Journal of Epidemiology and Global Health最新文献

Background: Respiratory syncytial virus (RSV) incidence among adults in Finland remains underreported, mostly due to non-specific RSV symptoms, infrequent standard-of-care testing, and reduced sensitivity of single-specimen nasal/nasopharyngeal RT-PCR testing among adults. We retrospectively estimated RSV-attributable incidence of all-cause respiratory hospitalizations and mortality in adults in Finland between 2011 and 2019.

Methods: We estimated incidence using time-series modeling by comparing the week-to-week variability in RSV diagnosis trends with the week-to-week variability in the events with any respiratory diagnosis. Weekly aggregated data on all-cause respiratory hospitalizations and deaths (J00-J99) were obtained from the Care Register for Health Care (HILMO) and Statistics Finland, respectively. Hospitalization data on RSV and influenza were obtained from HILMO. Data on all-cause respiratory diseases for age groups that showed a seasonal pattern were included in a hierarchical Bayesian model, sharing information across the age groups while accounting for seasonal fluctuations, and RSV and influenza circulation.

Results: The highest annual incidence rates of RSV-attributable respiratory hospitalizations were observed in adults aged ≥ 75 years (range 145-240 hospitalizations per 100,000 person-years), on average 7-fold higher than in adults aged 45-64 years (range 19-37 hospitalizations per 100,000 person-years). A biennial (low-high incidence) fluctuation of all-cause respiratory hospitalization incidence and mortality rate was observed in all age groups. A seasonal pattern for all-cause respiratory deaths was observed only for adults aged ≥ 75 years, who had an estimated RSV-attributable mortality rate of 8-14 deaths per 100,000 person-years. RSV-attributable deaths accounted for 3-5% of all all-cause respiratory deaths in this age group.

Conclusions: Respiratory morbidity and mortality associated with RSV infection among adults in Finland are substantial, particularly for those aged ≥ 75 years. Newly introduced RSV vaccines, which appear effective for the oldest adults, could have a substantial impact on this respiratory disease burden.

Background: Jordan faces significant challenges in cervical cancer prevention due to low screening participation and limited coverage. This study examined the sociodemographic factors associated with cervical cancer screening uptake among ever-married Jordanian women aged 20-49 years using data from the 2023 Jordan Population and Family Health Survey (JPFHS).  METHODS: We analyzed data from the 2023 JPFHS, which initially included 12,595 ever-married women. binary logistic regression analyses were conducted to identify sociodemographic predictors of cervical cancer screening uptake.

Results: A total of 12,405 ever-married women were included in the study. Among them, 2,038 (16.4%) reported having undergone cervical cancer screening through methods such as the Pap smear, human papillomavirus test, or visual inspection with acetic acid, while 10,367 (83.6%) had never been screened. Multivariable analysis revealed that older women, residents of Ajloun governorate, those with higher socioeconomic status, multiparous women, daily smokers, frequent internet users, and women with a history of HIV or sexually transmitted disease testing were more likely to undergo cervical cancer screening. Conversely, screening uptake was significantly lower among women residing in Irbid, Mafraq, Tafiela, and Aqaba governorates.

Conclusion: To improve cervical cancer screening rates, policymakers should prioritize poor and underserved women, particularly younger women who have lower participation rates. Strengthening healthcare infrastructure, especially in the southern governorates, and integrating preventive health education into school curricula are crucial steps toward increasing awareness and early detection. Additionally, primary prevention programs should adopt a more inclusive approach, targeting all population groups including those with healthy lifestyles rather than focusing solely on women with high-risk behaviors.

Concurrent HBV, HCV, and HDV infections pose a global health challenge, worsening disease, treatment, and patient outcomes, and burdening healthcare. In Iran, no comprehensive review has assessed HBV/HCV and HBV/HDV coinfection rates. This study conducted a systematic review and meta-analysis per PRISMA 2020 guidelines. The study was prospectively registered in PROSPERO (CRD420251007210). A comprehensive search was conducted across international (PubMed, Scopus, Embase, Web of Science, Cochrane Library) and Iranian databases (SID, Magiran), supplemented by Google Scholar, for studies published between January 2000 and March 2025. Eligible studies reported laboratory-confirmed cases of HBV, HCV, and/or HDV coinfections using ELISA, PCR, or real-time PCR. Because HDV replication depends on hepatitis B surface antigen (HBsAg), biologically independent HCV/HDV coinfection cannot occur. Consequently, studies that reported HCV/HDV coinfection without HBV were excluded. Two researchers independently conducted screening and data extraction and assessed study quality using the Newcastle-Ottawa Scale (NOS). To account for variability across studies, a random-effects model was used to estimate the pooled prevalence and its 95% confidence interval. Our analysis included 99 studies, encompassing more than 182,000 participants from regions of Iran. The pooled prevalence rates were 3% for HBV/HCV coinfection, 7% for HBV/HDV coinfection, and 1% for triple HBV/HCV/HDV infection. Due to significant heterogeneity across studies, random-effects models were used to obtain combined estimates. Substantial heterogeneity (I² up to 98%) was observed, attributable to variations in study populations, geographic regions, and diagnostic methods, as confirmed by sensitivity analyses and meta-regression. Publication bias was evident in most analyses. Key risk factors included blood transfusions, injection drug use, incarceration, and chronic liver disease. These findings underscore the urgent need for tailored prevention and surveillance programs. The high prevalence of coinfections in Iran, coupled with marked regional and population-based disparities, calls for standardized diagnostic protocols and targeted interventions that address behavioral and healthcare-associated risk factors.

Background: Celiac disease (CD) is an autoimmune condition marked by intestinal mucosa inflammation due to gluten. Currently, the sole effective treatment for CD is a gluten-free diet. knowledge and attitudes towards CD are essential for timely diagnosis and management. This research seeks to explore the knowledge and attitudes of blood donors regarding CD and gluten-free products in Yemen.

Methods: A cross-sectional study was executed involving 216 healthy male blood donors in Sana'a, Yemen. The questionnaire used in the study was a reliable survey instrument (with a Cronbach's alpha coefficient of 0.71) employed for the purpose of data collection. Demographic information, knowledge, and attitudes regarding CD were gathered through direct questionnaire administration. The questionnaire was divided into three parts: (1) demographic questions on age, sex, marital status, education level, blood groups, and body mass index (BMI); (2) knowledge assessment with 10 items; and (3) an attitude section with 4 questions. Statistical analysis utilized SPSS version 24 (IBM Chicago, IL, USA).

Results: A total of 216 blood donors were analysed. All participants were male, aged between 20 and 52 years. Among the participants, 14.8% exhibited familiarity with CD and gluten-free products. A comprehensive analysis revealed that 3.7% of participants possessed sufficient knowledge, 11.1% exhibited moderate knowledge, whereas 85.2% indicated a lack of knowledge regarding CD and gluten-free products. The vast majority 99.1% of participants demonstrated unfavourable attitudes towards CD and gluten-free products. A significant weak positive correlation was identified between knowledge scores and attitudes towards CD and gluten-free products (r = 0.370, P < 0.001). No correlation was found between socio-demographic factors and blood donors' knowledge and attitudes regarding CD and gluten-free products.

Conclusion: The research revealed a significant lack of awareness and ongoing misconceptions regarding CD within the Yemeni population. These results highlight the critical necessity for focused educational initiatives and enhanced availability of gluten-free products to promote timely diagnosis and efficient disease management.

Introduction: Dementia contributes significantly to morbidity and mortality associated with stroke, which has been a leading cause of death and disability in the U.S. We aim to determine the stroke mortality trends in the older population with dementia in the U.S from 1999 to 2023.

Methods: Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database was utilized to analyze the death records of older patients (aged ≥ 65 years) listing stroke as the underlying cause and dementia as the contributing cause of death. Age-adjusted mortality rates were computed per 100,000 population, and their variations over time were estimated as annual percent changes (APC).

Results: A total of 259,607 deaths occurred from stroke in older patients with dementia, with a 59% decrease in AAMR from 1999 (28.09) to 2023 (16.51). A stark rise in rates occurred from 1999 to 2001 (APC: 21.25; P < 0.05), followed by continuous declines until 2023. AAMRs were higher in females (26.3) than in males (21.9) and peaked in NH African Americans (29.5) and older adults aged 85 + years (114.73). Further rates peaked among non-metropolitan residents, the west (26.9), and the south regions (26.8).

Conclusion: Despite the decline in the dementia related mortality among older people with underlying stroke, the burden is still considerable and disproportionately affects females, NH African Americans, and non-metropolitan areas, therefore necessitating stroke-informed dementia care, better risk stratification, and even distribution of resources.

Background: Non-pharmaceutical interventions (NPIs) against COVID-19 globally altered RSV seasonality, yet longitudinal evidence on age-specific severity changes remains scarce in China.

Methods: In this hospital-based surveillance study, 20,305 children hospitalized with acute lower respiratory infection (ALRI) were enrolled. RSV was detected via RT-PCR across three phases: pre-pandemic (2017-2019), NPIs implementation (2020-2022), and post-NPIs (2023-2024).

Results: RSV positivity varied significantly between phases (p < 0.001), peaking at 38.85% (742/1,910) in 2021. Seasonal peaks shifted from winter (pre-pandemic) to spring (post-NPIs). The disease burden shifted toward infants aged 7-12 months (38.92%, 845/2,171 vs. 20.55%, 200/973 pre-pandemic; p < 0.001). Notably, mechanical ventilation was required in 8.00% (4/50) and 5.71% (2/35) of severe pneumonia cases aged 13-36 months during Phases II and III, respectively, whereas no cases were recorded pre-pandemic (0/14; p > 0.05).

Conclusion: NPIs fundamentally reshaped RSV epidemiology, inducing seasonal shifts and redirecting disease burden toward older infants experiencing delayed primary infection due to "immune debt."

Background: This study aimed to characterize the incidence, seasonality, and co-infection patterns of respiratory syncytial virus (RSV), influenza A and B, and SARS-CoV-2 among hospitalized children aged 0-5 years in Hamedan Province, a semi-arid region in western Iran, from April 2023 to March 2024. Key research questions included assessing post-pandemic shifts in viral seasonality, evaluating the extent of RSV circulation, and determining the frequency of co-infections in a resource-limited pediatric setting where regional data remain scarce.

Methods: A total of 586 nasopharyngeal/oropharyngeal samples were collected from children aged 0-5 years hospitalized with acute respiratory symptoms (≥ 2 of: fever ≥ 38 °C, cough, dyspnea, oxygen saturation < 95%). Multiplex real-time PCR (sensitivity 95%, specificity 98%) was used to detect RSV, SARS-CoV-2, and influenza A (H1N1, H3N2) and B. Statistical analysis included chi-square and Fisher's exact tests, and generalized linear models (binomial distribution, logit link).

Results: Among 586 inpatients (mean age: 2.8 years; 62.5% male), 27.0% tested positive for influenza (60% influenza A [35% H1N1, 25% H3N2], 40% influenza B), 6.0% for RSV, and 6.3% for SARS-CoV-2. Influenza peaked in autumn (41.3%, p < 0.001), RSV in winter (18.2%, p < 0.001), and SARS-CoV-2 in spring (15.3%, p = 0.005). Co-infections were rare (0.9%).

Conclusions: Findings reveal altered post-pandemic seasonality, reduced RSV activity, and low co-infection rates, suggesting potential ecological and immunological shifts. These trends highlight the need for sustained virus-specific surveillance and recalibrated vaccination strategies-particularly influenza vaccination in autumn and RSV prophylaxis in winter-in resource-limited pediatric settings.

Background: Emerging evidence suggests that insulin resistance (IR) may influence coronary artery disease (CAD) progression. However, the relationship between dietary insulinemic potential and IR surrogate markers and CAD severity remains unclear.

Methods: This cross-sectional study utilized data from the Nutrition Heshmat Registry (NUTHER) in Guilan, Iran, including 930 patients at risk for CAD. CAD severity was assessed using the Gensini score based on angiographic findings. Dietary intake was evaluated using a validated 168-item food frequency questionnaire (FFQ), with energy-adjusted dietary insulin load, and dietary insulin index calculated accordingly. The triglyceride-glucose (TyG)-BMI index was derived as a surrogate marker of insulin resistance.

Results: Of the 930 patients analyzed, 565 were categorized as having less severe CAD (Gensini score < 60) and 365 as severe CAD (Gensini score ≥ 60). Multiple regression models adjusted for various confounding factors showed that participants in the highest quartile of the TyG-BMI index had a 1.98-fold higher odds of severe CAD (OR (95%CI) = 1.98 (1.31-2.99); P-for-trend = 0.001), while those in the highest quartile of energy-adjusted dietary insulin load, and dietary insulin index had 2.41-fold and 2.22-fold increased odds of severe CAD, respectively (Q4 ORs (95%CIs) = 2.41 (1.41-4.12) for e.a.IL, and 2.22 (1.29-3.82) for e.a.II; P-for-trend < 0.001).

Conclusion: Our significant findings suggest that higher TyG-BMI, dietary insulin load, and insulin index are likely associated with an increased odds of severe CAD. Monitoring and modifying dietary insulinemic potential and improving metabolic health may serve as practical strategies for reducing CAD severity in at-risk populations.

Background: Lung cancer is the leading cause of cancer deaths worldwide. Due to late detection, patients have low survival rates. We aimed to examine lung cancer epidemiology in the Kingdom of Saudi Arabia by computing standardised rates for the different regions of the country and across years.

Methods: We used the Saudi Cancer Registry data to conduct a retrospective study for all lung cancer cases diagnosed between 2015 and 2020. We identified cases using ICD-O-3 codes, with no exclusions by morphology. We followed the Surveillance, Epidemiology, and End Results guidelines for staging. We analysed demographic and tumour characteristics and used mid-year population estimates from the General Authority for Statistics for standardisation. We then calculated age-sex standardised incidence rates and standardised incidence ratios using indirect standardisation. We compared geographical trends in incidence across regions and years.

Results: Based on the total number of 3,861 lung cancer cases reported to the Saudi Cancer Registry between 2015 and 2020, we estimated the average six-year crude incidence rate of 2.1 per 100,000. We observed variability in incidence across different regions ranging from 0.59 per 100,000 in Jazan to 3.36 per 100,000 in the Eastern Province. Age-standardised rates show males with consistently higher rates than females throughout the study period. Sex-based differences were statistically significant (P < 0.05). We also found that males had a higher proportion of squamous cell and small cell carcinomas than females (18.71% vs. 08.99% and 10.22% vs. 05.13% respectively).

Conclusions: Our findings show a male predominance, regional disparities, and late-stage adenocarcinoma diagnoses. These patterns are consistent with known risk factors, including tobacco exposure, environmental risks, and delayed detection, and support the implementation of targeted prevention, earlier diagnosis, and regionally tailored interventions in the Kingdom of Saudi Arabia.