Journal of Epidemiology and Global Health最新文献

Objectives: To investigate the epidemiological profile and cost burden of pediatric inpatients with tuberculous meningitis (TBM) in China.

Methods: We conducted a descriptive multicenter study involving pediatric TBM inpatients from 9 provincial hospitals and 20 municipal hospitals across 24 provinces in China from January 2016 to December 2021. Sociodemographic and geographic variables, admission and discharge information were extracted from face sheets of discharge medical records to describe the epidemiological characteristics. Length of hospital stay (LOS) and hospitalization expenses were used to assess disease burden.

Results: TBM accounted for 0.01% (971/7,647,598) of total hospitalization cases and 15.82% (971/6,138) of TB cases. The proportion of TBM children aged 1-3 (39.13%, 380/971) years were the highest. TBM children aged < 1 year had longest LOS (12d) and highest total costs ($2447.55). Minority patients had a higher proportion of TBM hospitalizations (24.09% vs 13.79%), longer LOS (11d) and higher diagnostic costs ($745.95 vs $628.47) than Han people. The northwest region had the highest rate of TBM hospitalization (n = 272, 28.01%) and the longest LOS (8d). TBM + PTB group exhibited the highest rate of outpatient admission (78.51%,263/335), shortest LOS (5d) and lowest total cost ($1729.75) and diagnostic cost ($827.30). The most prevalent concomitant TB infection site was the lung (n = 494, 50.82%). TBM + PTB + other EPTB group had the longest LOS (14d) and highest total cost ($3380.54).

Conclusion: Pediatric TBM poses substantial disease burden in China, especially in western regions and children under six years old. Early diagnosis and treatment for children with TBM should be suggested.

Background: Despite the growing evidence on the thrombophilia in Saudi population along its diverse regions, there have been no studies on thrombotic events in the Eastern Province of Saudi Arabia. This single-center study aimed to investigate the prevalence of venous thromboembolism (VTE) in a hematology clinic in the Eastern Province of Saudi Arabia between January 2015 and May 2023. The objective of this study was to investigate the clinical characteristics of VTE and compare them with national data.

Methods: This is a retrospective, observational, single-center study conducted in the Eastern Province from January 2015 to May 2023. After applying the inclusion and exclusion criteria and the prevalence rate calculation an analysis of n = 170 patients was conducted to compare the epidemiological results of the current study with national data published in other provinces of Saudi Arabia. Data collected included demographics, comorbidities and location with thrombosis recurrence.

Result: The prevalence rate of VTE in this cohort was 3.16%. Women made up 70% of the population. About 80.5% of cases were obese or overweight, 37.6% of cases had comorbidities that may increase the risk of thrombosis, and 12.9% of cases were associated with smoking. The most common site of VTE (56.5%) and the site of higher recurrence of VTE (21.8%) was the lower extremities. In addition, recurrent VTE was observed in 28.2% of cases, reflecting a significantly higher recurrence rate compared with other national studies (p = 0.001). Compared with other national statistics, the most significant risk factors for thrombosis in the Eastern Province were smoking, obesity and family history (p = 0.000). Compared with national statistics, this study demonstrated significantly higher rates of VTE in pregnancy, patients on hormonal therapy, and patients with rheumatological/autoimmune diseases (p = 0.001).

Conclusion: The incidence of VTE can be reduced by changing lifestyles and creating educational programs to educate people about the dangers of obesity and smoking.

Purpose: Pancreatic cancer remains a deadly disease with a low survival rate specifically if diagnosed at later stages. Surgery is one of the mainstay treatments for early stage disease but is accompanied by significant mortality and morbidity even in high volume centers. In the present study we wanted to determine the influence of pre-operative weight loss, BMI and liver function tests on postoperative outcomes.

Methods: Data for patients who underwent pancreatic surgery at the American University of Beirut Medical Center between 1998 and 2017 were analyzed. The data included patient demographics, pathologic diagnosis, stage, nodal involvement, tumor grade, surgical margin, type of adjuvant therapy, liver function tests and post-operative complications. The correlation and p-value were determined by the chi-square test with p-value < 0.05 considered statistically significant.

Results: The analysis included 236 patients. 63% were males and mean age was 60 years. A total of 96 (41%) patients had significant weight loss prior to surgery and 173 (31%) had a BMI > 30 kg/m2 which were considered obese. Obesity and significant weight loss were associated with increased risk of post-operative complications (P = 0.013 and P = 0.004, respectively). Transaminases and cholestatic liver enzymes were not associated with post-operative complications.

Conclusions: Assessment and management of nutritional status particularly weight loss and BMI prior to pancreatic cancer surgery may influence postoperative outcomes in this patient population.

Background: Aortic aneurysm has a subtle onset, high rupture mortality, rapid progression in younger individuals, and increasing annual mortality rates. Our study aimed to estimate the global burden and trends of early-onset aortic aneurysm from 1990 to 2021.

Methods: Participants aged 15-39 years from 204 countries and regions (Global Burdern of Disease, GBD) from 1990 to 2021.The primary assessment indicators include age-standardized death rates (ASDR), age-standardized disability-adjusted life years rates (ASDALYR), annual average percent change (AAPC), attributable risk factor proportions, slope index, concentration index, and predictive model for early-onset aortic aneurysm.

Results: From 1990 to 2021, the ASDR for aortic aneurysm in adolescents and young adults increased from 0.12 (95% confidence interval [CI] 0.11, 0.14) to 0.13 (0.11, 0.14) per 100,000 population, with an AAPC of 0.08% (-0.08%, 0.25%). The ASDALYR rose from 7.25 (6.52, 8.30) to 7.35 (6.51, 8.37), with an AAPC of 0.07% (-0.09%, 0.23%). Both ASDR and ASDALYR are higher in males than females, with a declining trend in females. Higher Socio-Demographic Index (SDI) countries exhibit higher ASDR and ASDALYR compared to lower SDI countries, with a continuous decline observed in high SDI nations. Smoking remains the top risk factor, with population growth being the primary driver. Models predict a global increase in aortic aneurysm deaths, predominantly among males.

Conclusion: The overall burden of early-onset aortic aneurysms has exhibited an increasing trend over the last three decades, especially in lower SDI countries. There is an urgent need to develop targeted prevention and control strategies across different regions and countries worldwide.

Background: Many of the studies in causal inference using propensity scores relied on binary treatments where it is estimated by logistic regression or machine learning algorithms. Since 2000s, attention has been given for multiple values (categorical) and continuous treatments and the propensity score associated with such treatments is called generalized propensity score (GPS). However, there is scant literature on the use of count treatments in causal inference. Besides, effective sample size, after weighting, along with other methods has not been practiced for GPS model performance measure. The study was done with the aim of using count treatments in causal inference; select appropriate GPS and outcome models for such treatment and ordinal outcome.

Method: A family of count models and a generalized boosted model (GBM) were used for GPS estimation. Their performance was measured in terms of covariate balancing power, effective sample size and the average treatment effect after GPS-based weighting. Marginal structural modeling (MSM) and covariate adjustment using GPS were used to estimate treatment effect on ordinal outcome. Stabilized inverse probability treatment weighting was used for covariate balancing assessment. Monte Carlo simulation study at various sample sizes with 1000 replication and household survey data were used in the study.

Result: GPS was trimmed at 1% and 99% which gave better results as compared to untrimmed results. The generalized boosted model performed well both in simulation and actual data producing a larger effective sample size and smaller metrics when estimating average treatment effect on the outcome. The MSM was found better than GPS as a covariate in the outcome model.

Conclusion: It is important to trim GPS when it approaches zero or one without loss of more information due to trimming. Effective sample size after weighting should be used along with other methods such as correlation and absolute standardized mean differences for GPS model selection. GBM should be used for GPS estimation for count treatments. MSM is important for the outcome model when weighting GPS method is used. Finally, the number of antenatal care services had an increasing effect on the probability of age-specific childhood vaccination.

Objective: The study aims to determine patterns of multimorbidity among common non-communicable diseases (NCDs) in Thailand.

Study design: Cross-sectional analysis.

Methods: This study obtained self-reported data from 42,785 participants of the Thai Cohort Study (TCS) via mailed questionnaires. Information was collected on eight chronic conditions. Common multimorbidity (co-occurrence of two or more chronic conditions) patterns were identified and classified using latent class analysis (LCA). Multinomial models assessed associations with demographic and lifestyle factors, testing linear trends with P for trend (p-trend). The spatial analysis was used to identify potential clusters and high-risk areas of the age-adjusted prevalence of multimorbidity at the study area.

Results: Four clusters were identified: "Relatively healthy" class (87.32%, reference), "Metabolic syndromes" class (10.20%), "Cardiometabolic disorders" class (1.53%), and "Multi-system conditions" class (0.95%) (percentages meaning proportion of this group). Older age and males were associated with an increased risk of multimorbidity. Attaining a university-level education was found to be a protective factor for in the classes of multimorbidity. Furthermore, engaging in housework appeared to be associated with a reduced risk of developing cardiometabolic conditions and multi-system disorders. Spatial analysis indicated that the high age-adjusted prevalence of "Cardiometabolic disorders" class tended to be clustered in central Thailand.

Conclusion: Multimorbidity patterns were related to sociodemographic factors and lifestyles, and geographic characteristics. Future research should focus on classifying and comparing multimorbidity among different populations such as different age groups and genders in various locations. This would help in formulating targeted health policies and interventions to reduce their health burden.

Introduction: Empowering women in Saudi Arabia has become a critical agenda, reflecting the nation's shifting societal and economic dynamics. This review highlighted recent policy initiatives, societal changes, and institutional reforms aimed at enhancing the role of women in the Saudi health sector.

Methods: This scoping review explored academic literature and government reports related to gender equality and women's empowerment in the Saudi health sector to provide an overview of the advancements made and the challenges that remain.

Results: The review found substantial progress in empowering female healthcare workers (HCWs), evidenced by increased participation in leadership roles, higher enrollment in medical education, and the implementation of workplace policies promoting gender equity. These efforts are aligned with Saudi Arabia's Vision 2030, which emphasizes inclusivity and diversity as central pillars for sustainable development. However, persistent challenges such as traditional gender norms, workplace biases, and limited access to mentorship and leadership opportunities were identified as barriers to further progress.

Conclusions: While significant strides have been made, achieving gender equality in the Saudi healthcare sector requires sustained efforts to address societal and institutional challenges. The transformative potential of education, leadership development, and mentorship programs should be harnessed to empower female HCWs. Continued policy reforms and cultural shifts are crucial for fostering a gender-diverse healthcare system.

Background: The epidemiology of multiple sclerosis (MS) is complex due to the interaction of various risk factors. This study assesses the global, regional, national and sub-national burden of MS and predicts future trends.

Methods: Data from the Global Burden of Disease Study 2021 was analyzed to assess the epidemiology of MS from 1990 to 2021. Data from the World Bank was used to determine the socio-demographic predictors of MS prevalence using multivariate analysis.

Results: Globally, 1.89 million people live with MS, with over 62,000 new cases diagnosed in 2021. The global prevalence of MS is 23.9 cases per 100,000 population, with a continuous increase over the past three decades. North America and Western Europe had the highest prevalence, incidence, disability-adjusted life-years (DALYs), and mortality rates. Countries with the highest prevalence were Sweden (219 /100,000 population), Canada (182), Norway (176), Ireland (163), and the UK (158). Analysis of subnational level data from US revealed that northern states such as Utah, Montana, and Rhode Island had incidence rates double those of southern states such as Hawaii, Mississippi and Louisiana.

Conclusions: The burden of MS is rising worldwide, especially in developed countries. To reduce this burden, it is essential to understand the distribution and risk factors of MS, and to address healthcare disparities in early diagnosis, access to treatment and social services.

Acute influenza-like illnesses (ILIs) are primarily caused by influenza type A or type B viruses. Several factors influence the risk of the spread of ILIs. The present study investigated the epidemiological characteristics, differences, and epidemiological trends of influenza viruses, noninfluenza respiratory pathogens, and locations where clusters occurred in Taiwan between 2011 and 2020. The study analyzed publicly available data on 1,545 confirmed ILI clusters, with the data obtained from the Taiwan Centers for Disease Control. In total, 1,334 ILI clusters were caused by influenza virus infection, 11 ILI clusters were caused by noninfluenza respiratory pathogens, and 78 ILI clusters were caused by pathogens not detected in routine testing. Additionally, for 122 ILI clusters, no pathogen detection was initiated. Significant differences were observed (p < 0.001) in the number of ILI clusters between influenza and noninfluenza respiratory pathogens in 2011-2020. In addition, significant differences were observed (p < 0.001) in the number of ILI clusters between locations in 2011-2020. In terms of specific pathogens within ILI clusters, single infections with influenza A virus accounted for the highest number of cases (69.6%, 1076/1358, odds ratio: 1.740-2.957, p < 0.001-0.012), followed by adenovirus infections among noninfluenza respiratory pathogens (58.3%, 7/12). Schools had the highest number of ILI clusters (47.3%, 731/1545) among the investigated institutions (odds ratio: 1.438-1.556, p < 0.001-0.012). This study provides valuable insights into ILI cluster transmission patterns in Taiwan over a 10-year period and highlights the importance of long-term studies covering a wide geographic area as a means of understanding the implications of such patterns.