Pub Date : 2025-02-01DOI: 10.1016/j.annepidem.2024.12.010
Sarah Gutkind , Megan E. Marziali , Emilie Bruzelius , Zachary L. Mannes , Silvia S. Martins , Deborah S. Hasin , Pia M. Mauro
Purpose
Most drug-related deaths in the United States (US) in 2022 involved opioids. However, methodological challenges in overdose surveillance may contribute to underestimation of opioid involvement in the overdose crisis. This scoping review aimed to synthesize existing literature to examine the breadth and contributing sources of misclassification of opioid-related overdose deaths.
Methods
In October 2022, we searched PubMed, Web of Science, and Scopus for studies on overdose surveillance, death certificates, and medicolegal death investigation (MDI) systems in the US published in 2013–2022. Two reviewers independently screened abstracts, reviewed full-texts, and performed data extraction of study characteristics.
Results
We identified 17 studies examining misclassification in drug-related deaths. Across studies, opioid involvement in drug-related deaths was underestimated nationally by 20–35 %. Unspecified drug-related deaths differed by geographic areas and MDI systems and decreased over time. States/counties with coroner MDI systems were more likely to report unspecified overdose deaths than those with medical examiners. Integrating toxicology testing, death scene investigations, and other data with death certificates identified additional opioid-related overdose deaths, particularly those involving heroin.
Conclusions
Findings highlight the need for additional resources for surveillance efforts, training for coroners, and data integration to improve reporting of opioid involvement in overdose deaths to inform interventions.
目的：2022年美国大多数与药物相关的死亡与阿片类药物有关。然而，过量监测中的方法学挑战可能导致阿片类药物在过量危机中的作用被低估。本综述旨在综合现有文献，研究阿片类药物过量死亡错误分类的广度和原因。方法：在2022年10月，我们检索PubMed、Web of Science和Scopus，检索2013-2022年美国发表的关于药物过量监测、死亡证明和医学法律死亡调查（MDI）系统的研究。两名审稿人独立筛选摘要，审查全文，并进行研究特征的数据提取。结果：我们确定了17项研究对药物相关死亡的错误分类。在所有研究中，阿片类药物参与药物相关死亡在全国范围内被低估了20-35%。未指明的药物相关死亡因地理区域和MDI系统而异，并随着时间的推移而减少。有验尸官MDI系统的州/县比有验尸官的州/县更有可能报告未指明的过量死亡。将毒理学测试、死亡现场调查和其他数据与死亡证明相结合，确定了更多与阿片类药物有关的过量死亡，特别是涉及海洛因的死亡。结论：研究结果强调需要为监测工作、验尸官培训和数据整合提供额外资源，以改进阿片类药物涉及过量死亡的报告，为干预措施提供信息。
{"title":"Misclassification of opioid-involvement in drug-related overdose deaths in the United States: A scoping review","authors":"Sarah Gutkind , Megan E. Marziali , Emilie Bruzelius , Zachary L. Mannes , Silvia S. Martins , Deborah S. Hasin , Pia M. Mauro","doi":"10.1016/j.annepidem.2024.12.010","DOIUrl":"10.1016/j.annepidem.2024.12.010","url":null,"abstract":"<div><h3>Purpose</h3><div>Most drug-related deaths in the United States (US) in 2022 involved opioids. However, methodological challenges in overdose surveillance may contribute to underestimation of opioid involvement in the overdose crisis. This scoping review aimed to synthesize existing literature to examine the breadth and contributing sources of misclassification of opioid-related overdose deaths.</div></div><div><h3>Methods</h3><div>In October 2022, we searched PubMed, Web of Science, and Scopus for studies on overdose surveillance, death certificates, and medicolegal death investigation (MDI) systems in the US published in 2013–2022. Two reviewers independently screened abstracts, reviewed full-texts, and performed data extraction of study characteristics.</div></div><div><h3>Results</h3><div>We identified 17 studies examining misclassification in drug-related deaths. Across studies, opioid involvement in drug-related deaths was underestimated nationally by 20–35 %. Unspecified drug-related deaths differed by geographic areas and MDI systems and decreased over time. States/counties with coroner MDI systems were more likely to report unspecified overdose deaths than those with medical examiners. Integrating toxicology testing, death scene investigations, and other data with death certificates identified additional opioid-related overdose deaths, particularly those involving heroin.</div></div><div><h3>Conclusions</h3><div>Findings highlight the need for additional resources for surveillance efforts, training for coroners, and data integration to improve reporting of opioid involvement in overdose deaths to inform interventions.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"102 ","pages":"Pages 8-22"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883191","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 : 2025-02-01DOI: 10.1016/j.annepidem.2024.12.013
Ang Li , Kate Mason , Yuxi Li, Rebecca Bentley
Housing is an often overlooked yet fundamental social determinant of health. Like other social epidemiology exposures, housing faces a tension between the promise of modern causal inference methods and the messy reality of complex social processes and reliance on observational data. We use examples from over a decade of research to illustrate some of the key challenges in undertaking causally focused healthy housing research and demonstrate approaches that have been applied to address these challenges. We reflect on the improved understanding these approaches have delivered, and the key gaps and next steps in generating the evidence required to act on housing as a social determinant of health.
{"title":"The challenges of quantifying the effects of housing on health using observational data","authors":"Ang Li , Kate Mason , Yuxi Li, Rebecca Bentley","doi":"10.1016/j.annepidem.2024.12.013","DOIUrl":"10.1016/j.annepidem.2024.12.013","url":null,"abstract":"<div><div>Housing is an often overlooked yet fundamental social determinant of health. Like other social epidemiology exposures, housing faces a tension between the promise of modern causal inference methods and the messy reality of complex social processes and reliance on observational data. We use examples from over a decade of research to illustrate some of the key challenges in undertaking causally focused healthy housing research and demonstrate approaches that have been applied to address these challenges. We reflect on the improved understanding these approaches have delivered, and the key gaps and next steps in generating the evidence required to act on housing as a social determinant of health.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"102 ","pages":"Pages 23-27"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923843","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 : 2025-02-01DOI: 10.1016/j.annepidem.2025.01.004
Dorthe C. Pedersen , Dan Hameiri-Bowen , Julie Aarestrup , Britt W. Jensen , Anne Tjønneland , Lene Mellemkjær , My von Euler-Chelpin , Ilse Vejborg , Zorana J. Andersen , Jennifer L. Baker
Purpose
Whether breast density mediates associations between early life body size and pubertal timing with postmenopausal breast cancer is underexplored.
Methods
We studied 33,939 Danish women attending the Capital Mammography Screening Program at ages 50–69 years. Early life anthropometry and pubertal timing information came from the Copenhagen School Health Records Register. Postmenopausal breast cancer information came from the Danish Breast Cancer Group database (n = 833). Breast density (BI-RADS) was categorized as low (n = 25,464; 75 %) or high. Risk ratios (RR) and hazard ratios (HR) were estimated using generalized linear regression and Cox proportional hazards analyses. Counterfactual mediation analyses were conducted.
Results
Evidence was limited for associations between birthweight and pubertal timing with breast density or breast cancer. Childhood BMI was inversely associated with high breast density (age 13y, RR=0.77 [0.72–0.81] for a z-score of 0.6 versus 0) and breast cancer (HR=0.90 [0.83–0.96] per z-score). Breast density mediated 37 % (17–170 %) of this association. Although childhood height was associated with breast density and breast cancer, there were few indications of mediation by breast density.
Conclusions
Breast density may partially explain the inverse association between childhood BMI and postmenopausal breast cancer, but not the positive association between childhood height and postmenopausal breast cancer.
{"title":"Associations of early life body size and pubertal timing with breast density and postmenopausal breast cancer risk: A mediation analysis","authors":"Dorthe C. Pedersen , Dan Hameiri-Bowen , Julie Aarestrup , Britt W. Jensen , Anne Tjønneland , Lene Mellemkjær , My von Euler-Chelpin , Ilse Vejborg , Zorana J. Andersen , Jennifer L. Baker","doi":"10.1016/j.annepidem.2025.01.004","DOIUrl":"10.1016/j.annepidem.2025.01.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Whether breast density mediates associations between early life body size and pubertal timing with postmenopausal breast cancer is underexplored.</div></div><div><h3>Methods</h3><div>We studied 33,939 Danish women attending the Capital Mammography Screening Program at ages 50–69 years. Early life anthropometry and pubertal timing information came from the Copenhagen School Health Records Register. Postmenopausal breast cancer information came from the Danish Breast Cancer Group database (n = 833). Breast density (BI-RADS) was categorized as low (n = 25,464; 75 %) or high. Risk ratios (RR) and hazard ratios (HR) were estimated using generalized linear regression and Cox proportional hazards analyses. Counterfactual mediation analyses were conducted.</div></div><div><h3>Results</h3><div>Evidence was limited for associations between birthweight and pubertal timing with breast density or breast cancer. Childhood BMI was inversely associated with high breast density (age 13y, RR=0.77 [0.72–0.81] for a <em>z</em>-score of 0.6 versus 0) and breast cancer (HR=0.90 [0.83–0.96] per <em>z</em>-score). Breast density mediated 37 % (17–170 %) of this association. Although childhood height was associated with breast density and breast cancer, there were few indications of mediation by breast density.</div></div><div><h3>Conclusions</h3><div>Breast density may partially explain the inverse association between childhood BMI and postmenopausal breast cancer, but not the positive association between childhood height and postmenopausal breast cancer.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"102 ","pages":"Pages 68-74"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.annepidem.2025.01.001
Kaitlyn K. Stanhope PhD , Sara Markowitz PhD , Michael R. Kramer PhD
Objective
To estimate associations between the length of state-level eviction moratoria enacted in March and April 2020 in the United States and perinatal outcomes.
Methods
We used data from natality files, 2020–2021 to identify individuals with Medicaid or no insurance who conceived in March-May 2020. The exposure was the number of months exposed to a moratorium (0 (referent, no state-level moratoria), 1–2, 3–4, 5 or more). Outcomes included preterm birth (PTB, < 37 weeks gestation), very preterm birth (VPTB, < 32 weeks gestation), low birthweight (LBW, < 2500 g), very low birthweight (VLBW, < 1500 g), primary cesarean, or maternal morbidity. We estimated risk ratios (RRs) using log-binomial regression, including individual, county, and state-level confounders. We conducted several sensitivity analyses to rule out residual state-level confounding including a negative control analysis of 2019 conceptions and difference-in-difference analysis.
Results
We included 375,821 births. Following adjustment, having a moratorium in place for 5 or more months was associated with slightly reduced risk of PTB (RR: 0.95, 95 % CI: 0.88, 1.02), VPTB (RR: 0.90, 95 % CI: 0.8–1.01), LBW (RR: 0.95, 95 % CI: 0.9–1.01), and VLBW (RR: 0.91, 95 % CI: 0.81–1.02) compared to states without a moratorium. There was no association with cesarean or maternal morbidity. Sensitivity analyses showed that all or most of the observed associations may be explained by residual state-level confounding.
Conclusions
State-level eviction moratoria were associated with improved birth outcomes, yet it is likely that all or most of the observed association is due to other policy actions or characteristics of enacting states.
{"title":"Duration of exposure to eviction moratoria in the early COVID-19 pandemic and perinatal outcomes: A population-level analysis of US births conceived in March-May 2020","authors":"Kaitlyn K. Stanhope PhD , Sara Markowitz PhD , Michael R. Kramer PhD","doi":"10.1016/j.annepidem.2025.01.001","DOIUrl":"10.1016/j.annepidem.2025.01.001","url":null,"abstract":"<div><h3>Objective</h3><div>To estimate associations between the length of state-level eviction moratoria enacted in March and April 2020 in the United States and perinatal outcomes.</div></div><div><h3>Methods</h3><div>We used data from natality files, 2020–2021 to identify individuals with Medicaid or no insurance who conceived in March-May 2020. The exposure was the number of months exposed to a moratorium (0 (referent, no state-level moratoria), 1–2, 3–4, 5 or more). Outcomes included preterm birth (PTB, < 37 weeks gestation), very preterm birth (VPTB, < 32 weeks gestation), low birthweight (LBW, < 2500 g), very low birthweight (VLBW, < 1500 g), primary cesarean, or maternal morbidity. We estimated risk ratios (RRs) using log-binomial regression, including individual, county, and state-level confounders. We conducted several sensitivity analyses to rule out residual state-level confounding including a negative control analysis of 2019 conceptions and difference-in-difference analysis.</div></div><div><h3>Results</h3><div>We included 375,821 births. Following adjustment, having a moratorium in place for 5 or more months was associated with slightly reduced risk of PTB (RR: 0.95, 95 % CI: 0.88, 1.02), VPTB (RR: 0.90, 95 % CI: 0.8–1.01), LBW (RR: 0.95, 95 % CI: 0.9–1.01), and VLBW (RR: 0.91, 95 % CI: 0.81–1.02) compared to states without a moratorium. There was no association with cesarean or maternal morbidity. Sensitivity analyses showed that all or most of the observed associations may be explained by residual state-level confounding.</div></div><div><h3>Conclusions</h3><div>State-level eviction moratoria were associated with improved birth outcomes, yet it is likely that all or most of the observed association is due to other policy actions or characteristics of enacting states.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"102 ","pages":"Pages 48-54"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973140","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 : 2025-02-01DOI: 10.1016/j.annepidem.2024.12.016
Zhengye Si, Jinpu Li, Emily Leary Ph.D.
Purpose
The objective of this study is to investigate the predictive ability of machine learning models for imbalanced outcomes from national survey data without the use of sampling weights.
Methods
We evaluated the predictive performance of machine learning models on imbalanced outcomes from the US National Health and Nutrition Examination Survey (USNHANES) without using sampling weights. Four machine learning models (support vector machine, random forest, least absolute shrinkage and selection operator regression, and deep neural network) were compared with a logistic model that incorporates the survey's complex sampling design. Three resampling methods (oversampling, undersampling, and combined) were used to address class imbalance during the model training process.
Results
For all models, the balanced accuracy was similar (ranging from 0.72 to 0.76) and the specificity was smaller than sensitivity except for random forest. The support vector machine and neural networks performed best with sensitivity (ranging from 0.79 to 0.83), while the random forest had the largest specificity (ranging from 0.86 to 0.96), with one exception. PR-AUC scores and Brier scores were low ranging from 0.2529 to 0.3313 (lower scores worse) and 0.1005–0.3245 (lower scores better), respectively
Conclusions
The machine learning models had overall similar predictive capacity to the recommended methods which integrate the complex sampling design for the prediction of osteoarthritis occurrence with USNHANES.
{"title":"Machine learning in public health informatics: Evidence that complex sampling structures may not be needed for prediction models with imbalanced outcomes","authors":"Zhengye Si, Jinpu Li, Emily Leary Ph.D.","doi":"10.1016/j.annepidem.2024.12.016","DOIUrl":"10.1016/j.annepidem.2024.12.016","url":null,"abstract":"<div><h3>Purpose</h3><div>The objective of this study is to investigate the predictive ability of machine learning models for imbalanced outcomes from national survey data without the use of sampling weights.</div></div><div><h3>Methods</h3><div>We evaluated the predictive performance of machine learning models on imbalanced outcomes from the US National Health and Nutrition Examination Survey (USNHANES) without using sampling weights. Four machine learning models (support vector machine, random forest, least absolute shrinkage and selection operator regression, and deep neural network) were compared with a logistic model that incorporates the survey's complex sampling design. Three resampling methods (oversampling, undersampling, and combined) were used to address class imbalance during the model training process.</div></div><div><h3>Results</h3><div>For all models, the balanced accuracy was similar (ranging from 0.72 to 0.76) and the specificity was smaller than sensitivity except for random forest. The support vector machine and neural networks performed best with sensitivity (ranging from 0.79 to 0.83), while the random forest had the largest specificity (ranging from 0.86 to 0.96), with one exception. PR-AUC scores and Brier scores were low ranging from 0.2529 to 0.3313 (lower scores worse) and 0.1005–0.3245 (lower scores better), respectively</div></div><div><h3>Conclusions</h3><div>The machine learning models had overall similar predictive capacity to the recommended methods which integrate the complex sampling design for the prediction of osteoarthritis occurrence with USNHANES.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"102 ","pages":"Pages 75-80"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973141","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 : 2025-02-01DOI: 10.1016/j.annepidem.2025.01.008
John Ferguson
In cohort studies, relative risks are estimated by comparing eventual disease risk in individuals exposed to the risk factor at baseline with similar unexposed individuals. However, such relative risk estimates intrinsically depend on how many of the unexposed individuals develop exposure after baseline and on the ages at which the exposed individuals developed exposure prior to baseline. These factors pertain to the distribution of risk factor incidence in the population, rather than to the causal effect the risk factor has on disease. As such, these cohort relative risk estimates have no straightforward causal interpretation, even after adjustment for confounding. Here, we instead consider initial exposure to the risk factor at differing ages as differing treatments, with corresponding potential outcomes. Subsequently, we define lifetime relative risk as the relative probability of eventual disease comparing initial exposure to the risk factor at differing ages to lifetime non-exposure. We describe a procedure to approximate lifetime relative risks using summary data from published cohort studies, and detail conditions under which such estimation is valid. In addition to being of independent interest, lifetime relative risks are useful in estimating population attributable fractions (PAF)s. In our applied example, we illustrate this connection via application of estimated lifetime relative risks to assess the PAF for incident vascular dementia due to hypertension in the United Kingdom.
{"title":"Calculation of lifetime relative risks from summary cohort data and application to calculation of attributable fractions","authors":"John Ferguson","doi":"10.1016/j.annepidem.2025.01.008","DOIUrl":"10.1016/j.annepidem.2025.01.008","url":null,"abstract":"<div><div>In cohort studies, relative risks are estimated by comparing eventual disease risk in individuals exposed to the risk factor at baseline with similar unexposed individuals. However, such relative risk estimates intrinsically depend on how many of the unexposed individuals develop exposure after baseline and on the ages at which the exposed individuals developed exposure prior to baseline. These factors pertain to the distribution of risk factor incidence in the population, rather than to the causal effect the risk factor has on disease. As such, these cohort relative risk estimates have no straightforward causal interpretation, even after adjustment for confounding. Here, we instead consider initial exposure to the risk factor at differing ages as differing treatments, with corresponding potential outcomes. Subsequently, we define lifetime relative risk as the relative probability of eventual disease comparing initial exposure to the risk factor at differing ages to lifetime non-exposure. We describe a procedure to approximate lifetime relative risks using summary data from published cohort studies, and detail conditions under which such estimation is valid. In addition to being of independent interest, lifetime relative risks are useful in estimating population attributable fractions (PAF)s. In our applied example, we illustrate this connection via application of estimated lifetime relative risks to assess the PAF for incident vascular dementia due to hypertension in the United Kingdom.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"102 ","pages":"Pages 102-113"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043295","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 : 2025-02-01DOI: 10.1016/j.annepidem.2025.01.005
Matteo Franchi , Marco Gennari , Gaia Severgnini , Fausto Biancari , Alice Bonomi , Federico De Marco , Gianluca Polvani , Marco Agrifoglio
Purpose
To compare the overall survival and the risk of all-cause and heart failure-specific hospitalization in nonagenarian patients hospitalized for symptomatic severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI) or conservative treatment.
Methods
Population-based retrospective cohort study based on healthcare utilization databases of the Italian region of Lombardy. The cohort included all nonagenarians hospitalized for AS between 2017 and 2021, who underwent TAVI within 90 days from first diagnosis or conservative treatment. The association between TAVI and clinical outcomes was assessed through Cox or Fine&Grey regression models. High-dimensional propensity score matching was used to reduce the heterogeneity between groups.
Results
Overall, 16,848 nonagenarians hospitalized for AS were identified. Among these, 320 patients underwent TAVI, of which 193 were matched to as many control patients. The 2-year survival rates were 76.0 % and 37.7 %, respectively, in TAVI and control patients, corresponding to an HR of 0.24 (95 % CI 0.15–0.37). The 2-year cumulative incidence of rehospitalization for heart failure was 11.1 % and 26.5 %, respectively, corresponding to an HR of 0.64 (95 % CI 0.40–0.99).
Conclusions
This study further supports the usefulness of TAVI in nonagenarians, as it showed to improve their survival rate, reduce their risk of rehospitalization, and likely increase their quality of life.
目的：比较因症状性重度主动脉瓣狭窄（AS）接受经导管主动脉瓣植入术（TAVI）或保守治疗的老年患者的总生存率、全因和心力衰竭特异性住院风险。方法：基于意大利伦巴第地区医疗保健利用数据库的人群回顾性队列研究。该队列包括2017年至2021年间因AS住院的所有90岁以上老人，他们在首次诊断或保守治疗后90天内接受了TAVI。通过Cox或Fine&Grey回归模型评估TAVI与临床结果之间的关系。采用高维倾向评分匹配来降低组间异质性。结果：总共有16,848名因AS住院的老年患者。其中320例患者接受了TAVI，其中193例与同样多的对照患者匹配。TAVI患者和对照组患者的2年生存率分别为76.0 %和37.7 %，相对危险度为0.24（95% % CI 0.15-0.37）。2年心力衰竭再住院的累计发生率分别为11.1 %和26.5% %，相对危险度为0.64（95 % CI 0.40-0.99）。结论：本研究进一步支持TAVI在90岁老人中的有效性，因为它显示出提高他们的生存率，降低他们再住院的风险，并可能提高他们的生活质量。
{"title":"Clinical outcomes after transcatheter aortic valve implantation in nonagenarian patients: A retrospective population-based cohort study","authors":"Matteo Franchi , Marco Gennari , Gaia Severgnini , Fausto Biancari , Alice Bonomi , Federico De Marco , Gianluca Polvani , Marco Agrifoglio","doi":"10.1016/j.annepidem.2025.01.005","DOIUrl":"10.1016/j.annepidem.2025.01.005","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the overall survival and the risk of all-cause and heart failure-specific hospitalization in nonagenarian patients hospitalized for symptomatic severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI) or conservative treatment.</div></div><div><h3>Methods</h3><div>Population-based retrospective cohort study based on healthcare utilization databases of the Italian region of Lombardy. The cohort included all nonagenarians hospitalized for AS between 2017 and 2021, who underwent TAVI within 90 days from first diagnosis or conservative treatment. The association between TAVI and clinical outcomes was assessed through Cox or Fine&Grey regression models. High-dimensional propensity score matching was used to reduce the heterogeneity between groups.</div></div><div><h3>Results</h3><div>Overall, 16,848 nonagenarians hospitalized for AS were identified. Among these, 320 patients underwent TAVI, of which 193 were matched to as many control patients. The 2-year survival rates were 76.0 % and 37.7 %, respectively, in TAVI and control patients, corresponding to an HR of 0.24 (95 % CI 0.15–0.37). The 2-year cumulative incidence of rehospitalization for heart failure was 11.1 % and 26.5 %, respectively, corresponding to an HR of 0.64 (95 % CI 0.40–0.99).</div></div><div><h3>Conclusions</h3><div>This study further supports the usefulness of TAVI in nonagenarians, as it showed to improve their survival rate, reduce their risk of rehospitalization, and likely increase their quality of life.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"102 ","pages":"Pages 81-85"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-31DOI: 10.1016/j.annepidem.2025.01.010
Elizabeth A. Onugha MD MSCI , Ankona Banerjee MS , Kenneth J. Nobleza MS , Duc T. Nguyen MD, PhD , Omar Rosales MS , Abiodun Oluyomi PhD , Jayna M. Dave PhD , Joshua Samuels MD, MPH
Objectives
To examine the association between socioeconomic characteristics of school neighborhoods and the prevalence of hypertension in adolescents.
Study design
We performed a secondary data analysis of over 21,000 adolescents who participated in a school BP surveillance program between 2000 and 2017. BP status was confirmed by BP measurements on up to 3 occasions to diagnose sustained hypertension according to standard pediatric hypertension guidelines. We assessed school neighborhood socioeconomic status (SES) via the area deprivation index (ADI), a composite measure of area-level socioeconomic deprivation and categorized into quartiles. Q1 represented schools in neighborhoods with the least social deprivation while Q4 represented neighborhood with the most socioeconomic deprivation. We performed a cross-sectional analysis using both univariate and multivariable regression analyses.
Results
Of 21,392 children included in our analysis, the prevalence of sustained hypertension was 2.6 %. Hispanics and African Americans were overrepresented in the schools in more deprived neighborhoods. The highest sustained hypertension rate was observed among students attending Q3 (5.5 %) and Q4 (4.2 %) schools compared to Q1 (2.7 %) and Q2 (2.0 %) schools (p < 0.001). Multivariable regression analysis showed that being male, obese, and attending school in a disadvantaged neighborhood were significantly associated with an increased prevalence of hypertension.
Conclusions
Our findings suggest that school neighborhood deprivation measured by ADI may be a risk factor for hypertension and may contribute to the racial/ ethnic disparities observed in hypertension prevalence in adolescents.
{"title":"School neighborhood deprivation is associated with a higher prevalence of hypertension","authors":"Elizabeth A. Onugha MD MSCI , Ankona Banerjee MS , Kenneth J. Nobleza MS , Duc T. Nguyen MD, PhD , Omar Rosales MS , Abiodun Oluyomi PhD , Jayna M. Dave PhD , Joshua Samuels MD, MPH","doi":"10.1016/j.annepidem.2025.01.010","DOIUrl":"10.1016/j.annepidem.2025.01.010","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine the association between socioeconomic characteristics of school neighborhoods and the prevalence of hypertension in adolescents.</div></div><div><h3>Study design</h3><div>We performed a secondary data analysis of over 21,000 adolescents who participated in a school BP surveillance program between 2000 and 2017. BP status was confirmed by BP measurements on up to 3 occasions to diagnose sustained hypertension according to standard pediatric hypertension guidelines. We assessed school neighborhood socioeconomic status (SES) via the area deprivation index (ADI), a composite measure of area-level socioeconomic deprivation and categorized into quartiles. Q1 represented schools in neighborhoods with the least social deprivation while Q4 represented neighborhood with the most socioeconomic deprivation. We performed a cross-sectional analysis using both univariate and multivariable regression analyses.</div></div><div><h3>Results</h3><div>Of 21,392 children included in our analysis, the prevalence of sustained hypertension was 2.6 %. Hispanics and African Americans were overrepresented in the schools in more deprived neighborhoods. The highest sustained hypertension rate was observed among students attending Q3 (5.5 %) and Q4 (4.2 %) schools compared to Q1 (2.7 %) and Q2 (2.0 %) schools (p < 0.001). Multivariable regression analysis showed that being male, obese, and attending school in a disadvantaged neighborhood were significantly associated with an increased prevalence of hypertension.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that school neighborhood deprivation measured by ADI may be a risk factor for hypertension and may contribute to the racial/ ethnic disparities observed in hypertension prevalence in adolescents.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"103 ","pages":"Pages 9-15"},"PeriodicalIF":3.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082005","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 : 2025-01-29DOI: 10.1016/j.annepidem.2025.01.011
Bo Ram Yang , Seung-Mi Lee
Purpose
This study investigated the association between electronic cigarette (e-cigarette) use and serum concentrations of heavy metals (lead, mercury, and cadmium) in the Korean population, utilizing data from the Korea National Health and Nutrition Examination Survey (KNHANES), a nationally representative cross-sectional survey.
Methods
Data from KNHANES 2013, 2016, and 2017 were analyzed. Participants were classified as e-cigarette users (individuals who had ever used e-cigarettes, including dual users who had also used conventional cigarettes), conventional smokers (individuals who had smoked at least 100 conventional cigarettes [5 packs], but not e-cigarettes, in their lifetime), and non-smokers (individuals who had never used e-cigarettes and either never smoked conventional cigarettes or smoked fewer than 100 cigarettes). Linear regression models were employed to evaluate the association between smoking status and heavy metal concentrations, adjusting for covariates including age, sex, income, education, and health behaviors. Subgroup analyses were performed based on sex, age, and obesity status.
Results
E-cigarette users exhibited significantly higher serum concentrations of heavy metals than non-smokers. Lead levels were 10.0 % higher (exponentiated β = 1.100; p < 0.001), mercury levels were 13.7 % higher (β = 1.137; p < 0.001), and cadmium levels were 61.4 % higher (β = 1.614; p < 0.001). Conventional smokers demonstrated elevated levels of these metals compared to non-smokers, but generally lower levels than e-cigarette users. Subgroup analyses revealed stronger associations among younger participants, males, and individuals with obesity, particularly for cadmium.
Conclusions
Dual use of e-cigarettes and conventional cigarettes is associated with elevated exposure to heavy metals compared to exclusive smoking cigarettes. These findings highlight the need for targeted public health interventions and stricter regulatory standards to address the risks associated with e-cigarette use.
{"title":"Electronic cigarette use and heavy metal exposure: Evidence from the Korea National Health and Nutrition Examination Survey","authors":"Bo Ram Yang , Seung-Mi Lee","doi":"10.1016/j.annepidem.2025.01.011","DOIUrl":"10.1016/j.annepidem.2025.01.011","url":null,"abstract":"<div><h3>Purpose</h3><div>This study investigated the association between electronic cigarette (e-cigarette) use and serum concentrations of heavy metals (lead, mercury, and cadmium) in the Korean population, utilizing data from the Korea National Health and Nutrition Examination Survey (KNHANES), a nationally representative cross-sectional survey.</div></div><div><h3>Methods</h3><div>Data from KNHANES 2013, 2016, and 2017 were analyzed. Participants were classified as e-cigarette users (individuals who had ever used e-cigarettes, including dual users who had also used conventional cigarettes), conventional smokers (individuals who had smoked at least 100 conventional cigarettes [5 packs], but not e-cigarettes, in their lifetime), and non-smokers (individuals who had never used e-cigarettes and either never smoked conventional cigarettes or smoked fewer than 100 cigarettes). Linear regression models were employed to evaluate the association between smoking status and heavy metal concentrations, adjusting for covariates including age, sex, income, education, and health behaviors. Subgroup analyses were performed based on sex, age, and obesity status.</div></div><div><h3>Results</h3><div>E-cigarette users exhibited significantly higher serum concentrations of heavy metals than non-smokers. Lead levels were 10.0 % higher (exponentiated β = 1.100; p < 0.001), mercury levels were 13.7 % higher (β = 1.137; p < 0.001), and cadmium levels were 61.4 % higher (β = 1.614; p < 0.001). Conventional smokers demonstrated elevated levels of these metals compared to non-smokers, but generally lower levels than e-cigarette users. Subgroup analyses revealed stronger associations among younger participants, males, and individuals with obesity, particularly for cadmium.</div></div><div><h3>Conclusions</h3><div>Dual use of e-cigarettes and conventional cigarettes is associated with elevated exposure to heavy metals compared to exclusive smoking cigarettes. These findings highlight the need for targeted public health interventions and stricter regulatory standards to address the risks associated with e-cigarette use.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"103 ","pages":"Pages 1-8"},"PeriodicalIF":3.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076451","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 : 2025-01-01DOI: 10.1016/j.annepidem.2024.11.004
Jason M. Nagata M.D., M.Sc. , Shirley Sui , Angela E. Kim M.Phil. , Iris Yuefan Shao M.P.H., Ph.D. , Christopher D. Otmar Ph.D. , Kyle T. Ganson Ph.D., M.S.W. , Alexander Testa Ph.D. , Erin E. Dooley M.S., Ph.D. , Holly C. Gooding M.D., MS.c. , Fiona C. Baker Ph.D. , Kelley Pettee Gabriel M.S., Ph.D.
Purpose
To examine the association between multiple dimensions of gender diversity and physical activity (daily steps) in a diverse national sample of early adolescents in the United States.
Methods
This study analyzed Year 2 data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 6038, Mage=12.0 years). Linear regression models were used to estimate the associations of gender diversity across multiple measures (transgender identity, felt gender, gender expression, gender non-contentedness) with daily step count measured by wrist-worn Fitbit devices.
Results
In this sample of early adolescents, 49.7 % were assigned female at birth, 39.4 % were from racial/ethnic minority groups, and 1 % to 16.9 % identified as gender diverse, depending on the measure used. Transgender identity was associated with 1394 (95 % confidence interval 284–2504) fewer steps per day compared to cisgender identity after adjusting for all covariates. Greater gender diversity, as measured by felt gender and gender non-contentedness, was also associated with lower daily steps.
Conclusions
Transgender and gender-diverse adolescents engage in less physical activity than their cisgender peers. This research has important implications for public health and policies focused on supporting physical activity among transgender and gender-diverse early adolescents.
{"title":"Gender diversity and daily steps: Findings from the Adolescent Brain Cognitive Development Study","authors":"Jason M. Nagata M.D., M.Sc. , Shirley Sui , Angela E. Kim M.Phil. , Iris Yuefan Shao M.P.H., Ph.D. , Christopher D. Otmar Ph.D. , Kyle T. Ganson Ph.D., M.S.W. , Alexander Testa Ph.D. , Erin E. Dooley M.S., Ph.D. , Holly C. Gooding M.D., MS.c. , Fiona C. Baker Ph.D. , Kelley Pettee Gabriel M.S., Ph.D.","doi":"10.1016/j.annepidem.2024.11.004","DOIUrl":"10.1016/j.annepidem.2024.11.004","url":null,"abstract":"<div><h3>Purpose</h3><div>To examine the association between multiple dimensions of gender diversity and physical activity (daily steps) in a diverse national sample of early adolescents in the United States.</div></div><div><h3>Methods</h3><div>This study analyzed Year 2 data from the Adolescent Brain Cognitive Development (ABCD) Study (<em>N</em> = 6038, <em>M</em><sub><em>age</em></sub>=12.0 years). Linear regression models were used to estimate the associations of gender diversity across multiple measures (transgender identity, felt gender, gender expression, gender non-contentedness) with daily step count measured by wrist-worn Fitbit devices.</div></div><div><h3>Results</h3><div>In this sample of early adolescents, 49.7 % were assigned female at birth, 39.4 % were from racial/ethnic minority groups, and 1 % to 16.9 % identified as gender diverse, depending on the measure used. Transgender identity was associated with 1394 (95 % confidence interval 284–2504) fewer steps per day compared to cisgender identity after adjusting for all covariates. Greater gender diversity, as measured by felt gender and gender non-contentedness, was also associated with lower daily steps.</div></div><div><h3>Conclusions</h3><div>Transgender and gender-diverse adolescents engage in less physical activity than their cisgender peers. This research has important implications for public health and policies focused on supporting physical activity among transgender and gender-diverse early adolescents.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"101 ","pages":"Pages 1-6"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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