International journal of epidemiology最新文献_第5页

EPICOVID-19 and EPICOVID 2.0: building knowledge on COVID-19 epidemiology during the pandemic in Brazil. EPICOVID-19和EPICOVID 2.0：在巴西大流行期间建立COVID-19流行病学知识。

IF 7.7 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

International journal of epidemiology

Pub Date : 2026-01-01 DOI: 10.1093/ije/dyaf198

Ethel L N Maciel,Guilherme L Werneck,Nísia T Lima

引用次数: 0

Diverging conclusions from risk difference and difference in restricted mean survival time in quantifying absolute treatment effect heterogeneity 在量化绝对治疗效果异质性时，风险差异和限制平均生存时间差异的结论存在分歧

IF 7.7 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

International journal of epidemiology

Pub Date : 2025-11-27 DOI: 10.1093/ije/dyaf191

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.

在临床试验中，基于风险的分析在理解异质性治疗效果（HTEs）方面越来越受欢迎。对于事件时间分析，当风险比（hr）在各个风险层中保持不变时，高风险患者在临床重要的绝对尺度上获益最多的假设可能不成立。绝对治疗效果可以用给定时间点的风险差异（RD）或限制平均生存时间的差异（ΔRMST）来衡量，这与功利主义医疗决策框架更接近。我们在时间到事件分析中检验了基于风险的HTE分析层，以确定不同风险层的绝对HTE模式，以及ΔRMST是否可能比RD产生更好的治疗决策。我们比较了特定时间点Kaplan-Meier估计值之间的差异以及Kaplan-Meier曲线之间的ΔRMST-the区域，并展示了这些指标如何优先考虑不同的亚组进行治疗。我们探索了包括恒定hr的场景，同时改变了总体事件率和风险模型的区分。结果当事件发生率和歧视率较低时，RD和ΔRMST单调增加，高危患者获益大于低危患者。随着事件发生率的增加和/或歧视的增加，出现了一个“最佳点”模式：中等风险患者比低风险和高风险患者受益更多。当使用RD时，即使在风险组中ΔRMST增加的情况下，也会出现“最佳点”模式，从而低估了高风险患者的益处，并可能导致治疗靶向性错误。结论以RD为特征的HTE模式可能与ΔRMST有很大差异，可能导致治疗错标。因此，我们建议使用ΔRMST来评估时间到事件数据中的绝对HTE。

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引用次数: 0

Mortality among individuals with congenital malformations who reach adulthood: long-term follow-up of the Jerusalem Perinatal Study cohort 成年后先天性畸形患者的死亡率：耶路撒冷围产期研究队列的长期随访

IF 7.7 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

International journal of epidemiology

Pub Date : 2025-11-14 DOI: 10.1093/ije/dyaf194

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.

虽然儿童时期先天性异常（CAs）的相关风险有很好的文献记载，但缺乏关于ca对成人死亡率的长期影响的数据。我们的目的是通过以人群为基础的耶路撒冷围产期研究队列研究出生时患有CAs的成年人的死亡风险。方法对1964-1976年出生、年满18岁的个体进行随访，直至2016年或死亡日期（中位年龄27.5岁）。我们根据存在/不存在、严重程度、多样性和受影响的身体系统对异常进行分类。构建Cox回归模型来估计ca与全因死亡率之间的风险比（HR）和95%置信区间（CI），调整出生体重、分娩方式、母亲年龄、出生时社会经济地位、母亲出生国，并按后代性别和母亲教育程度分层。结果91 459例活产子代中，18岁前死亡2429例（2.7%），18岁后死亡1454例（1.6%）。在87 621例存活至18岁的患者中，5621例（6.4%）患有ca。与没有畸形的人相比，有畸形（调整后的HR (HRadj) = 1.53, CI: 1.29-1.83）、单一畸形（HRadj = 1.51, CI: 1.27-1.81）、严重畸形（HRadj = 2.21, CI: 1.75-2.77）、中度和重度畸形合并（HRadj = 2.19, CI: 1.09-4.40）的人死亡率增加。此外，心血管（HRadj = 4.81, CI: 2.15-10.70）、胃肠道（HRadj = 2.74, CI: 1.47-5.11）和泌尿生殖系统异常（HRadj = 1.51, CI: 1.07-2.14）患者的成人死亡率也有所增加。结论成年CA患者的早死风险增高，且病情严重，机体系统受影响。有必要对成年ca患者进行长期和重点随访。

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引用次数: 0

Investigating the association between anthropometry and colorectal cancer survival: a two-sample Mendelian randomization analysis 调查人体测量与结直肠癌生存之间的关系：一项双样本孟德尔随机化分析

IF 7.7 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

International journal of epidemiology

Pub Date : 2025-11-14 DOI: 10.1093/ije/dyaf193

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.

背景：关于人体测量特征与结直肠癌（CRC）生存相关性的观察性流行病学研究提供了不一致的结果，并且潜在的局限性禁止调查因果关系。我们使用双样本孟德尔随机化（MR）研究了7个基因预测的人体特征[身高、体重指数（BMI）、腰围（WC）、臀围（HC）、腰臀围比、出生体重和体脂率]与CRC病例中CRC特异性死亡率之间的关系。方法分析来自结直肠癌遗传与流行病学协会和结肠癌家庭登记处的16964例结直肠癌病例，其中4010例因疾病死亡。我们进一步按解剖部位和分期进行分层分析。我们采用反方差加权方法，并进行敏感性分析，以评估潜在违反MR假设的影响，并调整对撞机偏差。结果1个标准差（SD 13.4 cm）高的遗传预测WC水平与较差的CRC生存相关[危险比（HR）]；1.22, 95%置信区间（CI）；1.02 - -1.47)。进一步观察到，在II/III期病例中，SD较高的遗传预测BMI （SD; 4.8 kg/m2， HR; 1.5, 95% CI; 1.15-1.95）和HC （SD; 9.2 cm， HR; 1.32, 95% CI; 1.02-1.73）与crc特异性死亡率呈正相关。后一种关联在敏感性分析中通常是稳健的。在大多数其他人体测量特征中发现了积极但不精确的关联。结论：尽管癌症生存研究存在局限性，但我们的研究结果支持结直肠癌患者应避免肥胖。进一步的研究应该为制定针对癌症监测期间超重/肥胖管理的建议提供信息。

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引用次数: 0

Additive interactions of smoking with obesity on ischemic heart disease mortality: a national prospective cohort study in the United States 吸烟与肥胖对缺血性心脏病死亡率的相互作用：美国的一项全国前瞻性队列研究

IF 7.7 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

International journal of epidemiology

Pub Date : 2025-11-10 DOI: 10.1093/ije/dyaf190

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.

吸烟和肥胖是缺血性心脏病（IHD）的重要可改变危险因素，通常聚集在同一个体中。美国以前的研究表明，它们对IHD死亡率的相互作用的结果是混合的，并且只在乘法尺度上调查了这个问题，而加法尺度更适合为公共卫生干预提供信息。方法将1997-2018年全国健康访谈调查数据与2019年全国死亡指数联系起来。共纳入579 503名18岁及以上的成年人。评估了截至2019年12月31日的死亡状况或最后推定存活者。我们使用Aalen的加性风险模型，并从Cox比例风险模型和考虑竞争风险的Fine-Gray亚分布模型中计算相互作用导致的相对过量风险（rei），以综合评估吸烟与肥胖对IHD死亡率的相互作用效应。结果在平均10.4年的随访期间，发生了13231例IHD死亡。加权死亡率为177.0 (95% CI: 172.3-181.7) / 100000人年（PY）。与个人影响的总和相比，目前每天吸烟和肥胖的结合与每10万日元中55.56人（95% CI: 30.37-80.74）的额外死亡相关。乘法相互作用（HR = 1.19, 1.03-1.39; HR = 1.40, 1.22-1.59）和Cox和Fine-Gray模型的大RERIs分别为1.00（0.59-1.40）和0.85(0.6-1.09)，支持了这种加性相互作用。结论我们的研究结果强调了在多个尺度上评估相互作用的重要性，这减少了相互作用效应的尺度依赖性，可以更好地转化为公共卫生策略。

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引用次数: 0

IF 7.7 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

International journal of epidemiology

Pub Date : 2025-11-10 DOI: 10.1093/ije/dyaf189

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。

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引用次数: 0

Efficacy of Bacillus Calmette–Guérin revaccination in preventing tuberculosis disease: a systematic review and meta-analysis 卡尔梅特芽孢杆菌-谷氨酰胺再接种预防结核病的疗效：系统评价和荟萃分析

IF 7.7 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

International journal of epidemiology

Pub Date : 2025-11-09 DOI: 10.1093/ije/dyaf186

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.

背景关于卡介苗复种的有效性尚无共识。正因为如此，我们的目的是比较卡介苗再接种和未再接种在预防结核病（TB）方面的效果。方法：我们从PubMed、Embase和Cochrane Library数据库中检索了从成立到2023年12月的研究，以比较卡介苗再接种与未再接种或安慰剂的研究。关注的结局是结核病、肺结核和肺外结核的发病率。我们在R统计软件4.3.1版中使用随机效应模型合并比值比（ORs）和95%置信区间（CI）。采用I2统计量评估异质性。结果meta分析纳入5项研究，共纳入1 012 007例患者，其中501 597例（49.56%）再次接种卡介苗。在随机对照试验中，与未接种疫苗的患者相比，再次接种疫苗的患者结核病发病率有所降低（OR 0.89; 95% CI: 0.81-0.98; P = 0.019; I2 = 53%）。当纳入观察性研究时，我们发现了同样的趋势（OR 0.90; 95% CI: 0.77-1.05; P = 0.124; I2 = 26%），以及预防肺外（OR 0.82; 95% CI: 0.38-1.76; P = 0.375; I2 = 24%）和肺（OR 0.93; 95% CI: 0.86-1.01; P = 0.062; I2 = 0%）病例。结论卡介苗再接种与结核、肺结核和肺外结核的发病率略有下降有关。

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引用次数: 0

Neighborhood disadvantage and multiple myeloma incidence in the Black Women’s Health Study 黑人妇女健康研究中的社区劣势与多发性骨髓瘤发病率

IF 7.7 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

International journal of epidemiology

Pub Date : 2025-11-09 DOI: 10.1093/ije/dyaf188

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.

背景：美国黑人有一个&；gt；与其他种族/民族相比，多发性骨髓瘤（MM）的风险增加了2倍。造成这种差异的潜在生物和环境机制仍然知之甚少。越来越多的证据表明，与社区有关的社会和经济因素可能会影响风险。方法：在黑人妇女健康研究中，我们通过测量剥夺、社会经济地位和MM来评估两个社区水平指数之间的关系，该研究是1995年建立的59,000名黑人妇女的前瞻性队列。参与者在基线和随访期间的地址进行了地理编码，并与美国人口普查局的数据相关联。我们使用Cox比例风险回归来计算邻里指数（分为四分位数）与MM发病率之间的关联的风险比（hr）和95%置信区间（ci）。多变量模型根据年龄、体重指数、受教育程度、饮酒、体育活动、吸烟和地理区域进行了调整。在2021年的随访期间，我们确定了276例MM病例。在随时间变化的年龄调整模型中，生活在高度不利地区（相对于最低）和低社会经济地位地区（相对于最高）的妇女比生活在特权地区的妇女有更高的MM发病率（多变量HR: 1.48, 95% CI: 1.02, 2.13; HR: 1.28, 95% CI: 0.87, 1.90）。结论生活在弱势群体高度集中或社会经济地位较低社区的黑人妇女发生MM的风险较高。未来研究确定可能影响MM风险的特定社区水平因素将是有益的。最终，社区再投资可能为减轻黑人妇女日益增加的MM负担提供机会。

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引用次数: 0

Geographic analysis and trends in mortality from mesothelioma in Mexico 1998-2022. 墨西哥1998-2022年间皮瘤死亡率的地理分析和趋势

IF 5.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

International journal of epidemiology

Pub Date : 2025-10-14 DOI: 10.1093/ije/dyaf181

Alejandro Cabello-López, Eduardo Pérez-Castro, Guadalupe Aguilar-Madrid, Carmina Jiménez-Ramírez, Cuauhtémoc Arturo Juárez-Pérez, Andreas Stang, Georg Johnen, Karl-Heinz Jöckel, Thomas Behrens

Background: Asbestos processing began in Mexico in the 1930s and continues to this day. Mesothelioma is a lethal cancer associated with asbestos exposure, which appears after an induction period of 20-50 years. Given this scenario, an updated description of mortality trends from mesothelioma in Mexico is needed.

Methods: Mortality data from mesothelioma in Mexico were retrieved for the period 1998-2022. Age-standardized mortality rates (World standard population) were computed per million according to sex, year, and state. Mortality trends were analysed through joinpoint regression analyses, estimating the annual percentage change in mesothelioma mortality for the studied period.

Results: In the period 1998-2022, 5472 people died from mesothelioma. Overall, 67% of deaths corresponded to males, and age-specific mortality rates were highest for people aged ≥55 years. Age-standardized mortality rates increased from 2.53 per million in 1998 to 3.46 per million in 2022, with the largest increase between 1998 and 2008 with an annual percentage increase of 4.34% (95% confidence interval [95% CI] 2.09, 11.86). Among males, an increase in mesothelioma mortality was observed in a 21-year period (annual percentage increase of 4.32% [95% CI 1.56, 19.35] during 1998-2008 and 0.58% [95% CI -1.72, 3.93] during 2008-2019). Higher age-standardized mortality rates were observed in the northern states and in central Mexico.

Conclusion: Mortality from mesothelioma increased over the period 1998-2022 in Mexico. Special attention should be given to regions with the highest death rates, and Mexico should promote policies towards a complete ban of asbestos.

背景：石棉加工始于20世纪30年代的墨西哥，并一直持续到今天。间皮瘤是一种与石棉接触有关的致命癌症，在20-50年的诱发期后出现。鉴于这种情况，需要对墨西哥间皮瘤死亡率趋势进行更新描述。方法：检索1998-2022年墨西哥间皮瘤死亡率数据。按性别、年份和州计算每百万人的年龄标准化死亡率（世界标准人口）。通过连接点回归分析分析死亡率趋势，估计研究期间间皮瘤死亡率的年百分比变化。结果：1998-2022年间，5472人死于间皮瘤。总体而言，67%的死亡为男性，年龄≥55岁的人群死亡率最高。年龄标准化死亡率从1998年的2.53 /百万人增加到2022年的3.46 /百万人，1998年至2008年期间增幅最大，年增幅为4.34%（95%可信区间[95% CI] 2.09, 11.86）。在男性中，间皮瘤死亡率在21年内观察到增加（1998-2008年期间每年百分比增加4.32% [95% CI 1.56, 19.35]， 2008-2019年期间每年百分比增加0.58% [95% CI -1.72, 3.93]）。在北部各州和墨西哥中部观察到较高的年龄标准化死亡率。结论：1998-2022年期间，墨西哥间皮瘤死亡率有所上升。应特别注意死亡率最高的地区，墨西哥应促进全面禁止石棉的政策。

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引用次数: 0

Birth cohort divergence in English and European multimorbidity trajectories. 英国和欧洲多病轨迹的出生队列差异。

IF 5.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

International journal of epidemiology

Pub Date : 2025-10-14 DOI: 10.1093/ije/dyaf185

Steven A Haas, Michael Caniglia, Nicholas J Bishop, Ana R Quiñones

Background: The rising rates of multimorbidity have important implications for individuals, caregivers, and healthcare systems. Research from North America documents that more recent birth cohorts of older adults are experiencing higher levels of mortality and multimorbidity than earlier cohorts.

Methods: The present study utilizes data from the English Longitudinal Study on Ageing and the Survey of Health, Ageing, and Retirement in Europe and longitudinal mixed-effects models to examine inter-cohort trends in multimorbidity in England and Europe between ages 40 and 85 years. We also examine whether population shifts in socio-demographic characteristics, health behaviours, or specific chronic conditions explain the cohort divergence.

Results: There are significant birth cohort differences in age-related trajectories of chronic disease accumulation between ages 40 and 85 years in both populations. More recent cohorts born after World War II experienced significantly more chronic disease than did those born in early cohorts at equivalent ages. In England and Europe, members of the 1946-1950 cohort had accumulated an average of one condition at ages of ∼65 and ∼70 years, respectively, while those born in 1915-1923 did so at ages of ∼80 and ∼85, respectively. Socio-demographic and behavioural factors are related to individual trajectories of chronic disease accumulation, but do not attenuate cohort divergence. The greatest divergence was observed for arthritis, diabetes, and cardiovascular disease. Within Europe, cohort divergence further varies by region.

Conclusion: Results echo North American patterns of a more rapid accumulation of multimorbidity among recent cohorts. Patterns persist after adjustment for socio-demographic and behavioural profiles, suggesting that the drivers of birth cohort divergence lie with broader structural forces (e.g. shifting epidemiologic environment and diagnostic processes) rather than individual-level characteristics.

背景：多病发病率的上升对个人、护理人员和医疗保健系统具有重要意义。来自北美的研究表明，较晚出生的老年人群体的死亡率和多病率高于较早出生的人群。方法：本研究利用来自英国老龄化纵向研究和欧洲健康、老龄化和退休调查的数据，以及纵向混合效应模型来检查英格兰和欧洲40至85岁之间多病的队列间趋势。我们还研究了社会人口特征、健康行为或特定慢性病的人口变化是否解释了队列差异。结果：在这两个人群中，40岁和85岁之间慢性疾病积累的年龄相关轨迹存在显著的出生队列差异。在第二次世界大战后出生的人群比在同等年龄出生的早期人群经历了更多的慢性疾病。在英国和欧洲，1946-1950年队列的成员分别在~ 65岁和~ 70岁时平均积累了一种疾病，而1915-1923年出生的人分别在~ 80岁和~ 85岁时积累了一种疾病。社会人口统计学和行为因素与慢性疾病积累的个体轨迹有关，但不会减弱队列差异。在关节炎、糖尿病和心血管疾病中观察到的差异最大。在欧洲，不同地区的人群差异进一步扩大。结论：结果与北美的模式相呼应，在最近的队列中，多重疾病的积累更快。在对社会人口和行为特征进行调整后，模式仍然存在，这表明出生队列差异的驱动因素在于更广泛的结构力量（例如，不断变化的流行病学环境和诊断过程），而不是个人层面的特征。

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