Annals of Epidemiology最新文献

Purpose: Tuberculosis (TB) was the leading infectious cause of death worldwide in 2023. U.S. tuberculosis (TB) cases mostly result from reactivation of latent TB infection (LTBI). LTBI treatment is about 90% effective in preventing TB disease; thus, screening and treatment are essential for U.S. TB elimination efforts. Persons at higher risk of infection seek care at primary care clinics, which represent a critical setting for scaling up TB testing and LTBI treatment.

Methods: Using longitudinal electronic health record (EHR) data, we described a comprehensive LTBI care cascade among individuals at higher risk of infection seeking care in U.S. primary care clinics - from identification of higher-risk persons through testing, diagnosis, and treatment.

Results: Among 3.5 million patients, 48% were determined to be at higher risk; 86% were not tested. Among those tested, there was a 17% test positivity rate. Only 61% of persons diagnosed with LTBI were prescribed treatment; 44% did not complete treatment.

Conclusions: We established baseline rates of TB infection testing and LTBI treatment outcomes within U.S. primary care clinics. Results highlight opportunities for expanding U.S. TB prevention efforts by implementing targeted interventions to improve testing and treatment outcomes within primary care settings to ultimately reduce TB morbidity.

Purpose: Digital cough screening for COVID-19 detection shows promise, but population differences in cough acoustics and screening accuracy require investigation. This study examined cough characteristics and COVID-19 screening performance in Lima, Peru and Montreal, Canada.

Methods: Cough recordings and clinical data were prospectively collected from 605 adults. COVID-19 and other respiratory pathogens were diagnosed via NAAT. Acoustic features were extracted and compared. COVID-19 classification used eXtreme Gradient Boosting (XGBoost) and a deep learning neural network, assessed via internal and external validations for audio-only, clinical-only, and combined models. A sub-analysis explored XGBoost prediction scores by underlying disease status.

Results: Significant heterogeneity in cough acoustic features existed between Lima and Montreal cohorts. XGBoost audio-based models trained and tested in Lima showed superior performance (area under the curve [AUC]: 0.71±0.08) compared to Montreal (AUC: 0.53±0.04). Both models demonstrated poor external validation performance when tested on the alternate dataset. Neural network models showed similar trends. Additionally, individuals with other respiratory diseases had differing COVID-19 prediction scores between sites, suggesting epidemiological context influences model performance.

Conclusions: Cough acoustics are population-specific, impacting cough-based classification algorithm utility across different epidemiological settings. COVID-19 cough screening models demonstrated limited transferability, highlighting challenges in developing globally applicable tools without representative training data.

Purpose: We developed metrics to estimate the number of people who could benefit from PrEP using clinical, behavioral, and economic considerations.

Methods: We estimated the distribution of annual HIV acquisition risk in the U.S. population and the number who would benefit from PrEP based on HIV acquisition risk thresholds. Estimates were generated for men who have sex with men (MSM), men who have sex with women (MSW), women who have sex with men (WSM), and people who inject drugs (PWID). Populations were stratified by state, age, and race and ethnicity. Adult PWID were stratified by state and sex. We also derived a measure anchored on a willingness-to-pay threshold to gain one quality-adjusted life year (QALY).

Results: We estimated 31-57% of MSM could benefit from PrEP by HIV acquisition risk thresholds, and 30% when using the cost-per-QALY threshold. For PWID, estimates ranged from 7% (cost-per-QALY) to 60% (highest risk threshold). MSW and WSM had the lowest proportions estimated to benefit (0-11%), but the absolute number of individuals remained large due to the size of these populations.

Discussion: These estimates provide a broader framework in which to examine need for PrEP at the population and program level in the United States.

Purpose: Germline genetic testing can identify people at high risk of hereditary cancers. Limited data exist on differences in receipt and knowledge of germline genetic testing for cancer predisposition (hereafter genetic testing for cancer).

Methods: Data from the National Center for Health Statistics Rapid Surveys System collected between January-February 2024 were analyzed to estimate prevalence of receipt, knowledge, and interest in genetic testing for cancer.

Results: An estimated 8.4% of adults received genetic testing for cancer. Among adults who had not received genetic testing for cancer, 52.0% knew genetic tests can indicate high risk of getting cancer in the future, and 40.7% expressed interest in getting tested in the future. The most common reason for interest was knowing risk would make a difference in health care decisions (93.3%). Among adults who did not report interest in genetic testing for cancer, the most common reason for disinterest was no provider recommendation (54.2%). Differences in receipt, knowledge, and interest were observed by sociodemographic characteristics and health history.

Conclusions: This report provides national estimates that can inform strategies to increase genetic testing for cancer among high-risk populations, including efforts to reduce potential testing barriers.

Purpose: Vaccine-related autoimmune diseases have been hypothesized for decades, but epidemiological studies have consistently shown no associations with routine childhood vaccinations. The introduction of mRNA-based COVID-19 vaccines renewed attention to this question, given theoretical mechanisms such as molecular mimicry and immune overactivation. Using medical records from the TriNetX US collaborative network, this study evaluated whether COVID-19 vaccination is associated with increased risk of autoimmune disease in children and explored the role of SARS-CoV-2 infection.

Methods: We analyzed autoimmune disease incidence trends among children aged 0-21 years from 2016 to 2024. Using a retrospective matched cohort study design with data from April 2020- April 2025, we compared: (1) vaccinated versus unvaccinated children (n = 936,919 versus 942,604), (2) vaccinated versus unvaccinated children with prior SARS-CoV-2 infection (n = 44,512 per group), and (3) vaccinated children with versus without prior infection (n = 43,170 per group). Autoimmune diagnoses (all conditions) were assessed during a fixed 180-day period after cohort entry. Cox proportional hazards models estimated hazard ratios (HRs).

Results: Trend analysis showed an increase in pediatric autoimmune disease incidence beginning in 2021. In comparative analyses, vaccinated children had a significantly lower overall hazard of autoimmune disease during the 180-day follow-up than unvaccinated children (HR=0.387; 95% CI: 0.365-0.410). Among children with prior SARS-CoV-2 infection, vaccination again had a protective association compared to unvaccinated (HR=0.690; 95% CI: 0.516-0.922). No significant difference was observed between vaccinated children with and without prior infection.

Conclusion: These findings suggest COVID-19 vaccination is associated with a lower hazard of autoimmune disease in children, including those with prior SARS-CoV-2 infection.

Purpose: Biological aging differences are linked to sociodemographic characteristics, but how intersecting social dimensions shape these differences remains unclear. Integrating aging biology and intersectionality theory, we examined the joint influence of multiple social determinants on phenotypic age acceleration (biological vs. chronological age).

Methods: Using data from 173,925 participants in the German NAKO study, we calculated phenotypic age acceleration based on blood-based biomarkers and created 72 intersectional social strata based on sociodemographic factors. We assessed differences across strata using intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (I-MAIHDA).

Results: All intersectional strata displayed phenotypic age deceleration (biologically younger than chronological age). The advantage was smallest among men without migration background, living alone and with low socioeconomic status. Substantial discriminatory accuracy (7.13%) revealed intersectional inequalities, predominantly driven by additive effects. Modest interaction effects indicated increased risk for individuals with migration background not living alone and medium/high socioeconomic status and those without migration background living alone with medium/low socioeconomic status.

Conclusions: Our findings suggest that intersectional strata shape biological aging beyond chronological age, potentially through cumulative physiological effects of chronic psychosocial stress. Future epidemiological research should explore the mechanisms linking intersecting social dimensions and biological aging, designing intersectionally-informed targeted interventions.