Journal of Epidemiology and Global Health最新文献

Background: Prostate cancer patients have a significantly higher risk of suicide compared to the general population. This study aimed to develop a nomogram for identifying high-risk patients and providing empirical evidence to guide effective intervention strategies.

Methods: We analyzed data from 176,730 prostate cancer patients diagnosed between 2004 and 2021, sourced from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly allocated to training (n = 123,711) and validation (n = 53,019) cohorts in a 7:3 ratio. Feature selection was conducted using the Least Absolute Shrinkage and Selection Operator (LASSO), followed by model construction with Cox proportional hazards regression. The results were visualized using nomogram. Model performance was evaluated with time-dependent receiver operating characteristic (ROC) curves, concordance index (C-index), and internal validation.

Results: Multivariate analysis identified seven independent predictors of suicide. The nomogram demonstrated favorable discriminative capability in both cohorts, with C-index of 0.746 and 0.703 for the training and bootstrapped validation cohorts. Time-dependent ROC analysis indicated strong accuracy in predicting suicide risk. Calibration plots displayed high concordance between predicted probabilities and actual outcomes, Kaplan-Meier analysis confirmed the model's significant discriminative ability among risk groups.

Limitations: This retrospective study, based on SEER data, lacks detailed clinical and mental health information. Additionally, potential coding errors and reporting biases may affect the accuracy of the results.

Conclusion: We developed a applicable nomogram for the individualized quantification of suicide risk in prostate cancer patients. This model provides clinicians with a robust tool for identifying high-risk patients and implementing timely interventions.

Background: Influenza imposes a substantial global health burden, particularly among high-risk populations such as the elderly, young children, and individuals with chronic conditions. In Saudi Arabia, a national influenza sentinel surveillance program was established in 2017 to monitor respiratory virus trends, yet comprehensive estimates of the influenza-associated burden remain limited. This study aims to address this gap by quantifying influenza-associated severe acute respiratory infection (SARI) hospitalization rates and estimating the broader influenza burden across severity levels.

Methods: Data from four sentinel hospitals in three regions of Saudi Arabia were analyzed across three influenza seasons: 2017-2018, 2018-2019, and 2022-2023. Weekly SARI case counts were combined with census population data to calculate SARI hospitalization rates per 100,000 population. Influenza positivity rates, derived from laboratory-confirmed cases, were used to estimate influenza-associated SARI hospitalization rates, stratified by age and season. The John Hopkins University/WHO Seasonal Influenza Burden Disease Estimator (Flutool) was employed to extrapolate national estimates of influenza-associated hospitalizations, deaths, and mild/moderate cases. Confidence intervals and age-specific stratifications were computed to enhance precision and comparability.

Results: The average annual SARI hospitalization rate was 294 per 100,000 population (95% CI: 288-300). Influenza-associated SARI hospitalization rates averaged 48 per 100,000 population (95% CI: 45-50), with the highest burden observed in individuals aged 65 years and older (269 per 100,000, 95% CI: 240-301) and children aged 0-4 years (118 per 100,000, 95% CI: 107-131). Seasonal variation was noted, with the highest rates in the 2017-2018 season. National estimates suggested a substantial burden, with influenza-associated hospitalizations totaling 17,678 in 2017-2018, 7,683 in 2018-2019, and 13,982 in 2022-2023. The flutool analysis estimated annual influenza-associated deaths ranging from 30 to 4,441 and mild/moderate cases reaching up to 6.3 million in the most severe season.

Conclusions: This study demonstrates a significant burden of influenza-associated SARI hospitalizations in Saudi Arabia, with the highest rates observed in the elderly and young children. Seasonal variation was evident, highlighting the urgent need to enhance influenza vaccination coverage, particularly among high-risk groups such as the elderly and young children, to reduce severe outcomes. Expanding sentinel surveillance to more regions and incorporating detailed clinical and economic data are recommended to better inform public health policies. Strengthening pandemic preparedness and tailoring vaccination campaigns based on seasonality and age-specific risk will be critical for mitigating the influenza burden in Saudi Arabia.

Schistosomiasis, a frequently overlooked parasitic disease, affects individuals worldwide. A comprehensive population-based observational study was conducted to assess the prevalence of schistosomiasis among both Saudi and non-Saudi residents. The primary objective of this research was to investigate the incidence of this parasitic infection within the population. Data on schistosomiasis incidence were collected by the Ministry of Health from January 2021 to December 2023. The chi-square test was employed to analyze the data and determine the incidence rates of schistosomiasis by type, gender, and nationality. Between 2021 and 2023, a total of 115 cases of schistosomiasis were reported. Among these, 61.7% were classified as intestinal schistosomiasis, 34.8% as urinary schistosomiasis, and 3.5% as mixed schistosomiasis. The findings revealed statistically significant differences (P < 0.05) in the prevalence rates of the different forms of schistosomiasis. Notably, 79.8% of the cases were observed in men, while women accounted for 20.2% of the cases. Furthermore, a majority of the reported cases (72%) were found among non-Saudi individuals. This study offers important insights into the epidemiology of schistosomiasis in Saudi Arabia. These findings underscore the effectiveness of public health interventions implemented in the country and provide a strategic framework for the global elimination of schistosomiasis.

Background: Advances in the understanding of idiopathic pulmonary fibrosis (IPF) and international cooperation have led to the publication and subsequent updates of international practice guidelines. The impact of these guidelines, especially significant updates occurring after 2011, on IPF epidemiology and clinical practices remains relatively unexplored.

Methods: This retrospective nationwide population-based study utilized the Whole-Population Datafiles (WPD) of Taiwan's National Health Insurance Research Database that contained basic demographics, complete claim data, and causes of death for all insured persons. We refined the code-based definition to identify IPF cases from the WPD between 2011 and 2019. Independent validation confirmed the high accuracy of this definition. We analyzed the annual standardized rates of IPF incidence, prevalence, overall and IPF-specific all-cause mortality. Additionally, we examined trends in the prescription of selected medications and the proportions of patients with respiratory failure receiving invasive (IMV) and non-invasive (NIV) mechanical ventilation.

Results: We included 4359 incident cases of IPF. From 2011 to 2019, the annual standardized incidence rates increased from 1.66 (95% confidence interval [CI], 1.36-1.97) to 11.35 (95% CI, 10.65-12.04) per 100,000 standard population, and the annual standardized prevalence rates increased from 1.98 (95% CI, 1.65-2.31) to 27.25 (95% CI, 26.17-28.33) per 100,000 standard population. The standardized IPF-specific all-cause mortality and respiratory failure rates remained stable. Male and older patients received IPF diagnoses more frequently, and experienced higher mortality rates, compared to their female and younger counterparts. Most deaths were attributed to respiratory causes, without significant seasonal variation. Changing trends in the management of IPF mirrored with the evolving guideline recommendations, and showed diminishing roles of immunosuppressants, growing usage of antifibrotics, and NIV usage surpassing IMV.

Conclusions: Our findings reflected the longitudinal impact of the recently evolving guideline recommendations on IPF epidemiology and real-world management.

Background: Neonatal disorders represent a significant public health challenge, particularly in low- and middle-income countries, where they account for 79% of global neonatal mortality. South Asia, comprising countries such as India, Pakistan, Bangladesh, Nepal, and Bhutan, bears a disproportionately high burden, contributing to 38% of the world's neonatal deaths. Despite notable progress, South Asia remains off track in meeting the Sustainable development goals (SDG). This study aims to assess the current burden, trends in neonatal disorders, and forecast mortality rates across South Asian countries, providing insights to guide investment priorities and improve neonatal outcomes.

Methods: Data for this study were sourced from the Global burden of disease (GBD) 2021 study, which utilizes a Bayesian meta-regression model to estimate mortality, prevalence, and disability-adjusted life years (DALYs). Spatial maps depicting the age-standardized prevalence rate and age-standardized mortality rate for neonatal disorders in South Asia were generated using QGIS software. Mortality forecasts for the period 2022-2031, attributed to various neonatal disorders, were produced employing the Auto-Regressive Integrated Moving Average model in R software. Additionally, an analysis of overall neonatal mortality trends from 1980 to 2021 was conducted, supplemented by a heat map that compares DALYs attributable to various neonatal disorders across South Asian countries in 2021.

Results: Between 1980 and 2021, South Asia experienced a substantial decline in neonatal mortality rates, with India and Bangladesh leading the progress. Mortality decreased by 40%, while DALYs fell by 35%, despite a 15% increase in the prevalence. The prevalence of neonatal encephalopathy due to birth asphyxia and trauma surged by 355%, yet its mortality dropped by 31%. Pakistan recorded the highest neonatal mortality and disease burden, particularly for hemolytic disease and other neonatal jaundice and neonatal encephalopathy due to birth asphyxia and trauma. In India and Bangladesh, neonatal preterm birth and neonatal sepsis and other neonatal infections contributed most to mortality. Neonatal encephalopathy due to birth asphyxia and trauma accounted for the highest DALYs. Forecasts predict continued reductions in neonatal mortality across South Asia, except in Pakistan, where persistently high rates are expected till 2031.

Conclusion: For South Asian countries to meet the SDG target for neonatal mortality by 2030, intensified and continuous efforts are required. These efforts should focus on identifying high-risk pregnancies and improving the quality of care during childbirth to address the root causes and reduce preventable neonatal deaths.

Background: The increase in malaria incidence and the reduction of funding for malaria control have highlighted the need to step up efforts in the fight against malaria in Mali. To further refine the malaria control strategy implemented in the country, this study aimed to evaluate the impact of control interventions at the health district level on malaria incidence in the general population.

Method: Malaria, rainfall, and intervention data were collected for the 75 health districts of Mali for the period from April 2017 to March 2022. The impact of the different control interventions on malaria incidence in the general population was assessed at the health district level with a Generalized Additive Mixed Model considering rainfall.

Results: Although coverage rates varied widely between health districts, most interventions showed an improvement in coverage over the study period. Two interventions had a small impact on incidence: long-lasting insecticidal net mass distribution (LLIN), with a reduction rate of 2.2 ‰ for an adjusted coverage rate from 30.0 to 79.0% (odds ratio (OR): 0.998; 95% confidence interval (CI) 0.997-0.999), and seasonal malaria chemoprevention (SMC), with a reduction rate of 1.9 ‰ for an adjusted coverage rate from 30.0 to 80.0% (OR: 0.9979; 95% CI 0.996-0.998).

Conclusion: The analysis found a small impact of LLIN and SMC on malaria incidence at the district level. Malaria control should be reinforced by improving coverage and utilization rates in the general population and in the most vulnerable groups and by deploying larger numbers of community health workers where needed.

Background: Older outpatients face a heightened risk of potentially inappropriate prescribing (PIP). However, there is a paucity of evidence evaluating PIP in older outpatients attending surgical outpatient departments in China using Chinese-specific criteria. This study aimed to assess the prevalence of PIP and identify associated factors within this population.

Methods: A cross-sectional design was employed, utilizing prescription data from older surgical outpatients across 100 hospitals in seven Chinese cities between January and December 2021. PIP was assessed based on Chinese criteria, and multivariate logistic regression analysis was performed to identify risk factors. Trends were analyzed using the average annual percent change (AAPC) via joinpoint regression.

Results: A total of 357,135 prescriptions for older surgical outpatients were analyzed. The prevalence of PIP according to Chinese criteria was 13.06%. The five most commonly identified potentially inappropriate medications (PIMs) were doxazosin, clopidogrel, tolterodine, estazolam, and the concurrent use of more than two NSAIDs, which together accounted for 52.73% of all PIMs. From January to December, the prevalence of PIP exhibited a slight decrease, from 13.29 to 13.21% (AAPC: -0.278%). Logistic regression revealed that factors such as tertiary-level hospital status, polypharmacy, pain, sleep disorders, hypertension, benign prostatic hyperplasia, and stone disease were positively associated with PIP in older surgical outpatients.

Conclusions: The study found that while the prevalence of PIP among older surgical outpatients in China is relatively low, attention is needed to the widespread use of certain PIMs.

Introduction: Viral hepatitis stands accountable for approximately 1.34 million deaths worldwide, with the number of fatalities steadily growing with time. This is partly due to the various genotypes of hepatitis C virus and having no vaccination developed yet. However, a paradigm shift in the epidemiology of hepatitis C was notable due to the emergence of direct-acting antiviral drugs. Nevertheless, related literature in the Saudi context still requires further investigations to improve strategies and interventions targeting HCV in Saudi Arabia.

Objectives: This study was conducted to estimate the lifetime prevalence of hepatitis C virus (HVC) in Riyadh, KSA, and assess factors associated with HCV that include demographics and co-morbidities.

Methods and materials: This cross-sectional study was conducted at a tertiary healthcare facility, located in Riyadh. The patients' database was searched for data regarding hepatitis C screening and treatment in a time window from 2017 to 2022. The study sample was composed of all individuals screened for or diagnosed with hepatitis C infection in the previously mentioned settings.

Results: Our sample included a total of 16,690 participants, 929 of which had positive test results (5.6%; 95% CI: 5.2-5.9%), with the rate being significantly higher in post-COVID-19 years due to a decreased number of tests performed. Positive test results were associated with male gender (43.4%), chronic kidney disease (11.8%), diabetes mellitus (34.9%), and hypertension (35%). Adjusted odds ratios (aOR) were obtained, with male gender (aOR: 2.47), widowed (aOR: 7.8) or divorced (aOR: 2.07) marital status, diabetes mellitus (aOR: 1.97), and hypertension (aOR: 2.87). Singles were found to be at lower risk of infection (aOR: 0.38). For each additional year of the study window, the odds of infection increased by 1.18.

Conclusion: Between 2017 and 2022, The HCV RNA positive cases were estimated to be 5.6%. Several risk factors were identified, including male gender, being widowed or divorced, and having diabetes mellitus, and hypertension. These results underline several opportunities to improve public health efforts and clinical practice in Saudi Arabia. That will further enhance the agenda targeting the burden of HCV in the country.

Clinical trial: Not applicable.

Background: Understanding the ethnic molecular subtype characteristics of breast cancer (BC) in Saudi women is crucial for providing comprehensive prognostic information and optimizing patient outcomes, making it essential to study their distribution and impact on survival.

Methods: This hospital-based cohort study analyzed clinic-pathological data from 1,035 Saudi women diagnosed with invasive BC and followed for 12 years, at King Faisal Specialist Hospital & Research Center. Cancers were classified into four molecular subtypes: luminal A, luminal B, human epidermal growth factor receptor 2 (HER2)-enriched, and triple-negative. Survival outcomes were assessed using Kaplan-Meier survival curves and Cox proportional hazard models.

Results: Luminal A was the most common molecular subtype (41.7%), followed by luminal B (23.4%), triple-negative (19.5%), and HER2-enriched (15.4%). Age at diagnosis, menopause, and tumor grade were significantly associated with subtypes (p < 0.05). Survival outcomes varied significantly (p = 0.0202), with luminal A and B showing the highest 5-year survival rates (~ 83%), triple-negative at 76.4% (hazard ratio: 1.55), and HER2-enriched tumors had the lowest at 69.1%, with a 1.75-fold higher risk of death. Advanced-stage cancers (III and IV) were strongly associated with increased mortality, with hazard ratios of 2.5 and 7.6, respectively, compared to early-stage disease.

Conclusions: Molecular subtypes and stage at diagnosis are key predictors of mortality in Saudi women with BC. The poor outcomes for HER2-enriched and TNBC subtypes highlight the need for timely diagnosis and targeted treatments, emphasizing the importance of personalized care and addressing ethnic variations in BC diagnosis.