Pub Date : 2025-12-19DOI: 10.1016/j.annepidem.2025.12.007
Bereket Kefale , Jonine Jancey , Amanuel T. Gebremedhin , Daniel Gashaneh Belay , Gavin Pereira , Gizachew A. Tessema
Purpose
This methodological systematic review aimed to identify and synthesise the existing under-five mortality (U5M) estimation methods globally.
Methods
We searched seven databases including Medline, Embase, Scopus, Web of Science, CINAHL, Global Health, and ProQuest Central, as well as grey literature sources from inception to September 25, 2025. The review protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023465476).
Results
Fifty-six studies were included in this review. The most frequently employed child mortality estimation method was the indirect method (n = 16), followed by the Global Burden of Disease (GBD) study method (n = 12) and the direct method (n = 11). The most commonly applied models were spatiotemporal Gaussian process regression and the Bayesian B-spline bias-reduction model. Substantial variation was observed across studies in geographical scope, temporal coverage, data sources, uncertainty quantification, statistical modelling, and bias adjustment.
Conclusions
There are substantial variations in U5M estimation methods, with challenges in data availability, uncertainty estimation, and bias adjustment. These findings highlight the need to harmonise methodological approaches and refine estimation methods. Strengthening vital registration systems is essential to ensure accurate, reliable data to inform evidence-based decision-making and track progress towards U5M reduction targets.
目的：本方法学系统综述旨在确定和综合全球现有的五岁以下儿童死亡率（U5M）估计方法。方法：检索Medline、Embase、Scopus、Web of Science、CINAHL、Global Health、ProQuest Central等7个数据库，以及创立至2025年9月25日的灰色文献来源。该评价方案已在国际前瞻性系统评价登记册（PROSPERO） （CRD42023465476）前瞻性注册。结果：本综述纳入56项研究。最常用的儿童死亡率估计方法是间接方法（n= 16），其次是全球疾病负担（GBD）研究方法（n=12）和直接方法（n= 11）。最常用的模型是时空高斯过程回归模型和贝叶斯b样条偏置减少模型。在地理范围、时间覆盖范围、数据来源、不确定性量化、统计建模和偏倚调整等方面，各研究均存在显著差异。结论：U5M估计方法存在很大差异，在数据可用性、不确定性估计和偏倚调整方面存在挑战。这些发现突出了协调方法方法和改进估计方法的必要性。加强生命登记系统对于确保准确、可靠的数据，为循证决策提供信息，跟踪实现降低儿童死亡率目标的进展至关重要。
{"title":"Under-five mortality estimation methods: A methodological systematic review","authors":"Bereket Kefale , Jonine Jancey , Amanuel T. Gebremedhin , Daniel Gashaneh Belay , Gavin Pereira , Gizachew A. Tessema","doi":"10.1016/j.annepidem.2025.12.007","DOIUrl":"10.1016/j.annepidem.2025.12.007","url":null,"abstract":"<div><h3>Purpose</h3><div>This methodological systematic review aimed to identify and synthesise the existing under-five mortality (U5M) estimation methods globally.</div></div><div><h3>Methods</h3><div>We searched seven databases including Medline, Embase, Scopus, Web of Science, CINAHL, Global Health, and ProQuest Central, as well as grey literature sources from inception to September 25, 2025. The review protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023465476).</div></div><div><h3>Results</h3><div>Fifty-six studies were included in this review. The most frequently employed child mortality estimation method was the indirect method (n = 16), followed by the Global Burden of Disease (GBD) study method (n = 12) and the direct method (n = 11). The most commonly applied models were spatiotemporal Gaussian process regression and the Bayesian B-spline bias-reduction model. Substantial variation was observed across studies in geographical scope, temporal coverage, data sources, uncertainty quantification, statistical modelling, and bias adjustment.</div></div><div><h3>Conclusions</h3><div>There are substantial variations in U5M estimation methods, with challenges in data availability, uncertainty estimation, and bias adjustment. These findings highlight the need to harmonise methodological approaches and refine estimation methods. Strengthening vital registration systems is essential to ensure accurate, reliable data to inform evidence-based decision-making and track progress towards U5M reduction targets.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"113 ","pages":"Pages 71-77"},"PeriodicalIF":3.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-19DOI: 10.1016/j.annepidem.2025.12.009
Hongjie Liu PhD., MS
Purpose
This paper illustrates the application of multilevel modeling to egocentric network data, where network alters are nested within their respective egos. The nested structure and intra-ego dependencies in such data violate the independence assumptions of traditional regression models.
Methods
Multilevel modeling addresses this dependency by accommodating hierarchical data structures, allowing for more accurate estimation of ego–alter associations. It also distinguishes the effects of variables measured at the alter, ego, and dyadic (ego–alter) levels on outcome variable. We describe model specifications involving random intercepts and slopes, cross-level interactions, and assumptions related to residuals and variance structures. An illustrative example is provided to demonstrate how to estimate fixed and random effects for both continuous and binary outcome variables, assess intraclass correlation, test cross-level interactions, and interpret model results.
Results
This paper serves as a practical guide for applying multilevel models to egocentric network data, outlining key conceptual foundations, methodological considerations, and step-by-step implementation using SAS and R.
Conclusions
The guide aims to support researchers in the social and health sciences in rigorously applying multilevel modeling to egocentric network data, fostering deeper insights into how individual, relational, and structural factors influence health-related outcomes.
{"title":"Multilevel modeling in egocentric network analysis: A practical guide with SAS and R","authors":"Hongjie Liu PhD., MS","doi":"10.1016/j.annepidem.2025.12.009","DOIUrl":"10.1016/j.annepidem.2025.12.009","url":null,"abstract":"<div><h3>Purpose</h3><div>This paper illustrates the application of multilevel modeling to egocentric network data, where network alters are nested within their respective egos. The nested structure and intra-ego dependencies in such data violate the independence assumptions of traditional regression models.</div></div><div><h3>Methods</h3><div>Multilevel modeling addresses this dependency by accommodating hierarchical data structures, allowing for more accurate estimation of ego–alter associations. It also distinguishes the effects of variables measured at the alter, ego, and dyadic (ego–alter) levels on outcome variable. We describe model specifications involving random intercepts and slopes, cross-level interactions, and assumptions related to residuals and variance structures. An illustrative example is provided to demonstrate how to estimate fixed and random effects for both continuous and binary outcome variables, assess intraclass correlation, test cross-level interactions, and interpret model results.</div></div><div><h3>Results</h3><div>This paper serves as a practical guide for applying multilevel models to egocentric network data, outlining key conceptual foundations, methodological considerations, and step-by-step implementation using SAS and R.</div></div><div><h3>Conclusions</h3><div>The guide aims to support researchers in the social and health sciences in rigorously applying multilevel modeling to egocentric network data, fostering deeper insights into how individual, relational, and structural factors influence health-related outcomes.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"113 ","pages":"Pages 64-70"},"PeriodicalIF":3.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Early-onset cancer (EOC), occurring in individuals aged 15–49 years, is a growing global health concern. High body mass index (BMI) is an established modifiable risk factor contributing to cancer morbidity and mortality.
Methods
Age-specific death percents and estimated annual percentage changes (APC) were calculated to assess mortality trends associated with high BMI using GBD 2021 data. Global and regional (5 socio-demographic (SDI) regions, 21 GBD regions and 204 countries) trends were analyzed. Statistical modeling, including 2 sample t-test were performed to estimate the standard deviations among each group which is plugged in the denominator to compute the statistic.
Results
In 2021, 23,078 EOC deaths related to high BMI occurred, accounting for 2.33 % of global EOC mortality, representing a 92.78 % increase since 1990. Males (2.96 %) exhibited a higher proportion of high BMI-attributable EOC deaths compared to females (1.72 %). High-income regions recorded the highest EOC deaths (3.78 %) associated with high BMI, with increasing trends observed across all SDI levels. At the national level, Tonga (8.38 %) and the UAE (8.09 %) had the highest high BMI-associated EOC mortality rates. Among cancer types, kidney and uterine cancers exhibited the highest mortality. Notably, high BMI demonstrated a protective effect against early-onset breast cancer in females.
Discussion
The rising burden of EOC mortality attributed to high BMI underscores the need for urgent interventions in young adult population. Addressing obesity through lifestyle changes, pharmacotherapy, and bariatric surgery is crucial for reducing cancer burden. Future research should refine risk estimates and inform targeted interventions.
{"title":"A global health crisis in young adults: 30-Year trends in high BMI-related early-onset cancer mortality","authors":"Rupayan Kundu MD , Rishabh Kundu MSc , Sudipto Mukherjee MD, PhD","doi":"10.1016/j.annepidem.2025.12.006","DOIUrl":"10.1016/j.annepidem.2025.12.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Early-onset cancer (EOC), occurring in individuals aged 15–49 years, is a growing global health concern. High body mass index (BMI) is an established modifiable risk factor contributing to cancer morbidity and mortality.</div></div><div><h3>Methods</h3><div>Age-specific death percents and estimated annual percentage changes (APC) were calculated to assess mortality trends associated with high BMI using GBD 2021 data. Global and regional (5 socio-demographic (SDI) regions, 21 GBD regions and 204 countries) trends were analyzed. Statistical modeling, including 2 sample t-test were performed to estimate the standard deviations among each group which is plugged in the denominator to compute the statistic.</div></div><div><h3>Results</h3><div>In 2021, 23,078 EOC deaths related to high BMI occurred, accounting for 2.33 % of global EOC mortality, representing a 92.78 % increase since 1990. Males (2.96 %) exhibited a higher proportion of high BMI-attributable EOC deaths compared to females (1.72 %). High-income regions recorded the highest EOC deaths (3.78 %) associated with high BMI, with increasing trends observed across all SDI levels. At the national level, Tonga (8.38 %) and the UAE (8.09 %) had the highest high BMI-associated EOC mortality rates. Among cancer types, kidney and uterine cancers exhibited the highest mortality. Notably, high BMI demonstrated a protective effect against early-onset breast cancer in females.</div></div><div><h3>Discussion</h3><div>The rising burden of EOC mortality attributed to high BMI underscores the need for urgent interventions in young adult population. Addressing obesity through lifestyle changes, pharmacotherapy, and bariatric surgery is crucial for reducing cancer burden. Future research should refine risk estimates and inform targeted interventions.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"114 ","pages":"Pages 7-11"},"PeriodicalIF":3.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-16DOI: 10.1016/j.annepidem.2025.12.005
Peter M. Socha , Tim D’Aoust , Erica EM Moodie
Purpose
Intraclass correlation coefficients (ICCs) can be used to adjust for clustering in sample size calculations, but different ICC estimators for binary outcomes can return different estimates. We assessed the ability of five common ICC estimators to calculate sample sizes that achieve the desired power, for studies that compare binary outcomes in treated and untreated twin pregnancies.
Methods
We simulated studies in twin pregnancies with varying levels of clustering and outcome prevalence. We used ICC estimators derived from logistic generalized estimating equations (GEE), analysis of variance (ANOVA), linear mixed modelling (LMM), and logistic generalized linear mixed modelling (GLMM). We calculated the required sample size to obtain 80 % power (5 % Type I error) using a standard formula and used simulation to estimate the empirical power.
Results
ICC estimates from GEE, ANOVA, and LMM were similar to each other, constant across outcome prevalence, and yielded required sample sizes that achieved the desired power. ICC estimators using logistic GLMM varied across outcome prevalence and yielded required sample sizes that were larger than necessary (power >80 %) when clustering was high or when outcome prevalence was low.
Conclusions
Investigators using ICCs in sample size calculations including twin pregnancies should consider avoiding estimates from logistic GLMMs.
{"title":"Comparing intraclass correlation coefficient estimators for binary outcomes in sample size calculations in twin pregnancies","authors":"Peter M. Socha , Tim D’Aoust , Erica EM Moodie","doi":"10.1016/j.annepidem.2025.12.005","DOIUrl":"10.1016/j.annepidem.2025.12.005","url":null,"abstract":"<div><h3>Purpose</h3><div>Intraclass correlation coefficients (ICCs) can be used to adjust for clustering in sample size calculations, but different ICC estimators for binary outcomes can return different estimates. We assessed the ability of five common ICC estimators to calculate sample sizes that achieve the desired power, for studies that compare binary outcomes in treated and untreated twin pregnancies.</div></div><div><h3>Methods</h3><div>We simulated studies in twin pregnancies with varying levels of clustering and outcome prevalence. We used ICC estimators derived from logistic generalized estimating equations (GEE), analysis of variance (ANOVA), linear mixed modelling (LMM), and logistic generalized linear mixed modelling (GLMM). We calculated the required sample size to obtain 80 % power (5 % Type I error) using a standard formula and used simulation to estimate the empirical power.</div></div><div><h3>Results</h3><div>ICC estimates from GEE, ANOVA, and LMM were similar to each other, constant across outcome prevalence, and yielded required sample sizes that achieved the desired power. ICC estimators using logistic GLMM varied across outcome prevalence and yielded required sample sizes that were larger than necessary (power >80 %) when clustering was high or when outcome prevalence was low.</div></div><div><h3>Conclusions</h3><div>Investigators using ICCs in sample size calculations including twin pregnancies should consider avoiding estimates from logistic GLMMs.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"113 ","pages":"Pages 55-59"},"PeriodicalIF":3.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-08DOI: 10.1016/j.annepidem.2025.12.003
Jared W. Parrish , Shannon Vance , Stephany Strahle , Sarah L. Stone , Xiaohui Geng , Generosa Kakoti , Syreen Goulmamine , Sean Coffinger
Purpose
Linking Pregnancy Risk Assessment Monitoring System (PRAMS) data with hospital discharge data (HDD) offers opportunities to explore self-reported factors on PRAMS with maternal health outcomes like severe maternal morbidity (SMM) and hypertensive disorders in pregnancy (HDP). This study outlines the methods and challenges with creating a multi-jurisdiction PRAMS-HDD record level linked dataset using existing data linkages for assessing factors associated with SMM and HDP.
Methods
Four jurisdictions participating in a PRAMS data linkage learning community linked PRAMS and HDD deliveries from 2017 to 2020 using various linkage strategies. Both SMM and HDP were identified in the HDD data using a standardized algorithm provided by the researcher. Record level PRAMS data with SMM and HDP indicators were then combined across states. Potential impact of linkage rates and quality, prevalence of the outcome, sampling strata, and response rates were assessed.
Results
Among the four states, 17,878 PRAMS respondents were linked to a hospital delivery recorded in the HDD. Linkage rates varied from 63 % to 99 % (86 % overall). 227 SMM (1.3 %) and 2889 HDP (17.2 %) cases were identified and varied significantly by state. Linkage rates influenced reliability of outcome classification.
Conclusions
Multi-jurisdiction PRAMS linkage offers potential for evaluating maternal health outcomes. However, variations in data quality, linkage rates and sampling strategy impact result reliability. Future multi-jurisdiction PRAMS linkage studies should prioritize standardizing data structures, protocols, and linkage methodology to maximize results quality and generalizability.
{"title":"Multi-jurisdiction linkage of PRAMS and hospital discharge data: Methods, key challenges, and practical applications","authors":"Jared W. Parrish , Shannon Vance , Stephany Strahle , Sarah L. Stone , Xiaohui Geng , Generosa Kakoti , Syreen Goulmamine , Sean Coffinger","doi":"10.1016/j.annepidem.2025.12.003","DOIUrl":"10.1016/j.annepidem.2025.12.003","url":null,"abstract":"<div><h3>Purpose</h3><div>Linking Pregnancy Risk Assessment Monitoring System (PRAMS) data with hospital discharge data (HDD) offers opportunities to explore self-reported factors on PRAMS with maternal health outcomes like severe maternal morbidity (SMM) and hypertensive disorders in pregnancy (HDP). This study outlines the methods and challenges with creating a multi-jurisdiction PRAMS-HDD record level linked dataset using existing data linkages for assessing factors associated with SMM and HDP.</div></div><div><h3>Methods</h3><div>Four jurisdictions participating in a PRAMS data linkage learning community linked PRAMS and HDD deliveries from 2017 to 2020 using various linkage strategies. Both SMM and HDP were identified in the HDD data using a standardized algorithm provided by the researcher. Record level PRAMS data with SMM and HDP indicators were then combined across states. Potential impact of linkage rates and quality, prevalence of the outcome, sampling strata, and response rates were assessed.</div></div><div><h3>Results</h3><div>Among the four states, 17,878 PRAMS respondents were linked to a hospital delivery recorded in the HDD. Linkage rates varied from 63 % to 99 % (86 % overall). 227 SMM (1.3 %) and 2889 HDP (17.2 %) cases were identified and varied significantly by state. Linkage rates influenced reliability of outcome classification.</div></div><div><h3>Conclusions</h3><div>Multi-jurisdiction PRAMS linkage offers potential for evaluating maternal health outcomes. However, variations in data quality, linkage rates and sampling strategy impact result reliability. Future multi-jurisdiction PRAMS linkage studies should prioritize standardizing data structures, protocols, and linkage methodology to maximize results quality and generalizability.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"113 ","pages":"Pages 47-54"},"PeriodicalIF":3.0,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1016/j.annepidem.2025.12.004
Omer Abdelgadir , Salome W. Njoroge , Anirudh S. Babu , Md Ibrahim Tahashilder , Jesus Gibran Hernandez-Perez , Luisa E. Torres-Sanchez , Maryam R. Hussain , Alejandro Villasante-Tezanos , Ioannis Malagaris , Wissam I. Khalife , Yong-Fang Kuo , David S. Lopez
Purpose
This study examines the association between use of metformin and testosterone replacement therapy (TTh) with risk of cardiovascular disease (CVD) and its subcategories in the overall population, hormone-related cancer (HRC) survivors, and cancer-free population.
Methods
A retrospective cohort of 58,028 men ≥ 65 years was identified using SEER-Medicare 2007–2015 data. Metformin and TTh prescriptions were ascertained for this analysis. The primary outcome was incident composite CVD and CVD subcategories (heart failure [HF], ischemic heart disease [IHD], peripheral arterial disease [PAD], and stroke). Multivariable time-dependent Cox proportional hazard models were conducted.
Results
Metformin use was inversely associated with CVD in the overall population (Hazard Ratio [HR] = 0.72, 95 % CI, 0.68 – 0.76), cancer-free population (HR = 0.72, 95 % CI, 0.68 – 0.76), and HRC survivors (HR = 0.67, 95 % CI, 0.64 – 0.73). Likewise, TTh use was inversely associated with CVD in overall population (HR = 0.82, 95 % CI, 0.67 – 0.99), cancer-free population (HR = 0.80, 95 % CI, 0.64 – 0.99), and HRC survivors (HR = 0.64, 95 % CI, 0.48 – 86).
Conclusions
Metformin and TTh were inversely associated with CVD among older men in the overall population, HRC survivors, and cancer-free populations. Metformin users showed the greatest CVD risk reduction. Further studies are warranted to confirm these associations.
{"title":"Cardiovascular effects of metformin and testosterone replacement therapy in older men with hormone-related cancers and cancer-free population","authors":"Omer Abdelgadir , Salome W. Njoroge , Anirudh S. Babu , Md Ibrahim Tahashilder , Jesus Gibran Hernandez-Perez , Luisa E. Torres-Sanchez , Maryam R. Hussain , Alejandro Villasante-Tezanos , Ioannis Malagaris , Wissam I. Khalife , Yong-Fang Kuo , David S. Lopez","doi":"10.1016/j.annepidem.2025.12.004","DOIUrl":"10.1016/j.annepidem.2025.12.004","url":null,"abstract":"<div><h3>Purpose</h3><div>This study examines the association between use of metformin and testosterone replacement therapy (TTh) with risk of cardiovascular disease (CVD) and its subcategories in the overall population, hormone-related cancer (HRC) survivors, and cancer-free population.</div></div><div><h3>Methods</h3><div>A retrospective cohort of 58,028 men ≥ 65 years was identified using SEER-Medicare 2007–2015 data. Metformin and TTh prescriptions were ascertained for this analysis. The primary outcome was incident composite CVD and CVD subcategories (heart failure [HF], ischemic heart disease [IHD], peripheral arterial disease [PAD], and stroke). Multivariable time-dependent Cox proportional hazard models were conducted.</div></div><div><h3>Results</h3><div>Metformin use was inversely associated with CVD in the overall population (Hazard Ratio [HR] = 0.72, 95 % CI, 0.68 – 0.76), cancer-free population (HR = 0.72, 95 % CI, 0.68 – 0.76), and HRC survivors (HR = 0.67, 95 % CI, 0.64 – 0.73). Likewise, TTh use was inversely associated with CVD in overall population (HR = 0.82, 95 % CI, 0.67 – 0.99), cancer-free population (HR = 0.80, 95 % CI, 0.64 – 0.99), and HRC survivors (HR = 0.64, 95 % CI, 0.48 – 86).</div></div><div><h3>Conclusions</h3><div>Metformin and TTh were inversely associated with CVD among older men in the overall population, HRC survivors, and cancer-free populations. Metformin users showed the greatest CVD risk reduction. Further studies are warranted to confirm these associations.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"113 ","pages":"Pages 38-46"},"PeriodicalIF":3.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1016/j.annepidem.2025.12.001
Daniel Kim M.D., Dr.P.H.
Background
Substantial gaps remain in life expectancy (LE) between Black and White Americans. The present study aimed to simulate hypothetical reductions in excess mortality risk for Black Americans across all ages; to identify the extent to which LE can improve as one varies the excess risk reduction level; and to provide quantitative estimates of potential LE gains if racial disparities in mortality were reduced in particular age groups.
Methods
I simulated counterfactual reductions in the Black–White mortality gap by scaling down the excess relative risk across all ages. I further calculated the overall LE weighted according to population shares of all major racial/ethnic groups, and then disaggregated these impacts by age group—children (0–17 years), young adults (18–29 years), middle-aged adults (30–49 years), older adults (50–64 years), and seniors (65+ years).
Results
Each successive 25% reduction in excess mortality risk was associated with an incremental improvement in LE, and closing the excess risk gap entirely was projected to improve overall LE by 0.48 years in females and 0.77 years in males. In both sexes, there was a striking pattern of the biggest LE gains being observed with narrowing the excess mortality gaps in middle-aged adult (30–49 years) and older adult (50−64 years) populations.
Conclusions
Overall, this study provides new quantitative evidence that addressing racial inequities in mortality—in particular the excess risks faced by Black Americans—could yield meaningful gains in national life expectancy.
{"title":"Quantifying U.S. life expectancy gains from reductions in Black-White mortality disparities: A simulation study","authors":"Daniel Kim M.D., Dr.P.H.","doi":"10.1016/j.annepidem.2025.12.001","DOIUrl":"10.1016/j.annepidem.2025.12.001","url":null,"abstract":"<div><h3>Background</h3><div>Substantial gaps remain in life expectancy (LE) between Black and White Americans. The present study aimed to simulate hypothetical reductions in excess mortality risk for Black Americans across all ages; to identify the extent to which LE can improve as one varies the excess risk reduction level; and to provide quantitative estimates of potential LE gains if racial disparities in mortality were reduced in particular age groups.</div></div><div><h3>Methods</h3><div>I simulated counterfactual reductions in the Black–White mortality gap by scaling down the excess relative risk across all ages. I further calculated the overall LE weighted according to population shares of all major racial/ethnic groups, and then disaggregated these impacts by age group—children (0–17 years), young adults (18–29 years), middle-aged adults (30–49 years), older adults (50–64 years), and seniors (65+ years).</div></div><div><h3>Results</h3><div>Each successive 25% reduction in excess mortality risk was associated with an incremental improvement in LE, and closing the excess risk gap entirely was projected to improve overall LE by 0.48 years in females and 0.77 years in males. In both sexes, there was a striking pattern of the biggest LE gains being observed with narrowing the excess mortality gaps in middle-aged adult (30–49 years) and older adult (50−64 years) populations.</div></div><div><h3>Conclusions</h3><div>Overall, this study provides new quantitative evidence that addressing racial inequities in mortality—in particular the excess risks faced by Black Americans—could yield meaningful gains in national life expectancy.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"113 ","pages":"Pages 60-63"},"PeriodicalIF":3.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145702490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1016/j.annepidem.2025.11.008
Fardowsa L.A. Yusuf PhD , Mohammad Ehsanul Karim PhD , Jason M. Sutherland PhD , Feng Zhu MSc , Yinshan Zhao PhD , Ruth Ann Marrie MD, PhD , Helen Tremlett PhD
Background
We investigated the association between multiple sclerosis (MS) and fractures, dislocations/sprains/strains, and burns preceding MS recognition.
Methods
We conducted a cohort study using clinical and population-based health administrative data in British Columbia, Canada (1991–2020). We compared the risk of a fracture, dislocation/sprain/strain, and burn in the six years preceding an MS cases’ first demyelinating claim (administrative cohort=9197) or MS symptom onset (clinical cohort=1446) to that of matched general population controls using modified Poisson regression. As sensitivity analyses, we used high-dimensional propensity scores (hdPS) to address residual confounding and targeted maximum likelihood estimation (TMLE) for mis-specification.
Results
In the six years before the first demyelinating claim (administrative cohort), the risk of a fracture (adjusted relative risks [adjRR]=1.28;95 %CI:1.20–1.36), dislocation/sprain/strain (adjRR=1.20;95 %CI:1.15–1.23), and burn (adjRR=1.40;95 %CI:1.22–1.62) was higher among MS cases. After hdPS adjustment and TMLE, the adjusted relative risks decreased slightly: fracture (hdPS=1.20; TMLE=1.20), dislocation/sprain/strain (hdPS=1.15; TMLE=1.15), and burn (hdPS=1.25; TMLE=1.26). Pre-MS symptom onset (clinical cohort), the associations were weaker but in the same direction.
Conclusion
Fractures, dislocations/sprains/strains, and burns were more common among people with MS before its classical recognition, suggesting that MS could be detected earlier.
{"title":"Injury preceding the classical recognition of multiple sclerosis: A population-based study","authors":"Fardowsa L.A. Yusuf PhD , Mohammad Ehsanul Karim PhD , Jason M. Sutherland PhD , Feng Zhu MSc , Yinshan Zhao PhD , Ruth Ann Marrie MD, PhD , Helen Tremlett PhD","doi":"10.1016/j.annepidem.2025.11.008","DOIUrl":"10.1016/j.annepidem.2025.11.008","url":null,"abstract":"<div><h3>Background</h3><div>We investigated the association between multiple sclerosis (MS) and fractures, dislocations/sprains/strains, and burns preceding MS recognition.</div></div><div><h3>Methods</h3><div>We conducted a cohort study using clinical and population-based health administrative data in British Columbia, Canada (1991–2020). We compared the risk of a fracture, dislocation/sprain/strain, and burn in the six years preceding an MS cases’ first demyelinating claim (administrative cohort=9197) or MS symptom onset (clinical cohort=1446) to that of matched general population controls using modified Poisson regression. As sensitivity analyses, we used high-dimensional propensity scores (hdPS) to address residual confounding and targeted maximum likelihood estimation (TMLE) for mis-specification.</div></div><div><h3>Results</h3><div>In the six years before the first demyelinating claim (administrative cohort), the risk of a fracture (adjusted relative risks [adjRR]=1.28;95 %CI:1.20–1.36), dislocation/sprain/strain (adjRR=1.20;95 %CI:1.15–1.23), and burn (adjRR=1.40;95 %CI:1.22–1.62) was higher among MS cases. After hdPS adjustment and TMLE, the adjusted relative risks decreased slightly: fracture (hdPS=1.20; TMLE=1.20), dislocation/sprain/strain (hdPS=1.15; TMLE=1.15), and burn (hdPS=1.25; TMLE=1.26). Pre-MS symptom onset (clinical cohort), the associations were weaker but in the same direction.</div></div><div><h3>Conclusion</h3><div>Fractures, dislocations/sprains/strains, and burns were more common among people with MS before its classical recognition, suggesting that MS could be detected earlier.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"113 ","pages":"Pages 30-37"},"PeriodicalIF":3.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145702404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-04DOI: 10.1016/j.annepidem.2025.12.002
D. Durán N MSc. , J.S. Kaufman PhD , A. Chiolero MD. PhD , C. Carmeli PhD
Purpose
With the rising prevalence of multi-morbidity among aging populations and disruptive events as new infectious disease threats, the traditional focus on the underlying cause of death (UCOD) can obscure the contribution of chronic diseases to mortality trends. The multiple cause of death (MCOD) approach addresses this limitation by considering all causes recorded on a death certificate. We aimed to quantify the effect of the COVID-19 pandemic on trends of chronic disease mortality by comparing the UCOD and MCOD approaches.
Methods
We conducted a population-based time series analysis using all deaths occurred 2011–2022 in Switzerland. We modelled pre-pandemic (2011–2019) trends to predict the expected chronic disease deaths during 2020–2022 had the pandemic not occurred. We quantified the monthly effect of the pandemic as the observed minus expected chronic disease deaths and estimated these effects by sex and age using (1) the UCOD and (2) the MCOD.
Results
Both approaches revealed similar overall trends of effects. However, a marked discrepancy occurred at the end of 2020, when Switzerland experienced the highest COVID-19 mortality, with MCOD quantifying a substantially higher excess of chronic disease deaths compared to UCOD.
Conclusion
MCOD complements UCOD in quantifying cause-specific mortality trends and may improve population health monitoring.
{"title":"Multiple causes of death data to track trends of mortality from chronic diseases: Insights from the COVID-19 pandemic in Switzerland","authors":"D. Durán N MSc. , J.S. Kaufman PhD , A. Chiolero MD. PhD , C. Carmeli PhD","doi":"10.1016/j.annepidem.2025.12.002","DOIUrl":"10.1016/j.annepidem.2025.12.002","url":null,"abstract":"<div><h3>Purpose</h3><div>With the rising prevalence of multi-morbidity among aging populations and disruptive events as new infectious disease threats, the traditional focus on the underlying cause of death (UCOD) can obscure the contribution of chronic diseases to mortality trends. The multiple cause of death (MCOD) approach addresses this limitation by considering all causes recorded on a death certificate. We aimed to quantify the effect of the COVID-19 pandemic on trends of chronic disease mortality by comparing the UCOD and MCOD approaches.</div></div><div><h3>Methods</h3><div>We conducted a population-based time series analysis using all deaths occurred 2011–2022 in Switzerland. We modelled pre-pandemic (2011–2019) trends to predict the expected chronic disease deaths during 2020–2022 had the pandemic not occurred. We quantified the monthly effect of the pandemic as the observed minus expected chronic disease deaths and estimated these effects by sex and age using (1) the UCOD and (2) the MCOD.</div></div><div><h3>Results</h3><div>Both approaches revealed similar overall trends of effects. However, a marked discrepancy occurred at the end of 2020, when Switzerland experienced the highest COVID-19 mortality, with MCOD quantifying a substantially higher excess of chronic disease deaths compared to UCOD.</div></div><div><h3>Conclusion</h3><div>MCOD complements UCOD in quantifying cause-specific mortality trends and may improve population health monitoring.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"113 ","pages":"Pages 23-29"},"PeriodicalIF":3.0,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.annepidem.2025.11.007
{"title":"The American College of Epidemiology Annals of Epidemiology Award, 2025","authors":"","doi":"10.1016/j.annepidem.2025.11.007","DOIUrl":"10.1016/j.annepidem.2025.11.007","url":null,"abstract":"","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"112 ","pages":"Page 127"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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