Mariangela F Silveira,Otávio Leão,Julio Croda,Eder Gatti,Ethel Maciel,Nisia T Lima,Fernando Vinholes Siqueira,Pedro C Hallal,Cesar G Victora
This nationwide cross-sectional survey in Brazil investigated COVID-19 and influenza vaccination coverage and inequalities. Data from 33 250 interviews conducted between March and June 2024 in 133 sentinel cities revealed high overall coverage: 90.2% for at least one dose of COVID-19 vaccine and 82.6% for influenza. However, significant disparities emerged. COVID-19 vaccination coverage increased with age, was higher among women and Whites, and strongly associated with higher education levels and wealth. Influenza vaccine coverage showed a U-shaped pattern by age and was lower among evangelicals compared with Catholics. Geographic variations were observed, with the Southeast region exhibiting the highest coverage and the North and Center-West the lowest. Co-coverage analysis indicated that 76.7% of participants received both vaccines. Reasons for non-vaccination included lack of belief in vaccine efficacy, concerns about side effects, and lack of access to healthcare. The findings highlight the need for targeted public health interventions to address vaccine hesitancy and inequalities in access, particularly focusing on specific subgroups such as evangelicals, Indigenous populations, and individuals with lower socioeconomic status.
{"title":"Coverage and inequalities in COVID-19 and influenza vaccination in Brazil: a nationwide cross-sectional survey.","authors":"Mariangela F Silveira,Otávio Leão,Julio Croda,Eder Gatti,Ethel Maciel,Nisia T Lima,Fernando Vinholes Siqueira,Pedro C Hallal,Cesar G Victora","doi":"10.1093/ije/dyaf105","DOIUrl":"https://doi.org/10.1093/ije/dyaf105","url":null,"abstract":"This nationwide cross-sectional survey in Brazil investigated COVID-19 and influenza vaccination coverage and inequalities. Data from 33 250 interviews conducted between March and June 2024 in 133 sentinel cities revealed high overall coverage: 90.2% for at least one dose of COVID-19 vaccine and 82.6% for influenza. However, significant disparities emerged. COVID-19 vaccination coverage increased with age, was higher among women and Whites, and strongly associated with higher education levels and wealth. Influenza vaccine coverage showed a U-shaped pattern by age and was lower among evangelicals compared with Catholics. Geographic variations were observed, with the Southeast region exhibiting the highest coverage and the North and Center-West the lowest. Co-coverage analysis indicated that 76.7% of participants received both vaccines. Reasons for non-vaccination included lack of belief in vaccine efficacy, concerns about side effects, and lack of access to healthcare. The findings highlight the need for targeted public health interventions to address vaccine hesitancy and inequalities in access, particularly focusing on specific subgroups such as evangelicals, Indigenous populations, and individuals with lower socioeconomic status.","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"20 1","pages":"i22-i30"},"PeriodicalIF":7.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771487","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":"Using an epidemiological lens to evaluate the impacts of COVID-19 in Brazil.","authors":"Pedro C Hallal,Cesar G Victora","doi":"10.1093/ije/dyaf199","DOIUrl":"https://doi.org/10.1093/ije/dyaf199","url":null,"abstract":"","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"24 1","pages":"i41-i43"},"PeriodicalIF":7.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771489","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}
Cleber Vinicius Brito Dos Santos,Lara Esteves Coelho,Paula Mendes Luz,Guilherme Tegoni Goedert,Daniel Csillag,Juliano Gennari,Otávio Amaral de Andrade Leão,Cauane Blumenberg,Fernando Vinholes Siqueira,Dalva Maria de Assis,Aline Maria de Souza da Silva,Greice Madeleine Ikeda do Carmo,Fernando Celso Barros,Claudio José Struchiner,Cesar Gomes Victora,Pedro Curi Hallal
BACKGROUNDPopulation-based data on COVID-19's impact are essential for informing public health policies, particularly in low- and middle-income countries. Here, we investigated the history of COVID-19 diagnoses across the Brazilian population, considering factors such as sex, age, skin colour/ethnicity, comorbidity, schooling, and socioeconomic level.METHODSIn this nationwide study, EPICOVID 2.0, we surveyed 133 cities in all Brazilian states between March and June 2024. We randomly selected 250 households per city and one individual from each household. Crude and adjusted prevalence ratios were calculated to examine the association between covariates and self-reports of prior COVID-19 diagnoses and hospitalizations, and odds ratios to assess the factors associated with the higher number of COVID-19 episodes.RESULTSOur analysis of 33 250 individuals revealed that 28.6% [95% confidence interval (CI), 27.3-29.9] of the study population had a previous COVID-19 diagnosis, with most of those reported presenting one episode (77.7%), followed by two (17.3%) and three episodes (5.0%). We observed a positive association between higher educational attainment and wealth quintiles and self-reported COVID-19 diagnoses. We also found that women presented a higher COVID-19 prevalence. About 4.5% (95% CI, 3.8-5.2) of participants who reported previous COVID-19 were hospitalized, with an average length of stay of 10.4 days. We did not find a difference in the prevalence of hospitalizations between socioeconomic strata. We observed that those who experienced two or more COVID-19 episodes had three times higher odds of being hospitalized.CONCLUSIONThese findings highlight significant disparities in the COVID-19 impact across socioeconomic and demographic groups in Brazil, underscoring the need for targeted public health interventions to address vulnerabilities and reduce the COVID-19 burden in Brazil.
{"title":"History of self-reported COVID-19 cases and hospitalizations in the Brazilian population: a countrywide survey.","authors":"Cleber Vinicius Brito Dos Santos,Lara Esteves Coelho,Paula Mendes Luz,Guilherme Tegoni Goedert,Daniel Csillag,Juliano Gennari,Otávio Amaral de Andrade Leão,Cauane Blumenberg,Fernando Vinholes Siqueira,Dalva Maria de Assis,Aline Maria de Souza da Silva,Greice Madeleine Ikeda do Carmo,Fernando Celso Barros,Claudio José Struchiner,Cesar Gomes Victora,Pedro Curi Hallal","doi":"10.1093/ije/dyaf153","DOIUrl":"https://doi.org/10.1093/ije/dyaf153","url":null,"abstract":"BACKGROUNDPopulation-based data on COVID-19's impact are essential for informing public health policies, particularly in low- and middle-income countries. Here, we investigated the history of COVID-19 diagnoses across the Brazilian population, considering factors such as sex, age, skin colour/ethnicity, comorbidity, schooling, and socioeconomic level.METHODSIn this nationwide study, EPICOVID 2.0, we surveyed 133 cities in all Brazilian states between March and June 2024. We randomly selected 250 households per city and one individual from each household. Crude and adjusted prevalence ratios were calculated to examine the association between covariates and self-reports of prior COVID-19 diagnoses and hospitalizations, and odds ratios to assess the factors associated with the higher number of COVID-19 episodes.RESULTSOur analysis of 33 250 individuals revealed that 28.6% [95% confidence interval (CI), 27.3-29.9] of the study population had a previous COVID-19 diagnosis, with most of those reported presenting one episode (77.7%), followed by two (17.3%) and three episodes (5.0%). We observed a positive association between higher educational attainment and wealth quintiles and self-reported COVID-19 diagnoses. We also found that women presented a higher COVID-19 prevalence. About 4.5% (95% CI, 3.8-5.2) of participants who reported previous COVID-19 were hospitalized, with an average length of stay of 10.4 days. We did not find a difference in the prevalence of hospitalizations between socioeconomic strata. We observed that those who experienced two or more COVID-19 episodes had three times higher odds of being hospitalized.CONCLUSIONThese findings highlight significant disparities in the COVID-19 impact across socioeconomic and demographic groups in Brazil, underscoring the need for targeted public health interventions to address vulnerabilities and reduce the COVID-19 burden in Brazil.","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"17 1","pages":"i1-i12"},"PeriodicalIF":7.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771565","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}
Lucia Campos Pellanda,Bernardo Horta,Deanívea Félix,Eucilene Alves Santana,Simone Vivaldini,Fernando Vinholes Siqueira,Cesar G Victora,Pedro C Hallal
BACKGROUNDThe COVID-19 pandemic imposed a substantial disease burden, yet few population-based studies assessed its long-term impacts on families. This study estimated the pandemic's impact on family income, employment, school interruption, food insecurity, and death of family members in Brazil.METHODSPopulation-based household survey with 33.250 participants from 133 large cities in Brazil during May and June 2024. Households were selected using a multistage probability sampling design in each city.RESULTSAmong respondents, 14.7% [95% confidence interval (CI):13.8%; 15.6%] reported the death of a family member due to COVID-19; 48.6% (95% CI: 47.1%; 50.1%) experienced reductions in family income; 34.9% (95% CI: 33.4%; 36.4%) reported that at least one family member stopped working; in 21.5% (95% CI: 20.1%; 22.9%) of families, at least one member interrupted studies; and 47.4% (95% CI: 45.9%; 48.8%) experienced food insecurity during the pandemic. These outcomes were more frequent among families with low income and with six or more members, except for the death of a family member, which was more commonly reported in households with higher incomes and educational levels. Job losses, interruption of studies, and food insecurity were more common in families led by women. Indigenous people experienced a high prevalence of food insecurity.CONCLUSIONThe COVID-19 pandemic exacerbated social and economic inequalities, with most impacts disproportionately affecting the poorest families, those led by women, and indigenous people. Conversely, the death of a relative was more commonly reported among the wealthiest families that include a larger number of older members.
{"title":"Impacts of the COVID-19 pandemic on Brazilian families: a countrywide population-based survey.","authors":"Lucia Campos Pellanda,Bernardo Horta,Deanívea Félix,Eucilene Alves Santana,Simone Vivaldini,Fernando Vinholes Siqueira,Cesar G Victora,Pedro C Hallal","doi":"10.1093/ije/dyaf135","DOIUrl":"https://doi.org/10.1093/ije/dyaf135","url":null,"abstract":"BACKGROUNDThe COVID-19 pandemic imposed a substantial disease burden, yet few population-based studies assessed its long-term impacts on families. This study estimated the pandemic's impact on family income, employment, school interruption, food insecurity, and death of family members in Brazil.METHODSPopulation-based household survey with 33.250 participants from 133 large cities in Brazil during May and June 2024. Households were selected using a multistage probability sampling design in each city.RESULTSAmong respondents, 14.7% [95% confidence interval (CI):13.8%; 15.6%] reported the death of a family member due to COVID-19; 48.6% (95% CI: 47.1%; 50.1%) experienced reductions in family income; 34.9% (95% CI: 33.4%; 36.4%) reported that at least one family member stopped working; in 21.5% (95% CI: 20.1%; 22.9%) of families, at least one member interrupted studies; and 47.4% (95% CI: 45.9%; 48.8%) experienced food insecurity during the pandemic. These outcomes were more frequent among families with low income and with six or more members, except for the death of a family member, which was more commonly reported in households with higher incomes and educational levels. Job losses, interruption of studies, and food insecurity were more common in families led by women. Indigenous people experienced a high prevalence of food insecurity.CONCLUSIONThe COVID-19 pandemic exacerbated social and economic inequalities, with most impacts disproportionately affecting the poorest families, those led by women, and indigenous people. Conversely, the death of a relative was more commonly reported among the wealthiest families that include a larger number of older members.","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"1 1","pages":"i13-i21"},"PeriodicalIF":7.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771566","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}
Fernando C Wehrmeister,Ana M B Menezes,Margareth Dalcolmo,Elena C C Prendergast,Talita G S Batista,Otavio Amaral de Andrade Leão,Cauane Blumenberg,Fernando Vinholes Siqueira,Claudio J Struchiner,Cesar G Victora,Pedro C Hallal
BACKGROUNDThe COVID-19 pandemic had severe impacts worldwide. We assessed the occurrence of a post-COVID-19 condition (PCC) in Brazil and described the persistence of symptoms 4 years after the start of the pandemic.METHODSA population-based survey was carried out in 133 large cities in 2024. The current prevalence of 21 COVID-19-related symptoms was recorded for all respondents, regardless of infection history. The World Health Organization's definition of PCC was adopted. Results were described by country region and socio-demographic characteristics.RESULTSOf the 33 250 individuals sampled, 28.6% [95% confidence interval (CI) 27.3 to 30.0] reported having had COVID-19, of whom 65.1% (95% CI 62.7 to 67.4) fulfilled the criteria for PCC at any time in the past. Prevalence of PCC was highest among those who were hospitalized and needed intubation or oxygen support [85.3% (95% CI 79.6 to 89.7)]. The average number of current symptoms among those with PCC was 7.21 (95% CI 6.73 to 7.69) compared with 2.77 (95% CI 2.62 to 2.92) among those without a COVID-19 history. The most common symptoms for those with COVID-19 history were memory loss, anosmia, loss of sensitivity in the hands, difficulty in concentration, and hair loss. Women and Indigenous individuals presented a higher average number of symptoms compared with those without a history.CONCLUSIONA high proportion of individuals who suffered from COVID-19 presented symptoms 4 years after the SARS-CoV-2 emergence; almost two-thirds presented PCC. Population-based studies in different countries are necessary to better understand the epidemiology of this serious condition.
2019冠状病毒病大流行在全球范围内产生了严重影响。我们评估了巴西covid -19后状况（PCC）的发生情况，并描述了大流行开始后4年症状的持续情况。方法于2024年在133个大城市开展人口调查。无论感染史如何，所有应答者均记录了当前流行的21种covid -19相关症状。采用了世界卫生组织对PCC的定义。结果由国家、地区和社会人口特征描述。结果在33 250例样本中，28.6%[95%置信区间（CI） 27.3 ~ 30.0]报告曾感染COVID-19，其中65.1% （95% CI 62.7 ~ 67.4）在过去任何时间符合PCC标准。住院并需要插管或氧支持的患者PCC患病率最高[85.3% (95% CI 79.6 ~ 89.7)]。PCC患者目前出现症状的平均次数为7.21次（95% CI 6.73至7.69），而没有COVID-19病史的患者为2.77次（95% CI 2.62至2.92）。有COVID-19病史的人最常见的症状是记忆力丧失、嗅觉丧失、手部敏感性丧失、注意力不集中和脱发。与没有病史的人相比，妇女和土著个体出现的平均症状数量更高。结论SARS-CoV-2出现4年后出现症状的患者比例较高；近三分之二是PCC。为了更好地了解这种严重疾病的流行病学，有必要在不同国家开展基于人群的研究。
{"title":"A countrywide study on post-COVID-19 condition in Brazil: the Epicovid 2.0.","authors":"Fernando C Wehrmeister,Ana M B Menezes,Margareth Dalcolmo,Elena C C Prendergast,Talita G S Batista,Otavio Amaral de Andrade Leão,Cauane Blumenberg,Fernando Vinholes Siqueira,Claudio J Struchiner,Cesar G Victora,Pedro C Hallal","doi":"10.1093/ije/dyaf143","DOIUrl":"https://doi.org/10.1093/ije/dyaf143","url":null,"abstract":"BACKGROUNDThe COVID-19 pandemic had severe impacts worldwide. We assessed the occurrence of a post-COVID-19 condition (PCC) in Brazil and described the persistence of symptoms 4 years after the start of the pandemic.METHODSA population-based survey was carried out in 133 large cities in 2024. The current prevalence of 21 COVID-19-related symptoms was recorded for all respondents, regardless of infection history. The World Health Organization's definition of PCC was adopted. Results were described by country region and socio-demographic characteristics.RESULTSOf the 33 250 individuals sampled, 28.6% [95% confidence interval (CI) 27.3 to 30.0] reported having had COVID-19, of whom 65.1% (95% CI 62.7 to 67.4) fulfilled the criteria for PCC at any time in the past. Prevalence of PCC was highest among those who were hospitalized and needed intubation or oxygen support [85.3% (95% CI 79.6 to 89.7)]. The average number of current symptoms among those with PCC was 7.21 (95% CI 6.73 to 7.69) compared with 2.77 (95% CI 2.62 to 2.92) among those without a COVID-19 history. The most common symptoms for those with COVID-19 history were memory loss, anosmia, loss of sensitivity in the hands, difficulty in concentration, and hair loss. Women and Indigenous individuals presented a higher average number of symptoms compared with those without a history.CONCLUSIONA high proportion of individuals who suffered from COVID-19 presented symptoms 4 years after the SARS-CoV-2 emergence; almost two-thirds presented PCC. Population-based studies in different countries are necessary to better understand the epidemiology of this serious condition.","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"66 1","pages":"i31-i40"},"PeriodicalIF":7.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771486","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":"Social long COVID: impacts of the COVID-19 pandemic on public health and policy in Brazil.","authors":"Natalia Pasternak Taschner","doi":"10.1093/ije/dyaf196","DOIUrl":"https://doi.org/10.1093/ije/dyaf196","url":null,"abstract":"","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"27 1","pages":"i44-i45"},"PeriodicalIF":7.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771567","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":"EPICOVID-19 and EPICOVID 2.0: building knowledge on COVID-19 epidemiology during the pandemic in Brazil.","authors":"Ethel L N Maciel,Guilherme L Werneck,Nísia T Lima","doi":"10.1093/ije/dyaf198","DOIUrl":"https://doi.org/10.1093/ije/dyaf198","url":null,"abstract":"","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"7 1","pages":"i48-i49"},"PeriodicalIF":7.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771488","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}
Carolien C H M Maas, David M Kent, Avinash G Dinmohamed, David van Klaveren
Background Risk-based analyses are increasingly popular for understanding heterogeneous treatment effects (HTEs) in clinical trials. For time-to-event analyses, the assumption that high-risk patients benefit most on the clinically important absolute scale when hazard ratios (HRs) are constant across risk strata might not hold. Absolute treatment effects can be measured as either the risk difference (RD) at a given time point or the difference in the restricted mean survival time (ΔRMST), which aligns more closely with utilitarian medical decision-making frameworks. We examined risk-based HTE analyses strata in time-to-event analyses to identify the patterns of absolute HTE across risk strata and whether the ΔRMST may lead to better treatment decisions than the RD. Methods Using artificial and empirical time-to-event data, we compared the RD—the difference between Kaplan–Meier estimates at a certain time point—and the ΔRMST—the area between the Kaplan–Meier curves—across risk strata and show how these metrics can prioritize different subgroups for treatment. We explored scenarios involving constant HRs while varying both the overall event rates and the discrimination of the risk models. Results When event rates and discrimination were low, the RD and the ΔRMST increased monotonically, with high-risk patients benefitting more than low-risk patients. As the event rate increased and/or discrimination increased, a ‘sweet spot’ pattern emerged: intermediate-risk patients benefit more than low-risk and high-risk patients. When the RD was used, the ‘sweet spot’ pattern emerged, even in circumstances in which the ΔRMST increased across the risk groups, thus understating the benefit for higher-risk patients and potentially leading to treatment mistargeting. Conclusion The pattern of HTE characterized by the RD may diverge substantially from the ΔRMST, potentially leading to treatment mistargeting. Therefore, we recommend the ΔRMST for assessing the absolute HTE in time-to-event data.
{"title":"Diverging conclusions from risk difference and difference in restricted mean survival time in quantifying absolute treatment effect heterogeneity","authors":"Carolien C H M Maas, David M Kent, Avinash G Dinmohamed, David van Klaveren","doi":"10.1093/ije/dyaf191","DOIUrl":"https://doi.org/10.1093/ije/dyaf191","url":null,"abstract":"Background Risk-based analyses are increasingly popular for understanding heterogeneous treatment effects (HTEs) in clinical trials. For time-to-event analyses, the assumption that high-risk patients benefit most on the clinically important absolute scale when hazard ratios (HRs) are constant across risk strata might not hold. Absolute treatment effects can be measured as either the risk difference (RD) at a given time point or the difference in the restricted mean survival time (ΔRMST), which aligns more closely with utilitarian medical decision-making frameworks. We examined risk-based HTE analyses strata in time-to-event analyses to identify the patterns of absolute HTE across risk strata and whether the ΔRMST may lead to better treatment decisions than the RD. Methods Using artificial and empirical time-to-event data, we compared the RD—the difference between Kaplan–Meier estimates at a certain time point—and the ΔRMST—the area between the Kaplan–Meier curves—across risk strata and show how these metrics can prioritize different subgroups for treatment. We explored scenarios involving constant HRs while varying both the overall event rates and the discrimination of the risk models. Results When event rates and discrimination were low, the RD and the ΔRMST increased monotonically, with high-risk patients benefitting more than low-risk patients. As the event rate increased and/or discrimination increased, a ‘sweet spot’ pattern emerged: intermediate-risk patients benefit more than low-risk and high-risk patients. When the RD was used, the ‘sweet spot’ pattern emerged, even in circumstances in which the ΔRMST increased across the risk groups, thus understating the benefit for higher-risk patients and potentially leading to treatment mistargeting. Conclusion The pattern of HTE characterized by the RD may diverge substantially from the ΔRMST, potentially leading to treatment mistargeting. Therefore, we recommend the ΔRMST for assessing the absolute HTE in time-to-event data.","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"283 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619576","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}
Felix O Kumolalo, Iaroslav Youssim, Yechiel Friedlander, Hagit Hochner, Ronit Calderon-Margalit, Orly Manor, Ora Paltiel
Background While risks associated with congenital anomalies (CAs) in childhood are well documented, data on the long-term impact of CAs on adult mortality are lacking. We aimed to study mortality risks in adults born with CAs using the population-based Jerusalem Perinatal Study cohort. Methods Individuals born in 1964–1976 who attained 18 years of age were followed up until 2016 or date of death (median 27.5 years). We categorized anomalies by presence/absence, severity, multiplicity, and body system affected. Cox regression models were constructed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between CAs and all-cause mortality, adjusting for birth weight, delivery mode, maternal age, socioeconomic status at birth, maternal country of birth, and stratified by offspring sex and maternal education. Results Of the 91 459 live-born offspring, 2429 (2.7%) died before attaining age 18 years and 1454 (1.6%) died thereafter. Of 87 621 who survived to age 18, 5621 (6.4%) had CAs. Mortality was increased in those bearing any (adjusted HR (HRadj) = 1.53, CI: 1.29–1.83), single (HRadj = 1.51, CI: 1.27–1.81), severe (HRadj = 2.21, CI: 1.75–2.77), and moderate and severe malformations combined (HRadj = 2.19, CI: 1.09–4.40), when compared to individuals without anomalies. Additionally, adult mortality was increased in individuals with cardiovascular (HRadj = 4.81, CI: 2.15–10.70), gastrointestinal (HRadj = 2.74, CI: 1.47–5.11), and genitourinary anomalies (HRadj = 1.51, CI: 1.07–2.14). Conclusion Increased risks of premature mortality are observed in individuals with CA who reach adulthood and are modified by severity and the body system affected. Long-term and focused follow-up for adults with CAs is warranted.
{"title":"Mortality among individuals with congenital malformations who reach adulthood: long-term follow-up of the Jerusalem Perinatal Study cohort","authors":"Felix O Kumolalo, Iaroslav Youssim, Yechiel Friedlander, Hagit Hochner, Ronit Calderon-Margalit, Orly Manor, Ora Paltiel","doi":"10.1093/ije/dyaf194","DOIUrl":"https://doi.org/10.1093/ije/dyaf194","url":null,"abstract":"Background While risks associated with congenital anomalies (CAs) in childhood are well documented, data on the long-term impact of CAs on adult mortality are lacking. We aimed to study mortality risks in adults born with CAs using the population-based Jerusalem Perinatal Study cohort. Methods Individuals born in 1964–1976 who attained 18 years of age were followed up until 2016 or date of death (median 27.5 years). We categorized anomalies by presence/absence, severity, multiplicity, and body system affected. Cox regression models were constructed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between CAs and all-cause mortality, adjusting for birth weight, delivery mode, maternal age, socioeconomic status at birth, maternal country of birth, and stratified by offspring sex and maternal education. Results Of the 91 459 live-born offspring, 2429 (2.7%) died before attaining age 18 years and 1454 (1.6%) died thereafter. Of 87 621 who survived to age 18, 5621 (6.4%) had CAs. Mortality was increased in those bearing any (adjusted HR (HRadj) = 1.53, CI: 1.29–1.83), single (HRadj = 1.51, CI: 1.27–1.81), severe (HRadj = 2.21, CI: 1.75–2.77), and moderate and severe malformations combined (HRadj = 2.19, CI: 1.09–4.40), when compared to individuals without anomalies. Additionally, adult mortality was increased in individuals with cardiovascular (HRadj = 4.81, CI: 2.15–10.70), gastrointestinal (HRadj = 2.74, CI: 1.47–5.11), and genitourinary anomalies (HRadj = 1.51, CI: 1.07–2.14). Conclusion Increased risks of premature mortality are observed in individuals with CA who reach adulthood and are modified by severity and the body system affected. Long-term and focused follow-up for adults with CAs is warranted.","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"94 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515917","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}
Afroditi Kanellopoulou, Emmanouil Bouras, Andrew T Chan, Loïc Le Marchand, Alicja Wolk, Anna H Wu, Marc J Gunter, Katharina Nimptsch, Philip Haycock, Sarah J Lewis, Richard M Martin, Verena Zuber, Amanda I Phipps, Ulrike Peters, Fränzel J B Van Duijnhoven, Konstantinos K Tsilidis
Background Observational epidemiologic studies on the association of anthropometric traits and colorectal cancer (CRC) survival provide inconsistent results, and potential limitations prohibit the investigation of causality. We examined the associations between seven genetically predicted anthropometric traits [height, body mass index (BMI), waist circumference (WC), hip circumference (HC), waist–hip circumference ratio, birth weight and body fat percentage] and CRC-specific mortality among CRC cases using two-sample Mendelian randomization (MR). Methods Analyses were performed using 16 964 CRC cases, out of which 4010 died due to their disease, from the Genetics and Epidemiology of Colorectal Cancer Consortium and Colon Cancer Family Registry. We further conducted stratified analyses by anatomical site and stage. We applied the inverse variance weighted approach, and sensitivity analyses were conducted to assess the impact of potential violations of MR assumptions and adjust for collider bias. Results One standard deviation (SD 13.4 cm) higher genetically predicted levels of WC were associated with worse CRC survival [hazard ratio (HR); 1.22, 95% confidence interval (CI); 1.02–1.47]. Positive associations were further observed for a SD higher genetically predicted BMI (SD; 4.8 kg/m2, HR; 1.5, 95% CI; 1.15–1.95) and HC (SD; 9.2 cm, HR; 1.32, 95% CI; 1.02–1.73) and CRC-specific mortality in cases of stages II/III. The latter associations were generally robust to sensitivity analyses. Positive but imprecisely estimated associations were found for most other anthropometric traits. Conclusions Despite the limitations of cancer survival research, our findings support that CRC cases should avoid obesity. Further research should inform the development of recommendations targeting overweight/obesity management during cancer surveillance.
{"title":"Investigating the association between anthropometry and colorectal cancer survival: a two-sample Mendelian randomization analysis","authors":"Afroditi Kanellopoulou, Emmanouil Bouras, Andrew T Chan, Loïc Le Marchand, Alicja Wolk, Anna H Wu, Marc J Gunter, Katharina Nimptsch, Philip Haycock, Sarah J Lewis, Richard M Martin, Verena Zuber, Amanda I Phipps, Ulrike Peters, Fränzel J B Van Duijnhoven, Konstantinos K Tsilidis","doi":"10.1093/ije/dyaf193","DOIUrl":"https://doi.org/10.1093/ije/dyaf193","url":null,"abstract":"Background Observational epidemiologic studies on the association of anthropometric traits and colorectal cancer (CRC) survival provide inconsistent results, and potential limitations prohibit the investigation of causality. We examined the associations between seven genetically predicted anthropometric traits [height, body mass index (BMI), waist circumference (WC), hip circumference (HC), waist–hip circumference ratio, birth weight and body fat percentage] and CRC-specific mortality among CRC cases using two-sample Mendelian randomization (MR). Methods Analyses were performed using 16 964 CRC cases, out of which 4010 died due to their disease, from the Genetics and Epidemiology of Colorectal Cancer Consortium and Colon Cancer Family Registry. We further conducted stratified analyses by anatomical site and stage. We applied the inverse variance weighted approach, and sensitivity analyses were conducted to assess the impact of potential violations of MR assumptions and adjust for collider bias. Results One standard deviation (SD 13.4 cm) higher genetically predicted levels of WC were associated with worse CRC survival [hazard ratio (HR); 1.22, 95% confidence interval (CI); 1.02–1.47]. Positive associations were further observed for a SD higher genetically predicted BMI (SD; 4.8 kg/m2, HR; 1.5, 95% CI; 1.15–1.95) and HC (SD; 9.2 cm, HR; 1.32, 95% CI; 1.02–1.73) and CRC-specific mortality in cases of stages II/III. The latter associations were generally robust to sensitivity analyses. Positive but imprecisely estimated associations were found for most other anthropometric traits. Conclusions Despite the limitations of cancer survival research, our findings support that CRC cases should avoid obesity. Further research should inform the development of recommendations targeting overweight/obesity management during cancer surveillance.","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"185 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515892","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}
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