Journal of Epidemiology and Community Health最新文献

Background: Frailty is dynamic. However, the relationship between handgrip strength (HGS) weakness, asymmetry and frailty progression is still unclear.

Methods: This cohort study used data from waves 4-9 (2008-2009 to 2018-2019) of the English Longitudinal Study of Ageing (ELSA) and waves 10-15 (2010 to 2020) of the Health and Retirement Study (HRS). HGS weakness was assessed by maximal HGS, and asymmetry by the ratio of HGS in the nondominant hand to that in the dominant hand. Frailty was assessed by frailty index (FI). Linear mixed-effect models were employed for our analyses. Random-effects meta-analyses were conducted to pool the results from the ELSA and HRS studies.

Results: A total of 7598 participants from ELSA and 7304 from HRS were included. After full adjustment, weakness (pooled β=0.796; 95% CI 0.504 to 1.089; p<0.001) and asymmetry (pooled β=0.072; 95% CI 0.017 to 0.126; p=0.010) were independently associated with accelerated frailty progression. For the combined status of these two indicators, individuals with both weakness and asymmetry exhibited the highest baseline FI (pooled β=12.772; 95% CI 11.756 to 13.789; p<0.001) and the fastest FI progression (pooled β=0.976; 95% CI 0.826 to 1.127; p<0.001). Moreover, HGS status changed over time, with distinct transition patterns being associated with different rates of frailty progression.

Conclusions: Incorporating HGS testing into annual health check-ups can aid in the early identification of HGS weakness and asymmetry, which may help prevent frailty progression.

Introduction: Accumulation of advanced glycation end products, measured by skin autofluorescence (SAF), has been shown to be associated with several chronic non-communicable diseases, particularly cardiovascular diseases (CVDs). The promotion of physical activity (PA) as a strategy for the prevention of CVD by modifying healthy habits has been widely studied.

Aim: To assess the evidence for the association between PA and SAF in the general adult population.

Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Synthesis Without Meta-analysis framework. A search was performed in MEDLINE (via PubMed), Web of Science, Scopus, Cochrane Library and SportDiscuss (via EBSCOhost), from inception to September 2024. Study quality was assessed using the National Heart, Lung and Blood Institute tools and the certainty of evidence was evaluated with Grading of Recommendations, Assessment Development and Evaluation. Vote counting based on the direction of effect was used as the standardised synthesis metric.

Results: In the systematic review, 17 studies were included. The qualitative synthesis showed a predominant consistency in favour of a beneficial association. Specifically, 58.8% of the studies reported a statistically significant inverse association, indicating that higher levels of PA or exercise frequency are correlated with lower SAF levels. The remaining studies (41.2%) reported non-significant results, though several showed favourable trends. No studies reported a positive association between PA and SAF. The quality of the studies was generally fair, and the certainty of evidence low.

Conclusions: PA is inversely associated with SAF. Therefore, while causality cannot be proven, it is hypothesised that PA may reduce SAF and thus have a positive impact on health.

Background: Individual screening for colorectal cancer (CRC) is typically performed through either direct clinical examination, such as a colonoscopy, or an approved non-invasive test that measures CRC markers shed from the tumour into stool. There are known barriers to current screening recommendations.

Methods: We present feasibility data demonstrating the detection of CRC-associated RNA biomarkers in community wastewater. RNA expression values for GAPDH (housekeeping marker) and CDH1 (colorectal neoplasia-associated marker) were quantified via droplet digital PCR. The CDH1 region evaluated in this study represents overall CDH1 concentration in wastewater samples, with elevated expression shown to be associated with colorectal neoplasia. Four neighbourhood clusters were assessed in this study: three CRC clusters (CRC Clusters #1-#3) and one control region (Control Cluster #1).

Results: Average normalised colorectal neoplasia-associated RNA markers (CDH1/GAPDH) for CRC clusters were 20.0 (CRC Cluster #1), 2.2 (CRC Cluster #2) and 4.0 (CRC Cluster #3); average normalised colorectal neoplasia-associated RNA markers (CDH1/GAPDH) for Control Cluster #1 were 2.6.

Conclusion: Our data provide proof of principle for a novel application of wastewater surveillance to track potential cancer burden. We demonstrate that CDH1 is detectable in wastewater, potentially accelerating the development of this approach for epidemiological studies. Further investigation with additional samples and closer alignment with documented case activity will be necessary in future population-level CRC surveillance research.

Background: Onychomycosis is a common fungal nail infection worldwide; however, comprehensive data on global prevalence, causative pathogens, risk factors and socioeconomic distribution remain limited. This study examines these aspects globally to inform clinical practice.

Methods: This systematic review, registered on PROSPERO and following Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analyses of Observational Studies in Epidemiology guidelines, searched Scopus, PubMed and EMBASE for English-language studies published from January 2013 to September 2023 reporting on onychomycosis prevalence. A random-effects model estimated global prevalence, with meta-regression and subgroup analyses by study setting, region, income level, demographics and fungal species.

Results: Of 4961 studies, 219 were included. The pooled prevalence among tested samples was 22.91% (95% CI 20.32% to 25.60%). Laboratory-based, medical centre-based or hospital-based studies showed higher prevalence (24.19%; 95% CI 20.99% to 27.54%) compared with community-based studies (8.57%; 95% CI 6.77% to 10.55%). Prevalence was highest in Southeast Asia (42.99%) and lowest in West Asia (16.15%). High-income countries exhibited a prevalence of 25.90%, compared with 17.76% in low-income countries. Prevalence was comparable for men (31.54%) and women (30.05%), peaking at ages 41-50 years (25.05%). Higher prevalence was observed among individuals with metabolic disorders (53.96%) and occlusive footwear users (44.17%). Dermatophytes predominated (53.03%), followed by non-dermatophyte moulds (22.30%) and yeasts (22.12%), with regional differences.

Conclusions: Onychomycosis represents a considerable global health burden that varies by study setting, geographic region and socioeconomic factors. Given the low to very low certainty of evidence primarily from healthcare settings, these findings underscore the need for more community-based epidemiological research and the importance of targeted prevention and effective management strategies.

Prospero registration number: CRD42024501728.

Background: To quantify inequalities in obesity-related complication (ORC) prevalence and differences in healthcare costs between the most (Q1) and least (Q5) deprived quintiles of people living with obesity.

Methods: Retrospective, open cohort study of ~2.5 million people residing in North-West London using linked primary and secondary electronic health records. Individuals aged ≥18 years living with obesity (body mass index ≥30 kg/m²) between 1 January 2016 and 31 December 2019 were eligible. The population was stratified into deprivation quintiles per the Index of Multiple Deprivation (IMD). Individuals were grouped into non-mutually exclusive ORC prevalence groups covering 27 ORCs, including ORC multimorbidity. Primary outcomes were ORC prevalence and healthcare cost differences between the lowest and the highest deprivation quintiles. ORC prevalence and healthcare costs were age-standardised to the European Standard Population.

Results: Out of 362 023 people living with obesity, 64 866 were in IMD Q1 (most deprived) and 24 590 in Q5. The largest ORC prevalence differences between Q1 and Q5 were seen in conditions with highest prevalence overall: type 2 diabetes (5.1 percentage point prevalence difference; 19.5% prevalence), hypertension (3.8, 32.7%) and depression (3.4, 6.3%). The percentage point prevalence difference was larger with increasing ORC multimorbidity: 1.2 for at least one, 3.7 for at least two and 4.0 for at least three ORCs. Healthcare costs were greater in the most deprived quintile compared with the least deprived quintile for every ORC population, with the largest differences seen in peripheral arterial disease (£2801 cost difference), cancer (£2785), renal failure (£2108).

Conclusions: Targeted interventions proportionate to these health and cost burdens could improve health equity and reduce healthcare cost, yet their causal drivers require further study.

Background: Behaviours across a 24-hour day, including physical activity, sedentary time and sleep, are disrupted following cancer and contribute to cancer-related outcomes. This study describes the day-to-day 24-hour behaviour profiles of individuals with and without cancer, considering time since diagnosis and cancer types.

Methods: Seven days of accelerometer data from the UK Biobank (M±SD_age=62.3±7.9 years; 56.4% female) were derived from machine learning models to assess the 24-hour behaviours in individuals with cancer (n=10 152; M±SD_{years since diagnosis}=7.4±6.1 years) compared with healthy (free of diseases) individuals (n=13 722). Diagnoses were identified using the International Classification of Disease codes within cancer registries. Bayesian compositional data analysis compared profiles between individuals with and without cancer, across time since diagnosis (<1 year, 1-5 years, >5 years) and 14 cancer types.

Results: The least physically active profiles were observed for individuals within 1 year following cancer diagnosis and in cancers with poor prognoses. Compared with healthy individuals, those within 1 year following cancer diagnosis had 40 min/day less physical activity (light plus moderate-to-vigorous intensities), compensated by 40 min/day more inactive time (sedentary plus sleep periods). Differences also varied across cancer types, ranging from 22-75 min/day less physical activity and 22-75 min/day more inactive time, between individuals with cancers and healthy individuals. Cancers with poorer prognoses (eg, lung, gastrointestinal tract) had the least optimal profiles, whereas cancers with better prognoses (eg, prostate, skin) showed profiles closer to healthy individuals.

Conclusion: The 24-hour behaviour profiles differed by cancer history, prognosis and type. Supporting a healthy balance of behaviours, that can feasibly be achieved within a 24-hour day, should be considered for cancer survivors, particularly in the year after diagnosis and in poor prognosis cancers.

Background: Non-communicable diseases (NCDs) represent a significant cause of morbidity and mortality globally. Despite a strong evidence base outlining increased risk of communicable diseases and poor mental health in people who have experienced imprisonment, the risk of NCDs has not been quantified in previous reviews. This study aimed to describe the incidence of morbidity and mortality of physical NCDs in people who have experienced imprisonment compared with the general population in high-income countries.

Methods: We searched MEDLINE, Embase, CINAHL and SocINDEX (PROSPERO CRD42024540173) for comparative studies of morbidity or mortality from NCDs. Articles were assessed against predefined criteria to select studies that included people with experience of imprisonment; measured NCD incidence; compared incidence to a general population; and were conducted in a high-income country. Two reviewers conducted independent risk of bias assessment using an adapted version of the Newcastle-Ottawa Scale. Data were synthesised using random-effects meta-analyses and vote counting based on effect direction. Meta-regression and subgroup analysis investigated heterogeneity.

Results: Of 3085 articles screened, 32 were included providing 341 datapoints. Meta-analysis showed a higher risk of mortality from several diseases, including respiratory disease (risk ratio (RR) 2.38 (95% CI 1.18 to 4.80), I²=97%), cardiovascular disease (RR 1.80 (95% CI 1.32 to 2.46), I²=99%), liver disease and cirrhosis (RR 2.50 (95% CI 1.08 to 5.77), I²=99%), digestive disease (RR 2.92 (95% CI 1.09 to 7.78), I²=99%), neurological disease (RR 1.94 (95% CI 1.09 to 3.44), I²=92%), head and neck cancer (RR 21.31 (95% CI 4.32 to 105.14), I²=97%), liver cancer (RR 4.07 (95% CI 2.34 to 7.08), I²=94%), cervical cancer (RR 3.95 (95% CI 3.11 to 5.01), I²=0%) and lung cancer (RR 1.95 (95% CI 1.34 to 2.85), I²=0%). Synthesis without meta-analysis also indicated imprisonment was associated with increased morbidity from multiple NCDs.

Conclusions: Several NCDs, including multiple cancers, cardiovascular disease, respiratory disease and liver disease, are substantially more common in people who have experienced imprisonment compared with the general population, highlighting a need for primary prevention and NCD management.

Addressing health inequalities is an international priority. Various approaches have gained popularity in the academic literature and policy-making documents. However, there has been a lack of progress in tackling health inequalities. We outline the main characteristics and principles of five commonly cited approaches: asset-based, place-based, upstream, systems-based and proportionate universalism. We examine how these approaches are described in the literature and the logic by which they are thought to tackle health inequalities.There was variation in how each approach was described and interpreted. The logic behind how the approaches could improve population health was clearly articulated but often under-developed with respect to health inequalities. Although rarely acknowledged explicitly, it was implied that these approaches seek to reduce health inequalities through focussing on more socially disadvantaged sub-groups in a population, identifying the most impactful intervention levers and/or working to minimise stigma and minimise inequalities in access and uptake of interventions. More attention should be paid to the important principles, features and underlying logic of these approaches in relation to health inequalities to better understand the potential supports and barriers to their success. This will support those working to implement them to do so in ways that are sensitive to local and contextual specificities.

Background: Theatre interventions such as psychodrama are increasingly being used to help individuals with mental health conditions. Previous findings provided mixed results on the impact of theatre interventions for reducing psychological symptoms. Given the growing use of theatre interventions, it is important to investigate their impact on specific mental health conditions. This systematic review and meta-analysis aims to examine the impact of theatre interventions on mental health outcomes and suicidality.

Methods: The review was prospectively registered on The International Prospective Register of Systematic Reviews (CRD42021212666), and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for reporting. Embase, ProQuest Central, PsycInfo, PubMed and Scopus were searched. All English-language studies examining the impact of theatre interventions and on mental health outcomes and/or suicidality were included.

Results: In total, 42 papers met the inclusion criteria. Of these, 21 studies were included in meta-analyses that found significant reductions in standardised mean change using raw score standardisation symptoms of anxiety (k=10; -0.45 (95% CI -0.71 to -0.19)) depression (k=16; -0.79 (95% CI -1.07 to -0.51)) and post-traumatic stress disorder (k=6; -0.82 (95% CI -1.21 to -0.42)) among adult participants of theatre intervention studies. Results from studies excluded from meta-analyses indicated that theatre interventions helped reduce symptoms of schizophrenia and psychosis for adults and lowered the risk of suicidal ideation and suicide attempt among adolescents. Most studies had a high/serious risk or some concerns about bias.

Conclusion: Theatre interventions may be useful to help reduce symptoms of mental health conditions. Further high-quality research is necessary to build on the existing evidence and to assess both the short- and long-term impacts of theatre interventions on mental health outcomes.