Annals of Epidemiology最新文献_第5页

Injury preceding the classical recognition of multiple sclerosis: A population-based study 多发性硬化症经典识别前的损伤：一项基于人群的研究。

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.2025.11.008

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.

背景：我们研究了多发性硬化症（MS）与骨折、脱位/扭伤/拉伤以及识别多发性硬化症之前的烧伤之间的关系。方法：我们使用加拿大不列颠哥伦比亚省（1991-2020）的临床和基于人群的卫生管理数据进行了一项队列研究。我们使用修正泊松回归比较了在MS患者首次声称脱髓鞘（行政队列= 9197）或MS症状发作（临床队列= 1446）之前的6年中骨折、脱位/扭伤/拉伤和烧伤的风险与匹配的一般人群对照。作为敏感性分析，我们使用高维倾向得分（hdPS）来解决残留混淆问题，并使用目标最大似然估计（TMLE）来处理错误规范。结果：在第一次脱髓鞘索赔前的6年（行政队列）中，MS患者发生骨折（调整后的相对风险[adjRR]=1.28;95%CI:1.20-1.36）、脱位/扭伤/劳损（adjRR=1.20;95%CI:1.15-1.23）和烧伤（adjRR=1.40;95%CI:1.22-1.62）的风险较高。调整hdPS和TMLE后，调整后的相对危险度：骨折（hdPS=1.20； TMLE=1.20）、脱位/扭伤/拉伤（hdPS=1.15； TMLE=1.15）、烧伤（hdPS=1.25； TMLE=1.26）略有降低。ms前症状发作（临床队列），相关性较弱，但方向相同。结论：在MS经典识别前，骨折、脱位/扭伤/拉伤、烧伤在MS患者中更为常见，提示MS可以早期发现。

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引用次数: 0

Mediation learning module: Pedersen et al (2025), Associations of early life body size and pubertal timing with breast density and postmenopausal breast cancer risk: A mediation analysis Pedersen et al .(2025)，早期生活体型和青春期时间与乳腺密度和绝经后乳腺癌风险的关联：一个中介分析

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

Annals of Epidemiology

Pub Date : 2026-01-01 Epub Date: 2026-01-07 DOI: 10.1016/j.annepidem.2025.10.021

Jeb Jones PhD, MPH, MS

Educational Engagement Modules (EEMs) are teaching materials for educators and students that facilitate a deeper understanding of key epidemiological methods and concepts. Each EEM poses a series of questions using a recently published paper in Annals to further understanding of a specific study design and to encourage critical thinking and careful evaluation. This EEM focuses on the use of mediation in a study exploring whether breast density mediates the relationship between early life characteristics and postmenopausal breast cancer: Pedersen DC, Hameiri-Bowen D, Aarestrup J, Jensen BW, Tjønneland A, Mellemkjær L, von Euler-Chelpin M, Vejborg I, Andersen ZJ, Baker JL. Associations of early life body size and pubertal timing with breast density and postmenopausal breast cancer risk: A mediation analysis. Ann Epidemiol. 2025 Feb;102:68–74. doi: 10.1016/j.annepidem.2025.01.004. Epub 2025 Jan 10. PMID: 39798680 [1].

教育参与模块（EEMs）是为教育工作者和学生提供的教材，有助于更深入地理解关键的流行病学方法和概念。每个EEM提出一系列问题，使用最近发表在《年鉴》上的一篇论文，以进一步理解特定的研究设计，并鼓励批判性思维和仔细评估。乳腺密度是否在早期生活特征与绝经后乳腺癌之间起中介作用的研究：Pedersen DC， Hameiri-Bowen D, Aarestrup J, Jensen BW, Tjønneland a, Mellemkjær L, von Euler-Chelpin M, Vejborg I, Andersen ZJ, Baker JL。早期生活体型和青春期时间与乳腺密度和绝经后乳腺癌风险的关联：一个中介分析。流行病学杂志。2025;102:68-74。doi: 10.1016 / j.annepidem.2025.01.004。Epub 2025年1月10日中国经济：39798680[1]。

引用次数: 0

Vaginal microbiome structure in pregnancy and host factors predict preterm birth: Results from the ECHO Cohort 妊娠期阴道微生物群结构和宿主因素预测早产：来自ECHO队列的结果。

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

Annals of Epidemiology

Pub Date : 2025-12-01 Epub Date: 2025-11-19 DOI: 10.1016/j.annepidem.2025.11.003

Kimberly S. McKee PhD, MPH , Christine M. Bassis PhD , Jonathan Golob MD , Beatrice Palazzolo MSc , Sarah S. Comstock PhD , Christian Rosas-Salazar MD, MPH , Joseph B. Stanford MD , Sen Ananda PhD , Thomas O’Connor PhD , James E. Gern MD , Nigel Paneth MD, MPH , Anne L. Dunlop MD, MPH , for the ECHO Cohort Consortium

Purpose

The vaginal microbiome is dynamic, typically shifting during pregnancy toward enrichment of Lactobacillus. However, proliferation of Lactobacillus may be absent among women with preterm births (PTBs). We sought to identify robust vaginal microbiota signatures along with host factors that predicted PTB across diverse U.S. cohorts.

Methods

We meta-analyzed 16S rRNA gene amplicon sequence data from the Environmental influences on Child Health Outcomes Cohort. We classified community state types (CSTs) and employed penalized logistic regression models to assess the association between vaginal CST and PTB. We generated supervised random forest models and validated them using a train-and-test approach to identify the most predictive vaginal taxa and host factors.

Results

Of 683 births, 12 % were preterm. Overall, 26 % had a non- L. iners Lactobacillus-dominant CST (I, II, V), 43 % had a L. iners-dominant CST (III), and 30 % had a diverse, non-Lactobacillus-dominant (IV-B, IV-C) CST. Vaginal CST was strongly associated with PTB (adjusted odds ratio [aOR], 3.86, 95 % confidence interval [CI], 1.57–11.3 for diverse, non-Lactobacillus-dominant communities and aOR, 3.03, 95 % CI, 1.25–8.78 for L. iners-dominant compared to L. crispatus-dominant communities). The model with the highest area under the curve (AUC=.77) included Gardnerella vaginalis, age, Prevotella timonensis, and L. crispatus.

Conclusions

Along with host factors, vaginal microbiota could be used for predictive risk scoring for PTB across different U.S. cohorts.

目的：阴道微生物群是动态的，通常在怀孕期间向乳酸杆菌的富集转移。然而，乳酸菌的增殖可能不存在于早产妇女中。我们试图识别强大的阴道微生物群特征，以及在美国不同人群中预测PTB的宿主因素。方法：我们荟萃分析了来自环境对儿童健康结局影响队列的16S rRNA基因扩增子序列数据。我们对社区状态类型（CST）进行分类，并采用惩罚逻辑回归模型来评估阴道CST与PTB之间的关系。我们生成了有监督的随机森林模型，并使用训练和测试方法验证了它们，以确定最具预测性的阴道分类群和宿主因素。结果：683例新生儿中，早产率为12%。总体而言，26%为非乳杆菌显性CST (I， II， V)， 43%为乳杆菌显性CST (III)， 30%为多种非乳杆菌显性（IV-B, IV-C） CST。阴道CST与PTB密切相关（各种非乳酸菌优势群落的调整优势比[aOR]为3.86,95%可信区间[CI]为1.57-11.3，而乳酸菌优势群落的调整优势比[aOR]为3.03,95% CI为1.25-8.78）。曲线下面积最高（AUC=.77）的模型包括阴道加德纳菌、年龄、铁皮普雷沃菌和crispatus。结论：与宿主因素一起，阴道微生物群可用于美国不同队列中PTB的预测风险评分。

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引用次数: 0

Impact of school-based infection prevention strategies on household COVID-19 and respiratory disease outcomes: A cross-sectional study 基于学校的感染预防策略对家庭COVID-19和呼吸道疾病结局的影响：一项横断面研究

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

Annals of Epidemiology

Pub Date : 2025-12-01 Epub Date: 2025-11-04 DOI: 10.1016/j.annepidem.2025.10.019

Sanjana Pampati , Elizabeth A. Stuart , Justin Lessler , Kirsten E. Wiens , Lance A. Waller , Benjamin Lopman , Jodie L. Guest , M. Kate Grabowski , Jeb Jones

Purpose

Schools used a wide range of infection prevention strategies during 2022 when there were surges of the Omicron variant of SARS-CoV-2, respiratory syncytial virus, and influenza. We examined data from the Spring semester of the 2021/2022 school year in the United States to describe use of school-based infection prevention strategies, factors associated with implementation, and associations with COVID-19 and respiratory disease related outcomes.

Methods

We analyzed data from January-June 2022 from the COVID-19 Trends and Impact Survey, a daily, cross-sectional survey on Facebook to examine associations between 11 school-based infection prevention strategies and 5 household COVID-19 and respiratory disease related outcomes (e.g., positive COVID-19 test, COVID-19 like illness). Analyses were restricted to parents with a child < 18 years old who was attending school in-person (n = 228,624). Multivariable, quasibinomial regression models were fit, adjusting for child-, household-, county-level covariates and state.

Results

Universal mask requirements were associated with decreased odds and having no school-based extracurriculars with increased odds of all examined outcomes. Additional prevention strategies were associated with reduced odds of specific outcomes: modified cafeteria use, regular testing of teachers and staff, ventilation improvements, and restricted entry.

Conclusions

Findings affirm the protective effect of universal mask requirements in school settings. No school based extracurriculars being associated with increased odds of examined outcomes may be a result of reverse causation bias. State and local health departments and education agencies can provide technical assistance to schools to ensure appropriate adoption of strategies based on each school’s unique circumstances.

目的：在2022年SARS-CoV-2、呼吸道合胞病毒和流感的欧米克隆变体激增期间，学校采用了广泛的感染预防策略。我们检查了美国2021/2022学年春季学期的数据，以描述基于学校的感染预防策略的使用情况、与实施相关的因素以及与COVID-19和呼吸系统疾病相关结果的关联。方法：我们分析了2022年1月至6月来自COVID-19趋势和影响调查的数据，该调查是Facebook上的一项每日横断面调查，旨在研究11种基于学校的感染预防策略与5种家庭COVID-19和呼吸道疾病相关结果（例如COVID-19检测阳性，COVID-19样疾病）之间的关系。分析仅限于有孩子的父母。结果：普遍的口罩要求与降低的几率有关，没有学校课外活动与所有检查结果的几率增加有关。额外的预防策略与特定结果的几率降低有关：改变自助餐厅的使用，对教师和工作人员进行定期测试，改善通风，限制进入。结论：研究结果肯定了在学校环境中普遍要求口罩的保护作用。没有基于学校的课外活动与测试结果增加的几率相关可能是反向因果偏差的结果。州和地方卫生部门及教育机构可向学校提供技术援助，以确保根据每所学校的独特情况适当采用战略。

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引用次数: 0

Sexual orientation identity and attraction changes among youth: prospective versus retrospective measurement 青少年的性取向、认同和吸引力变化：前瞻性与回顾性测量。

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

Annals of Epidemiology

Pub Date : 2025-12-01 Epub Date: 2025-10-06 DOI: 10.1016/j.annepidem.2025.10.006

Lynsie R. Ranker PhD, MPH , Sabra L. Katz-Wise PhD , Allegra R. Gordon ScD, MPH , R. Korkodilos , Ziming Xuan ScD, SM, MA , Kimberly M. Nelson PhD, MPH

Purpose

Prior work has documented sexual orientation change, or fluidity, among youth over time. Some studies measure change via retrospective recall while others assess change prospectively. It is unclear whether retrospective recall and prospective assessment measure change experiences similarly. The current study examines whether prospectively assessed change in sexual orientation identity (SOI) and attractions aligns with change as assessed via retrospective recall of change.

Methods

US youth (N = 1235), aged 14–25 years, participated in a longitudinal online cohort. Prospective change in SOI and attraction were determined by comparing self-reported SOI and attraction at baseline and 4-month follow-up. Retrospective recall of SOI and attraction change was assessed at 4-month follow-up. The sensitivity and specificity of retrospective recall of change was assessed in relation to change detected prospectively.

Results

Prospectively, 12.8 % of youth changed their reported SOI between baseline and follow-up. Retrospectively, only 5.0 % recalled change for the same period. Prospectively, 21.9 % reported attraction changes between baseline and follow-up. Retrospectively, only 12.4 % recalled attraction changes. Only 17.3 % (95 % CI 11.3, 23.4) who prospectively reported SOI change and 28.7 % (95 % CI 23.3, 34.2) who prospectively reported attraction change also reported change retrospectively.

Conclusions

The prevalence of change in SOI and attractions varied substantially by whether change was assessed prospectively or retrospectively. Researchers and clinicians should consider how the method and timing of assessment may influence their ability to detect changes in SOI and attractions within youth populations. Identification of youth experiencing change is critical for allocation of relevant resources and support.

目的：先前的工作已经记录了性取向的变化，或流动性，随着时间的推移，在青少年中。一些研究通过回顾性回忆来衡量变化，而另一些研究则是前瞻性地评估变化。目前尚不清楚回顾性回忆和前瞻性评估是否同样改变了经验。目前的研究考察了前瞻性评估的性取向、身份（SOI）和吸引力的变化是否与通过回顾性回忆变化评估的变化一致。方法：美国青少年（N= 1235），年龄14-25岁，参与纵向在线队列研究。通过比较基线和4个月随访时自我报告的SOI和吸引力来确定SOI和吸引力的预期变化。在4个月的随访中评估SOI的回顾性回忆和吸引力变化。回顾性回忆变化的敏感性和特异性与前瞻性检测变化的相关性进行了评估。结果：前瞻性地，12.8%的年轻人在基线和随访期间改变了他们报告的SOI。回顾性分析，只有5.0%的人回忆起同一时期的变化。21.9%的人报告了基线和随访期间的吸引力变化。回想起来，只有12.4%的人回忆起吸引力的变化。只有17.3% （95% CI 11.3, 23.4）前瞻性报告SOI变化的患者和28.3% （95% CI 23.3, 34.2）前瞻性报告吸引力变化的患者也回顾性报告了变化。结论：无论是前瞻性评估还是回顾性评估，SOI和吸引力变化的流行程度存在很大差异。研究人员和临床医生应该考虑评估的方法和时间如何影响他们检测青年人群中SOI变化和吸引力的能力。确定正在经历变化的青年对于分配相关资源和支持至关重要。

{"title":"Sexual orientation identity and attraction changes among youth: prospective versus retrospective measurement","authors":"Lynsie R. Ranker PhD, MPH , Sabra L. Katz-Wise PhD , Allegra R. Gordon ScD, MPH , R. Korkodilos , Ziming Xuan ScD, SM, MA , Kimberly M. Nelson PhD, MPH","doi":"10.1016/j.annepidem.2025.10.006","DOIUrl":"10.1016/j.annepidem.2025.10.006","url":null,"abstract":"<div><h3>Purpose</h3><div>Prior work has documented sexual orientation change, or fluidity, among youth over time. Some studies measure change via retrospective recall while others assess change prospectively. It is unclear whether retrospective recall and prospective assessment measure change experiences similarly. The current study examines whether prospectively assessed change in sexual orientation identity (SOI) and attractions aligns with change as assessed via retrospective recall of change.</div></div><div><h3>Methods</h3><div>US youth (N = 1235), aged 14–25 years, participated in a longitudinal online cohort. Prospective change in SOI and attraction were determined by comparing self-reported SOI and attraction at baseline and 4-month follow-up. Retrospective recall of SOI and attraction change was assessed at 4-month follow-up. The sensitivity and specificity of retrospective recall of change was assessed in relation to change detected prospectively.</div></div><div><h3>Results</h3><div>Prospectively, 12.8 % of youth changed their reported SOI between baseline and follow-up. Retrospectively, only 5.0 % recalled change for the same period. Prospectively, 21.9 % reported attraction changes between baseline and follow-up. Retrospectively, only 12.4 % recalled attraction changes. Only 17.3 % (95 % CI 11.3, 23.4) who prospectively reported SOI change and 28.7 % (95 % CI 23.3, 34.2) who prospectively reported attraction change also reported change retrospectively.</div></div><div><h3>Conclusions</h3><div>The prevalence of change in SOI and attractions varied substantially by whether change was assessed prospectively or retrospectively. Researchers and clinicians should consider how the method and timing of assessment may influence their ability to detect changes in SOI and attractions within youth populations. Identification of youth experiencing change is critical for allocation of relevant resources and support.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"112 ","pages":"Pages 8-14"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253604","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

A machine learning approach for a 15-year prediction model of liver cancer incidence: Results from two large Chinese population cohorts 用于肝癌发病率15年预测模型的机器学习方法：来自两个大型中国人群队列的结果。

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

Annals of Epidemiology

Pub Date : 2025-12-01 Epub Date: 2025-10-16 DOI: 10.1016/j.annepidem.2025.10.015

Yu-Xuan Xiao , Yi-Xin Zou , Zhuo-Ying Li , Qiu-Ming Shen , Da-Ke Liu , Yu-Ting Tan , Hong-Lan Li , Yong-Bing Xiang

Background

Primary liver cancer (PLC) remains a major public health concern, particularly in China where the incidence is high. Existing prediction models often focus on high-risk populations and depend heavily on laboratory data, which limits their utility in general population screening.

Methods

We developed and validated a 15-year PLC risk prediction model using data from two large prospective cohort studies in Shanghai (n = 132,360), including 618 incident PLC cases. Candidate variables encompassed sociodemographic characteristics, lifestyle behaviors, medical history, and dietary factors. Predictor selection was performed using LASSO regression and the Boruta algorithm. Five machine learning models and logistic regression were compared. Model performance was evaluated using AUC, calibration plots and net reclassification improvement (NRI). SHapley Additive exPlanations (SHAP) were used to interpret model predictions. Web-based tools, including a simplified risk calculator, were developed to facilitate practical application.

Results

LightGBM achieved the best discrimination (AUC = 0.766) and excellent calibration. Net reclassification analysis indicated an improved ability to correctly classify low-risk individuals. The model effectively stratified the population: the high-risk group had a 15-year PLC risk that was 39.56 times that of the low-risk group. SHAP analysis revealed biologically meaningful associations. A simplified logistic model with fewer variables also performed well (AUC = 0.762), supporting effective risk stratification.

Conclusion

We developed a questionnaire-based 15-year PLC risk prediction model applicable to the general Chinese population. Both the full and simplified models demonstrated strong performance and interpretability, making them valuable tools for large-scale screening and targeted prevention, especially in resource-limited settings.

背景：原发性肝癌（PLC）仍然是一个主要的公共卫生问题，特别是在发病率高的中国。现有的预测模型往往侧重于高风险人群，严重依赖实验室数据，这限制了它们在一般人群筛查中的效用。方法：我们利用上海两项大型前瞻性队列研究的数据（n = 132360）建立并验证了一个15年PLC风险预测模型，其中包括618例PLC事件。候选变量包括社会人口学特征、生活方式行为、病史和饮食因素。预测因子选择采用LASSO回归和Boruta算法。比较了五种机器学习模型和逻辑回归。采用AUC、标定图和净重分类改进（NRI）对模型性能进行评价。SHapley加性解释（SHAP）用于解释模型预测。开发了基于网络的工具，包括简化的风险计算器，以方便实际应用。结果：LightGBM具有最佳的鉴别效果（AUC = 0.766）和良好的定标性。净重新分类分析表明正确分类低风险个体的能力有所提高。该模型有效地将人群分层：高风险组的15年PLC风险是低风险组的39.56倍。SHAP分析揭示了生物学上有意义的关联。变量较少的简化logistic模型也表现良好（AUC = 0.762），支持有效的风险分层。结论：我们建立了一种适用于中国普通人群的基于问卷的15年PLC风险预测模型。完整模型和简化模型都表现出强大的性能和可解释性，使其成为大规模筛查和有针对性预防的宝贵工具，特别是在资源有限的环境中。

{"title":"A machine learning approach for a 15-year prediction model of liver cancer incidence: Results from two large Chinese population cohorts","authors":"Yu-Xuan Xiao , Yi-Xin Zou , Zhuo-Ying Li , Qiu-Ming Shen , Da-Ke Liu , Yu-Ting Tan , Hong-Lan Li , Yong-Bing Xiang","doi":"10.1016/j.annepidem.2025.10.015","DOIUrl":"10.1016/j.annepidem.2025.10.015","url":null,"abstract":"<div><h3>Background</h3><div>Primary liver cancer (PLC) remains a major public health concern, particularly in China where the incidence is high. Existing prediction models often focus on high-risk populations and depend heavily on laboratory data, which limits their utility in general population screening.</div></div><div><h3>Methods</h3><div>We developed and validated a 15-year PLC risk prediction model using data from two large prospective cohort studies in Shanghai (n = 132,360), including 618 incident PLC cases. Candidate variables encompassed sociodemographic characteristics, lifestyle behaviors, medical history, and dietary factors. Predictor selection was performed using LASSO regression and the Boruta algorithm. Five machine learning models and logistic regression were compared. Model performance was evaluated using AUC, calibration plots and net reclassification improvement (NRI). SHapley Additive exPlanations (SHAP) were used to interpret model predictions. Web-based tools, including a simplified risk calculator, were developed to facilitate practical application.</div></div><div><h3>Results</h3><div>LightGBM achieved the best discrimination (AUC = 0.766) and excellent calibration. Net reclassification analysis indicated an improved ability to correctly classify low-risk individuals. The model effectively stratified the population: the high-risk group had a 15-year PLC risk that was 39.56 times that of the low-risk group. SHAP analysis revealed biologically meaningful associations. A simplified logistic model with fewer variables also performed well (AUC = 0.762), supporting effective risk stratification.</div></div><div><h3>Conclusion</h3><div>We developed a questionnaire-based 15-year PLC risk prediction model applicable to the general Chinese population. Both the full and simplified models demonstrated strong performance and interpretability, making them valuable tools for large-scale screening and targeted prevention, especially in resource-limited settings.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"112 ","pages":"Pages 28-37"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318874","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

Beyond associations: From theory to interventions in health inequalities research using causal inference 超越关联：使用因果推理的健康不平等研究从理论到干预。

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

Annals of Epidemiology

Pub Date : 2025-12-01 Epub Date: 2025-10-06 DOI: 10.1016/j.annepidem.2025.10.001

Maria Gueltzow , Maarten J. Bijlsma , Frank J. van Lenthe

One of the central goals of public health is not only to improve the health in the population overall, but also to reduce the unequal distribution of health and disease within the population. Even though a large amount of research is directed towards identifying and understanding health inequalities, much of this research is based on associations. This type of research can help to identify what groups in society are at risk of having worse health but cannot tell us how these inequalities may be reduced. In order to move beyond identifying who is at risk, we illustrate how we can combine the existing theoretical foundations with the counterfactual outcomes framework to understand how health inequalities can be tackled. We show how the Commission on Social Determinants of Health (CSDH) framework and the Diderichsen model can be translated into practice through the use of DAGs and notation. This will aid in generating more informative evidence on how certain interventions can reduce inequalities.

公共卫生的中心目标之一不仅是提高全体人口的健康水平，而且还要减少人口中健康和疾病分配的不平等。尽管大量研究的目的是确定和了解健康不平等，但其中许多研究是基于关联。这种类型的研究可以帮助确定社会中哪些群体面临健康状况更差的风险，但不能告诉我们如何减少这些不平等。为了进一步确定谁处于危险之中，我们说明了如何将现有理论基础与反事实结果框架结合起来，以了解如何解决卫生不平等问题。我们展示了健康的社会决定因素委员会（CSDH）框架和Diderichsen模型如何通过使用dag和符号转化为实践。这将有助于产生关于某些干预措施如何减少不平等的更翔实的证据。

引用次数: 0

Cardiovascular disease mortality trends in young adults aged 18–34 years, United States, 2000–2023 2000-2023年美国18-34岁年轻人心血管疾病死亡率趋势

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

Annals of Epidemiology

Pub Date : 2025-12-01 Epub Date: 2025-10-11 DOI: 10.1016/j.annepidem.2025.10.014

Adam S. Vaughan PhD , Nicholas Sutton MPH , Rebecca C. Woodruff PhD , LaTonia C. Richardson PhD , Janet S. Wright MD , Fátima Coronado MD

Purpose

This study examines national trends in mortality from cardiovascular disease (CVD) and select subtypes among U.S. young adults aged 18–34 years from 2000 to 2023.

Methods

National mortality data from the National Vital Statistics System were used to identify CVD, heart disease, stroke, and hypertension-related CVD deaths among U.S. residents aged 18–34 from 2000 to 2023. Crude and age-standardized death rates were calculated overall and by age group, sex, and race and ethnicity. Temporal trends were calculated as percent change using a log-linear model.

Results

From 2000–2023, age-standardized CVD and heart disease death rates among young adults did not statistically change (percent change: −2.2 % [95 % CI: −7.8, 3.7] and −2.4 % [95 % CI: −8.3 %, 3.8 %], respectively). Stroke death rates decreased (percent change: −15.7 % [-21.0 %, −10.0 %])). However, hypertension-related CVD death rates increased by 78.5 % [95 % CI: 63.6 %, 94.7 %]). Patterns across demographic groups were broadly similar.

Conclusion

Despite stability or modest declines in CVD death rates among young adults, hypertension-related CVD death rates increased sharply during 2000–2023. These findings merit public health action and underscore the need for better identification and management of hypertension and other CVD risk factors among young adults.

目的：本研究调查了2000年至2023年美国18-34岁年轻人心血管疾病（CVD）死亡率的全国趋势和选择亚型。方法：使用来自国家生命统计系统的全国死亡率数据来确定2000年至2023年18-34岁美国居民中心血管疾病、心脏病、中风和高血压相关的心血管疾病死亡。粗死亡率和年龄标准化死亡率按总体、年龄组、性别、种族和民族计算。使用对数线性模型计算时间趋势为百分比变化。结果：从2000年到2023年，年轻人的年龄标准化心血管疾病和心脏病死亡率没有统计学变化（百分比变化分别为-2.2% [95% CI: -7.8, 3.7]和-2.4% [95% CI: -8.3%, 3.8%]）。中风死亡率下降（百分比变化：-15.7%[-21.0%,-10.0%]）。然而，高血压相关的心血管疾病死亡率增加了78.5% [95% CI: 63.6%, 94.7%])。不同人口群体的模式大致相似。结论：尽管年轻人的心血管疾病死亡率稳定或适度下降，但高血压相关的心血管疾病死亡率在2000-2023年期间急剧上升。这些发现值得采取公共卫生行动，并强调需要更好地识别和管理年轻人中的高血压和其他心血管疾病危险因素。

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引用次数: 0

COMBINE EBIs: A novel COllaborative Method for Building INterventions from Existing Evidence-Based Interventions 结合ebi：一种基于现有证据的干预措施构建干预措施的新型协作方法。

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

Annals of Epidemiology

Pub Date : 2025-12-01 Epub Date: 2025-11-06 DOI: 10.1016/j.annepidem.2025.10.018

Justin Knox , Kara Portier , Christopher Magana , Maggie Denning , Christopher M. Ferraris , Emily Dove-Medows , Cho-Hee Shrader , Ohemaa Poku , Phil Kreniske , Robert Remien , Efrat Aharonovich , Jennifer C. Elliott , Denis Nash , Kathryn Lancaster , Till Baernighausen , Kayo Fujimoto , Adam Carrico , John A. Schneider , Alida Bouris , D. Scott Batey , Stefan D. Baral

Purpose

Combining evidence-based interventions (EBIs) is a discrete process from adapting EBIs, and specific guidance for how to combine EBIs could be helpful amidst the proliferation of frameworks that combine and stage EBIs and calls for services to be combined or bundled. To address this gap, we developed and applied the COllaborative Method for Building INterventions from Existing Evidence-Based Interventions (COMBINE-EBIs) approach, a five-step process for combining EBIs.

Methods

The five steps of COMBINE-EBIs are: (1) Identify and Select EBIs, (2) Develop a Shared Conceptual Model, (3) Evaluate the Conceptual Model, (4) Create a Single Combined Protocol, and (5) Refine through Further Input.

Results

We developed and applied the 5-step COMBINE-EBIs process to build a fully refined, pre-tested, combined multi-component intervention that leverages intrinsic social network support and mHealth technology to support people with HIV who drink heavily improve HIV care outcomes and reduce alcohol use.

Conclusions

COMBINE-EBIs is a rigorous, systematic and efficient approach for building multi-component, multi-modal interventions to address multiple, co-occurring health behaviors simultaneously. COMBINE-EBIs is a resource efficient approach that could facilitate the creation of additional multi-component interventions to address complex, co-occurring health conditions synergistically. Future research should evaluate the feasibility and utility of COMBINE-EBIs, including where adaptations are needed to maximize utility.

目的：结合循证干预措施（ebi）是适应ebi的一个离散过程，对于如何结合ebi的具体指导可能有助于结合和分级ebi的框架的扩散，以及对服务进行组合或捆绑的呼吁。为了解决这一差距，我们开发并应用了基于现有证据的干预措施构建干预措施的协作方法（combined -EBIs）方法，这是一个结合ebi的五步过程。方法：组合ebi的五个步骤是：(1)识别和选择ebi，(2)开发共享概念模型，(3)评估概念模型，(4)创建单个组合协议，(5)通过进一步输入进行改进。结果：我们开发并应用了5步联合ebi流程，以建立一个完全完善的、预先测试的、组合的多成分干预，利用内在的社会网络支持和移动健康技术来支持大量饮酒的艾滋病毒感染者，改善艾滋病毒护理结果并减少酒精使用。结论：联合ebi是一种严谨、系统和有效的方法，可构建多组分、多模式的干预措施，同时解决多种共同发生的健康行为。联合ebi是一种资源效率高的方法，可以促进创建额外的多成分干预措施，以协同解决复杂的、同时发生的健康状况。未来的研究应评估联合ebi的可行性和效用，包括需要在哪些方面进行调整以使效用最大化。

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引用次数: 0

Cumulative exposure to economic hardship and self-rated health among Korean women: An exploration of age heterogeneity 韩国妇女的经济困难累积暴露和自我评价健康：年龄异质性的探索

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

Annals of Epidemiology

Pub Date : 2025-12-01 Epub Date: 2025-10-30 DOI: 10.1016/j.annepidem.2025.10.017

Gum-Ryeong Park Ph.D. , Jinho Kim Ph.D.

Purpose

Acknowledging the importance of subjective financial measures that objective indicators may not be able to fully capture, this study investigates whether and how perceived economic hardship influences self-rated health among women. Specifically, it examines the cumulative effects of perceived economic hardship while exploring variations across different age groups.

Methods

This study analyzed data from the Korean Longitudinal Survey of Women & Families (2006–2022), including 12,800 participants who experienced varying levels of economic hardship. Economic hardship was assessed based on subjective perceptions reported across consecutive survey waves (ranging from 1 wave to over 4 waves), while self-rated health was measured on a five-point scale. To account for unmeasured individual-level heterogeneity, fixed effects models were employed in the analysis.

Results

Prolonged exposure to economic hardship is associated with greater declines in self-rated health, with longer durations of hardship leading to increasingly severe negative impacts. Also, age differences were observed, as older adults experienced significantly larger declines in self-rated health compared to their younger counterparts as the duration of hardship increased.

Conclusion

The findings on the cumulative effects of perceived economic hardship on health underscore the importance of incorporating subjective measures of economic conditions into research and policy discussions.

目的认识到客观指标可能无法充分反映的主观财务指标的重要性，本研究调查了经济困难是否以及如何影响妇女自评健康。具体来说，它考察了感知到的经济困难的累积效应，同时探索了不同年龄组的差异。方法本研究分析了韩国女性家庭纵向调查（2006-2022）的数据，其中包括12,800名经历不同程度经济困难的参与者。经济困难是根据连续几轮调查（从1波到4波以上）中报告的主观看法来评估的，而自我评价的健康状况是用五分制来衡量的。为了解释未测量的个体水平异质性，固定效应模型被用于分析。结果长时间的经济困难与自我评价健康的更大下降有关，更长的困难持续时间导致越来越严重的负面影响。此外，年龄差异也被观察到，随着困难持续时间的增加，老年人的自我评估健康状况明显比年轻人下降得更大。结论关于感知经济困难对健康的累积影响的研究结果强调了将经济条件的主观衡量纳入研究和政策讨论的重要性。

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