Jiajun Luo, Loren Saulsberry, William Isaac Krakowka, Habibul Ahsan, Briseis Aschebrook-Kilfoy
Background: Perceived discrimination in health care settings can have adverse consequences on mental health in minority groups. However, the association between perceived discrimination and mental health is prone to unmeasured confounding. The study aims to quantitatively evaluate the influence of unmeasured confounding in this association, using g-estimation.
Methods: In a predominantly African American cohort, we applied g-estimation to estimate the association between perceived discrimination and mental health, adjusted and unadjusted for measured confounders. Mental health was measured using clinical diagnoses of anxiety, depression and bipolar disorder. Perceived discrimination was measured as the number of patient-reported discrimination events in health care settings. Measured confounders included demographic, socioeconomic, residential and health characteristics. The influence of confounding was denoted as α1 from g-estimation. We compared α1 for measured and unmeasured confounding.
Results: Strong associations between perceived discrimination in health care settings and mental health outcomes were observed. For anxiety, the odds ratio (95% confidence interval) unadjusted and adjusted for measured confounders were 1.30 (1.21, 1.39) and 1.26 (1.17, 1.36), respectively. The α1 for measured confounding was -0.066. Unmeasured confounding with α1=0.200, which was over three times that of measured confounding, corresponds to an odds ratio of 1.12 (1.01, 1.24). Similar results were observed for other mental health outcomes.
Conclusion: Compared with measured confounding, unmeasured that was three times measured confounding was not enough to explain away the association between perceived discrimination and mental health, suggesting that this association is robust to unmeasured confounding. This study provides a novel framework to quantitatively evaluate unmeasured confounding.
背景:医疗机构中的歧视感会对少数群体的心理健康产生不利影响。然而,感知到的歧视与心理健康之间的关联容易受到未测量混杂因素的影响。本研究旨在利用g估计法定量评估未测量混杂因素对这种关联的影响:方法:在一个以非洲裔美国人为主的队列中,我们采用 g 估计法估算了感知到的歧视与心理健康之间的关联,并对测量到的混杂因素进行了调整和未调整。心理健康通过焦虑症、抑郁症和躁郁症的临床诊断来衡量。感知到的歧视以患者报告的医疗机构中歧视事件的数量来衡量。测量的混杂因素包括人口、社会经济、居住和健康特征。混杂因素的影响用 g 估计中的α1 表示。我们比较了测量混杂因素和未测量混杂因素的α1:结果:在医疗机构中感知到的歧视与心理健康结果之间存在密切联系。就焦虑而言,未经调整的几率比(95% 置信区间)为 1.30(1.21, 1.39),经测量混杂因素调整后为 1.26(1.17, 1.36)。测量混杂因素的α1为-0.066。未测量混杂因素的α1=0.200,是测量混杂因素的三倍多,对应的几率比为 1.12(1.01,1.24)。其他心理健康结果也观察到类似的结果:与测量混杂因素相比,三倍于测量混杂因素的未测量混杂因素不足以解释感知到的歧视与心理健康之间的关联,这表明这种关联不受未测量混杂因素的影响。这项研究为定量评估未测量混杂因素提供了一个新的框架。
{"title":"Assessment of unmeasured confounding in the association between perceived discrimination and mental health in a predominantly African American cohort using g-estimation.","authors":"Jiajun Luo, Loren Saulsberry, William Isaac Krakowka, Habibul Ahsan, Briseis Aschebrook-Kilfoy","doi":"10.1093/ije/dyae085","DOIUrl":"10.1093/ije/dyae085","url":null,"abstract":"<p><strong>Background: </strong>Perceived discrimination in health care settings can have adverse consequences on mental health in minority groups. However, the association between perceived discrimination and mental health is prone to unmeasured confounding. The study aims to quantitatively evaluate the influence of unmeasured confounding in this association, using g-estimation.</p><p><strong>Methods: </strong>In a predominantly African American cohort, we applied g-estimation to estimate the association between perceived discrimination and mental health, adjusted and unadjusted for measured confounders. Mental health was measured using clinical diagnoses of anxiety, depression and bipolar disorder. Perceived discrimination was measured as the number of patient-reported discrimination events in health care settings. Measured confounders included demographic, socioeconomic, residential and health characteristics. The influence of confounding was denoted as α1 from g-estimation. We compared α1 for measured and unmeasured confounding.</p><p><strong>Results: </strong>Strong associations between perceived discrimination in health care settings and mental health outcomes were observed. For anxiety, the odds ratio (95% confidence interval) unadjusted and adjusted for measured confounders were 1.30 (1.21, 1.39) and 1.26 (1.17, 1.36), respectively. The α1 for measured confounding was -0.066. Unmeasured confounding with α1=0.200, which was over three times that of measured confounding, corresponds to an odds ratio of 1.12 (1.01, 1.24). Similar results were observed for other mental health outcomes.</p><p><strong>Conclusion: </strong>Compared with measured confounding, unmeasured that was three times measured confounding was not enough to explain away the association between perceived discrimination and mental health, suggesting that this association is robust to unmeasured confounding. This study provides a novel framework to quantitatively evaluate unmeasured confounding.</p>","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141497960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ling Yang, Christiana Kartsonaki, Julia Simon, Pang Yao, Yu Guo, Jun Lv, Robin G Walters, Yiping Chen, Hannah Fry, Daniel Avery, Canqing Yu, Jianrong Jin, Alexander J Mentzer, Naomi Allen, Julia Butt, Michael Hill, Liming Li, Iona Y Millwood, Tim Waterboer, Zhengming Chen
Background: Epstein-Barr virus (EBV) is a major cause of nasopharyngeal carcinoma (NPC) and measurement of different EBV antibodies in blood may improve early detection of NPC. Prospective studies can help assess the roles of different EBV antibodies in predicting NPC risk over time.
Methods: A case-cohort study within the prospective China Kadoorie Biobank of 512 715 adults from 10 (including two NPC endemic) areas included 295 incident NPC cases and 745 subcohort participants. A multiplex serology assay was used to quantify IgA and IgG antibodies against 16 EBV antigens in stored baseline plasma samples. Cox regression was used to estimate adjusted hazard ratios (HRs) for NPC and C-statistics to assess the discriminatory ability of EBV-markers, including two previously identified EBV-marker combinations, for predicting NPC.
Results: Sero-positivity for 15 out of 16 EBV-markers was significantly associated with higher NPC risk. Both IgA and IgG antibodies against the same three EBV-markers showed the most extreme HRs, i.e. BGLF2 (IgA: 124.2 (95% CI: 63.3-243.9); IgG: 8.6 (5.5-13.5); LF2: [67.8 (30.0-153.1), 10.9 (7.2-16.4)]); and BFRF1: 26.1 (10.1-67.5), 6.1 (2.7-13.6). Use of a two-marker (i.e. LF2/BGLF2 IgG) and a four-marker (i.e. LF2/BGLF2 IgG and LF2/EA-D IgA) combinations yielded C-statistics of 0.85 and 0.84, respectively, which persisted for at least 5 years after sample collection in both endemic and non-endemic areas.
Conclusions: In Chinese adults, plasma EBV markers strongly predict NPC occurrence many years before clinical diagnosis. LF2 and BGLF2 IgG could identify NPC high-risk individuals to improve NPC early detection in community and clinical settings.
{"title":"Prospective evaluation of the relevance of Epstein-Barr virus antibodies for early detection of nasopharyngeal carcinoma in Chinese adults.","authors":"Ling Yang, Christiana Kartsonaki, Julia Simon, Pang Yao, Yu Guo, Jun Lv, Robin G Walters, Yiping Chen, Hannah Fry, Daniel Avery, Canqing Yu, Jianrong Jin, Alexander J Mentzer, Naomi Allen, Julia Butt, Michael Hill, Liming Li, Iona Y Millwood, Tim Waterboer, Zhengming Chen","doi":"10.1093/ije/dyae098","DOIUrl":"10.1093/ije/dyae098","url":null,"abstract":"<p><strong>Background: </strong>Epstein-Barr virus (EBV) is a major cause of nasopharyngeal carcinoma (NPC) and measurement of different EBV antibodies in blood may improve early detection of NPC. Prospective studies can help assess the roles of different EBV antibodies in predicting NPC risk over time.</p><p><strong>Methods: </strong>A case-cohort study within the prospective China Kadoorie Biobank of 512 715 adults from 10 (including two NPC endemic) areas included 295 incident NPC cases and 745 subcohort participants. A multiplex serology assay was used to quantify IgA and IgG antibodies against 16 EBV antigens in stored baseline plasma samples. Cox regression was used to estimate adjusted hazard ratios (HRs) for NPC and C-statistics to assess the discriminatory ability of EBV-markers, including two previously identified EBV-marker combinations, for predicting NPC.</p><p><strong>Results: </strong>Sero-positivity for 15 out of 16 EBV-markers was significantly associated with higher NPC risk. Both IgA and IgG antibodies against the same three EBV-markers showed the most extreme HRs, i.e. BGLF2 (IgA: 124.2 (95% CI: 63.3-243.9); IgG: 8.6 (5.5-13.5); LF2: [67.8 (30.0-153.1), 10.9 (7.2-16.4)]); and BFRF1: 26.1 (10.1-67.5), 6.1 (2.7-13.6). Use of a two-marker (i.e. LF2/BGLF2 IgG) and a four-marker (i.e. LF2/BGLF2 IgG and LF2/EA-D IgA) combinations yielded C-statistics of 0.85 and 0.84, respectively, which persisted for at least 5 years after sample collection in both endemic and non-endemic areas.</p><p><strong>Conclusions: </strong>In Chinese adults, plasma EBV markers strongly predict NPC occurrence many years before clinical diagnosis. LF2 and BGLF2 IgG could identify NPC high-risk individuals to improve NPC early detection in community and clinical settings.</p>","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11249388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michele Sassano, Giulia Collatuzzo, Monireh Sadat Seyyedsalehi, Claudio Pelucchi, Rossella Bonzi, Domenico Palli, Monica Ferraroni, Nuno Lunet, Samantha Morais, Lizbeth López-Carrillo, Reza Malekzadeh, Mohammadreza Pakseresht, Malaquias López-Cervantes, Mary H Ward, Maria Constanza Camargo, Maria Paula Curado, Jesùs Vioque, Zuo-Feng Zhang, Stefania Boccia, Eva Negri, Carlo La Vecchia, Paolo Boffetta
Background Evidence on the potential association between dietary copper intake and gastric cancer (GC) is lacking. Thus, we aimed to evaluate this association within the Stomach cancer Pooling (StoP) Project—an international consortium of epidemiological studies on GC. Methods Data from five case–control studies within the StoP Project were included (2448 cases, 4350 controls). We estimated adjusted odds ratios (ORs) and 95% CIs for the association between dietary copper intake and GC using multivariable mixed-effects logistic regression models. We also modelled the dose–response relationship between copper intake and GC using a logistic mixed-effects model with fractional polynomial. Results The OR for the highest quartile of copper intake compared with the lowest one was 0.78 (95% CI: 0.63–0.95; P for trend = 0.013). Results were similar for non-cardia-type (OR: 0.72; 95% CI: 0.57–0.91), intestinal-type (OR: 0.75; 95% CI: 0.56–0.99) and other histological-type GC (OR: 0.65; 95% CI: 0.44–0.96). The dose–response analysis showed a steep decrease in ORs for modest intakes (<1 mg/day), which were subsequently steady for ≤3 mg/day (OR: 0.09; 95% CI: 0.02–0.41) and slowly increased for higher intakes. Conclusions The findings of our large study suggest that copper intake might be inversely associated with GC, although their confirmation by prospective studies is required.
{"title":"Dietary intake of copper and gastric cancer: a pooled analysis within the Stomach cancer Pooling (StoP) Project","authors":"Michele Sassano, Giulia Collatuzzo, Monireh Sadat Seyyedsalehi, Claudio Pelucchi, Rossella Bonzi, Domenico Palli, Monica Ferraroni, Nuno Lunet, Samantha Morais, Lizbeth López-Carrillo, Reza Malekzadeh, Mohammadreza Pakseresht, Malaquias López-Cervantes, Mary H Ward, Maria Constanza Camargo, Maria Paula Curado, Jesùs Vioque, Zuo-Feng Zhang, Stefania Boccia, Eva Negri, Carlo La Vecchia, Paolo Boffetta","doi":"10.1093/ije/dyae059","DOIUrl":"https://doi.org/10.1093/ije/dyae059","url":null,"abstract":"Background Evidence on the potential association between dietary copper intake and gastric cancer (GC) is lacking. Thus, we aimed to evaluate this association within the Stomach cancer Pooling (StoP) Project—an international consortium of epidemiological studies on GC. Methods Data from five case–control studies within the StoP Project were included (2448 cases, 4350 controls). We estimated adjusted odds ratios (ORs) and 95% CIs for the association between dietary copper intake and GC using multivariable mixed-effects logistic regression models. We also modelled the dose–response relationship between copper intake and GC using a logistic mixed-effects model with fractional polynomial. Results The OR for the highest quartile of copper intake compared with the lowest one was 0.78 (95% CI: 0.63–0.95; P for trend = 0.013). Results were similar for non-cardia-type (OR: 0.72; 95% CI: 0.57–0.91), intestinal-type (OR: 0.75; 95% CI: 0.56–0.99) and other histological-type GC (OR: 0.65; 95% CI: 0.44–0.96). The dose–response analysis showed a steep decrease in ORs for modest intakes (&lt;1 mg/day), which were subsequently steady for ≤3 mg/day (OR: 0.09; 95% CI: 0.02–0.41) and slowly increased for higher intakes. Conclusions The findings of our large study suggest that copper intake might be inversely associated with GC, although their confirmation by prospective studies is required.","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140651458","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}
Chungsoo Kim, Dong Han Yu, Hyeran Baek, Jaehyeong Cho, Seng Chan You, Rae Woong Park
{"title":"Data Resource Profile: Health Insurance Review and Assessment Service Covid-19 Observational Medical Outcomes Partnership (HIRA Covid-19 OMOP) database in South Korea.","authors":"Chungsoo Kim, Dong Han Yu, Hyeran Baek, Jaehyeong Cho, Seng Chan You, Rae Woong Park","doi":"10.1093/ije/dyae062","DOIUrl":"https://doi.org/10.1093/ije/dyae062","url":null,"abstract":"","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140714822","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}
Sjoerd van Alten, Benjamin W Domingue, Jessica Faul, Titus Galama, Andries T Marees
Background: Biobanks typically rely on volunteer-based sampling. This results in large samples (power) at the cost of representativeness (bias). The problem of volunteer bias is debated. Here, we (i) show that volunteering biases associations in UK Biobank (UKB) and (ii) estimate inverse probability (IP) weights that correct for volunteer bias in UKB.
Methods: Drawing on UK Census data, we constructed a subsample representative of UKB's target population, which consists of all individuals invited to participate. Based on demographic variables shared between the UK Census and UKB, we estimated IP weights (IPWs) for each UKB participant. We compared 21 weighted and unweighted bivariate associations between these demographic variables to assess volunteer bias.
Results: Volunteer bias in all associations, as naively estimated in UKB, was substantial-in some cases so severe that unweighted estimates had the opposite sign of the association in the target population. For example, older individuals in UKB reported being in better health, in contrast to evidence from the UK Census. Using IPWs in weighted regressions reduced 87% of volunteer bias on average. Volunteer-based sampling reduced the effective sample size of UKB substantially, to 32% of its original size.
Conclusions: Estimates from large-scale biobanks may be misleading due to volunteer bias. We recommend IP weighting to correct for such bias. To aid in the construction of the next generation of biobanks, we provide suggestions on how to best ensure representativeness in a volunteer-based design. For UKB, IPWs have been made available.
背景:生物库通常依赖于以志愿者为基础的抽样。这样做的结果是样本量大(功率大),但代表性(偏差大)却是代价。志愿者偏差问题备受争议。在此,我们(i) 表明志愿者偏差会影响英国生物库(UKB)中的关联;(ii) 估计反概率(IP)权重,以纠正英国生物库中的志愿者偏差:根据英国人口普查数据,我们构建了一个代表英国生物库目标人群的子样本,其中包括所有受邀参与的个人。根据英国人口普查和英国广播公司共享的人口统计学变量,我们估算出了每位英国广播公司参与者的 IP 权重 (IPW)。我们比较了这些人口统计学变量之间的 21 个加权和非加权二元关联,以评估志愿者偏差:根据英国调查局的天真估计,所有关联中的志愿者偏差都很大,在某些情况下甚至严重到未加权估计值与目标人群中关联的符号相反。例如,在英国人口普查中,年龄较大的人报告健康状况较好,这与英国人口普查的证据相反。在加权回归中使用 IPW 平均减少了 87% 的志愿者偏差。基于志愿者的抽样大大减少了英国生物库的有效样本量,仅为原来的 32%:结论:大规模生物库的估计值可能会因志愿者偏差而产生误导。我们建议采用 IP 加权法来纠正这种偏差。为了帮助建设下一代生物库,我们就如何在基于志愿者的设计中最好地确保代表性提出了建议。对于英国生物库,IPW 已经可用。
{"title":"Reweighting UK Biobank corrects for pervasive selection bias due to volunteering.","authors":"Sjoerd van Alten, Benjamin W Domingue, Jessica Faul, Titus Galama, Andries T Marees","doi":"10.1093/ije/dyae054","DOIUrl":"10.1093/ije/dyae054","url":null,"abstract":"<p><strong>Background: </strong>Biobanks typically rely on volunteer-based sampling. This results in large samples (power) at the cost of representativeness (bias). The problem of volunteer bias is debated. Here, we (i) show that volunteering biases associations in UK Biobank (UKB) and (ii) estimate inverse probability (IP) weights that correct for volunteer bias in UKB.</p><p><strong>Methods: </strong>Drawing on UK Census data, we constructed a subsample representative of UKB's target population, which consists of all individuals invited to participate. Based on demographic variables shared between the UK Census and UKB, we estimated IP weights (IPWs) for each UKB participant. We compared 21 weighted and unweighted bivariate associations between these demographic variables to assess volunteer bias.</p><p><strong>Results: </strong>Volunteer bias in all associations, as naively estimated in UKB, was substantial-in some cases so severe that unweighted estimates had the opposite sign of the association in the target population. For example, older individuals in UKB reported being in better health, in contrast to evidence from the UK Census. Using IPWs in weighted regressions reduced 87% of volunteer bias on average. Volunteer-based sampling reduced the effective sample size of UKB substantially, to 32% of its original size.</p><p><strong>Conclusions: </strong>Estimates from large-scale biobanks may be misleading due to volunteer bias. We recommend IP weighting to correct for such bias. To aid in the construction of the next generation of biobanks, we provide suggestions on how to best ensure representativeness in a volunteer-based design. For UKB, IPWs have been made available.</p>","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11076923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wenhua Yu, Wenzhong Huang, Antonio Gasparrini, Francesco Sera, Alexandra Schneider, Susanne Breitner, Jan Kyselý, Joel Schwartz, Joana Madureira, Vânia Gaio, Yue Leon Guo, Rongbin Xu, Gongbo Chen, Zhengyu Yang, Bo Wen, Yao Wu, Antonella Zanobetti, Haidong Kan, Jiangning Song, Shanshan Li, Yuming Guo
Background: Model-estimated air pollution exposure products have been widely used in epidemiological studies to assess the health risks of particulate matter with diameters of ≤2.5 µm (PM2.5). However, few studies have assessed the disparities in health effects between model-estimated and station-observed PM2.5 exposures.
Methods: We collected daily all-cause, respiratory and cardiovascular mortality data in 347 cities across 15 countries and regions worldwide based on the Multi-City Multi-Country collaborative research network. The station-observed PM2.5 data were obtained from official monitoring stations. The model-estimated global PM2.5 product was developed using a machine-learning approach. The associations between daily exposure to PM2.5 and mortality were evaluated using a two-stage analytical approach.
Results: We included 15.8 million all-cause, 1.5 million respiratory and 4.5 million cardiovascular deaths from 2000 to 2018. Short-term exposure to PM2.5 was associated with a relative risk increase (RRI) of mortality from both station-observed and model-estimated exposures. Every 10-μg/m3 increase in the 2-day moving average PM2.5 was associated with overall RRIs of 0.67% (95% CI: 0.49 to 0.85), 0.68% (95% CI: -0.03 to 1.39) and 0.45% (95% CI: 0.08 to 0.82) for all-cause, respiratory, and cardiovascular mortality based on station-observed PM2.5 and RRIs of 0.87% (95% CI: 0.68 to 1.06), 0.81% (95% CI: 0.08 to 1.55) and 0.71% (95% CI: 0.32 to 1.09) based on model-estimated exposure, respectively.
Conclusions: Mortality risks associated with daily PM2.5 exposure were consistent for both station-observed and model-estimated exposures, suggesting the reliability and potential applicability of the global PM2.5 product in epidemiological studies.
{"title":"Ambient fine particulate matter and daily mortality: a comparative analysis of observed and estimated exposure in 347 cities.","authors":"Wenhua Yu, Wenzhong Huang, Antonio Gasparrini, Francesco Sera, Alexandra Schneider, Susanne Breitner, Jan Kyselý, Joel Schwartz, Joana Madureira, Vânia Gaio, Yue Leon Guo, Rongbin Xu, Gongbo Chen, Zhengyu Yang, Bo Wen, Yao Wu, Antonella Zanobetti, Haidong Kan, Jiangning Song, Shanshan Li, Yuming Guo","doi":"10.1093/ije/dyae066","DOIUrl":"10.1093/ije/dyae066","url":null,"abstract":"<p><strong>Background: </strong>Model-estimated air pollution exposure products have been widely used in epidemiological studies to assess the health risks of particulate matter with diameters of ≤2.5 µm (PM2.5). However, few studies have assessed the disparities in health effects between model-estimated and station-observed PM2.5 exposures.</p><p><strong>Methods: </strong>We collected daily all-cause, respiratory and cardiovascular mortality data in 347 cities across 15 countries and regions worldwide based on the Multi-City Multi-Country collaborative research network. The station-observed PM2.5 data were obtained from official monitoring stations. The model-estimated global PM2.5 product was developed using a machine-learning approach. The associations between daily exposure to PM2.5 and mortality were evaluated using a two-stage analytical approach.</p><p><strong>Results: </strong>We included 15.8 million all-cause, 1.5 million respiratory and 4.5 million cardiovascular deaths from 2000 to 2018. Short-term exposure to PM2.5 was associated with a relative risk increase (RRI) of mortality from both station-observed and model-estimated exposures. Every 10-μg/m3 increase in the 2-day moving average PM2.5 was associated with overall RRIs of 0.67% (95% CI: 0.49 to 0.85), 0.68% (95% CI: -0.03 to 1.39) and 0.45% (95% CI: 0.08 to 0.82) for all-cause, respiratory, and cardiovascular mortality based on station-observed PM2.5 and RRIs of 0.87% (95% CI: 0.68 to 1.06), 0.81% (95% CI: 0.08 to 1.55) and 0.71% (95% CI: 0.32 to 1.09) based on model-estimated exposure, respectively.</p><p><strong>Conclusions: </strong>Mortality risks associated with daily PM2.5 exposure were consistent for both station-observed and model-estimated exposures, suggesting the reliability and potential applicability of the global PM2.5 product in epidemiological studies.</p>","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11082424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140897830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marcos Quijal-Zamorano, M. Martínez-Beneito, Joan Ballester, Marc Marí-Dell'Olmo
Abstract Background Distributed lag non-linear models (DLNMs) are the reference framework for modelling lagged non-linear associations. They are usually used in large-scale multi-location studies. Attempts to study these associations in small areas either did not include the lagged non-linear effects, did not allow for geographically-varying risks or downscaled risks from larger spatial units through socioeconomic and physical meta-predictors when the estimation of the risks was not feasible due to low statistical power. Methods Here we proposed spatial Bayesian DLNMs (SB-DLNMs) as a new framework for the estimation of reliable small-area lagged non-linear associations, and demonstrated the methodology for the case study of the temperature-mortality relationship in the 73 neighbourhoods of the city of Barcelona. We generalized location-independent DLNMs to the Bayesian framework (B-DLNMs), and extended them to SB-DLNMs by incorporating spatial models in a single-stage approach that accounts for the spatial dependence between risks. Results The results of the case study highlighted the benefits of incorporating the spatial component for small-area analysis. Estimates obtained from independent B-DLNMs were unstable and unreliable, particularly in neighbourhoods with very low numbers of deaths. SB-DLNMs addressed these instabilities by incorporating spatial dependencies, resulting in more plausible and coherent estimates and revealing hidden spatial patterns. In addition, the Bayesian framework enriches the range of estimates and tests that can be used in both large- and small-area studies. Conclusions SB-DLNMs account for spatial structures in the risk associations across small areas. By modelling spatial differences, SB-DLNMs facilitate the direct estimation of non-linear exposure-response lagged associations at the small-area level, even in areas with as few as 19 deaths. The manuscript includes an illustrative code to reproduce the results, and to facilitate the implementation of other case studies by other researchers.
{"title":"Spatial Bayesian distributed lag non-linear models (SB-DLNM) for small-area exposure-lag-response epidemiological modelling","authors":"Marcos Quijal-Zamorano, M. Martínez-Beneito, Joan Ballester, Marc Marí-Dell'Olmo","doi":"10.1093/ije/dyae061","DOIUrl":"https://doi.org/10.1093/ije/dyae061","url":null,"abstract":"Abstract Background Distributed lag non-linear models (DLNMs) are the reference framework for modelling lagged non-linear associations. They are usually used in large-scale multi-location studies. Attempts to study these associations in small areas either did not include the lagged non-linear effects, did not allow for geographically-varying risks or downscaled risks from larger spatial units through socioeconomic and physical meta-predictors when the estimation of the risks was not feasible due to low statistical power. Methods Here we proposed spatial Bayesian DLNMs (SB-DLNMs) as a new framework for the estimation of reliable small-area lagged non-linear associations, and demonstrated the methodology for the case study of the temperature-mortality relationship in the 73 neighbourhoods of the city of Barcelona. We generalized location-independent DLNMs to the Bayesian framework (B-DLNMs), and extended them to SB-DLNMs by incorporating spatial models in a single-stage approach that accounts for the spatial dependence between risks. Results The results of the case study highlighted the benefits of incorporating the spatial component for small-area analysis. Estimates obtained from independent B-DLNMs were unstable and unreliable, particularly in neighbourhoods with very low numbers of deaths. SB-DLNMs addressed these instabilities by incorporating spatial dependencies, resulting in more plausible and coherent estimates and revealing hidden spatial patterns. In addition, the Bayesian framework enriches the range of estimates and tests that can be used in both large- and small-area studies. Conclusions SB-DLNMs account for spatial structures in the risk associations across small areas. By modelling spatial differences, SB-DLNMs facilitate the direct estimation of non-linear exposure-response lagged associations at the small-area level, even in areas with as few as 19 deaths. The manuscript includes an illustrative code to reproduce the results, and to facilitate the implementation of other case studies by other researchers.","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140714837","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}
Lauren E McCullough, Lindsay J Collin, Muriel Statman
{"title":"Unravelling race inequities in cardiovascular disease mortality among cancer survivors: new insights and future directions.","authors":"Lauren E McCullough, Lindsay J Collin, Muriel Statman","doi":"10.1093/ije/dyae049","DOIUrl":"https://doi.org/10.1093/ije/dyae049","url":null,"abstract":"","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862779","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}
Simon R Procter, Proma Paul, Erzsébet Horváth-Puhó, Bronner P Gonçalves
Background: Maternal colonization by the bacterium Group B streptococcus (GBS) increases risk of preterm birth, a condition that has an important impact on the health of children. However, research studies that quantify the effect of GBS colonization on preterm birth have reported variable estimates of the effect measure.
Methods: We performed a simulated cohort study of pregnant women to assess how timing of exposure (GBS colonization) assessment might influence results of studies that address this question. We used published data on longitudinal maternal GBS colonization and on the distribution of preterm births by gestational age to inform parameters used in the simulations.
Results: Assuming that the probability of preterm birth is higher during weeks when pregnant women are colonized by GBS, our results suggest that studies that assess exposure status early during pregnancy are more likely to estimate an association between GBS colonization and preterm birth that is closer to the null, compared with studies that assess exposure either at birth or during gestational weeks matched to preterm births. In sensitivity analyses assuming different colonization acquisition rates and diagnostic sensitivities, we observed similar results.
Conclusions: Accurate quantification of the effect of maternal GBS colonization on the risk of preterm birth is necessary to understand the full health burden linked to this bacterium. In this study, we investigated one possible explanation, related to the timing of exposure assessment, for the variable findings of previous observational studies. Our findings will inform future research on this question.
{"title":"Timing of exposure assessment in studies on Group B streptococcus colonization and preterm birth.","authors":"Simon R Procter, Proma Paul, Erzsébet Horváth-Puhó, Bronner P Gonçalves","doi":"10.1093/ije/dyae076","DOIUrl":"https://doi.org/10.1093/ije/dyae076","url":null,"abstract":"<p><strong>Background: </strong>Maternal colonization by the bacterium Group B streptococcus (GBS) increases risk of preterm birth, a condition that has an important impact on the health of children. However, research studies that quantify the effect of GBS colonization on preterm birth have reported variable estimates of the effect measure.</p><p><strong>Methods: </strong>We performed a simulated cohort study of pregnant women to assess how timing of exposure (GBS colonization) assessment might influence results of studies that address this question. We used published data on longitudinal maternal GBS colonization and on the distribution of preterm births by gestational age to inform parameters used in the simulations.</p><p><strong>Results: </strong>Assuming that the probability of preterm birth is higher during weeks when pregnant women are colonized by GBS, our results suggest that studies that assess exposure status early during pregnancy are more likely to estimate an association between GBS colonization and preterm birth that is closer to the null, compared with studies that assess exposure either at birth or during gestational weeks matched to preterm births. In sensitivity analyses assuming different colonization acquisition rates and diagnostic sensitivities, we observed similar results.</p><p><strong>Conclusions: </strong>Accurate quantification of the effect of maternal GBS colonization on the risk of preterm birth is necessary to understand the full health burden linked to this bacterium. In this study, we investigated one possible explanation, related to the timing of exposure assessment, for the variable findings of previous observational studies. Our findings will inform future research on this question.</p>","PeriodicalId":14147,"journal":{"name":"International journal of epidemiology","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283680","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}