Annals of Epidemiology最新文献_第4页

Impact of extensive health examination survey screening on quality of life, healthcare use, and mortality: A longitudinal matched cohort study 广泛健康检查筛查对生活质量、医疗保健使用和死亡率的影响：一项纵向匹配队列研究。

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

Annals of Epidemiology

Pub Date : 2026-01-01 Epub Date: 2025-12-19 DOI: 10.1016/j.annepidem.2025.12.008

Ingvild M. Rosenlund MD, PhD , Ellisiv B. Mathiesen Professor, MD, PhD , Unni Ringberg MD, PhD , Liv-Hege Johnsen MD, PhD , Tom Wilsgaard Professor, PhD , Jørgen Isaksen MD, PhD , Tor Ingebrigtsen Professor, MD, PhD

Purpose

Widespread use of diagnostic testing in asymptomatic individuals raises ethical concerns. We aimed to investigate whether participation in an extensive health examination survey is associated with psychosocial outcomes, healthcare use, and mortality.

Methods

This longitudinal matched cohort study included 461 participants who underwent comprehensive screening examinations as part of the population-based Tromsø7 Study, including electrocardiogram, carotid artery ultrasound, echocardiography, brain magnetic resonance imaging, and spirometry. Age- and sex-matched controls (n = 461) were drawn from Tromsø7 participants who only underwent limited basic measurements. Health-related quality of life, psychological distress, and health anxiety were assessed at baseline and after 5 years. Data on healthcare utilization and mortality were obtained from national registries.

Results

No significant differences were found in psychosocial outcomes. Healthcare use was largely similar, although screening participants had slightly fewer hospital admissions, 0.23 vs. 0.31 per person-year (95 % CI 0.19, 0.28 vs. 0.25, 0.38). Screening participants also had lower, but non-significant, risk of death compared with controls, hazard ratio 0.69 (95 % CI 0.47, 1.01).

Conclusion

Extensive health examination survey screening was not associated with psychosocial harms, healthcare use or statistically significant differences in mortality. Overall, the findings suggest that participation in such screening is safe.

目的：在无症状个体中广泛使用诊断测试引起了伦理问题。我们的目的是调查参与广泛的健康检查调查是否与心理社会结局、医疗保健使用和死亡率有关。方法：这项纵向匹配队列研究纳入了461名参与者，作为基于人群的Tromsø7研究的一部分，他们接受了全面的筛查检查，包括心电图、颈动脉超声、超声心动图、脑磁共振成像和肺活量测定。年龄和性别匹配的对照组（n=461）来自仅接受有限基本测量的Tromsø7参与者。在基线和5年后评估与健康相关的生活质量、心理困扰和健康焦虑。关于医疗保健利用和死亡率的数据来自国家登记处。结果：心理社会结局无显著差异。医疗保健使用大致相似，尽管筛查参与者的住院率略低，每人年0.23比0.31 （95% CI 0.19, 0.28比0.25,0.38）。与对照组相比，筛查参与者的死亡风险也较低，但不显著，风险比为0.69 （95% CI 0.47, 1.01）。结论：广泛的健康检查调查筛查与心理社会伤害、医疗保健使用或死亡率的统计学显著差异无关。总的来说，研究结果表明，参与这种筛查是安全的。

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引用次数: 0

Comparing intraclass correlation coefficient estimators for binary outcomes in sample size calculations in twin pregnancies 比较双胎妊娠中样本量计算中二元结果的类内相关系数估计。

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

Annals of Epidemiology

Pub Date : 2026-01-01 Epub Date: 2025-12-16 DOI: 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.

目的：类内相关系数（ICCs）可用于调整样本大小计算中的聚类，但二元结果的不同ICC估计器可以返回不同的估计。我们评估了五种常见的ICC估计器在比较治疗和未治疗双胎妊娠的二元结果的研究中计算达到期望功率的样本量的能力。方法：我们模拟了双胎妊娠中不同程度的聚类和结局患病率的研究。我们使用了从logistic广义估计方程（GEE）、方差分析（ANOVA）、线性混合模型（LMM）和logistic广义线性混合模型（GLMM）推导出的ICC估计量。我们使用标准公式计算所需的样本量以获得80%的功率（5%的I型误差），并使用模拟来估计经验功率。结果：从GEE、方差分析和LMM得出的ICC估计值彼此相似，在结果患病率中是恒定的，并且产生了达到所需功率的所需样本量。当聚类高或结果患病率低时，使用logistic GLMM的ICC估计值因结果患病率而异，并产生所需的样本量大于必要的样本量（功率bbb80 %）。结论：在包括双胎妊娠在内的样本量计算中使用icc的研究人员应考虑避免使用logistic glmm进行估计。

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引用次数: 0

Cardiovascular effects of metformin and testosterone replacement therapy in older men with hormone-related cancers and cancer-free population 二甲双胍和睾酮替代疗法对老年男性激素相关癌症和无癌症人群的心血管影响

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

Annals of Epidemiology

Pub Date : 2026-01-01 Epub Date: 2025-12-05 DOI: 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.

目的：本研究探讨了在总体人群、激素相关癌症（HRC）幸存者和无癌症人群中，二甲双胍和睾酮替代疗法（TTh）与心血管疾病（CVD）及其亚类风险之间的关系。方法：采用2007-2015年SEER-Medicare数据，对58028名≥65岁的男性进行回顾性队列研究。本分析确定了二甲双胍和TTh处方。主要结局是复合心血管疾病和心血管疾病亚类别（心力衰竭[HF]、缺血性心脏病[IHD]、外周动脉疾病[PAD]和中风）的发生率。采用多变量时变Cox比例风险模型。结果：二甲双胍的使用与总体人群（风险比[HR] = 0.72, 95% CI, 0.68 - 0.76）、无癌人群（HR = 0.72, 95% CI, 0.68 - 0.76）和HRC幸存者（HR = 0.67, 95% CI, 0.64 - 0.73）的心血管疾病呈负相关。同样，在总体人群（HR = 0.82, 95% CI, 0.67 - 0.99）、无癌人群（HR = 0.80, 95% CI, 0.64 - 0.99）和HRC幸存者（HR = 0.64, 95% CI, 0.48 - 86）中，TTh的使用与CVD呈负相关。结论：在总体人群、HRC幸存者和无癌人群的老年男性中，二甲双胍和th与CVD呈负相关。二甲双胍使用者心血管疾病风险降低幅度最大。需要进一步的研究来证实这些关联。

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引用次数: 0

Under-five mortality estimation methods: A methodological systematic review 五岁以下儿童死亡率估计方法：方法学系统审查。

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

Annals of Epidemiology

Pub Date : 2026-01-01 Epub Date: 2025-12-19 DOI: 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。

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引用次数: 0

Quantifying U.S. life expectancy gains from reductions in Black-White mortality disparities: A simulation study 通过减少黑人-白人死亡率差异量化美国人的预期寿命：一项模拟研究。

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

Annals of Epidemiology

Pub Date : 2026-01-01 Epub Date: 2025-12-05 DOI: 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.

背景：美国黑人和白人之间的预期寿命（LE）仍然存在巨大差距。本研究旨在模拟所有年龄段的美国黑人超额死亡风险降低的假设；展示如何在改变超额风险降低水平时改善LE；如果在特定年龄组中减少死亡率的种族差异，则提供潜在的LE收益的定量估计。方法：我通过缩小所有年龄段的过度相对风险来模拟黑人-白人死亡率差距的反事实降低。我进一步根据所有主要种族/族裔群体的人口份额计算了总体LE加权，然后按年龄组(儿童（0-17岁）、年轻人（18-29岁）、中年人（30-49岁）、老年人（50-64岁）和老年人（65岁以上）对这些影响进行了分类。结果：每连续减少25%的额外死亡风险与LE的增量改善相关，并且完全关闭额外风险差距预计将使女性的总体LE改善0.48年，男性的总体LE改善0.77年。在两性中，观察到一个显著的模式，即随着中年成人（30-49岁）和老年成人（50-64岁）人群的超额死亡率差距缩小，最大的寿命增加。结论：总的来说，这项研究提供了新的定量证据，表明解决死亡率方面的种族不平等问题——特别是美国黑人面临的过度风险——可以在全国预期寿命方面产生有意义的收益。

{"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":"2026-01-01","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}

引用次数: 0

Multi-jurisdiction linkage of PRAMS and hospital discharge data: Methods, key challenges, and practical applications PRAMS与医院出院数据的多辖区联动：方法、关键挑战和实际应用。

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

Annals of Epidemiology

Pub Date : 2026-01-01 Epub Date: 2025-12-08 DOI: 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.

目的：将妊娠风险评估监测系统（PRAMS）数据与出院数据（HDD）联系起来，为探索PRAMS中与孕产妇严重发病率（SMM）和妊娠期高血压疾病（HDP）等孕产妇健康结局相关的自我报告因素提供了机会。本研究概述了利用现有数据链接创建多辖区PRAMS-HDD记录级链接数据集的方法和挑战，以评估与SMM和HDP相关的因素。方法：参与PRAMS数据链接学习社区的四个司法管辖区使用各种链接策略将PRAMS和HDD的交付从2017-2020年联系起来。使用研究者提供的标准化算法在HDD数据中识别SMM和HDP。创纪录水平的PRAMS数据与SMM和HDP指标然后在各州合并。评估了连接率和质量的潜在影响、结果的普遍性、抽样层次和反应率。结果：在这四个州中，17,878名PRAMS受访者与HDD记录的医院分娩有关。连锁率从63%到99%不等（总体86%）。确诊SMM 227例（1.3%），HDP 2889例（17.2%），各州差异显著。连锁率影响结果分类的可靠性。结论：多辖区PRAMS联动提供了评估孕产妇健康结果的潜力。然而，数据质量、联动率和抽样策略的变化会影响结果的可靠性。未来的多辖区PRAMS关联研究应优先考虑标准化数据结构、协议和关联方法，以最大限度地提高结果质量和普遍性。

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引用次数: 0

Multilevel modeling in egocentric network analysis: A practical guide with SAS and R 自我中心网络分析中的多层次建模：使用SAS和R的实用指南。

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

Annals of Epidemiology

Pub Date : 2026-01-01 Epub Date: 2025-12-19 DOI: 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.

目的：本文阐述了多层次建模在以自我为中心的网络数据中的应用，其中网络改变者嵌套在各自的自我中。这些数据的嵌套结构和自我依赖违背了传统回归模型的独立性假设。方法：多层建模通过适应分层数据结构来解决这种依赖关系，允许更准确地估计自我-改变关联。它还区分了在改变、自我和二元（自我-改变）水平上测量的变量对结果变量的影响。我们描述了涉及随机截距和斜率、跨层相互作用以及与残差和方差结构相关的假设的模型规范。提供了一个说明性的例子来演示如何估计连续和二元结果变量的固定和随机效应，评估类内相关性，测试跨水平相互作用，并解释模型结果。结果：本文为将多层次模型应用于自我中心网络数据提供了实用指南，概述了关键的概念基础、方法考虑以及使用SAS和r的逐步实施。结论：该指南旨在支持社会科学和健康科学的研究人员将多层次模型严格应用于自我中心网络数据，从而深入了解个体、关系和结构因素如何影响健康相关结果。

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引用次数: 0

Impact of integrase strand transfer inhibitors on cardiovascular disease in people with HIV 整合酶链转移抑制剂对HIV感染者心血管疾病的影响

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

Annals of Epidemiology

Pub Date : 2026-01-01 Epub Date: 2025-11-25 DOI: 10.1016/j.annepidem.2025.11.006

Buwei He , Bankole Olatosi , Jiajia Zhang , Sharon Weissman , Xiaoming Li , Xueying Yang

Purpose

Integrase Strand Transfer Inhibitors (INSTIs) are effective and well-tolerated in HIV treatment, but their cardiovascular impact remains uncertain. This study evaluated the association between INSTI-based antiretroviral therapy (ART) and cardiovascular disease (CVD) risk in people with HIV (PWH).

Methods

We conducted a retrospective cohort study using electronic health records and survey data from the All of Us research program. Adults with HIV on continuous ART for ≥ 1 year, free of CVD at baseline and within one year of ART initiation, were included. INSTI exposure was categorized by regimen status. Cox proportional hazards models assessed the association between INSTI use and CVD. A subgroup analysis examined INSTI-naïve individuals who later switched to INSTI-based ART.

Results

Among 2175 PWH, 437 (20.09 %) experienced CVD events; 1715 (78.85 %) used INSTIs. INSTI-only (aHR = 0.65, 95 % CI: 0.50–0.83) and partial-INSTI use (aHR = 0.34, 95 % CI: 0.27–0.42) were linked to lower CVD risk. In the INSTI-naïve cohort (N = 1300), switching to INSTIs reduced CVD risk (aHR = 0.32, 95 % CI: 0.25–0.40). Older age (≥ 70) increased CVD risk.

Conclusions

INSTI-based ART may lower CVD risk among PWH. Further research is needed to validate these findings.

Summary

INSTI-based ART was associated with reduced cardiovascular disease risk among people with HIV, suggesting potential cardioprotective effects that warrant further investigation.

目的整合酶链转移抑制剂（insis）在HIV治疗中是有效且耐受性良好的，但其对心血管的影响仍不确定。本研究评估了基于inist的抗逆转录病毒治疗（ART）与HIV感染者（PWH）心血管疾病（CVD）风险之间的关系。方法采用电子健康记录和“我们所有人”研究项目的调查数据进行回顾性队列研究。纳入持续接受抗逆转录病毒治疗≥ 1年、基线时无心血管疾病和开始接受抗逆转录病毒治疗一年内的艾滋病毒感染者。INSTI暴露按方案状态分类。Cox比例风险模型评估了INSTI使用与心血管疾病之间的关系。一项亚组分析检查了INSTI-naïve后来转而使用基于insi的ART的个体。结果2175例PWH中，437例（20.09 %）发生CVD事件；1715例（78.85 %）使用insi。仅使用insti （aHR = 0.65, 95 % CI: 0.50-0.83）和部分使用insti （aHR = 0.34, 95 % CI: 0.27-0.42）与降低心血管疾病风险相关。在INSTI-naïve队列中（N = 1300），切换到intis降低了心血管疾病的风险（aHR = 0.32, 95% % CI: 0.25-0.40）。年龄越大（≥70岁）心血管疾病风险增加。结论以sinsti为基础的ART可降低PWH患者心血管疾病风险。需要进一步的研究来验证这些发现。基于sti的ART与艾滋病毒感染者心血管疾病风险降低相关，提示潜在的心脏保护作用值得进一步研究。

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引用次数: 0

Multiple causes of death data to track trends of mortality from chronic diseases: Insights from the COVID-19 pandemic in Switzerland 利用多种死亡原因数据跟踪慢性病死亡率趋势：来自瑞士COVID-19大流行的见解

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

Annals of Epidemiology

Pub Date : 2026-01-01 Epub Date: 2025-12-04 DOI: 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.

目的：随着老龄化人口中多病发病率的上升和破坏性事件作为新的传染病威胁，传统上对潜在死亡原因（UCOD）的关注可能会掩盖慢性病对死亡率趋势的贡献。多种死亡原因（MCOD）方法通过考虑死亡证明上记录的所有原因来解决这一限制。我们旨在通过比较UCOD和MCOD方法来量化COVID-19大流行对慢性病死亡率趋势的影响。方法：我们对瑞士2011-2022年发生的所有死亡进行了基于人群的时间序列分析。我们模拟了大流行前（2011-2019年）的趋势，以预测2020-2022年期间未发生大流行的预期慢性病死亡人数。我们将大流行的每月影响量化为观察到的减去预期的慢性病死亡人数，并使用(1)UCOD和(2)MCOD按性别和年龄估计这些影响。结果：两种方法显示出相似的总体效果趋势。然而，2020年底出现了明显差异，当时瑞士的COVID-19死亡率最高，与UCOD相比，MCOD量化的慢性病死亡人数要高得多。结论：MCOD可作为UCOD的补充，用于量化死因特异性死亡率趋势，并可改善人群健康监测。

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引用次数: 0

Unravelling impact of comorbidities on mortality risks in CKD patients during the COVID-19 pandemic: An explainable AI-driven study COVID-19大流行期间CKD患者合并症对死亡风险的影响：一项可解释的人工智能驱动研究

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

Annals of Epidemiology

Pub Date : 2026-01-01 Epub Date: 2025-11-25 DOI: 10.1016/j.annepidem.2025.11.005

Zeinab Abdollahi , Lin Huo , Donald Fraser , Shang-Ming Zhou

Objectives

The chronic kidney disease (CKD) patients were at high risk for severe clinical complications during the COVID-19 pandemic. Our objectives were to evaluate comorbidity prevalence; predict mortality risks for CKD patients during the pandemic; assess how various health factors interact to influence mortality; and provide insights for targeted prevention strategies.

Method

We analysed data from 186,396 CKD patients in Mexico during the entire pandemic (Jan 2020- May 2023). Explainable artificial intelligence (XAI) methods with extreme gradient boosting (XGBoost) models and Shapley Additive Explanations (SHAP) were developed to predict mortality for CKD patients with model interpretations. Different metrics were used to comprehensively evaluate model’s generalisation performances.

Results

The most prevalent comorbidities were hypertension (64.39 %), diabetes (49.79 %), and obesity (16.46 %). Male patients and older individuals showed higher risk for adverse outcomes. The overall mortality rate was 19.33 %, with significantly higher mortality in COVID-19 positive patients (33.9 %) compared to COVID-19 negative patients (10.1 %). Comorbidities with the most significant impact on the mortality included diabetes, hypertension, and obesity, which were more frequent in the COVID-19 positive group and associated with higher rates of intubation, and ICU admission. Pneumonia was identified as a major predictor of negative outcomes in CKD patients with COVID-19. CVD was more common in the COVID-19 negative group. Our machine learning models achieved performances of AUC= 0.76 and F₁-score= 0.75 for predicting mortality during the pandemic.

Conclusion

Targeted management of comorbid conditions, especially respiratory infections, is crucial in CKD patients during pandemics.

目的新冠肺炎大流行期间，慢性肾脏疾病（CKD）患者是发生严重临床并发症的高危人群。我们的目的是评估合并症的患病率；预测大流行期间CKD患者的死亡风险；评估各种健康因素如何相互作用影响死亡率；并为有针对性的预防战略提供见解。方法：我们分析了墨西哥186,396例CKD患者在整个大流行期间（2020年1月至2023年5月）的数据。采用极端梯度增强（XGBoost）模型和Shapley加性解释（SHAP）的可解释人工智能（XAI）方法来预测具有模型解释的CKD患者的死亡率。采用不同的指标综合评价模型的泛化性能。结果合并症以高血压（64.39 %）、糖尿病（49.79 %）和肥胖（16.46 %）居多。男性患者和老年人出现不良后果的风险更高。总死亡率为19.33 %，其中COVID-19阳性患者的死亡率（33.9 %）明显高于COVID-19阴性患者的死亡率（10.1 %）。对死亡率影响最大的合并症包括糖尿病、高血压和肥胖，这些合并症在COVID-19阳性组中更为常见，并与插管率和ICU入院率较高相关。肺炎被认为是CKD合并COVID-19患者预后不良的主要预测因素。CVD在COVID-19阴性组中更为常见。我们的机器学习模型在预测大流行期间的死亡率方面实现了AUC= 0.76和F1-score= 0.75的性能。结论大流行期间对CKD患者的合并症，特别是呼吸道感染进行有针对性的管理至关重要。

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引用次数: 0