Annals of Epidemiology最新文献_第10页

The association between metabolic syndrome and risk of severe infection: A population-based cohort study 代谢综合征与严重感染风险之间的关系：一项基于人群的队列研究

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-10-01 Epub Date: 2025-08-18 DOI: 10.1016/j.annepidem.2025.08.015

Ming Zhao , Jiayi Huang , Luojia Dai , Chenyu Liang , Yankun Liu , Haili Wang , Xin Zhang , Shuzhen Zhao , Chengnan Guo , Zhenqiu Liu , Tiejun Zhang

Purpose

The association between metabolic syndrome (MetS) and severe infection remains inconclusive. We investigated the potential associations between MetS and its components and severe infection in a large population-based cohort.

Methods

We used data from Shanghai Suburban Adult Cohort and Biobank which includes 35,193 participants who were enrolled in 2016 and 2017 with follow-up until March 2024. Severe infections, defined as those requiring hospital admission or resulting in mortality, were identified through medical records. Cox proportional hazards models were used to analyze the associations between MetS and its components with incident severe infection.

Results

During a median of 6.96 years of follow-up, a total of 1143 (11.78 %) severe infections occurred in participants with MetS and 2337 (9.18 %) in No MetS group. MetS was associated with an increased risk of severe infection compared to the No MetS group (HR, 1.19; 95 % CI, 1.11–1.28). Among the individual components, elevated waist circumference, fasting blood glucose, and reduced HDL cholesterol were associated with increased severe infection risk, whereas elevated blood pressure alone was associated with reduced severe infection risk (HR, 0.91; 95 % CI, 0.85–0.98). The risk of severe infection also increased with increasing number of MetS components, with the highest risk found in the presence of all 5 components (HR, 1.70; 95 % CI, 1.39–2.07).

Conclusions

MetS was associated with an increased risk of severe infection. Further studies are warranted to elucidate the association between MetS and severe infection.

目的代谢综合征（MetS）与严重感染之间的关系尚不明确。我们在一个以人群为基础的队列中调查了MetS及其成分与严重感染之间的潜在关联。方法使用上海郊区成人队列和生物库的数据，包括2016年和2017年入组的35193名参与者，随访至2024年3月。严重感染，定义为需要住院或导致死亡的感染，是通过医疗记录确定的。Cox比例风险模型用于分析MetS及其组成部分与突发严重感染之间的关系。结果在中位随访6.96年期间，有MetS的参与者共发生1143例（11.78 %）严重感染，无MetS组发生2337例（9.18 %）严重感染。与无MetS组相比，MetS与严重感染风险增加相关（HR, 1.19; 95 % CI, 1.11-1.28）。在个体成分中，腰围升高、空腹血糖和高密度脂蛋白胆固醇降低与严重感染风险增加相关，而单独升高的血压与严重感染风险降低相关（HR, 0.91; 95 % CI, 0.85-0.98）。严重感染的风险也随着MetS成分数量的增加而增加，所有5种成分都存在时风险最高（HR, 1.70; 95 % CI, 1.39-2.07）。结论smets与严重感染风险增加相关。需要进一步的研究来阐明MetS与严重感染之间的关系。

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引用次数: 0

Correlates of single morbidities and multimorbidity in children: A cross-sectional study 儿童单发病和多发病的相关性：一项横断面研究

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-10-01 Epub Date: 2025-08-28 DOI: 10.1016/j.annepidem.2025.08.039

Alex Luther , Danielle Fearon , Ian Colman , Joel A. Dubin , Laura Duncan , Scott T. Leatherdale , Dillon Browne , Mark A. Ferro

This study investigated and compared correlates of multimorbidity with other single morbidity statuses (physical illness only, mental disorder only, neurodevelopmental disorder only) among children in Canada. The epidemiological sample included 33,715 children aged 5–17 years from the Canadian Health Survey of Children and Youth. Classification of children by morbidity status was based on reports from the person most knowledgeable (PMK). Multinomial logistic regression quantified associations between demographic and psychosocial characteristics and morbidity status using odds ratios (ORs) and 95 % confidence intervals (CIs). Female (OR=0.5 [0.5–0.6]) and immigrant children (OR=0.6 [0.5–0.8]) were less likely to report multimorbidity, as well as singular morbidity statuses. Older children (OR=2.3 [2.1–2.6]) were more likely to report multimorbidity. Elevated parent stress (OR:2.1 [1.7–2.5]), worse parent mental health (OR=3.0 [2.4–3.7]), and communities perceived as less safe (OR:1.5 [1.2–2.0]) were associated with higher odds of multimorbidity. Differences in magnitudes of association across morbidity statuses for child age and sex, as well as PMK mental health, and stress levels represent opportunities to identify at-risk children to aid in the prevention of multimorbidity. Strong associations between parent stress and mental health and child morbidity highlight the need to adopt integrated health services that use a family-centred model of care.

本研究调查并比较了加拿大儿童多发病与其他单一发病状态（仅躯体疾病、仅精神障碍、仅神经发育障碍）的相关性。流行病学样本包括来自加拿大儿童和青年健康调查的33,715名5-17岁儿童。根据发病率状况对儿童进行分类是基于最了解情况的人（PMK）的报告。多项逻辑回归使用比值比（ORs）和95% %置信区间（CIs）量化了人口统计学和社会心理特征与发病率状况之间的关联。女性（OR=0.5[0.5 - 0.6]）和移民儿童（OR=0.6[0.5 - 0.8]）报告多重发病和单一发病状态的可能性较小。年龄较大的儿童（OR=2.3[2.1-2.6]）更有可能报告多重发病。父母压力升高（OR:2.1[1.7-2.5]）、父母心理健康状况较差（OR=3.0[2.4-3.7]）以及被认为不太安全的社区（OR:1.5[1.2-2.0]）与多重发病的几率较高相关。儿童年龄和性别以及PMK心理健康和压力水平的发病率状况之间的关联程度差异，为识别高危儿童提供了机会，有助于预防多重发病率。父母压力与心理健康和儿童发病率之间的密切联系突出表明，需要采用采用以家庭为中心的护理模式的综合保健服务。

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引用次数: 0

Leveraging mediation analysis as a tool to study mechanisms underlying health inequities. 利用中介分析作为研究卫生不公平机制的工具。

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-10-01 Epub Date: 2025-07-13 DOI: 10.1016/j.annepidem.2025.07.002

Judith J M Rijnhart, Ryan J Bailey, Jessica Agbodo, Vishakha Agrawal, Valerie M Rodriguez-Olmo, Jason L Salemi

Purpose: To describe three statistical approaches that help gain a comprehensive understanding of mechanisms underlying health inequities: univariate regression analysis, effect modification analysis, and mediation analysis.

Methods: We described how univariate regression analysis, effect modification analysis, and mediation analysis can be used to gain insight into mechanisms underlying health inequities. We demonstrated the application of these approaches using a motivating example from the Health and Retirement Study in which we studied the role of education in ethnic disparities in episodic memory.

Results: Univariate regression analysis showed that Hispanic individuals on average had lower episodic memory scores compared to non-Hispanic individuals. Effect modification analysis showed that the beneficial effect of education on episodic memory was less strong in Hispanic individuals compared to non-Hispanic individuals. Mediation analysis showed that the ethnic disparity in episodic memory was not only driven by effect modification, but also by differences in the distribution of education years across ethnic groups.

Conclusion: The combined study of effect modification and mediation provides a comprehensive understanding of the mechanisms that cause and sustain health inequities. Insight into these mechanisms is crucial to determine targets for interventions and policies aimed at eliminating health inequities.

目的：描述有助于全面了解卫生不公平机制的三种统计方法：单变量回归分析、效应修正分析和中介分析。方法：我们描述了如何使用单变量回归分析、效应修正分析和中介分析来深入了解健康不平等的机制。我们使用健康与退休研究中的一个激励例子来演示这些方法的应用，在该研究中，我们研究了教育在情景记忆中的种族差异中的作用。结果：单变量回归分析显示，西班牙裔个体的情景记忆得分平均低于非西班牙裔个体。效应修正分析表明，教育对情景记忆的有益影响在西班牙裔个体中不如非西班牙裔个体强。中介分析表明，情节记忆的种族差异不仅受到效应修正的驱动，还受到受教育年限分布差异的驱动。结论：效应修正与中介的结合研究有助于全面了解卫生不平等的产生和维持机制。深入了解这些机制对于确定旨在消除卫生不平等的干预措施和政策的目标至关重要。

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引用次数: 0

Family incarceration and barriers to mental health care among low-income US veterans 低收入美国退伍军人的家庭监禁和心理保健障碍

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-10-01 Epub Date: 2025-08-11 DOI: 10.1016/j.annepidem.2025.08.006

Alexander Testa PhD , Luis Mijares MS , Jack Tsai PhD

Background

Family member incarceration is a risk factor for mental health challenges. However, less research has investigated the relationship between family member incarceration and barriers to mental health services.

Methods

Data were drawn from the 2023 National Veteran Homeless and Other Poverty Experiences (NV-HOPE) Survey, a nationally representative sample of US veterans living at or below 300 % of the federal poverty level (N = 978). Logistic regression models were used to examine the association between family member incarceration and self-reported barriers to mental health care, adjusting for demographic, socioeconomic, and military service characteristics.

Results

Overall, 42.1 % of veterans reported that a family member had been incarcerated. Veterans with an incarcerated family member had 1.63 times greater odds of reporting any barrier to mental health care (95 % CI: 1.13–2.33). Specific barriers to mental health care reported by these veterans included embarrassment (OR = 2.25, 95 % CI = 1.18, 4.29), being treated differently by peers (OR = 2.51, 95 % CI = 1.24, 5.08), not knowing where to seek help (OR = 2.25, 95 % CI = 1.23, 4.10), inadequate transportation (OR = 7.01, 95 % CI = 2.99, 16.41), difficulty scheduling appointments (OR = 2.84, 95 % CI = 1.65, 4.89), and treatment cost (OR = 1.72, 95 % CI = 1.14, 2.60).

Conclusions

Family member incarceration is associated with increased barriers to mental health care among low-income US veterans. These findings highlight the potential value of programs within veteran healthcare that address the barriers to mental health access, especially among those with a history of family member incarceration.

家庭成员监禁是心理健康挑战的一个风险因素。然而，很少有研究调查家庭成员监禁与心理健康服务障碍之间的关系。数据来自2023年全国退伍军人无家可归和其他贫困经历（NV-HOPE）调查，这是一个具有全国代表性的样本，美国退伍军人的生活水平在 联邦贫困线的300%或以下（N = 978）。采用Logistic回归模型检验家庭成员监禁与自我报告的精神卫生保健障碍之间的关系，并对人口统计学、社会经济和兵役特征进行调整。结果总体而言，42.1 %的退伍军人报告有家庭成员被监禁。家庭成员被监禁的退伍军人报告精神卫生保健障碍的几率为1.63倍（95 % CI: 1.13-2.33）。这些退伍军人报告的心理保健具体障碍包括尴尬（OR = 2.25, 95 % CI = 1.18, 4.29）、被同伴区别对待（OR = 2.51, 95 % CI = 1.24, 5.08）、不知道去哪里寻求帮助（OR = 2.25, 95 % CI = 1.23, 4.10）、交通不便（OR = 7.01, 95 % CI = 2.99, 16.41）、难以安排预约（OR = 2.84, 95 % CI = 1.65, 4.89）和治疗费用（OR = 1.72, 95 % CI = 1.14, 2.60）。结论：家庭成员监禁与低收入美国退伍军人心理保健障碍增加有关。这些发现强调了退伍军人医疗保健项目的潜在价值，这些项目解决了心理健康准入的障碍，特别是那些有家庭成员监禁史的人。

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引用次数: 0

Where you live and where you receive care: Using cross-classified multilevel modeling to examine hospital and neighborhood variation in in-hospital mortality and mortality disparities. 你住在哪里，你在哪里接受治疗：使用交叉分类多层次模型来检查医院和社区在住院死亡率和死亡率差异方面的变化。

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-10-01 Epub Date: 2025-07-22 DOI: 10.1016/j.annepidem.2025.07.021

Alina Schnake-Mahl, Ana V Diez Roux, Bian Liu, Louisa W Holaday, Albert Siu, Edwin McCulley, Usama Bilal, Katherine A Ornstein

Purpose: Both hospitals and neighborhoods likely play important roles in driving health outcomes and inequities, but there has been limited prior research examining both contexts simultaneously. In this analysis we examine the contributions of these two critical contexts, neighborhoods and hospitals, to variation in in-hospital mortality and mortality disparities.

Methods: We used cross-classified multi-level models, a statistical technique that can incorporate data from multiple non-nested levels, to examine the variation in contribution of neighborhoods and hospitals to in-hospital mortality. Our study focuses on COVID-19 in hospital mortality from New York State in 2020, as a methodological case study of cross classified multilevel modeling, given the well documented variation in COVID-19 in-hospital mortality across contexts.

Results: We found that nearly one in five patients hospitalized for COVID-19 died, and there was substantial variation in risk of in-hospital mortality by neighborhoods and hospitals, with more variation across hospitals (τ₀₀:0.29) than across neighborhoods (τ₀₀:0.02). Neighborhoods did not explain hospital variability and vice versa: both contexts appeared to contribute independently to in-hospital mortality rates. We also found several hospital, neighborhood, and individual factors were associated with in hospital mortality disparities in fully adjusted models: lower hospital quality and safety-net hospitals, social vulnerability, older age, not having private insurance, and being Hispanic or non-Hispanic other.

Conclusions: Our findings suggest the importance of simultaneously considering hospital and neighborhood contexts to understand in-hospital outcome disparities. Understanding the contribution of these critical contexts has important implications for targeting interventions to ensure equitable hospital outcomes despite inequities in neighborhood and hospital contexts.

目的：医院和社区可能在推动健康结果和不平等方面发挥重要作用，但同时检查这两种情况的先前研究有限。在本分析中，我们研究了这两个关键背景的贡献，社区和医院，在院内死亡率和死亡率差异的变化。方法：我们使用交叉分类多层次模型（一种可以纳入多个非嵌套水平数据的统计技术）来检查社区和医院对住院死亡率的贡献变化。鉴于不同背景下COVID-19住院死亡率的变化有充分记录，我们的研究重点是2020年纽约州COVID-19住院死亡率，作为交叉分类多层次建模的方法学案例研究。结果：我们发现近五分之一的COVID-19住院患者死亡，不同社区和医院的住院死亡率风险差异很大，医院之间的差异（τ00:0.29）大于社区之间的差异（τ 00:02）。社区并不能解释医院的差异，反之亦然：这两种情况似乎都独立地影响了住院死亡率。我们还发现，在完全调整的模型中，一些医院、社区和个人因素与院内死亡率差异有关：较低的医院质量和安全网医院、社会脆弱性、年龄较大、没有私人保险、西班牙裔或非西班牙裔其他。结论：我们的研究结果表明，同时考虑医院和社区背景对于了解院内结局差异的重要性。了解这些关键环境的贡献对有针对性的干预措施具有重要意义，以确保在社区和医院环境不平等的情况下公平的医院结果。

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引用次数: 0

Rising maternal obesity and persistent suboptimal gestational weight gain among women living with HIV in Kenya: A retrospective cohort study 2008–2017 在肯尼亚感染人类免疫缺陷病毒的妇女中，孕产妇肥胖上升和妊娠期体重持续次优增加：2008-2017年回顾性队列研究

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-10-01 Epub Date: 2025-08-06 DOI: 10.1016/j.annepidem.2025.08.001

Nazha M. Diwan , Betty Mbithe , John Kinuthia , Tony J. Cagle , Charles Kibaara , Andrew Nagy Adly , Michael H. Chung , Angela M. Bengtson

Purpose

To describe trends in pre-pregnancy BMI (ppBMI), gestational weight gain (GWG), and associations with birth outcomes among women living with HIV (WLWH) in Kenya.

Methods

WLWH who initiated antenatal care ≤ 14 weeks of gestation at the Coptic Hope Center in Nairobi and Maseno, Kenya between 2008 and 2017 were identified. PpBMI was defined using first-trimester BMI (Kg/m²); GWG was assessed using weekly GWG rate in the second-and-third trimesters per National Academy of Medicine (NAM) guidelines. Associations between GWG z-scores and birthweight, low/high birthweight, and emergency cesarean-section (c-section) were examined using mixed-effects models.

Results

We identified 1190 pregnancies, of which more than half had overweight (34.3 %) or obese (18.0 %) ppBMI, 45.1 % had normal ppBMI, and 2.6 % were underweight. From 2008–2017, obese ppBMI among WLWH doubled, while normal ppBMI decreased by 8.2 %. Suboptimal GWG rates, both above and below NAM-recommendations, were common across ppBMI categories. A one-unit increase in GWG z-score was associated with higher birthweight (+45.96, 95 % CI: 15.29–75.17) and increased risk of emergency c-section (aRR=1.35, 95 % CI: 1.03–1.82).

Conclusion

From 2008–2017, maternal obesity among WLWH in Kenya increased, while GWG rates remained suboptimal. Future studies should examine barriers and possible interventions to address rising ppBMI and promote healthy GWG among WLWH.

目的：描述肯尼亚感染艾滋病毒（WLWH）的妇女孕前体重指数（ppBMI）、妊娠体重增加（GWG）的趋势以及与分娩结局的关系。方法：对2008年至2017年在肯尼亚内罗毕和马塞诺科普特希望中心（Coptic Hope Center）开展产前保健的妊娠≤14周的WLWH进行鉴定。PpBMI采用妊娠早期BMI （Kg/m2）定义；根据美国国家医学科学院（NAM）指南，使用妊娠中期和妊娠晚期的每周GWG率来评估GWG。使用混合效应模型检验GWG - z评分与出生体重、低/高出生体重和紧急剖宫产（c-section）之间的关系。结果：我们确定了1190名孕妇，其中超过一半的孕妇ppBMI超重（34.3%）或肥胖（18.0%），45.1%的孕妇ppBMI正常，2.6%的孕妇体重不足。从2008年到2017年，肥胖人群的ppBMI增加了一倍，而正常人群的ppBMI下降了8.2%。高于或低于nami推荐值的次优GWG率在ppBMI类别中都很常见。GWG - z评分每增加一个单位与出生体重增加（+45.96,95% CI: 15.29-75.17）和急诊剖腹产风险增加相关（aRR=1.35, 95% CI: 1.03-1.82）。结论：从2008年到2017年，肯尼亚产妇肥胖增加，而GWG率仍然不理想。未来的研究应检查障碍和可能的干预措施，以解决ppBMI上升和促进健康的GWG在WLWH。

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引用次数: 0

Temporal trends in COVID-19 vaccine uptake among social housing residents compared to the general population in Ontario, Canada: A population-based panel study 与加拿大安大略省普通人群相比，社会住房居民中COVID-19疫苗接种的时间趋势：一项基于人群的小组研究

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-10-01 Epub Date: 2025-08-19 DOI: 10.1016/j.annepidem.2025.08.024

Gina Agarwal MBBS PhD , Homa Keshavarz PhD , Ricardo Angeles MD PhD , Melissa Pirrie PhD , Francine Marzanek BEd , Francis Nguyen MPH , Jasdeep Brar HBSc , J. Michael Paterson MSc

Background

This study examined temporal trends in COVID-19 vaccine uptake among social housing residents compared to the general population in Ontario, Canada, during the first year of vaccine availability.

Methods

We analyzed 2021 COVID-19 vaccination data from Ontario administrative databases. The social housing population was identified using postal codes of designated social housing buildings. Vaccination rates were compared quarterly across age and sex categories between social housing residents and the general population.

Results

In 2021, there were 14,842,488 eligible individuals identified in Ontario administrative health data, with 328,276 individuals residing in social housing. By the end of 2021, 75.45 % of adult social housing residents were fully vaccinated (2 or more COVID-19 vaccine doses) compared to 87.46 % of the general adult population. This gap persisted over time and across sexes. Over the same period, 30.61 % of the children and youth in social housing achieved full vaccination rates compared to 30.21 % of the general population, with greater vaccine uptake among females.

Conclusion

Despite COVID-19 vaccination policies aimed at prioritizing vulnerable groups in Ontario, Canada, adult social housing residents had lower vaccination rates compared to the general population. Children and youth in social housing achieved slightly higher vaccination coverage. These findings underscore the need for more targeted efforts to improve vaccine accessibility and uptake among social housing residents.

本研究调查了在疫苗可用的第一年，与加拿大安大略省的普通人群相比，社会住房居民中COVID-19疫苗接种的时间趋势。方法分析安大略省行政数据库中2021年COVID-19疫苗接种数据。使用指定的社会住房建筑的邮政编码确定社会住房人口。按季度比较社会住房居民和一般人口之间不同年龄和性别类别的疫苗接种率。结果2021年，安大略省行政卫生数据确定了14,842,488名符合条件的个人，其中328,276人居住在社会住房中。到2021年底，75.45% %的成年社会住房居民充分接种了COVID-19疫苗（2剂及以上），而普通成年人口的这一比例为87.46% %。这种差距随着时间的推移和性别的不同而持续存在。在同一时期，30.61% %的社会住房儿童和青年实现了全面疫苗接种率，而一般人口的这一比例为30.21% %，女性的疫苗接种率更高。结论尽管加拿大安大略省的COVID-19疫苗接种政策旨在优先考虑弱势群体，但与普通人群相比，成年社会住房居民的疫苗接种率较低。社会住房中的儿童和青年的疫苗接种覆盖率略高。这些发现强调需要更有针对性的努力来提高社会住房居民的疫苗可及性和吸收率。

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引用次数: 0

Commentary on community-engaged epidemiology and abolitional possibility with a case study on aluminum worker health 社区参与流行病学与废除的可能性——以铝厂工人健康为例。

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-10-01 Epub Date: 2025-08-13 DOI: 10.1016/j.annepidem.2025.08.009

Elizabeth S. McClure , Pavithra Vasudevan , Cherrel K. Manley , Elizabeth Teka

This collaborative project addresses the possibilities and limits of occupational epidemiology in supporting struggles for environmental justice through a case study of aluminum smelting. We focus on illness and toxic exposure among Black workers and their families in Badin, North Carolina, a primary aluminum smelting plant site for Alcoa, in operation from 1915 to 2007. We conducted two quantitative analyses—one documenting disparities in work exposure trajectories, and one comparing mortality rates among workers to those in the general population. Supplementing these conventional epidemiological methods, we developed a third approach in collaboration with community members: an open-ended household survey designed to gather qualitative data regarding former workers’ job histories, medical histories, and concerns related to toxic exposures and discrimination at the smelting plant. This approach was conceived in response to residents’ questions about disparate health outcomes of toxic exposure in the workplace. The current occupational epidemiology literature published about aluminum smelting does not reflect concerns voiced by community collaborators regarding the extent of harm caused by occupational exposure to toxins, nor does it include analyses of race or gender disparities due to discriminate labor divisions. We argue that despite the discipline’s history of efforts to address health inequities, contemporary occupational epidemiology is limited in its methodological capacity eliminate health disparities rooted in structural racism. We illustrate how such a method may both broaden the scientific knowledge base and support organizing towards developing an abolitional approach to epidemiology.

本合作项目通过对铝冶炼的案例研究，探讨职业流行病学在支持环境正义斗争中的可能性和局限性。我们关注的是美国铝业公司1915年至2007年在北卡罗莱纳州巴丁市运营的原铝冶炼厂黑人工人及其家庭的疾病和有毒物质暴露情况。我们进行了两项定量分析，一项记录了工作接触轨迹的差异，另一项比较了工人与一般人群的死亡率。除了这些传统的流行病学方法之外，我们还与社区成员合作开发了第三种方法：一项开放式家庭调查，旨在收集有关前工人的工作经历、病史以及与冶炼厂有毒物质接触和歧视有关的问题的定性数据。这种方法是为了回应居民关于工作场所接触有毒物质的不同健康结果的问题。目前发表的关于铝冶炼的职业流行病学文献并没有反映出社区合作者对职业接触毒素造成的危害程度的担忧，也没有包括由于歧视劳动分工而造成的种族或性别差异的分析。我们认为，尽管该学科致力于解决健康不平等的历史，但当代职业流行病学在消除植根于结构性种族主义的健康差异方面的方法能力有限。我们说明了这种方法如何既可以扩大科学知识库，又可以支持组织开发一种废除流行病学的方法。

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引用次数: 0

A spatially dynamic agent-based model for assessing the effect of gentrification-induced migration and HIV transmission among heterosexual African American/Black women 基于空间动态主体的非裔美国/黑人异性恋女性移民与艾滋病传播影响评估模型

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-10-01 Epub Date: 2025-08-19 DOI: 10.1016/j.annepidem.2025.08.007

Shayla Nolen , Sam E. Bessey , Chanelle J. Howe , Bridgette M. Rice , Katie B. Biello , Brandon D.L. Marshall

Purpose

Develop a spatially dynamic agent-based model to assess the impact of gentrification-induced migration on HIV transmission among heterosexual African American/Black women.

Methods

We simulated a population of heterosexual African American/Black adults diagnosed with or at risk for HIV in a spatially dynamic agent-based model. We included behavioral and HIV-related probabilities based on neighborhood of residence, distance to healthcare facilities from their neighborhood, and neighborhood disadvantage status. To assess the impact of gentrification, migration was implemented in the model using probabilities that varied based on the gentrification status of their neighborhood. We then compared this scenario to a scenario where gentrification does not impact migration.

Results

Among African American/Black women, we estimated their mean incidence rates for the scenarios with and without gentrification impacting out-migration to be 57.2 and 57.4 per 100,000, respectively.

Conclusions

Gentrification appears to have minimal impact on HIV transmission based on some metrics, possibly because of the displacement of people most affected by HIV.

目的建立一个基于空间动态主体的模型，评估高档化导致的移民对异性恋非洲裔美国人/黑人妇女中艾滋病毒传播的影响。方法：我们在一个基于空间动态主体的模型中模拟了被诊断患有或有感染艾滋病毒风险的异性恋非洲裔美国人/黑人成年人。我们纳入了基于居住社区、社区到医疗机构的距离以及社区弱势地位的行为和艾滋病毒相关概率。为了评估中产阶级化的影响，在模型中使用基于其社区中产阶级化状态的概率来实现迁移。然后，我们将这种情况与中产阶级化不影响移民的情况进行了比较。结果在非裔美国人/黑人妇女中，我们估计在有或没有中产阶级化影响的情况下，她们的平均发病率分别为57.2 / 100,000和57.4 / 100,000。根据某些指标，高档化似乎对艾滋病毒传播的影响最小，可能是因为受艾滋病毒影响最严重的人流离失所。

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引用次数: 0

Adverse childhood experiences (ACEs) and adolescent reproductive health: Differentiating household and community adversity. 不良童年经历与青少年生殖健康：区分家庭和社区逆境。

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-10-01 Epub Date: 2025-07-16 DOI: 10.1016/j.annepidem.2025.07.022

Christine M Forke, Laura G Barr, Laura Sinko, Melissa E Dichter, Peter F Cronholm

Purpose: To add to existing knowledge on relationships between Conventionally-identified Adverse Childhood Experiences (ACEs) and adolescent reproductive health (ARH) outcomes, we identified contributions of Expanded (community-level) ACEs, integrating measures of ACE co-occurrence and burden.

Methods: Secondary analysis of 2012-2013 Philadelphia ACEs data from a population-based adult sample. Weighted regressions, adjusted for age, sex, race/ethnicity, and socioeconomic status, tested associations between Conventional and Expanded ACEs (separately and co-occurring) and ACE burden (lowest to highest exposure) with: early sexarche (<15 years), adolescent pregnancy (<19 years), and unintended adolescent pregnancy.

Results: Conventional ACEs showed strong dose-response relationships with all outcomes (aOR range: 2.04-4.96, p < 0.05). Expanded ACEs were associated with early sexarche (aOR=2.50; 95 % CI: 1.27, 4.94), adolescent pregnancy (aOR=1.69; 95 % CI: 1.16, 2.46), and unintended adolescent pregnancy (aOR=1.54; 95 % CI: 1.04, 2.29); dose-response patterns were inconsistent. Co-occurring Conventional and Expanded ACEs produced the greatest odds for all outcomes except early sexarche (aOR range: 3.20-14.97, p < 0.05).

Conclusions: Conventional and Expanded ACEs are important independently and jointly. ARH outcomes peaked when Conventional and Expanded ACEs co-occurred and both exposures were high. Results suggest that Conventional ACEs may be overestimated when assessed in isolation, highlighting the importance of considering Expanded ACEs to minimize bias and target appropriate interventions.

目的：为了补充现有的关于传统确定的不良童年经历（ACE）与青少年生殖健康（ARH）结果之间关系的知识，我们确定了扩展（社区水平）的不良童年经历（ACE）的贡献，整合了ACE共发生和负担的措施。方法：从基于人群的成人样本中对2012-2013年费城ace数据进行二次分析。经年龄、性别、种族/民族和社会经济地位调整后的加权回归检验了常规ACE和扩展ACE（单独发生和共同发生）以及ACE负担（最低至最高暴露）与早期性别行为之间的关系。结果：常规ACE与所有结果显示出强烈的剂量-反应关系（aOR范围：2.04-4.96）。结论：常规ACE和扩展ACE单独和共同重要。当常规ace和扩展ace同时发生且两种暴露量都很高时，ARH结果达到顶峰。结果表明，在单独评估时，常规ace可能被高估，这突出了考虑扩展ace以减少偏差和针对适当干预措施的重要性。

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引用次数: 0