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}
Yachen Zhu, Carolin Kilian, Julia Lemp, Laura Llamosas-Falcón, Charlotte Probst
Background Smoking and obesity are important modifiable risk factors for ischemic heart disease (IHD), often clustering within the same individuals. Previous US studies showed mixed findings regarding their interaction effects on IHD mortality and only investigated the question on the multiplicative scale, while additive scale is better suited to inform public health interventions. Methods We linked the 1997–2018 National Health Interview Survey data to the 2019 National Death Index. A total of 579 503 adults aged 18 years and older were included. Mortality status or last presumed alive was assessed until 31 December 2019. We used Aalen’s additive hazards models and calculated the relative excess risk due to interaction (RERI) from Cox proportional hazards models and Fine-Gray subdistribution models that accounted for competing risks to comprehensively evaluate the interaction effect of smoking with obesity on IHD mortality. Results During 10.4 years of follow-up on average, 13 231 IHD deaths occurred. The weighted mortality rate was 177.0 (95% CI: 172.3–181.7) per 100 000 person-years (PY). The combination of current everyday smoking and obesity was associated with 55.56 (95% CI: 30.37–80.74) additional deaths per 100 000 PY compared to the sum of their individual effects. This additive interaction was supported by multiplicative interactions (HR = 1.19, 1.03–1.39; HR = 1.40, 1.22–1.59) and large RERIs of 1.00 (0.59–1.40) and 0.85 (0.6–1.09) from the Cox and Fine-Gray models, respectively. Conclusions Our findings highlight the importance of evaluating interactions on multiple scales, which reduces scale-dependence of the interaction effect and can translate better into public health strategies.
{"title":"Additive interactions of smoking with obesity on ischemic heart disease mortality: a national prospective cohort study in the United States","authors":"Yachen Zhu, Carolin Kilian, Julia Lemp, Laura Llamosas-Falcón, Charlotte Probst","doi":"10.1093/ije/dyaf190","DOIUrl":"https://doi.org/10.1093/ije/dyaf190","url":null,"abstract":"Background Smoking and obesity are important modifiable risk factors for ischemic heart disease (IHD), often clustering within the same individuals. Previous US studies showed mixed findings regarding their interaction effects on IHD mortality and only investigated the question on the multiplicative scale, while additive scale is better suited to inform public health interventions. Methods We linked the 1997–2018 National Health Interview Survey data to the 2019 National Death Index. A total of 579 503 adults aged 18 years and older were included. Mortality status or last presumed alive was assessed until 31 December 2019. We used Aalen’s additive hazards models and calculated the relative excess risk due to interaction (RERI) from Cox proportional hazards models and Fine-Gray subdistribution models that accounted for competing risks to comprehensively evaluate the interaction effect of smoking with obesity on IHD mortality. Results During 10.4 years of follow-up on average, 13 231 IHD deaths occurred. The weighted mortality rate was 177.0 (95% CI: 172.3–181.7) per 100 000 person-years (PY). The combination of current everyday smoking and obesity was associated with 55.56 (95% CI: 30.37–80.74) additional deaths per 100 000 PY compared to the sum of their individual effects. This additive interaction was supported by multiplicative interactions (HR = 1.19, 1.03–1.39; HR = 1.40, 1.22–1.59) and large RERIs of 1.00 (0.59–1.40) and 0.85 (0.6–1.09) from the Cox and Fine-Gray models, respectively. Conclusions Our findings highlight the importance of evaluating interactions on multiple scales, which reduces scale-dependence of the interaction effect and can translate better into public health strategies.","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"47 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145478325","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}
Wenzhong Huang, Rongbin Xu, Yao Wu, Zhengyu Yang, Ee Ming Wong, Melissa C Southey, John L Hopper, Michael J Abramson, Elizabeth A Ritchie, Shanshan Li, Shuai Li, Yuming Guo
Background Weather-related disasters are devastating and may exhibit greater intensity globally under a changing climate, leaving survivors with greater and sustained health risks. However, the potential epigenetic mechanisms underlying the persistent adverse health impacts remain unclear. We aimed to examine the association between tropical cyclones (TCs) or flood exposure and biological aging based on DNA methylation. Methods We analysed peripheral blood samples from 479 women in 130 families across Australia and derived six metrics of DNA methylation age acceleration (DNAmAgeAC) for each participant, including Horvath’s, Hannum’s, and Zhang’s DNAmAge, PhenoAge, and GrimAge versions 1 (GrimAge1) and 2 (GrimAge2). Linear mixed-effect and distributed lag nonlinear models accounting for familial clustering and delayed effects were used to estimate the DNAmAgeAC associated with TCs or flood exposure. Results TCs or flood exposures were generally associated with higher DNAmAgeAC of various metrics, which persisted for ≤6 months after exposure. Overall, participants exposed to TCs or floods had higher DNAmAgeAC based on Horvath’s age [2.66 years, 95% confidence interval (CI): –2.94 to 8.27; P = .357], Hannum’s age (6.81 years, 95% CI: 1.75–11.88; P = .008), PhenoAge (8.96 years, 95% CI: 2.35–15.57; P = .008), Zhang’s age (0.93 years, 95% CI: –0.56 to 2.42; P = .224), GrimAge1 (2.60 years, 95% CI: –0.64 to 5.83; P = .115), and GrimAge2 (4.31 years, 95% CI: 0.52–8.09; P = .026). Socioeconomic status, age, smoking, and drinking behaviors modified the associations, with generally stronger adverse associations observed among the participants living in lower socioeconomic areas, <60 years of age, with higher smoking indices, or being current/former drinkers. The adverse associations were partially mediated by a shift in leucocyte distributions, particularly the change in the proportions of naive CD8+ T cells, exhausted cytotoxic CD8+ T cells, and granulocytes. Conclusion TC or flood exposures were associated with accelerated biological aging measured by using DNA methylation in Australian women, especially for those living in lower socioeconomic areas, <60 years of age, who were more smokers or drinkers. The accelerated aging may be partially contributed by the potential infections and alterations in the immune status in human bodies after climate-related disasters.
与天气有关的灾害具有破坏性，在气候变化的情况下，可能在全球范围内表现出更大的强度，使幸存者面临更大和持续的健康风险。然而，潜在的表观遗传机制的持续不利的健康影响仍不清楚。我们的目的是研究热带气旋（tc）或洪水暴露与基于DNA甲基化的生物衰老之间的关系。我们分析了来自澳大利亚130个家庭的479名女性的外周血样本，并为每位参与者获得了6个DNA甲基化年龄加速（DNAmAgeAC）指标，包括Horvath、Hannum和Zhang的DNAmAge、PhenoAge和GrimAge版本1 （GrimAge1）和2 （GrimAge2）。考虑家族聚类和延迟效应的线性混合效应和分布滞后非线性模型被用于估计与tc或洪水暴露相关的DNAmAgeAC。结果TCs或洪水暴露通常与各种指标的较高DNAmAgeAC相关，并持续暴露后≤6个月。总体而言，暴露于tc或洪水的参与者具有更高的基于Horvath年龄的DNAmAgeAC[2.66岁，95%置信区间（CI）： -2.94至8.27；Hannum年龄（6.81岁，95% CI: 1.75 ~ 11.88; P = 0.008）、PhenoAge年龄（8.96岁，95% CI: 2.35 ~ 15.57; P = 0.008）、Zhang年龄（0.93岁，95% CI: -0.56 ~ 2.42; P = 0.224）、GrimAge1年龄（2.60岁，95% CI: -0.64 ~ 5.83; P = 0.115）、GrimAge2年龄（4.31岁，95% CI: 0.52 ~ 8.09; P = 0.026）。社会经济地位、年龄、吸烟和饮酒行为改变了这种关联，生活在社会经济地位较低地区的参与者通常观察到更强的不良关联。60岁以上，吸烟指数较高，或目前或曾经饮酒者。这些不良关联部分是由白细胞分布的变化介导的，特别是幼稚CD8+ T细胞、耗尽的细胞毒性CD8+ T细胞和粒细胞比例的变化。结论：通过DNA甲基化测量，TC或洪水暴露与澳大利亚妇女的加速生物衰老有关，特别是那些生活在社会经济水平较低地区的妇女。60岁，吸烟者或饮酒者较多。气候灾害后人体潜在的感染和免疫状态的改变可能是加速衰老的部分原因。
{"title":"Climate-related disasters and biological aging based on DNA methylation: a twin and family study in Australian women","authors":"Wenzhong Huang, Rongbin Xu, Yao Wu, Zhengyu Yang, Ee Ming Wong, Melissa C Southey, John L Hopper, Michael J Abramson, Elizabeth A Ritchie, Shanshan Li, Shuai Li, Yuming Guo","doi":"10.1093/ije/dyaf189","DOIUrl":"https://doi.org/10.1093/ije/dyaf189","url":null,"abstract":"Background Weather-related disasters are devastating and may exhibit greater intensity globally under a changing climate, leaving survivors with greater and sustained health risks. However, the potential epigenetic mechanisms underlying the persistent adverse health impacts remain unclear. We aimed to examine the association between tropical cyclones (TCs) or flood exposure and biological aging based on DNA methylation. Methods We analysed peripheral blood samples from 479 women in 130 families across Australia and derived six metrics of DNA methylation age acceleration (DNAmAgeAC) for each participant, including Horvath’s, Hannum’s, and Zhang’s DNAmAge, PhenoAge, and GrimAge versions 1 (GrimAge1) and 2 (GrimAge2). Linear mixed-effect and distributed lag nonlinear models accounting for familial clustering and delayed effects were used to estimate the DNAmAgeAC associated with TCs or flood exposure. Results TCs or flood exposures were generally associated with higher DNAmAgeAC of various metrics, which persisted for ≤6 months after exposure. Overall, participants exposed to TCs or floods had higher DNAmAgeAC based on Horvath’s age [2.66 years, 95% confidence interval (CI): –2.94 to 8.27; P = .357], Hannum’s age (6.81 years, 95% CI: 1.75–11.88; P = .008), PhenoAge (8.96 years, 95% CI: 2.35–15.57; P = .008), Zhang’s age (0.93 years, 95% CI: –0.56 to 2.42; P = .224), GrimAge1 (2.60 years, 95% CI: –0.64 to 5.83; P = .115), and GrimAge2 (4.31 years, 95% CI: 0.52–8.09; P = .026). Socioeconomic status, age, smoking, and drinking behaviors modified the associations, with generally stronger adverse associations observed among the participants living in lower socioeconomic areas, &lt;60 years of age, with higher smoking indices, or being current/former drinkers. The adverse associations were partially mediated by a shift in leucocyte distributions, particularly the change in the proportions of naive CD8+ T cells, exhausted cytotoxic CD8+ T cells, and granulocytes. Conclusion TC or flood exposures were associated with accelerated biological aging measured by using DNA methylation in Australian women, especially for those living in lower socioeconomic areas, &lt;60 years of age, who were more smokers or drinkers. The accelerated aging may be partially contributed by the potential infections and alterations in the immune status in human bodies after climate-related disasters.","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"69 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145478326","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}
Yohanna Idsabella Rossi, Gabriel Bolner, Fabiana Dolovitsch de Oliveira, Jonathan Costa Dall’Acqua, Vânio Antunes do Livramento Junior, Cícero Armídio Gomes Dias
Background There is no consensus on the efficacy of Bacillus Calmette–Guérin (BCG) revaccination. Because of this, we aimed to compare the effect of BCG revaccination with no revaccination in preventing tuberculosis (TB) disease. Methods We searched PubMed, Embase, and the Cochrane Library databases from inception to December of 2023 for studies that compared BCG revaccination with no revaccination or placebo for this systematic review and meta-analysis. Outcomes of interest were incidence of TB disease, pulmonary TB and extrapulmonary TB. We pooled odds ratios (ORs) with 95% confidence interval (CI) using a random-effects model in R statistical software version 4.3.1. Heterogeneity was assessed with I2 statistics. Results Five studies, involving 1 012 007 patients, of whom 501 597 (49.56%) were revaccinated with BCG, were included in the meta-analysis. There was a benefit in tuberculosis disease incidence in patients who received revaccination compared to patients who did not (OR 0.89; 95% CI: 0.81–0.98; P = .019; I2 = 53%) in the randomized controlled trials. When including observational studies, we found the same trend (OR 0.90; 95% CI: 0.77–1.05; P = .124; I2 = 26%) as well as in preventing against both extrapulmonary (OR 0.82; 95% CI: 0.38–1.76; P = .375; I2 = 24%) and pulmonary (OR 0.93; 95% CI: 0.86–1.01; P = .062; I2 = 0%) cases. Conclusions BCG revaccination was associated with a slight decrease in the incidence of tuberculosis, pulmonary tuberculosis, and extrapulmonary tuberculosis.
{"title":"Efficacy of Bacillus Calmette–Guérin revaccination in preventing tuberculosis disease: a systematic review and meta-analysis","authors":"Yohanna Idsabella Rossi, Gabriel Bolner, Fabiana Dolovitsch de Oliveira, Jonathan Costa Dall’Acqua, Vânio Antunes do Livramento Junior, Cícero Armídio Gomes Dias","doi":"10.1093/ije/dyaf186","DOIUrl":"https://doi.org/10.1093/ije/dyaf186","url":null,"abstract":"Background There is no consensus on the efficacy of Bacillus Calmette–Guérin (BCG) revaccination. Because of this, we aimed to compare the effect of BCG revaccination with no revaccination in preventing tuberculosis (TB) disease. Methods We searched PubMed, Embase, and the Cochrane Library databases from inception to December of 2023 for studies that compared BCG revaccination with no revaccination or placebo for this systematic review and meta-analysis. Outcomes of interest were incidence of TB disease, pulmonary TB and extrapulmonary TB. We pooled odds ratios (ORs) with 95% confidence interval (CI) using a random-effects model in R statistical software version 4.3.1. Heterogeneity was assessed with I2 statistics. Results Five studies, involving 1 012 007 patients, of whom 501 597 (49.56%) were revaccinated with BCG, were included in the meta-analysis. There was a benefit in tuberculosis disease incidence in patients who received revaccination compared to patients who did not (OR 0.89; 95% CI: 0.81–0.98; P = .019; I2 = 53%) in the randomized controlled trials. When including observational studies, we found the same trend (OR 0.90; 95% CI: 0.77–1.05; P = .124; I2 = 26%) as well as in preventing against both extrapulmonary (OR 0.82; 95% CI: 0.38–1.76; P = .375; I2 = 24%) and pulmonary (OR 0.93; 95% CI: 0.86–1.01; P = .062; I2 = 0%) cases. Conclusions BCG revaccination was associated with a slight decrease in the incidence of tuberculosis, pulmonary tuberculosis, and extrapulmonary tuberculosis.","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"10 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472703","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}
Etienne X Holder, Raphael Szalat, Julie R Palmer, Kimberly A Bertrand
Background Black Americans have a >2-fold increased risk of multiple myeloma (MM) compared with other racial/ethnic groups. The underlying biological and environmental mechanisms contributing to this disparity remain poorly understood. Emerging evidence suggests that social and economic factors associated with neighborhoods may influence risk. Methods We evaluated associations between two neighborhood-level indices by measuring deprivation and socioeconomic status and MM within the Black Women’s Health Study—a prospective cohort of 59 000 Black women established in 1995. Participant addresses at baseline and over follow-up were geocoded and linked with United States Census Bureau data. We used Cox proportional hazards regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of neighborhood indices, categorized into quartiles, and MM incidence. Multivariable models were adjusted for age, body mass index, educational attainment, alcohol consumption, physical activity, cigarette smoking, and geographic region. Results During follow-up through 2021, we identified 276 incident MM cases. In time-varying age-adjusted models, women living in areas of high disadvantage (vs lowest) and low socioeconomic status (vs highest) had a higher incidence of MM than women living in areas of privilege (multivariable HR: 1.48, 95% CI: 1.02, 2.13; HR: 1.28, 95% CI: 0.87, 1.90, respectively). Conclusion Black women living in neighborhoods of high concentrated disadvantage or low socioeconomic status have an increased MM risk. Future studies to identify specific neighborhood-level factors that might influence the risk of MM would be beneficial. Ultimately, community reinvestment may offer an opportunity to reduce the increasing burden of MM among Black women.
{"title":"Neighborhood disadvantage and multiple myeloma incidence in the Black Women’s Health Study","authors":"Etienne X Holder, Raphael Szalat, Julie R Palmer, Kimberly A Bertrand","doi":"10.1093/ije/dyaf188","DOIUrl":"https://doi.org/10.1093/ije/dyaf188","url":null,"abstract":"Background Black Americans have a &gt;2-fold increased risk of multiple myeloma (MM) compared with other racial/ethnic groups. The underlying biological and environmental mechanisms contributing to this disparity remain poorly understood. Emerging evidence suggests that social and economic factors associated with neighborhoods may influence risk. Methods We evaluated associations between two neighborhood-level indices by measuring deprivation and socioeconomic status and MM within the Black Women’s Health Study—a prospective cohort of 59 000 Black women established in 1995. Participant addresses at baseline and over follow-up were geocoded and linked with United States Census Bureau data. We used Cox proportional hazards regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of neighborhood indices, categorized into quartiles, and MM incidence. Multivariable models were adjusted for age, body mass index, educational attainment, alcohol consumption, physical activity, cigarette smoking, and geographic region. Results During follow-up through 2021, we identified 276 incident MM cases. In time-varying age-adjusted models, women living in areas of high disadvantage (vs lowest) and low socioeconomic status (vs highest) had a higher incidence of MM than women living in areas of privilege (multivariable HR: 1.48, 95% CI: 1.02, 2.13; HR: 1.28, 95% CI: 0.87, 1.90, respectively). Conclusion Black women living in neighborhoods of high concentrated disadvantage or low socioeconomic status have an increased MM risk. Future studies to identify specific neighborhood-level factors that might influence the risk of MM would be beneficial. Ultimately, community reinvestment may offer an opportunity to reduce the increasing burden of MM among Black women.","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":"80 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472873","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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