF) can help fill gaps in dietary intakes.

Methods: We used household food consumption data to model the contributions of existing LSFF programs (vitamin A-fortified refined oil and iron and folic acid-fortified wheat flour) and the potential contributions of expanding these programs to meeting the micronutrient requirements of WRA (15-49 years) and children (6-59 months).

Results: Without fortification, apparent inadequacy of household diets for meeting micronutrient requirements exceeded 70% for vitamin A, thiamin, riboflavin, folate, and zinc, was 61% for iron among WRA (43% among children), and was ~25% for vitamin B12. At estimated current compliance, fortified refined oil was predicted to reduce vitamin A inadequacy to ~35%, and could further reduce inadequacy to ~25% if compliance with the standard improved. Fortified wheat flour at estimated current compliance reduced iron and, especially, folate inadequacy, but improvements in compliance would be necessary to achieve the full potential. Beyond existing programs, expanding wheat flour fortification to include additional micronutrients was predicted to have a modest impact on thiamin and riboflavin inadequacies and larger impacts on vitamin B12 and, especially, zinc inadequacies. Adding a program to import fortified rice could further reduce inadequacies of multiple micronutrients (generally by > 10 percentage points), although potential risk of high intake of vitamin A, folic acid, and zinc among children should be carefully considered. With both wheat flour and rice fortification, predicted prevalence of vitamin A, iron, and zinc inadequacy remained above 25% in some regions, pointing to the potential need for coordinated, targeted micronutrient interventions to fully close gaps.

Conclusions: When considered alongside evidence on the cost and affordability of these programs, this evidence can help inform the development of a comprehensive micronutrient intervention strategy in Senegal.

Background: Chronic kidney disease (CKD) has emerged as a substantial global health challenge, with a marked rise in associated mortality. However, it often goes undetected until advanced stages, particularly in low-income and middle-income countries such as South Africa. We investigated the prevalence and progression of CKD in South Africa, utilising a subset of data from the National Health Laboratory Services Multi-morbidity Cohort.

Methods: This study was a retrospective analysis of adults aged 18-85 years who underwent initial creatinine laboratory testing at government hospitals and clinics from January 2012 to January 2016. CKD was assessed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, excluding the race factor, with a cut-off of CKD-EPI<60 mL/min/1.73 m². Lab-diagnosed CKD was defined as two estimated glomerular filtration rate measurements <60 mL/min/1.73 m² at least 90 days apart. Cox regression and survival curves were used to estimate HRs and rates of progression.

Results: Among 6 106 521 adults tested between 2012 and 2016, 1.5% (95% CI 1.4% to 1.5%) were diagnosed with CKD, with the majority in stage 3. Over follow-up (median: 2 years, IQR: 0.8-3.6 years), 28.2% (95% CI 27.7% to 28.6%) of patients diagnosed as stage 3a progressed to a more severe disease state. Among patients who were in stage 3b at diagnosis, 29.6% (95% CI 29.0% to 30.1%) progressed and 33.3% (95% CI 32.5% to 34.1%) of stage 4 patients progressed. We estimated a 48% higher adjusted hazard of CKD progression for individuals with diabetes (adjusted HR 1.48, 95% CI 1.41 to 1.57) compared with those without. Advancing age also increased the risk, particularly for those aged >50 years.

Conclusions: This study underscores the urgency for early detection and management of CKD in South Africa, particularly for high-risk individuals. Strengthening primary healthcare systems and raising CKD awareness are vital for improved patient outcomes and to alleviate the burden on healthcare resources. Early intervention can delay CKD progression, thus reducing the need for costly treatments like dialysis and transplantation.