Pub Date : 2025-08-13DOI: 10.1007/s10654-025-01266-1
Isobel M F Todd,Lars Henning Pedersen,Maria C Magnus,Natasha Nassar,Jessica E Miller,David P Burgner
Several perinatal exposures impact severe infection risk in offspring. However, most studies consider exposures in isolation rather than the impact of multiple co-occurring perinatal exposures. Here, we investigated the risk of hospitalised childhood infections associated with combinations of multiple perinatal exposures. We studied liveborn, singleton births in Denmark between 1997 and 2019 (n = 1,113,708) and Norway between 2008 and 2018 (n = 470,270) through national registry linkage. Seven perinatal exposures were evaluated including maternal antibiotic use during pregnancy, maternal smoking, maternal diabetes, hypertensive disorders of pregnancy, caesarean section birth, offspring being small for gestational age (SGA), and preterm birth. The outcome was hospitalised infections before 5 years age. Using Cox regression, we estimated hazard ratios (HR) of hospitalised infections for: (1) each exposure individually; (2) the cumulative number of exposures; (3) each unique combination of the seven exposures; (4) pairwise interactions between exposures. Results were combined through meta-analysis. Each exposure was individually associated with greater hospitalised infection risk with pooled HR estimates ranging from 1.08 (95% CI 1.08-1.09) for SGA to 1.45 (95% CI 1.43-1.46) for preterm birth. Cumulative risk was observed for increasing number of exposures from a pooled HR of 1.17 (95% CI 1.17-1.18) for one exposure to 1.88 (95% CI 1.78-1.99) for five or more exposures. Analyses of unique combinations of the exposures showed a particularly increased risk among preterm children with one or more additional exposures. Our findings can inform targeted strategies for the prevention and management of childhood infections. We highlight a simple, intuitive method for measuring risk associated with co-occurring exposures.
几种围产期暴露会影响后代的严重感染风险。然而，大多数研究考虑的是孤立的暴露，而不是多重同时发生的围产期暴露的影响。在这里，我们调查了住院儿童感染的风险与多个围产期暴露的组合。我们通过国家登记联系研究了1997年至2019年丹麦（n = 1,113,708）和2008年至2018年挪威（n = 470,270）的活产单胎婴儿。研究评估了7种围产期暴露，包括孕妇在妊娠期间使用抗生素、孕妇吸烟、孕妇糖尿病、妊娠高血压疾病、剖宫产、胎儿小于胎龄（SGA）和早产。结果是5岁前住院感染。使用Cox回归，我们估计了住院感染的风险比（HR）：(1)每个暴露单独；（二）累计暴露次数；(3)七个曝光的每个独特组合；(4)暴露之间的两两相互作用。结果通过meta分析合并。每次暴露单独与住院感染风险增加相关，合并HR估计范围从SGA的1.08 （95% CI 1.08-1.09）到早产的1.45 （95% CI 1.43-1.46）。累积风险随着暴露次数的增加而增加，从一次暴露的总危险度为1.17 （95% CI 1.17-1.18）到五次或更多暴露的总危险度为1.88 （95% CI 1.78-1.99）。对暴露的独特组合进行的分析表明，有一种或多种额外暴露的早产儿的风险尤其增加。我们的发现可以为儿童感染的预防和管理提供有针对性的策略。我们强调了一种简单、直观的方法来测量与同时发生的暴露相关的风险。
{"title":"Associations between multiple perinatal exposures and risk of childhood hospitalisation with infection: a registry-based study in two countries.","authors":"Isobel M F Todd,Lars Henning Pedersen,Maria C Magnus,Natasha Nassar,Jessica E Miller,David P Burgner","doi":"10.1007/s10654-025-01266-1","DOIUrl":"https://doi.org/10.1007/s10654-025-01266-1","url":null,"abstract":"Several perinatal exposures impact severe infection risk in offspring. However, most studies consider exposures in isolation rather than the impact of multiple co-occurring perinatal exposures. Here, we investigated the risk of hospitalised childhood infections associated with combinations of multiple perinatal exposures. We studied liveborn, singleton births in Denmark between 1997 and 2019 (n = 1,113,708) and Norway between 2008 and 2018 (n = 470,270) through national registry linkage. Seven perinatal exposures were evaluated including maternal antibiotic use during pregnancy, maternal smoking, maternal diabetes, hypertensive disorders of pregnancy, caesarean section birth, offspring being small for gestational age (SGA), and preterm birth. The outcome was hospitalised infections before 5 years age. Using Cox regression, we estimated hazard ratios (HR) of hospitalised infections for: (1) each exposure individually; (2) the cumulative number of exposures; (3) each unique combination of the seven exposures; (4) pairwise interactions between exposures. Results were combined through meta-analysis. Each exposure was individually associated with greater hospitalised infection risk with pooled HR estimates ranging from 1.08 (95% CI 1.08-1.09) for SGA to 1.45 (95% CI 1.43-1.46) for preterm birth. Cumulative risk was observed for increasing number of exposures from a pooled HR of 1.17 (95% CI 1.17-1.18) for one exposure to 1.88 (95% CI 1.78-1.99) for five or more exposures. Analyses of unique combinations of the exposures showed a particularly increased risk among preterm children with one or more additional exposures. Our findings can inform targeted strategies for the prevention and management of childhood infections. We highlight a simple, intuitive method for measuring risk associated with co-occurring exposures.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"15 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144825880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical and epidemiological characteristics of the 2024-2025 measles outbreak in Sarajevo Canton.","authors":"Anes Jogunčić,Rusmir Baljić,Aysun Tekin,Asaf Salčinović,Irma Dizdarević,Alma Sejtarija Memišević,Belma Gazibera,Amila Muratspahić,Amos Lal,Lutvo Sporišević","doi":"10.1007/s10654-025-01287-w","DOIUrl":"https://doi.org/10.1007/s10654-025-01287-w","url":null,"abstract":"","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"19 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144825882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-13DOI: 10.1007/s10654-025-01285-y
Ruijie Xie,Sha Sha,Hermann Brenner,Ben Schöttker
BACKGROUNDInflammation plays a crucial role in cardiovascular disease (CVD), but the value of inflammation-related proteins in predicting major adverse cardiovascular events (MACE) is unclear. This study evaluated whether incorporating inflammation-related proteins into the SCORE2 model improves 10-year MACE risk prediction.METHODSThis study included 47,382 participants from the UK Biobank and 4,135 participants from the German ESTHER study without prior CVD or diabetes. We tested C-reactive protein (CRP) and 73 inflammation-related proteins measured with Olink® panels. Biomarker selection was performed using least absolute shrinkage and selection operator (LASSO) regression with bootstrapping separately for males and females. Selected proteins were added to the SCORE2 model variables. Model performance was evaluated using Harrell's C-index, net reclassification index (NRI), and integrated discrimination index (IDI).RESULTSSeven inflammation-related proteins but not CRP were selected, including two for both sexes, three specifically for males, and two specifically for females. Incorporating these proteins significantly improved the C-index (95% confidence interval (95%CI)) of the refitted SCORE2 model from 0.716 (0.698, 0.734) to 0.750 (0.732, 0.768) in internal validation in the UK Biobank and from 0.677 (0.644, 0.710) to 0.713 (0.681, 0.745) in external validation in the ESTHER study. The NRI with 95%CI was 12.4% (5.2%, 16.3%) in internal validation and 4.2% (0.5%, 23.6%) in external validation. The IDI also improved significantly.CONCLUSIONIncorporating inflammation-related proteins into the SCORE2 model significantly improves the prediction of 10-year MACE risk among individuals without prior CVD or diabetes. Measuring these proteins may enhance risk stratification in clinical practice.
{"title":"Circulating inflammation-related proteome improves cardiovascular risk prediction. Results from two large European cohort studies.","authors":"Ruijie Xie,Sha Sha,Hermann Brenner,Ben Schöttker","doi":"10.1007/s10654-025-01285-y","DOIUrl":"https://doi.org/10.1007/s10654-025-01285-y","url":null,"abstract":"BACKGROUNDInflammation plays a crucial role in cardiovascular disease (CVD), but the value of inflammation-related proteins in predicting major adverse cardiovascular events (MACE) is unclear. This study evaluated whether incorporating inflammation-related proteins into the SCORE2 model improves 10-year MACE risk prediction.METHODSThis study included 47,382 participants from the UK Biobank and 4,135 participants from the German ESTHER study without prior CVD or diabetes. We tested C-reactive protein (CRP) and 73 inflammation-related proteins measured with Olink® panels. Biomarker selection was performed using least absolute shrinkage and selection operator (LASSO) regression with bootstrapping separately for males and females. Selected proteins were added to the SCORE2 model variables. Model performance was evaluated using Harrell's C-index, net reclassification index (NRI), and integrated discrimination index (IDI).RESULTSSeven inflammation-related proteins but not CRP were selected, including two for both sexes, three specifically for males, and two specifically for females. Incorporating these proteins significantly improved the C-index (95% confidence interval (95%CI)) of the refitted SCORE2 model from 0.716 (0.698, 0.734) to 0.750 (0.732, 0.768) in internal validation in the UK Biobank and from 0.677 (0.644, 0.710) to 0.713 (0.681, 0.745) in external validation in the ESTHER study. The NRI with 95%CI was 12.4% (5.2%, 16.3%) in internal validation and 4.2% (0.5%, 23.6%) in external validation. The IDI also improved significantly.CONCLUSIONIncorporating inflammation-related proteins into the SCORE2 model significantly improves the prediction of 10-year MACE risk among individuals without prior CVD or diabetes. Measuring these proteins may enhance risk stratification in clinical practice.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"114 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-12DOI: 10.1007/s10654-025-01286-x
Ellen E Walters,Susan E Luczak,Christopher R Beam,Malin Ericsson,William S Kremen,Robert F Krueger,Kristian E Markon,Matt McGue,Marianne Nygaard,Matthew S Panizzon,Brenda L Plassman,Chandra A Reynolds,Perminder S Sachdev,Anbu Thalamuthu,Keith E Whitfield,Nancy L Pedersen,Margaret Gatz,
Low educational attainment is recognized as a modifiable risk factor for dementia. Despite the commonly accepted notion that greater educational attainment confers lower dementia risk, few family-based studies have investigated the causal bases for the association. Using data from seven twin samples from Sweden, Denmark, Australia, and the US participating in the IGEMS (Interplay of Genes and Environment in Multiple Studies) consortium (N = 60,027, 10.92% with dementia), we tested whether twins who achieve higher education than their co-twins have lower risk of dementia. The primary analysis applied a multilevel between-within regression framework, supported by descriptive statistics of within-pair differences. Results confirmed an overall association between educational attainment and dementia risk, such that individuals with higher educational attainment had less likelihood of developing dementia (phenotypic regression coefficient = -0.68, p <.0001). Within twin pairs, however, twins who achieved greater education than their co-twins did not uniformly show lower dementia risk (within-family regression coefficient = -0.07, p =.0983, while between-family regression coefficient = -0.98, p <.0001). Taken together, the pattern of results shows that the effect of educational attainment on dementia risk is largely attributable to genetic influences in common to educational attainment and dementia, although there are also contributions from environmental influences shared between members of the same family. Results were similar in men and women. These findings add to the literature by using a co-twin control design to address possible reasons that low educational attainment is associated with greater dementia risk.
{"title":"Is educational attainment protective against developing dementia? A twin study of genetic and environmental contributions.","authors":"Ellen E Walters,Susan E Luczak,Christopher R Beam,Malin Ericsson,William S Kremen,Robert F Krueger,Kristian E Markon,Matt McGue,Marianne Nygaard,Matthew S Panizzon,Brenda L Plassman,Chandra A Reynolds,Perminder S Sachdev,Anbu Thalamuthu,Keith E Whitfield,Nancy L Pedersen,Margaret Gatz, ","doi":"10.1007/s10654-025-01286-x","DOIUrl":"https://doi.org/10.1007/s10654-025-01286-x","url":null,"abstract":"Low educational attainment is recognized as a modifiable risk factor for dementia. Despite the commonly accepted notion that greater educational attainment confers lower dementia risk, few family-based studies have investigated the causal bases for the association. Using data from seven twin samples from Sweden, Denmark, Australia, and the US participating in the IGEMS (Interplay of Genes and Environment in Multiple Studies) consortium (N = 60,027, 10.92% with dementia), we tested whether twins who achieve higher education than their co-twins have lower risk of dementia. The primary analysis applied a multilevel between-within regression framework, supported by descriptive statistics of within-pair differences. Results confirmed an overall association between educational attainment and dementia risk, such that individuals with higher educational attainment had less likelihood of developing dementia (phenotypic regression coefficient = -0.68, p <.0001). Within twin pairs, however, twins who achieved greater education than their co-twins did not uniformly show lower dementia risk (within-family regression coefficient = -0.07, p =.0983, while between-family regression coefficient = -0.98, p <.0001). Taken together, the pattern of results shows that the effect of educational attainment on dementia risk is largely attributable to genetic influences in common to educational attainment and dementia, although there are also contributions from environmental influences shared between members of the same family. Results were similar in men and women. These findings add to the literature by using a co-twin control design to address possible reasons that low educational attainment is associated with greater dementia risk.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"41 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144819774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-06DOI: 10.1007/s10654-025-01281-2
Marta Ponzano,Ran S Rotem,Andrea Bellavia
Complex multidimensional data are becoming more widely available and are drastically affecting the way epidemiological studies are designed and conducted. Novel frameworks such as the exposome-which encompasses the comprehensive and cumulative set of exposures affecting individuals throughout their lifetime and the complex mechanisms through which they act - provide a unique opportunity to transform how public health recommendations are identified at the population and individual level. This data revolution is accompanied by a growing interest in analytical approaches that can handle the complexity of these novel research questions. These include semi-parametric and non-parametric statistical and machine learning methodologies that provide compelling frameworks for analyzing large-scale databases while mitigating overfitting. Nevertheless, interpreting results from these complex methods is often challenging. While discussions on interpretability have largely focused on statistical inference, causal considerations and the practical applicability of the findings to inform the design of tangible interventions have received less attention-despite being essential components of epidemiological research. With this commentary we provide a general overview of these three levels of interpretability-statistical, causal, and actionable-and discuss available tools that can aid epidemiologists to improve results interpretability as they start utilizing more complex analytical approaches.
{"title":"Complex methods for complex data: key considerations for interpretable and actionable results in exposome research.","authors":"Marta Ponzano,Ran S Rotem,Andrea Bellavia","doi":"10.1007/s10654-025-01281-2","DOIUrl":"https://doi.org/10.1007/s10654-025-01281-2","url":null,"abstract":"Complex multidimensional data are becoming more widely available and are drastically affecting the way epidemiological studies are designed and conducted. Novel frameworks such as the exposome-which encompasses the comprehensive and cumulative set of exposures affecting individuals throughout their lifetime and the complex mechanisms through which they act - provide a unique opportunity to transform how public health recommendations are identified at the population and individual level. This data revolution is accompanied by a growing interest in analytical approaches that can handle the complexity of these novel research questions. These include semi-parametric and non-parametric statistical and machine learning methodologies that provide compelling frameworks for analyzing large-scale databases while mitigating overfitting. Nevertheless, interpreting results from these complex methods is often challenging. While discussions on interpretability have largely focused on statistical inference, causal considerations and the practical applicability of the findings to inform the design of tangible interventions have received less attention-despite being essential components of epidemiological research. With this commentary we provide a general overview of these three levels of interpretability-statistical, causal, and actionable-and discuss available tools that can aid epidemiologists to improve results interpretability as they start utilizing more complex analytical approaches.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"57 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-31DOI: 10.1007/s10654-025-01243-8
Marie Beslay,Anna-Belle Beau,Davide Messina,Justine Benevent,Elisa Ballardini,Laia Barrachina-Bonet,Clara Cavero-Carbonell,Alex Coldea,Laura García-Villodre,Anja Geldhof,Rosa Gini,Kerstin Hellwig,Sue Jordan,Maarit K Leinonen,Sandra Lopez-Leon,Marco Manfrini,Visa Martikainen,Vera R Mitter,Amanda J Neville,Hedvig Nordeng,Aurora Puccini,Sandra Vukusic,Christine Damase-Michel,Yvonne Geissbühler,Joan K Morris
Multiple sclerosis (MS) is a chronic autoimmune condition primarily affecting women and often diagnosed during childbearing years. This study assessed the impact of the lookback period and calculation method on MS prevalence in three healthcare data sources including women of childbearing age (from Italy, Norway and Wales) and three data sources including pregnant women (from France, Finland and Spain). Women aged 15 to 49 years from 2005 to 2019 were included, data from pregnant women were collected around the pregnancy period. MS cases were identified based on at least one MS diagnosis or one dispensation for an MS-specific medication. All data sources provided inpatient diagnoses and medication data; outpatient diagnoses were available in Norway and Finland, and primary care diagnoses in Norway, Finland and Wales. We assessed MS case detection rate by lookback period, and compared three methods for estimating yearly MS prevalence: period prevalence (PP), average point prevalence (APP) and person-time prevalence (PTP). The estimated lookback periods to identify 95% of MS cases ranged from 6 to 9 years. APP and PTP provided lower prevalence estimates than PP, especially when the lookback to identify MS was short. In women of childbearing age, MS prevalence increased over time with all calculation methods and the highest MS prevalence was observed in Norway (PP of 402 per 100,000 in 2019). Finland showed the highest MS prevalence in pregnant women (PP of 218 per 100,000 in 2018). This study highlights the importance of sufficient lookback and available data to accurately estimate MS prevalence.
{"title":"Methods of estimating prevalence of multiple sclerosis in six European healthcare data sources: a contribution from the ConcePTION project.","authors":"Marie Beslay,Anna-Belle Beau,Davide Messina,Justine Benevent,Elisa Ballardini,Laia Barrachina-Bonet,Clara Cavero-Carbonell,Alex Coldea,Laura García-Villodre,Anja Geldhof,Rosa Gini,Kerstin Hellwig,Sue Jordan,Maarit K Leinonen,Sandra Lopez-Leon,Marco Manfrini,Visa Martikainen,Vera R Mitter,Amanda J Neville,Hedvig Nordeng,Aurora Puccini,Sandra Vukusic,Christine Damase-Michel,Yvonne Geissbühler,Joan K Morris","doi":"10.1007/s10654-025-01243-8","DOIUrl":"https://doi.org/10.1007/s10654-025-01243-8","url":null,"abstract":"Multiple sclerosis (MS) is a chronic autoimmune condition primarily affecting women and often diagnosed during childbearing years. This study assessed the impact of the lookback period and calculation method on MS prevalence in three healthcare data sources including women of childbearing age (from Italy, Norway and Wales) and three data sources including pregnant women (from France, Finland and Spain). Women aged 15 to 49 years from 2005 to 2019 were included, data from pregnant women were collected around the pregnancy period. MS cases were identified based on at least one MS diagnosis or one dispensation for an MS-specific medication. All data sources provided inpatient diagnoses and medication data; outpatient diagnoses were available in Norway and Finland, and primary care diagnoses in Norway, Finland and Wales. We assessed MS case detection rate by lookback period, and compared three methods for estimating yearly MS prevalence: period prevalence (PP), average point prevalence (APP) and person-time prevalence (PTP). The estimated lookback periods to identify 95% of MS cases ranged from 6 to 9 years. APP and PTP provided lower prevalence estimates than PP, especially when the lookback to identify MS was short. In women of childbearing age, MS prevalence increased over time with all calculation methods and the highest MS prevalence was observed in Norway (PP of 402 per 100,000 in 2019). Finland showed the highest MS prevalence in pregnant women (PP of 218 per 100,000 in 2018). This study highlights the importance of sufficient lookback and available data to accurately estimate MS prevalence.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"1 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Children with heavy prenatal alcohol exposure may experience increased healthcare needs and access barriers. We aimed to quantify their healthcare utilisation patterns compared to all other Danish children in this nationwide cohort study of children born 1997-2020, followed until Dec 31, 2022. Data was derived from eight national registers. Heavy prenatal alcohol exposure was defined by hospital contacts with 100% alcohol-attributable diagnoses given to mother or child, redeemed prescriptions for drugs to treat alcohol dependence, or enrollment into treatment clinics, one year before or during pregnancy. We estimated age- and sex-specific rates and incidence rate ratios (IRRs) for use of somatic and psychiatric hospitals, and use of general practice (GP), and risk ratio (RR) for participation in the GP-based preventive child health programme. Of 1,457,962 children followed for 17,778,705 person-years, 5898 (0.4%) were heavily prenatal alcohol exposed. Exposed children had higher use of GP and hospitals compared to reference children, particularly notable for psychiatric hospital contacts with IRR for respectively ages 0-5, 6-11 and 12-18 years of 3.55 (2.98-4.24), 2.68 (2.41-2.98), and 2.19 (1.95-2.46); and for planned outpatient contacts 2.01 (1.92-2.10), 1.29 (1.21-1.37), and 1.20 (1.12-1.28). Despite higher healthcare use, participation in the preventive child health programme had a RR of 0.69 (95% CI 0.67-0.72) for exposed compared to reference children. The higher use of hospitals and GP, but lower participation in the child health programme underscores the long-term consequences and societal burden of heavy prenatal alcohol exposure, and leaves a need for awareness and adequate support to ensure health equity.
产前大量接触酒精的儿童可能面临更多的保健需求和获取障碍。我们旨在量化他们的医疗保健利用模式，并将其与1997-2020年出生的所有其他丹麦儿童进行全国队列研究，随访至2022年12月31日。数据来自八个国家登记册。重度产前酒精暴露的定义是，在怀孕前或怀孕期间，与医院接触的母亲或孩子的诊断结果100%与酒精有关，获得治疗酒精依赖的药物处方，或进入治疗诊所。我们估计了年龄和性别特定的比率和使用躯体和精神病院的发病率比（IRRs），以及使用全科医生（GP），以及参与以全科医生为基础的预防性儿童保健计划的风险比（RR）。在17778705人年随访的1457962名儿童中，5898名（0.4%）产前重度酒精暴露。与对照儿童相比，暴露儿童使用全科医生和医院的比例更高，特别是在0-5岁、6-11岁和12-18岁的精神病院接触的IRR分别为3.55（2.98-4.24）、2.68（2.41-2.98）和2.19 (1.95-2.46)；计划门诊接触为2.01（1.92-2.10）、1.29（1.21-1.37）和1.20（1.12-1.28）。尽管医疗保健使用率较高，但与对照儿童相比，暴露儿童参与预防性儿童保健计划的相对危险度为0.69 （95% CI 0.67-0.72）。医院和全科医生的使用率较高，但儿童保健方案的参与率较低，这突出了产前大量饮酒的长期后果和社会负担，需要提高认识并提供足够的支持，以确保保健公平。
{"title":"Heavy prenatal alcohol exposure and healthcare use during childhood and adolescence: a Danish nationwide cohort study 1997-2022.","authors":"Julie Marie Winckler,Kathrine Kold Sørensen,Katrine Strandberg-Larsen,Christian Torp-Pedersen,Ulrik Schiøler Kesmodel,Mikkel Porsborg Andersen,Marcella Broccia","doi":"10.1007/s10654-025-01280-3","DOIUrl":"https://doi.org/10.1007/s10654-025-01280-3","url":null,"abstract":"Children with heavy prenatal alcohol exposure may experience increased healthcare needs and access barriers. We aimed to quantify their healthcare utilisation patterns compared to all other Danish children in this nationwide cohort study of children born 1997-2020, followed until Dec 31, 2022. Data was derived from eight national registers. Heavy prenatal alcohol exposure was defined by hospital contacts with 100% alcohol-attributable diagnoses given to mother or child, redeemed prescriptions for drugs to treat alcohol dependence, or enrollment into treatment clinics, one year before or during pregnancy. We estimated age- and sex-specific rates and incidence rate ratios (IRRs) for use of somatic and psychiatric hospitals, and use of general practice (GP), and risk ratio (RR) for participation in the GP-based preventive child health programme. Of 1,457,962 children followed for 17,778,705 person-years, 5898 (0.4%) were heavily prenatal alcohol exposed. Exposed children had higher use of GP and hospitals compared to reference children, particularly notable for psychiatric hospital contacts with IRR for respectively ages 0-5, 6-11 and 12-18 years of 3.55 (2.98-4.24), 2.68 (2.41-2.98), and 2.19 (1.95-2.46); and for planned outpatient contacts 2.01 (1.92-2.10), 1.29 (1.21-1.37), and 1.20 (1.12-1.28). Despite higher healthcare use, participation in the preventive child health programme had a RR of 0.69 (95% CI 0.67-0.72) for exposed compared to reference children. The higher use of hospitals and GP, but lower participation in the child health programme underscores the long-term consequences and societal burden of heavy prenatal alcohol exposure, and leaves a need for awareness and adequate support to ensure health equity.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"23 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We aimed (i) to assess the relationship of pregnancy-average particulate matter (PM) exposure with birthweight, birthweight at term, low birthweight at term, small for gestational age, and preterm birth, (ii) to identify critical windows of susceptibility to PM exposure across pregnancy on birthweight and small for gestational age, and (iii) to assess the presence of socioeconomic inequalities on these associations. We established a population-based, nationwide cohort using the Spanish birth registry between 2004 and 2016 (N = 3,678,445). We estimated daily PM10 and PM2.5 concentrations for the entire pregnancy at the maternal residential address at child's delivery using spatiotemporal land use random-forest models. Linear, logistic, and distributed lag linear models were used for the different analysis. All models were stratified by maternal educational level and area-level deprivation index. Mean PM10 and PM2.5 concentrations during pregnancy were 25.1 and 12.7 µg/m3, respectively. Higher pregnancy-average PM10 concentrations were associated with lower birthweight and increased odds of preterm birth (-7.1 g [95%CI -8.5; -5.7] and OR 1.04 [95%CI 1.02; 1.05], respectively, per 10 µg/m3 increase in PM10). Similar results were found for PM2.5, in particular for levels above 10 µg/m3. These associations were stronger in infants born to mothers with lower education, particularly when combined with residence in more deprived areas. We observed some windows of susceptibility to PM10 for birthweight, mainly in the third trimester of pregnancy, with a similar pattern across socioeconomic levels. We did not observe windows of susceptibility to PM2.5. Structural policies to reduce exposure to current PM levels in pregnant women and socioeconomic inequalities are needed.
我们的目的是(1)评估妊娠期平均颗粒物（PM）暴露与出生体重、足月出生体重、足月低出生体重、小胎龄和早产之间的关系，(2)确定整个妊娠期出生体重和小胎龄对PM暴露易感的关键窗口，以及(3)评估这些关联中存在的社会经济不平等。我们利用2004年至2016年西班牙出生登记处建立了一个以人口为基础的全国性队列（N = 3,678,445）。我们使用时空土地利用随机森林模型估计了母亲居住地址在孩子出生时整个怀孕期间的每日PM10和PM2.5浓度。采用线性、logistic和分布滞后线性模型进行不同的分析。所有模型均采用母亲受教育程度和地区剥夺指数进行分层。怀孕期间PM10和PM2.5的平均浓度分别为25.1和12.7µg/m3。较高的妊娠期平均PM10浓度与较低的出生体重和早产几率增加相关(-7.1 g [95%CI -8.5；-5.7] OR 1.04 [95%CI 1.02；[1.05]， PM10每增加10µg/m3)。PM2.5也出现了类似的结果，特别是当PM2.5浓度超过10微克/立方米时。这些关联在受教育程度较低的母亲所生的婴儿中更为明显，特别是当母亲居住在更贫困的地区时。我们观察到一些PM10对出生体重的易感性窗口，主要是在怀孕的第三个月，在社会经济水平上具有相似的模式。我们没有观察到PM2.5敏感性窗口。需要采取结构性政策，以减少孕妇暴露于目前的PM水平和社会经济不平等。
{"title":"Particulate matter exposure during pregnancy and birth outcomes: exposure windows of susceptibility and socioeconomic inequalities.","authors":"Mònica Guxens,Núria Botella,Massimo Stafoggia,Marcelle Canto,Sami Petricola,Antònia Valentín,Aitana Lertxundi,Ana Fernández-Somoano,Carmen Freire,Anna García-Altés,Elia Diez,Marc Marí-Dell'Olmo,Carmen Iñiguez,María José López,Rebeca Ramis,Anne-Claire Binter","doi":"10.1007/s10654-025-01274-1","DOIUrl":"https://doi.org/10.1007/s10654-025-01274-1","url":null,"abstract":"We aimed (i) to assess the relationship of pregnancy-average particulate matter (PM) exposure with birthweight, birthweight at term, low birthweight at term, small for gestational age, and preterm birth, (ii) to identify critical windows of susceptibility to PM exposure across pregnancy on birthweight and small for gestational age, and (iii) to assess the presence of socioeconomic inequalities on these associations. We established a population-based, nationwide cohort using the Spanish birth registry between 2004 and 2016 (N = 3,678,445). We estimated daily PM10 and PM2.5 concentrations for the entire pregnancy at the maternal residential address at child's delivery using spatiotemporal land use random-forest models. Linear, logistic, and distributed lag linear models were used for the different analysis. All models were stratified by maternal educational level and area-level deprivation index. Mean PM10 and PM2.5 concentrations during pregnancy were 25.1 and 12.7 µg/m3, respectively. Higher pregnancy-average PM10 concentrations were associated with lower birthweight and increased odds of preterm birth (-7.1 g [95%CI -8.5; -5.7] and OR 1.04 [95%CI 1.02; 1.05], respectively, per 10 µg/m3 increase in PM10). Similar results were found for PM2.5, in particular for levels above 10 µg/m3. These associations were stronger in infants born to mothers with lower education, particularly when combined with residence in more deprived areas. We observed some windows of susceptibility to PM10 for birthweight, mainly in the third trimester of pregnancy, with a similar pattern across socioeconomic levels. We did not observe windows of susceptibility to PM2.5. Structural policies to reduce exposure to current PM levels in pregnant women and socioeconomic inequalities are needed.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"20 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-24DOI: 10.1007/s10654-025-01276-z
Peter Alping,Thomas Frisell,Anna He,Jan Hillert,Katharina Fink,Kyla A McKay
The Swedish Multiple Sclerosis (MS) Register is a nationwide clinical tool and research database. Its generalizability to the broader MS population has not been previously assessed. We aimed to quantify the register's completeness and potential disparities between those who were included and those who were not. Using linked national registers, we identified persons with MS through December 2020 as those with ≥ 3 MS diagnoses in the National Patient Register. We assessed the MS register's completeness and compared characteristics between included and non-included persons, using overlap weighting to account for age differences. Among 21,320 prevalent (2020) and 7,355 incident (2011-2020) MS cases, the completeness of the MS register was 85% and 87%, respectively, but varied by county (67-94% in 2020). Prevalent cases not included in the register were older (mean 62.4 vs. 52.3 years) and more likely to have no salaried income (55.3% vs. 30.5%); had fewer years of education (20.8% vs. 12.0% with ≤ 9 years); more often been hospitalized (41.5% vs. 32.2%); and collected more unique prescribed drugs (median 7 vs. 5 drugs per year). Incident cases were also older at first MS diagnosis (mean 50.3 vs. 39.2 years). All differences were attenuated by adjusting for age, although disparities remained. The Swedish MS Register demonstrates high completeness, but may not fully represent older persons with MS, those diagnosed later in life, and those of lower socioeconomic status. These limitations should be considered when interpreting findings based on the register's data.
{"title":"Completeness and generalizability of the Swedish MS register.","authors":"Peter Alping,Thomas Frisell,Anna He,Jan Hillert,Katharina Fink,Kyla A McKay","doi":"10.1007/s10654-025-01276-z","DOIUrl":"https://doi.org/10.1007/s10654-025-01276-z","url":null,"abstract":"The Swedish Multiple Sclerosis (MS) Register is a nationwide clinical tool and research database. Its generalizability to the broader MS population has not been previously assessed. We aimed to quantify the register's completeness and potential disparities between those who were included and those who were not. Using linked national registers, we identified persons with MS through December 2020 as those with ≥ 3 MS diagnoses in the National Patient Register. We assessed the MS register's completeness and compared characteristics between included and non-included persons, using overlap weighting to account for age differences. Among 21,320 prevalent (2020) and 7,355 incident (2011-2020) MS cases, the completeness of the MS register was 85% and 87%, respectively, but varied by county (67-94% in 2020). Prevalent cases not included in the register were older (mean 62.4 vs. 52.3 years) and more likely to have no salaried income (55.3% vs. 30.5%); had fewer years of education (20.8% vs. 12.0% with ≤ 9 years); more often been hospitalized (41.5% vs. 32.2%); and collected more unique prescribed drugs (median 7 vs. 5 drugs per year). Incident cases were also older at first MS diagnosis (mean 50.3 vs. 39.2 years). All differences were attenuated by adjusting for age, although disparities remained. The Swedish MS Register demonstrates high completeness, but may not fully represent older persons with MS, those diagnosed later in life, and those of lower socioeconomic status. These limitations should be considered when interpreting findings based on the register's data.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"277 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-19DOI: 10.1007/s10654-025-01275-0
Lihuan Guan,Lei Feng,Anderson Li Yang Khoo,Kaisy Xinhong Ye,Roger Ho,Tze Pin Ng,Anis Larbi,Brian K Kennedy,Woon-Puay Koh,Yap Seng Chong,Andrea B Maier
The global population is ageing rapidly. While genetics, lifestyle, and environment are known contributors to healthspan, most insights are drawn from Western cohorts, leaving Asian populations underrepresented despite unique biological, lifestyle, and cultural factors. The SG90 cohort study aimed to fill knowledge gaps in healthy ageing by identifying modifiable medical, biological, lifestyle, psychological, behavioural, and social factors that contribute to longevity in the oldest-old. The study recruited 1,158 participants aged 85 and above from the Singapore Chinese Health Study (SCHS) and Singapore Longitudinal Aging Study (SLAS) between 2015 and 2021. Data collection involved face-to-face interviews to obtain sociodemographic, lifestyle, sleep, functional status, quality of life, medical conditions and healthcare economics information, along with clinical assessments covering physical examinations, anthropometry, physical performance, cognition, and mental health. Biospecimens, including blood, saliva, stool, urine, toenails, hair, and skin tape strips were collected to support extensive multi-omic and cellular analyses. Participants, primarily female (64.5%) and Chinese (97.5%) with a median age of 87 years [interquartile range (IQR): 86-89], were mostly non-smokers (72.1%) and infrequent alcohol consumers (94.9%), with 66.5% exercising regularly. Functional assessments indicate high independence, with median Basic activities of daily living (BADL) and Instrumental ADL (IADL) scores of 20 (IQR: 19-20) and 14 (IQR: 11-16), respectively. 36% of participants rated their self-reported health as good to excellent. The SG90 cohort study offers a comprehensive clinical and biological data resource on healthy ageing among Asia's oldest-old, laying a foundation for targeted interventions to promote healthy longevity and quality of life.
{"title":"The SG90 cohort of the oldest-old in Singapore.","authors":"Lihuan Guan,Lei Feng,Anderson Li Yang Khoo,Kaisy Xinhong Ye,Roger Ho,Tze Pin Ng,Anis Larbi,Brian K Kennedy,Woon-Puay Koh,Yap Seng Chong,Andrea B Maier","doi":"10.1007/s10654-025-01275-0","DOIUrl":"https://doi.org/10.1007/s10654-025-01275-0","url":null,"abstract":"The global population is ageing rapidly. While genetics, lifestyle, and environment are known contributors to healthspan, most insights are drawn from Western cohorts, leaving Asian populations underrepresented despite unique biological, lifestyle, and cultural factors. The SG90 cohort study aimed to fill knowledge gaps in healthy ageing by identifying modifiable medical, biological, lifestyle, psychological, behavioural, and social factors that contribute to longevity in the oldest-old. The study recruited 1,158 participants aged 85 and above from the Singapore Chinese Health Study (SCHS) and Singapore Longitudinal Aging Study (SLAS) between 2015 and 2021. Data collection involved face-to-face interviews to obtain sociodemographic, lifestyle, sleep, functional status, quality of life, medical conditions and healthcare economics information, along with clinical assessments covering physical examinations, anthropometry, physical performance, cognition, and mental health. Biospecimens, including blood, saliva, stool, urine, toenails, hair, and skin tape strips were collected to support extensive multi-omic and cellular analyses. Participants, primarily female (64.5%) and Chinese (97.5%) with a median age of 87 years [interquartile range (IQR): 86-89], were mostly non-smokers (72.1%) and infrequent alcohol consumers (94.9%), with 66.5% exercising regularly. Functional assessments indicate high independence, with median Basic activities of daily living (BADL) and Instrumental ADL (IADL) scores of 20 (IQR: 19-20) and 14 (IQR: 11-16), respectively. 36% of participants rated their self-reported health as good to excellent. The SG90 cohort study offers a comprehensive clinical and biological data resource on healthy ageing among Asia's oldest-old, laying a foundation for targeted interventions to promote healthy longevity and quality of life.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"47 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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