Frontiers in epidemiology最新文献

Chronic inflammatory diseases such as autoimmune disorders, cancer, cardiovascular diseases and neurodegenerative disorders are a significant cause of morbidity and mortality in the industrialized world. Socioeconomically disadvantaged communities bear a disproportionately high burden of these inflammatory diseases. This review synthesizes evidence linking various domains of the Social Determinants of Health (SDoH)-economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context-to inflammatory pathways and mechanisms. Across domains, biological mechanisms such as cytokine dysregulation, toll-like receptor (TLR) activation, hypothalamic-pituitary-adrenal (HPA) axis alterations and gut microbiome disruption act together to sustain proinflammatory states that drive adverse health outcomes in marginalized communities. Although causality is obscured by interrelated determinants, identifying inflammation as a shared pathway between various determinants highlights the need for structural interventions to reduce chronic disease burden.

Introduction: Synedmic geographic analysis is new epidemiological tool used to implement crucial effective intervention to combat integrated diseases. This study aims to determine spatial patterns and geographic profiling of three concurrent diseases including TB/CPVID-19, HIV/HCV, and Mortality/Morbidity in Libya during the Libyan armed conflict.

Methods: Geographic thematic mapping and spatiotemporal analysis were used to examine the syndemic geographic profiling of three integrated diseases including COVID-19 and TB, HCV/HIV, and Mortality and Morbidity during the Libyan armed conflict. The total number of notified TB and the cumulative number of COVID-19 cases, HIV and HCV cases, and Mortality and morbidity cases during the conflict period were reported. Such data were obtained at individual and geographic levels from each district involved in the armed conflict then analyzed and classified according to location, timing, and intensity of the Libyan armed conflict.

Results: High co-occurrence of TB and COVID-19 was evident. The southern region (i.e., Sebha), Tripoli, and Benghazi consistently portrayed higher incorporation patterns of the two intertwined infections. Conversely, the western mountain region and the Southeast region exhibited a lower concordance during the pandemic period. The co-occurrence of HIV and HCV infections was clear all over the country. The highest condensation of the concomitant is in the Western region, particularly the western mountains, Zawia followed by Jufra and Ghat. Followed by the Eastern region, particularly Deana and Benghazi. This was less tense in the Southern and Med region municipalities. Mortality and morbidity show a visible syndemic geographic pattern. The highest density of these two concomitant patterns was Benghazi, Derna and, Ajdabia in the Eastern region and Sirt, Musrta, Baniwaled in the Western region and to a lesser extent in Zawia and Shati.This study highlights the need syndemic geographic patterns of integrated diseases to focus on wellbeing beyond standard health parameters. Clear decisions about prioritisation of health care to be provided based the geographic region in need.

Introduction: A high burden of tuberculosis (TB) complicated by occupational risk factors implies a need for the workplace to develop strategies to reduce workplace incidence of TB.

Methods: We conducted a cross-sectional study to establish the knowledge, attitudes, and practices (KAP) related to TB among senior management officials of manufacturing and construction companies associated with exposure to silica dust. The study was conducted in Lusaka and Southern provinces of Zambia between February and October 2022 using a 28-question multiple-choice self-administered electronic questionnaire. Descriptive statistics were used to determine KAP levels. The total score in KAP was calculated based on correct responses out of a maximum of 17, 7, and 14 points, respectively and categorized into "poor" or "good" using the mean/median. Logistic regression was done to explore the association between characteristics and KAP.

Results: Of 118 participants, 48.3% were aged between 31-40 years, 86.4% were male), and 63.6% represented construction companies. The median/mean KAP scores were 8(IQR 6-10), 3.3 (SD 1.66) and 6.00 (IQR 4-8) respectively. Of the participants, only 47.5% (56/118) had good knowledge, 49.2% (58/118) had good attitudes, and 47.5% (56/118) had good practice scores. Individuals aged over 50 years old, female, and officials from construction companies had higher odds of good knowledge (aOR = 7.8, p = 0.027; aOR = 4.70, p = 0.016 and aOR = 3.45, p = 0.008 respectively) and good attitude (aOR = 14.64, p = 0.021; aOR = 6.51, p = 0.006 and aOR = 3.90, p = 0.006 respectively) Participants working in construction companies had higher odds of good practice (aOR = 2.26, p = 0.048).

Discussion: Senior management officials had gaps in knowledge despite having favorable attitudes and practices. Companies must be educated on TB alongside efforts to improve attitudes and practices towards TB in the workplace.

In Germany, a consortium of authority-accredited laboratories (ALM) covered approximately 90% of all severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) tests during the COVID-19 pandemic (March 2020 until January 2023), and they likewise conducted serological mass tests for IgG antibodies until May 2021. We analyzed the ALM-observed week-resolved time courses of test-positive fractions of PCR and IgG tests, by least-squares fitting a simple function of the former to the course of the latter. Specifically, we show that scaling and shifting the cumulative sum of previous PCR-positive fractions effectively reproduces the time course of the IgG-positive fraction. The value of 0.14 found for the fitted scaling parameter means that only 14% of those who were tested PCR-positively actually became infected with SARS-CoV-2. This parameter fit further implies that a quarter of the German population already carried IgG antibodies from natural infections in their blood at the turn of the year from 2020 to 2021. To check this fit using a second, independent analysis, we took from the literature the Germany-specific ratio of 1:10 for the ratio between one positive PCR test and the corresponding number of persons actually infected with SARS-CoV-2, and therewith estimated the time course of the latter within the German population. The courses of all three fractions, i.e., both the observed and the fit-estimated IgG-positives and the fit-estimated infected, matched each other well in the period from early December 2020 to May 2021. The extrapolated courses of both the fit-estimated fractions, i.e., those of the IgG-positives and the infected, align well to perfectly with the IgG-positive fraction (92%) reported by the Robert Koch Institute at the end of 2021.

Background: Colorectal cancer (CRC) is a leading cause of cancer deaths in the United States. While national CRC mortality rates have improved over time, this rate differs between non-Hispanic (nH) Black and nH White populations and by geography.

Methods: The 30 most populous cities in the US were analyzed using national vital statistics data. Numerators were obtained from death certificates of residents of these cities with CRC as the underlying cause of death. US Census data provided population-based denominators. We calculated Black:White rate ratios (RRs) and corresponding confidence intervals for the most recent time period studied (2017-2019) to assess racial inequities. We calculated average annual percent changes to evaluate CRC mortality trends from 2009-2019.

Results: CRC mortality rates statistically significantly decreased nationally and in 25 of the 30 cities. In most cities, nH Black populations experienced a greater decrease in CRC mortality over time than nH White populations. However, in 20 cities, the Black:White CRC mortality rate ratio was greater than 1 (ranging from 1.28 in New York to 2.68 in Washington, D.C.; p < 0.05), indicating persistent racial inequities. Between 2009 and 2019, six cities saw statistically significant decreases in racial inequities, two cities saw increases, and the remaining cities demonstrated persistent disparities.

Conclusions: Despite improvements in CRC mortality, Black:White disparities persist. Structural racism may contribute to these disparities through differential access to care and risk factor exposure. Identifying geographic differences in Black:White CRC mortality may serve as a catalyst for local governments to implement place-based initiatives that reduce screening barriers and contribute to health equity.

Background and objective: American Indian populations face disproportionately high rates of atherosclerotic cardiovascular disease (CVD), yet the potential consequences of mid-life carotid atherosclerosis on brain health and cognition later in life remain poorly understood. This study addresses a critical knowledge gap by evaluating whether subclinical carotid atherosclerosis in midlife is associated with later-life structural brain abnormalities and cognitive performance in a large cohort of American Indian adults from the Strong Heart Study. This is the first investigation to explore these associations in this underserved and understudied population, using longitudinal data with vascular, neuroimaging, and cognitive measures.

Methods: A total of 783 participants (mean age 59.9 years) underwent carotid ultrasonography between 1998 and 1999 to assess intima-media thickness and plaque. Between 2010 and 2013, participants received brain magnetic resonance imaging to assess infarcts, hemorrhages, white matter lesions, and brain atrophy. Cognitive function was also evaluated during this period. Multivariable regression models adjusted for sociodemographic, behavioral, and clinical CVD risk factors were used to assess associations.

Results: Greater intima-media thickness was associated with more severe sulcal widening, and presence and extent of plaque were associated with poorer verbal fluency; both findings remained significant after adjustment for sociodemographic, behavioral, and clinical risk factors. No significant associations were observed between carotid measures and the presence of infarcts, hemorrhages, or white matter lesions.

Conclusion: These findings suggest that subclinical carotid atherosclerosis in midlife may contribute to later-life brain atrophy and cognitive vulnerability, particularly in verbal fluency, among American Indians.

Purpose: Glomerular filtration rate (GFR) is used for evaluating kidney function. Creatinine and cystatin C levels are the two endogenous substances used to estimate GFR (eGFR_CR and eGFR_CYS). The agreement between these two is reflected by the eGFR_CYS/eGFR_CR ratio. An eGFR_CYS/eGFR_CR ratio <0.70 has been strongly associated with mortality and morbidity. An explanation is a selective decrease in the filtration of substances of different masses, and this condition is referred to as "Shrunken pore syndrome" (SPS). We aim to investigate the prevalence of SPS and its association with morbidity and mortality in a well-characterized population-based cohort.

Methods: The study population consisted of 5,061 individuals from the Malmö Diet and Cancer cardiovascular cohort (MDC-CC) with baseline examinations between 1991 and 1994 and a median follow-up of 25.3 years (IQR = 5.7). The eGFR_CYS/eGFR_CR ratio was categorized into four groups and used to estimate a generalized propensity score for SPS to adjust for confounding factors. Individuals were matched to create a quartet (one from each eGFR_CYS/eGFR_CR ratio category) with similar scores. We related the eGFR_CYS/eGFR_CR ratio to all-cause mortality, incident cardiovascular disease, incident kidney disease, and incident diabetes using Cox proportional hazards models with shared frailty.

Results: SPS was detected in 405 individuals (8.0%). The hazard ratio (HR) for all-cause mortality was 1.6 [95% confidence interval (CI) 1.3-2.0] when comparing individuals with SPS to the reference group (eGFR_CYS/eGFR_CR ratio ≥ 1.0). For incident kidney disease, the association seems to stem from a low eGFR_CYS rather than the eGFR_CYS/eGFR_CR ratio. For the other two outcomes, robust and statistically significant associations could not be found.

Conclusion: SPS was prevalent among middle-aged, generally healthy, individuals and led to markedly higher mortality during follow-up.

Introduction: This study aimed to investigate the excess mortality observed in China between 2020 and 2023 and its underlying causes, including the COVID-19 pandemic, sex ratio, and aging trends.

Methods: We collected data regarding number of deaths and mortality rates of the years 2015-2019 from the China Statistical Yearbook of Population and Employment, and analyzed the data by age and sex. We created a standardized sex and age structure dataset and compared the excess mortality rates of different sexes and age groups for the years 2020 to 2023.

Results: The sex-and age-specific number of deaths in all three years decreased compared to the number of deaths in the standardized sex and age structure dataset. The most significant decline was observed in 2021, whereas the number of deaths in 2022 and 2023 increased compared to that in 2021. It has been found that excess mortality is generally less prevalent among older age groups, and excess mortality rate tends to be lower among younger age groups. Additionally, in 2021, 2022, and 2023, the excess mortality rate was greater for men than for women, whereas it was greater for women in 2020. These differences can be attributed to various factors.

Discussion: This is the first study to examine excess mortality in China during the COVID-19 pandemic using age- and sex-standardized data. These findings underscore the need for a deeper exploration of the effects of sex and age on health outcomes.

Background: In December 2019, the world experienced one of the significant health crises of the 21st century with the emergence and rapid spread of the potentially fatal 2019 coronavirus (COVID-19). In this context, sentinel surveillance of SARS-CoV-2 variants was conducted in Conakry. Here we report the first data on reproduction numbers and risk factors during the Omicron post-epidemic period in Guinea.

Methods: A sentinel syndromic and genomic surveillance study was conducted on suspected patients from October 2022 to July 2024 at healthcare facilities in Conakry. Individual data and nasopharyngeal swabs were collected and sent to the Centre de Recherche et de Formation en Infectiologie de Guinée (CERFIG) laboratory for screening and sequencing by next-generation sequencing (NGS). The effective reproduction number (Rt) were estimated using EpiEstim to assess the transmission potential of the Omicron variant. Generalized linear models based on the binomial distribution were employed to analyze factors associated with SARS-CoV-2 positivity, following the identification of primary risk factors using Bayesian model averaging and the Data balancing algorithm using propensity score matching.

Results: Data from 1174 patients with suspected cases with a median age of 31 years (IQR: 20-51), were analyzed. The overall COVID-19 positivity rate was 11.8%. The global effective reproduction number (Rt) was 2.08 [95% CI: 0.35-5.81]. Only ageusia [AOR = 2.0; 95% CI (1.1-3.6)] was independently associated with SARS-CoV-2 test positivity.

Conclusion: SARS-CoV-2 is still circulating in Guinea, with a high positivity rate and a high number of effective reproductions in this post-epidemic period in our country. The associated factors and the circulation of variants with a diversity of circulating strains suggest the need to strengthen genomic and epidemiological surveillance, with the support of all those involved in the response to COVID-19, to ensure continuity of alerts and decision-making for public health.

Background: Implementation research (IR) studies and clinical trials have yielded conflicting results on improving treatment outcomes, especially among adolescent patients. To address this, we performed a Bayesian random-effects meta-analysis to evaluate the effectiveness of current IR interventions in improving retention in care and reducing viral suppression among HIV-infected adolescents.

Method: A comprehensive search was conducted from 1 January 2000 to 31 December 2020. A Bayesian random-effects meta-analysis was performed using historical evidence from adolescent interventions conducted outside sub-Saharan Africa (SSA) and from adult-derived interventions within SSA. A Bayesian Copas random-effects model was used to account for publication bias and study variations. Power priors were used to weight the contribution of historical data to the analysis. Bayesian meta-analysis was particularly suited for this study since it allowed us to directly include prior assessments from several intervention studies into the pooled intervention data.

Results: The pooled results from the 12 studies across eight African countries, involving 19,223 adolescent patients, showed significantly superior retention effects in adolescent-specialized interventions compared to standard care settings [odds ratio (OR) = 3.87; 95% credible interval (CrI): 0.94-10.82]. When 100% of data from eight observational studies on adolescent treatment outcomes were added to the analysis, the resulting OR was 3.02 (95% CrI: 1.01, 6.92). However, inclusion of 100% of historical data from adult randomised control trials (RCTs) reduced the retention effect to OR = 1.24 (95% CrI: 1.03-1.48). Regardless of whether adolescent historical data or adult RCT data were used, the associated posterior probability of benefiting from the intervention remained almost 1. There was no difference between standard care and specialized adolescent care in terms of virological suppression (OR = 1.27; 95% CrI: 0.57-2.32). However, specialized adolescent intervention achieved a superior overall retention rate of 59.7% compared to 52.1% under standard care.

Conclusion: Current adolescent-specific interventions are effective in improving retention rates in HIV care. Evidence from adult interventions showed a reduced retention effect, suggesting that while adult-promising interventions may improve adolescent treatment outcomes, they may require modifications.