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Estimated Excess Deaths Due to COVID-19 Among the Urban Population of Mainland China, December 2022 to January 2023. 2022 年 12 月至 2023 年 1 月中国大陆城市人口因 COVID-19 导致的超额死亡估计数。
IF 5.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2024-01-29 DOI: 10.1097/EDE.0000000000001723
Leon Raphson, Marc Lipsitch

Background: Mainland China experienced a major surge in SARS-CoV-2 infections in December 2022-January 2023, but its impact on mortality was unclear given the underreporting of coronavirus disease 2019 deaths.

Methods: Using obituary data from the Chinese Academy of Engineering (CAE), we estimated the excess death rate among senior CAE members by taking the difference between the observed rate of all-cause death in December 2022-January 2023 and the expected rate for the same months in 2017-2022, by age groups. We used this to extrapolate an estimate of the number of excess deaths in December 2022-January 2023 among urban dwellers in Mainland China.

Results: In December 2022-January 2023, we estimated excess death rates of 0.94 per 100 persons (95% confidence interval [CI] = -0.54, 3.16) in CAE members aged 80-84 years, 3.95 (95% CI = 0.50, 7.84) in 85-89 years, 10.35 (95% CI = 3.59, 17.71) in 90-94 years, and 16.88 (95% CI = 0.00, 34.62) in 95 years and older. Using our baseline assumptions, this extrapolated to 917,000 (95% CI = 425,000, 1.45 million) excess deaths among urban dwellers in Mainland China, much higher than the 81,000 in-hospital deaths officially reported from 9 December 2022 to 30 January 2023.

Conclusions: As in many jurisdictions, we estimate that the coronavirus disease 2019 pandemic had a much wider impact on mortality than what was officially documented in Mainland China.

背景:2022 年 12 月至 2023 年 1 月期间,中国大陆的 SARS-CoV-2 感染率大幅上升,但由于 COVID-19 死亡病例报告不足,其对死亡率的影响尚不明确:2022年12月至2023年1月,中国大陆SARS-CoV-2感染率大幅上升,但由于COVID-19死亡病例报告不足,其对死亡率的影响尚不明确:我们利用中国工程院(CAE)的讣告数据,通过计算 2022 年 12 月至 2023 年 1 月观察到的全因死亡率与 2017 年至 2022 年同期各年龄组预期死亡率之间的差值,估算出中国工程院资深院士的超额死亡率。我们据此推算出2022年12月至2023年1月中国大陆城市居民的超额死亡人数:我们估计,在2022年12月至2023年1月期间,80-84岁的CAE成员每百人的超额死亡率为0.94(95%置信区间:-0.54,3.16),85-89岁的超额死亡率为3.95(95% CI:0.50,7.84),90-94岁的超额死亡率为10.35(95% CI:3.59,17.71),95岁及以上的超额死亡率为16.88(95% CI:0.00,34.62)。根据我们的基线假设,推断中国大陆城市居民的超额死亡人数为91.7万(95% CI:42.5万-145万),远高于官方报告的2022年12月9日至2023年1月30日的8.1万例院内死亡:与许多国家一样,我们估计 COVID-19 大流行对死亡率的影响比中国大陆官方记录的要大得多。
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引用次数: 0
A Capture-Recapture-based Ascertainment Probability Weighting Method for Effect Estimation With Under-ascertained Outcomes. 基于捕获-再捕获的确定概率加权法,用于结果不确定的效应估计。
IF 5.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2024-03-04 DOI: 10.1097/EDE.0000000000001717
Carl Bonander, Anton Nilsson, Huiqi Li, Shambhavi Sharma, Chioma Nwaru, Magnus Gisslén, Magnus Lindh, Niklas Hammar, Jonas Björk, Fredrik Nyberg

Outcome under-ascertainment, characterized by the incomplete identification or reporting of cases, poses a substantial challenge in epidemiologic research. While capture-recapture methods can estimate unknown case numbers, their role in estimating exposure effects in observational studies is not well established. This paper presents an ascertainment probability weighting framework that integrates capture-recapture and propensity score weighting. We propose a nonparametric estimator of effects on binary outcomes that combines exposure propensity scores with data from two conditionally independent outcome measurements to simultaneously adjust for confounding and under-ascertainment. Demonstrating its practical application, we apply the method to estimate the relationship between health care work and coronavirus disease 2019 testing in a Swedish region. We find that ascertainment probability weighting greatly influences the estimated association compared to conventional inverse probability weighting, underscoring the importance of accounting for under-ascertainment in studies with limited outcome data coverage. We conclude with practical guidelines for the method's implementation, discussing its strengths, limitations, and suitable scenarios for application.

结果不完全确定是指病例的识别或报告不完全,这给流行病学研究带来了巨大挑战。虽然捕获-再捕获方法可以估算未知病例数,但其在估算观察性研究中暴露效应方面的作用尚未得到充分证实。本文提出了一种整合了捕获-再捕获和倾向得分加权的确定概率加权框架。我们提出了一种二元结果效应的非参数估计方法,该方法将暴露倾向得分与两个条件独立的结果测量数据相结合,以同时调整混杂因素和不确定因素。为了展示该方法的实际应用,我们将其用于估算瑞典某地区医疗保健工作与 COVID-19 检测之间的关系。我们发现,与传统的反向概率加权法相比,确定概率加权法会极大地影响估计的关联性,这突出了在结果数据覆盖范围有限的研究中考虑确定性不足的重要性。最后,我们提出了实施该方法的实用指南,讨论了该方法的优势、局限性和适合的应用场景。
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引用次数: 0
Erratum: "Posttraumatic stress disorder and gastrointestinal disorders in the Danish population". 丹麦人口中的创伤后应激障碍和胃肠道疾病。
IF 5.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2024-01-22 DOI: 10.1097/EDE.0000000000001715
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引用次数: 0
Using Negative Control Populations to Assess Unmeasured Confounding and Direct Effects. 使用阴性对照人群来评估未测量的混杂因素和直接影响。
IF 5.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2024-03-07 DOI: 10.1097/EDE.0000000000001724
Marco Piccininni, Mats Julius Stensrud

Sometimes treatment effects are absent in a subgroup of the population. For example, penicillin has no effect on severe symptoms in individuals infected by resistant Staphylococcus aureus , and codeine has no effect on pain in individuals with certain polymorphisms in the CYP2D6 enzyme. Subgroups where a treatment is ineffective are often called negative control populations or placebo groups. They are leveraged to detect bias in different disciplines. Here we present formal criteria that justify the use of negative control populations to rule out unmeasured confounding and mechanistic (direct) causal effects. We further argue that negative control populations, satisfying our formal conditions, are available in many settings, spanning from clinical studies of infectious diseases to epidemiologic studies of public health interventions. Negative control populations can also be used to rule out placebo effects in unblinded randomized experiments. As a case study, we evaluate the effect of mobile stroke unit dispatches on functional outcomes at discharge in individuals with suspected stroke, using data from a large trial. Our analysis supports the hypothesis that mobile stroke units improve functional outcomes in these individuals.

有时,治疗效果在人群中的某个子群体中是不存在的。例如,青霉素对感染耐药金黄色葡萄球菌的人的严重症状没有效果,可待因对 CYP2D6 酶中某些多态性的人的疼痛没有效果。治疗无效的亚组通常称为阴性对照组或安慰剂组。在不同学科中,它们被用来检测偏倚。在此,我们提出了正式的标准,证明使用阴性对照组来排除未测量的混杂因素和机理(直接)因果效应是合理的。我们进一步论证,满足我们的正式条件的阴性对照人群可用于多种场合,从传染病的临床研究到公共卫生干预的流行病学研究。阴性对照人群还可用于排除非盲随机实验中的安慰剂效应。作为一项案例研究,我们利用一项大型试验的数据评估了移动卒中单元派遣对疑似卒中患者出院时功能预后的影响。我们的分析支持移动卒中单元改善这些患者功能预后的假设。
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引用次数: 0
Simulating the Simultaneous Impact of Medication for Opioid Use Disorder and Naloxone on Opioid Overdose Death in Eight New York Counties. 模拟阿片类药物使用障碍的药物治疗和纳洛酮对纽约州八个县阿片类药物过量死亡的同时影响。
IF 4.7 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2024-02-19 DOI: 10.1097/EDE.0000000000001703
Magdalena Cerdá, Ava D Hamilton, Ayaz Hyder, Caroline Rutherford, Georgiy Bobashev, Joshua M Epstein, Erez Hatna, Noa Krawczyk, Nabila El-Bassel, Daniel J Feaster, Katherine M Keyes

Background: The United States is in the midst of an opioid overdose epidemic; 28.3 per 100,000 people died of opioid overdose in 2020. Simulation models can help understand and address this complex, dynamic, and nonlinear social phenomenon. Using the HEALing Communities Study, aimed at reducing opioid overdoses, and an agent-based model, Simulation of Community-Level Overdose Prevention Strategy, we simulated increases in buprenorphine initiation and retention and naloxone distribution aimed at reducing overdose deaths by 40% in New York Counties.

Methods: Our simulations covered 2020-2022. The eight counties contrasted urban or rural and high and low baseline rates of opioid use disorder treatment. The model calibrated agent characteristics for opioid use and use disorder, treatments and treatment access, and fatal and nonfatal overdose. Modeled interventions included increased buprenorphine initiation and retention, and naloxone distribution. We predicted a decrease in the rate of fatal opioid overdose 1 year after intervention, given various modeled intervention scenarios.

Results: Counties required unique combinations of modeled interventions to achieve a 40% reduction in overdose deaths. Assuming a 200% increase in naloxone from current levels, high baseline treatment counties achieved a 40% reduction in overdose deaths with a simultaneous 150% increase in buprenorphine initiation. In comparison, low baseline treatment counties required 250-300% increases in buprenorphine initiation coupled with 200-1000% increases in naloxone, depending on the county.

Conclusions: Results demonstrate the need for tailored county-level interventions to increase service utilization and reduce overdose deaths, as the modeled impact of interventions depended on the county's experience with past and current interventions.

背景:美国正处于阿片类药物过量流行的时期;2020 年,每 10 万人中有 28.3 人死于阿片类药物过量。模拟模型有助于理解和应对这一复杂、动态、非线性的社会现象。我们利用旨在减少阿片类药物过量的 "HEALing 社区研究 "和基于代理的模型 SiCLOPS(社区级药物过量预防策略模拟),模拟了丁丙诺啡的启动和保留以及纳洛酮的分发,目的是将纽约各县的药物过量死亡人数减少 40%:我们的模拟涵盖 2020-2022 年。八个县的城市或农村以及阿片类药物使用障碍治疗基线率的高低形成了鲜明对比。该模型校准了阿片类药物使用和使用障碍、治疗和治疗途径以及致命和非致命过量的代理特征。模型中的干预措施包括增加丁丙诺啡的使用和保留以及纳洛酮的分发。我们预测,在各种模型干预方案下,干预后 1 年阿片类药物致死过量率将下降:结果:各县需要独特的模型干预组合,才能将过量用药致死率降低 40%。假定纳洛酮在现有水平上增加 200%,高基线治疗县的过量用药死亡人数减少了 40%,同时丁丙诺啡的使用率增加了 150%。相比之下,低基线治疗县的丁丙诺啡使用量需要增加 250%-300%,同时纳洛酮的使用量需要增加 200%-1000%,具体取决于各县的情况:结果表明,有必要采取量身定制的县级干预措施,以提高服务利用率并减少用药过量死亡,因为干预措施的示范影响取决于各县在过去和当前干预措施方面的经验。
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引用次数: 0
Partial Identification of the Effects of Sustained Treatment Strategies. 部分确定持续治疗策略的效果。
IF 5.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2024-04-18 DOI: 10.1097/EDE.0000000000001721
Elizabeth W Diemer, Joy Shi, Sonja A Swanson

Although many epidemiologic studies focus on point identification, it is also possible to partially identify causal effects under consistency and the data alone. However, the literature on the so-called "assumption-free" bounds has focused on settings with time-fixed exposures. We describe assumption-free bounds for the effects of both static and dynamic sustained interventions. To provide intuition for the width of the bounds, we also discuss a mathematical connection between assumption-free bounds and clone-censor-weight approaches to causal effect estimation. The bounds, which are often wide in practice, can provide important information about the degree to which causal analyses depend on unverifiable assumptions made by investigators.

尽管许多流行病学研究侧重于点识别,但也有可能在一致性和数据唯一性的条件下部分识别因果效应。然而,关于所谓 "无假设 "界限的文献主要集中在时间固定的暴露环境中。我们描述了静态和动态持续干预效果的无假设界限。为了直观地说明界限的宽度,我们还讨论了无假设界限与因果效应估算的克隆-张量-加权方法之间的数学联系。这些界限在实践中通常很宽,可以提供重要信息,说明因果分析在多大程度上依赖于研究者所做的无法验证的假设。
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引用次数: 0
Adjusting Incidence Estimates with Laboratory Test Performances: A Pragmatic Maximum Likelihood Estimation-Based Approach. 用实验室检测结果调整发病率估计值:基于最大似然估计的实用方法。
IF 5.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2024-03-07 DOI: 10.1097/EDE.0000000000001725
Yingjie Weng, Lu Tian, Derek Boothroyd, Justin Lee, Kenny Zhang, Di Lu, Christina P Lindan, Jenna Bollyky, Beatrice Huang, George W Rutherford, Yvonne Maldonado, Manisha Desai

Understanding the incidence of disease is often crucial for public policy decision-making, as observed during the COVID-19 pandemic. Estimating incidence is challenging, however, when the definition of incidence relies on tests that imperfectly measure disease, as in the case when assays with variable performance are used to detect the SARS-CoV-2 virus. To our knowledge, there are no pragmatic methods to address the bias introduced by the performance of labs in testing for the virus. In the setting of a longitudinal study, we developed a maximum likelihood estimation-based approach to estimate laboratory performance-adjusted incidence using the expectation-maximization algorithm. We constructed confidence intervals (CIs) using both bootstrapped-based and large-sample interval estimator approaches. We evaluated our methods through extensive simulation and applied them to a real-world study (TrackCOVID), where the primary goal was to determine the incidence of and risk factors for SARS-CoV-2 infection in the San Francisco Bay Area from July 2020 to March 2021. Our simulations demonstrated that our method converged rapidly with accurate estimates under a variety of scenarios. Bootstrapped-based CIs were comparable to the large-sample estimator CIs with a reasonable number of incident cases, shown via a simulation scenario based on the real TrackCOVID study. In more extreme simulated scenarios, the coverage of large-sample interval estimation outperformed the bootstrapped-based approach. Results from the application to the TrackCOVID study suggested that assuming perfect laboratory test performance can lead to an inaccurate inference of the incidence. Our flexible, pragmatic method can be extended to a variety of disease and study settings.

了解疾病的发病率往往对公共政策决策至关重要,正如在 COVID-19 大流行期间所观察到的那样。然而,当发病率的定义依赖于对疾病进行不完全测量的检测时,对发病率的估算就具有挑战性,例如在检测 SARS-CoV-2 病毒时使用了性能不稳定的检测方法。据我们所知,目前还没有实用的方法来解决实验室检测病毒的性能所带来的偏差。在一项纵向研究中,我们开发了一种基于最大似然估计(MLE)的方法,利用期望最大化算法估计实验室性能调整后的发病率。我们使用基于引导的方法和大样本区间估计法构建了置信区间(CI)。我们通过大量模拟对我们的方法进行了评估,并将其应用于一项真实世界研究(TrackCOVID),该研究的主要目标是确定 2020 年 7 月至 2021 年 3 月期间旧金山湾区 SARS-CoV-2 感染的发病率和风险因素。模拟结果表明,在各种情况下,我们的方法都能迅速收敛,得出准确的估计值。基于 Bootstrapped 的置信区间(CIs)与大样本估计值的置信区间(CIs)相当,且有合理的发病病例数。在更极端的模拟场景中,大样本区间估计的覆盖率优于基于引导的方法。应用于 TrackCOVID 研究的结果表明,假设实验室测试性能完美会导致对发病率的推断不准确。我们灵活、实用的方法可扩展到各种疾病和研究环境中。
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引用次数: 0
Association Between Home Renovation and Sleeping Problems Among Children Aged 6-18 Years: A Nationwide Survey in China. 家庭装修与 6 至 18 岁儿童睡眠问题之间的关系:一项在中国进行的全国性调查。
IF 5.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2024-01-23 DOI: 10.1097/EDE.0000000000001719
Dao-Sen Wang, Hong-Zhi Zhang, Si-Han Wu, Zheng-Min Qian, Stephen Edward McMillin, Elizabeth Bingheim, Wei-Hong Tan, Wen-Zhong Huang, Pei-En Zhou, Ru-Qing Liu, Li-Wen Hu, Gong-Bo Chen, Bo-Yi Yang, Xiao-Wen Zeng, Qian-Sheng Hu, Li-Zi Lin, Guang-Hui Dong

Background: Although the indoor environment has been proposed to be associated with childhood sleep health, to our knowledge no study has investigated the association between home renovation and childhood sleep problems.

Methods: The study included 186,470 children aged 6-18 years from the National Chinese Children Health Study (2012-2018). We measured childhood sleeping problems via the Chinese version of the Sleep Disturbance Scale for Children (C-SDSC). Information on home renovation exposure within the recent 2 years was collected via parent report. We estimated associations between home renovation and various sleeping problems, defined using both continuous and categorized (binary) C-SDSC t-scores, using generalized mixed models. We fitted models with city as a random effect variable, and other covariates as fixed effects.

Results: Out of the overall participants, 89,732 (48%) were exposed to recent home renovations. Compared to the unexposed group, children exposed to home renovations had higher odds of total sleep disorder (odd ratios [OR] = 1.3; 95% confidence interval [CI] = 1.2, 1.4). Associations varied when we considered different types of home renovation materials. Children exposed to multiple types of home renovation had higher odds of sleeping problems. We observed similar findings when considering continuous C-SDSC t-scores. Additionally, sex and age of children modified the associations of home renovation exposure with some of the sleeping problem subtypes.

Conclusions: We found that home renovation was associated with higher odds of having sleeping problems and that they varied when considering the type of renovation, cumulative exposure, sex, and age differences.

背景:尽管室内环境被认为与儿童睡眠健康有关,但据我们所知,还没有研究调查过家庭装修与儿童睡眠问题之间的关系:研究纳入了《中国儿童健康状况全国调查(2012-2018年)》中186470名6至18岁的儿童。我们采用中文版儿童睡眠障碍量表(C-SDSC)测量儿童睡眠问题。我们还通过家长报告收集了最近两年内家庭装修暴露的信息。我们使用广义混合模型估算了家庭装修与各种睡眠问题之间的关系,这些睡眠问题使用连续和分类(二元)的 C-SDSC t 分数来定义。我们将城市作为随机效应变量,将其他协变量作为固定效应变量,对模型进行了拟合:在所有参与者中,有 89 732 人[48%]受到近期房屋装修的影响。与未受影响组相比,受房屋装修影响的儿童患总睡眠障碍的几率更高[奇数比(OR)=1.3,95% CI:1.2-1.4]。当我们考虑到不同类型的家庭装修材料时,两者之间的关系也有所不同。接触过多种类型装修材料的儿童出现睡眠问题的几率更高。在考虑连续的 C-SDSC t 分数时,我们也观察到了类似的结果。此外,儿童的性别和年龄也改变了家庭装修与某些睡眠问题亚型之间的关系:我们发现,房屋装修与较高的睡眠问题几率有关,而且在考虑到装修类型、累积接触、性别和年龄差异时,睡眠问题的几率也有所不同。
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引用次数: 0
Application of a Web-based Tool for Quantitative Bias Analysis: The Example of Misclassification Due to Self-reported Body Mass Index. 应用网络工具进行定量偏差分析:以自报体重指数导致的误分类为例。
IF 5.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2024-02-01 DOI: 10.1097/EDE.0000000000001726
Hailey R Banack, Samantha N Smith, Lisa M Bodnar

Background: We describe the use of Apisensr, a web-based application that can be used to implement quantitative bias analysis for misclassification, selection bias, and unmeasured confounding. We apply Apisensr using an example of exposure misclassification bias due to use of self-reported body mass index (BMI) to define obesity status in an analysis of the relationship between obesity and diabetes.

Methods: We used publicly available data from the National Health and Nutrition Examination Survey. The analysis consisted of: (1) estimating bias parameter values (sensitivity, specificity, negative predictive value, and positive predictive value) for self-reported obesity by sex, age, and race-ethnicity compared to obesity defined by measured BMI, and (2) using Apisensr to adjust for exposure misclassification.

Results: The discrepancy between self-reported and measured obesity varied by demographic group (sensitivity range: 75%-89%; specificity range: 91%-99%). Using Apisensr for quantitative bias analysis, there was a clear pattern in the results: the relationship between obesity and diabetes was underestimated using self-report in all age, sex, and race-ethnicity categories compared to measured obesity. For example, in non-Hispanic White men aged 40-59 years, prevalence odds ratios for diabetes were 3.06 (95% confidence inerval = 1.78, 5.30) using self-reported BMI and 4.11 (95% confidence interval = 2.56, 6.75) after bias analysis adjusting for misclassification.

Conclusion: Apisensr is an easy-to-use, web-based Shiny app designed to facilitate quantitative bias analysis. Our results also provide estimates of bias parameter values that can be used by other researchers interested in examining obesity defined by self-reported BMI.

背景:我们介绍了 Apisensr 的使用方法,这是一种基于网络的应用程序,可用于对误分、选择偏倚和未测量混杂因素进行定量偏倚分析。在分析肥胖与糖尿病之间的关系时,我们以使用自我报告的体重指数(BMI)来定义肥胖状态导致的暴露误分类偏差为例,应用了 Apisensr:我们使用了美国国家健康与营养调查(NHANES)的公开数据。分析包括1)按性别、年龄和种族-人种估算自我报告肥胖的偏倚参数值(灵敏度、特异性、阴性预测值、阳性预测值),与按测量的体重指数定义的肥胖进行比较;2)使用 Apisensr 调整暴露误分类:结果:自我报告与测量肥胖之间的差异因人口群体而异(灵敏度范围:75% 至 89%;特异性范围:91% 至 99%)。使用 Apisensr 进行定量偏差分析,结果有一个明显的模式:在所有年龄、性别和种族人种类别中,使用自我报告与测量肥胖相比,肥胖与糖尿病之间的关系被低估了。例如,在 40-59 岁的非西班牙裔白人男性中,使用自我报告的体重指数得出的糖尿病患病几率比为 3.06(95% CI:1.78, 5.30),而经过偏差分析调整误分类后得出的患病几率比为 4.11(95% CI:2.56, 6.75):Apisensr是一款易于使用、基于网络的Shiny应用程序,旨在促进定量偏倚分析。我们的研究结果还提供了偏倚参数值的估计值,可供其他有兴趣研究由自我报告的体重指数定义的肥胖症的研究人员使用。
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引用次数: 0
Interpretations of Studies on SARS-CoV-2 Vaccination and Post-acute COVID-19 Sequelae. 关于 SARS-CoV-2 疫苗接种和 COVID-19 急性后遗症的研究解读。
IF 5.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-04-18 DOI: 10.1097/ede.0000000000001720
Bronner P Gonçalves, Piero L Olliaro, Peter Horby, Laura Merson, Benjamin J Cowling
This article discusses causal interpretations of epidemiologic studies of the effects of vaccination on sequelae after acute severe acute respiratory syndrome coronavirus 2 infection. To date, researchers have tried to answer several different research questions on this topic. While some studies assessed the impact of postinfection vaccination on the presence of or recovery from post-acute coronavirus disease 2019 syndrome, others quantified the association between preinfection vaccination and postacute sequelae conditional on becoming infected. However, the latter analysis does not have a causal interpretation, except under the principal stratification framework-that is, this comparison can only be interpreted as causal for a nondiscernible stratum of the population. As the epidemiology of coronavirus disease 2019 is now nearly entirely dominated by reinfections, including in vaccinated individuals, and possibly caused by different Omicron subvariants, it has become even more important to design studies on the effects of vaccination on postacute sequelae that address precise causal questions and quantify effects corresponding to implementable interventions.
本文讨论了关于接种疫苗对急性严重呼吸系统综合征冠状病毒 2 感染后遗症影响的流行病学研究的因果关系解释。迄今为止,研究人员试图回答有关这一主题的几个不同的研究问题。一些研究评估了感染后接种疫苗对急性冠状病毒病2019年最新注册送彩金综合征的出现或恢复的影响,另一些研究则量化了感染前接种疫苗与感染后急性后遗症之间的关系。然而,后一种分析并不具有因果关系解释,除非是在主分层框架下--也就是说,这种比较只能被解释为对不可辨别的人口阶层具有因果关系。由于 2019 年冠状病毒疾病的流行病学现在几乎完全由再感染所主导,包括接种过疫苗的人,而且可能是由不同的 Omicron 亚变体引起的,因此设计有关疫苗接种对急性后遗症影响的研究变得更加重要,这些研究要解决精确的因果问题,并量化与可实施的干预措施相对应的效果。
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