International journal of epidemiology最新文献

Background: Observational studies have consistently found educational inequalities in cardiovascular disease (CVD) risk. Mendelian randomization (MR) analyses have suggested a direct causal effect of education; however, estimates may be biased by demography or dynastic effects. This study aimed to estimate the effects of educational attainment on CVD risk and serum lipid concentrations before and after accounting for family structure.

Methods: This study included 26 961 siblings from the Trøndelag Health Study (HUNT) and 23 640 siblings from UK Biobank, and used data on >120 000 individuals, predominantly of European ancestry, from a recent international within-sibship genome-wide association study. The exposure was educational attainment. The outcomes were CVD risk and serum concentrations of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. Standard and within-sibship MR analyses were used.

Results: In the summary data analysis, there was a 6% lower risk of CVD [odds ratio (OR) 0.94, 95% confidence interval (CI) 0.92 to 0.96] for each additional standard deviation of liability to educational attainment. This was consistent having accounted for family structure (OR 0.96, 95% CI 0.91 to 1.01). Educational attainment was also beneficially associated with each serum lipid concentration both before and after accounting for family structure. Results were broadly similar in the individual participant analysis.

Conclusion: There is a protective effect of educational attainment on CVD risk and a beneficial effect on serum lipid concentrations not due to familial factors shared by siblings, suggesting that increasing education may be beneficial for cardiovascular health.

Background: Coinciding with the SARS-CoV-2 pandemic, malaria cases and malaria-related deaths increased globally between 2020 and 2022. However, evidence linking the pandemic to increased malaria burden remains ambiguous. We assessed the extent to which an observed malaria resurgence in Lambaréné, Gabon, can be associated with pandemic-related disruptions in malaria control programmes.

Methods: Using observational data from two tertiary referral hospitals, spanning 2018 to early 2023, we applied autoregressive integrated moving average (ARIMA) models in an interrupted time series (ITS) framework to test for changes in trends and levels following the onset of the pandemic. The primary outcome is the monthly malaria diagnosis rate (per 1000 all-cause hospital diagnoses). As a sub-analysis, we focused on monthly maternal malaria incidence.

Results: Following an initial drop (-47.32, P = 0.031), potentially due to risk-averse behaviours, the malaria diagnosis rate gradually and concavely increased (linear term: 7.32, P = 0.001; squared term: -0.19, P = 0.001) to a peak above pre-pandemic levels. Additional analyses suggest that this resurgence was likely driven by disruptions to malaria control activities and a waning efficacy of malaria control tools administered pre-pandemic. Conversely, a resurgence in maternal malaria incidence was not estimated.

Conclusion: Findings align with several national and global descriptive reports, but add a more detailed understanding of underlying dynamics, therefore reinforcing the importance of maintaining malaria control in the general population. The absence of a meaningful increase in maternal malaria provides some reassurance that malaria in pregnancy-specific control remained unchanged during the SARS-CoV-2 pandemic. However, observed peaks in post-pandemic maternal malaria incidence should raise concerns given the risks that malaria poses to this group.

Background: During the Zika virus (ZIKV) epidemic in Brazil, regional disparities in yellow fever (YF) vaccination coverage and microcephaly incidence led to the hypothesis that maternal YF vaccination could protect against ZIKV infection and microcephaly.

Methods: This case-cohort study was conducted in Campo Grande, Brazil, from 2018 to 2022 and included children with confirmed in utero ZIKV exposure (2015-2018) and a matched control group, totaling 129 mother-child dyads. Maternal blood samples were collected to assess ZIKV exposure and neutralizing YF vaccine-induced antibody (NAb) titers. Associations between YF NAb titer, congenital anomalies, and infant neurodevelopmental delay were evaluated.

Results: Mean YF NAb titers differed between ZIKV-exposed and unexposed mothers (P = .011) and between mothers of children with and without microcephaly (P = .037). Congenital anomalies were associated with lower YF NAb titers (P < .001), prenatal ZIKV exposure (P = .001), and lower family income (P < .001). Neurodevelopmental delay was associated with prenatal ZIKV exposure [adjusted odds ratio (aOR): 4.35, 95% confidence interval (CI): 1.65-13.03], prenatal care with at least six visits (aOR: 0.22, CI: 0.06-0.78), and adequate or large for gestational age birth weight (aOR: 0.09, CI: 0.01-0.44).

Conclusion: Differences in maternal YF NAb titers by ZIKV exposure and microcephaly suggest a potential protective effect of YF vaccination against ZIKV acquisition and/or development of microcephaly, which should be investigated. Developmental delay, although not associated with maternal YF immunity, was associated with antenatal ZIKV exposure, less prenatal care visits, and being small for gestational age.