Journal of Epidemiology and Global Health最新文献

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.

Background: The Gulf Cooperation Council region hosts large numbers of migrant workers, which has important implications for public health. Studies have documented varied disease risks among these populations. This paper examines risk factors for communicable diseases among migrant workers in this region. It darws on a social-ecological model to explore the interplay of individual, social, environmental, and structural factors. The paper also outlines policy areas where action may strengthen public health outcomes.

Methods: This study conducted a systematic review following PRISMA guidelines. We searched PubMed, Scopus, Embase, Web of Science, CINAHL, and Global Health. We identified 113 records through database searches, screened 72 unique records after duplicate removal, and assessed 24 at full-text for eligibility. Extracted data were managed using standardized Excel-based forms, cross-checked for accuracy, and synthesised narratively by grouping studies according to disease type and risk-factor domains following established guidance. We applied co-occurrence analysis of risk factors across studies. Data synthesis used a narrative approach to compare findings across heterogeneous study designs, focusing on recurring patterns in reported.

Results: Co-occurrence analysis using Pearson correlations, Jaccard coefficients, and phi coefficients (bootstrap 95% CIs) showed susbtantial convergent validity. Healthcare access and language barriers each appeared frequently alongside labour camps. Crowded conditions were often linked with low awareness. Migration from endemic countries showed little overlap with occupational exposure.

Conclusions: Communicable disease risks among migrant workers in the GCC arise from multiple, interacting factors. Healthcare access barriers and labour camp housing repeatedly emerged among the most prominent co-occurring risk factors. Communicable disease risks among migrant workers in the GCC largely reflect structural conditions, particularly housing, healthcare access, and legal and occupational vulnerabilities, highlighting the need for coordinated regional policies that strengthen surveillance, improve living conditions, and expand equitable access to care.

Purpose: While Zambia has an efficient program for early detection of cervical cancer, most cases are diagnosed at advanced stages. This study examined the time between suspecting cancers at screening clinics and histopathologic confirmation of cervical cancer in the Lusaka Province of Zambia.

Methods: This study included the records of 3,483 women with suspected cancerous lesions identified by visual inspection of the cervix (VIA) who were referred from Lusaka Province screening facilities from 2014 to 2022. The study linked screening records with corresponding histopathologic results of the lesions after examination at the University Teaching Hospital. Variables abstracted from the medical records included age, human immunodeficiency virus (HIV) status, district of residence and referral clinic, and dates of referral and confirmed diagnosis.

Results: False-positive VIA results constituted about 90% of all referrals. Women living with HIV (WLWH) had longer wait times between screening referrals and receipt of histopathologic results, most notably women coming from rural settings (median of 146 days) compared to urban settings (median of 69 days) (p < 0.05). Among women diagnosed with low-grade intraepithelial lesions, WLWH had a 63% higher risk of confirmed cancer diagnosis (CI: 1.16, 2.29) than women not living with HIV. For high-grade intraepithelial lesions, the adjusted HR showed WLWH having a 17% (CI: 0.89, 1.53) higher risk of confirmed cancer diagnosis compared to women not living with HIV.

Conclusion: The high rate of false-positives and long wait times call for expanded service infrastructure, particularly in rural settings, and continuing provider education/training to optimize screening sensitivity and shorten wait times in the Lusaka Province. Such measures may reduce the overload on the existing histopathology infrastructure and may provide lessons for other limited-resource countries facing similar cancer control and prevention challenges.