Frontiers in epidemiology最新文献

Introduction: Previous studies indicate that the prevalence of type 2 diabetes (T2D) will increase substantially over the coming decades. One projection from 2019 estimated an increase in prevalence in Germany by 54% to 77% (depending on future trends in incidence and mortality) between 2015 and 2040. We aim to update this projection by incorporating recently published trends in T2D incidence in Germany that include the changes during the SARS-CoV-2 pandemic.

Materials and methods: We used a partial differential equation that describes the illness-death model to project the age- and sex-specific T2D prevalence among adults between 2015 and 2040. This required input data for the age- and sex-specific incidence, mortality of the general population, mortality rate ratio of people with vs. without T2D and prevalence in the initial year of the projection. We considered five scenarios with different future trends in incidence and their impact on prevalence. Using the most recently available data on T2D incidence, we assumed that the incidence remains constant as observed in 2021 for the whole projection horizon (first scenario). In further scenarios, we assumed that the observed age- and sex-specific trends in incidence between 2015 and 2021 would continue until 2025 (second scenario), 2030 (third scenario), 2035 (fourth scenario) and 2040 (fifth scenario). One additional scenario assumed that the age-specific prevalence remains constant.

Results: Observed trends in incidence suggest a decrease between 2015 and 2017, and a slight upward trend thereafter until 2021 in most age groups. Depending on how long these observed increases in incidence continue, the number of people with T2D in Germany will increase from 6.8 million in 2015 to between 10.9 million and 14.2 million in 2040. These numbers correspond to increases in prevalence from 10.5% in 2015 to between 15.5% and 20.1% in 2040. In the constant prevalence scenario, the overall prevalence and number of people with T2D in 2040 was 11.4% and 8.1 million, respectively.

Conclusions: The future prevalence of T2D in Germany strongly depends on how long the recently observed increasing trend in T2D incidence will continue, which warrants close monitoring of these trends in post-pandemic years.

Background: Measles is a major public health concern that causes morbidity and mortality among children. In 2019, measles incidence reached its highest level in 23 years, with low measles containing vaccine dose one coverage playing a vital role. It can be prevented by two doses of the measles vaccine, either alone or in combination with measles-rubella (MR), which is a low-cost strategy for lowering morbidity and mortality among children.

Objectives: To conduct spatial analysis of measles cases and vaccination coverage in the Somali region, Eastern Ethiopia.

Methods: This retrospective study was done by using public health emergency directorate measles data from 2022 to 2023 and four years (July 2019-July 2023) of vaccination data from district health information system version 2.36. After the data completeness and consistency were ensured, it was cleaned and recoded. STATA version 17 and QGIS version 3.38 software were used for the data analysis.

Results: From 2022 to 2023, the disease affected more than 5,930 people. The majority of the participants, 5,260 (88.7%), were under the age of 59 months, with 3,184 (53.7%) being male. Furthermore, the majority of residents were from Nogob 2,238 (37.7%), Erer 1,027 (17.3%), and Jarar 954 (16.1%). According to clinical symptoms, 5,930 (100%) of the cases had fever, cough, and rash, and more than two-thirds, 4,901 (82.6%), had complications. A measles vaccination coverage of 59.4% and a measles incidence of 0.087 per 100 people were found in the region.

Conclusions: This study found a very low measles vaccination coverage. Furthermore, Nogob, Erer, and Jarar zones showed the highest measles incidence rate, respectively. It is recommended to strengthen routine immunization services according to the national vaccination agenda, categorize, and reach unvaccinated children through catch-up vaccination campaigns. A concerted effort should be made to improve MCV2 coverage in hard-to-reach areas of the region. Special focus should be given to vaccine cold chain management in the zone and its districts with high vaccination coverage but also a high measles incidence rate. An investigation should be done into the associated factors of the higher incidence despite its vaccination coverage.

Background: Obesity is closely associated with lipid metabolism, and the accumulation of lipids leads to low-level inflammation in the body, which can trigger cardiovascular disease. This study aimed to explore the association between a novel marker of lipid accumulation, the abdominal volume index (AVI), inflammatory parameters, and mortality.

Methods: This study enrolled 2,109 older adult senior citizens (aged over 60 years) with hypertension from the National Health and Nutrition Examination Survey. The primary endpoints included all-cause mortality and cardiovascular mortality, which were assessed by linking the data to the National Death Index records. Cox regression model and subgroup analysis were constructed to investigate the associations between AVI and both all-cause and cardiovascular mortality. Restricted cubic splines were employed to further explore the relationships among AVI, inflammatory parameters, and mortality. By considering inflammatory factors as mediators, we investigate the mediating effects of AVI on mortality.

Results: After a median follow-up of 69 months, there were 1,260 deaths, with 337 attributed to cardiovascular causes within the older adult population studied. In the multivariable-adjusted model, AVI was positively associated with both all-cause and cardiovascular mortality [Hazard Ratio (HR) = 1.09, 95% CI = 1.06-1.11 for all-cause mortality; HR = 1.07, 95% CI = 1.03-1.12 for cardiovascular mortality]. Kaplan-Meier survival plots indicated an overall median survival time of 144 months. Mediation analysis revealed that Systemic Inflammatory Response Index (SIRI), Monocyte-to-HDL ratio (MHR), and Neutrophil-to-Lymphocyte ratio (NLR) mediated 27.15%, 35.15%, and 16.55%, respectively, of the association between AVI and all-cause mortality.

Conclusion: AVI is positively associated with all-cause mortality in older adults with hypertension, and this association appears to be partially mediated by inflammatory parameters.

Objective: This study analyzed the trend, seasonal variations and forecasting of chronic respiratory disease morbidity in charcoal producing areas, northwest Ethiopia, aiming to provide evidences in planning, designing strategies, and decision-makings for preparedness and resource allocation to prevent CRD and reduce public health burden in the future.

Materials and methods: The trend, seasonal variation, and forecasting for CRD were estimated using data collected from the three zones of Amhara region annual reports of DHIS2 records. Smoothing decomposition analysis was employed to demonstrate the trend and seasonal component of CRD. The ARIMA (2, 1, 2) (0, 0, 0) model was used to forecast CRD morbidity. The model's fitness was checked based on Bayesian information criteria. The stationarity of the data was assessed with a line chart and statistically with the Ljung-Box Q-test. SPSS version 27 was utilized for statistical analysis.

Results: The annual morbidity rate of CRD has shown an increasing trend in both sexes over a seven-year period among people aged 15 years and older. Seasonal variation in CRD morbidity was observed. The smoothing decomposition analysis depicted that the seasonal component was attributed to 44.47% and 19.16% of excess CRD cases in the period between September to November, and June to August, respectively. A substantial difference among the three zones of the Amhara region in CRD morbidity rate was noted, with the highest observed in the Awi zone. Forecasting with the ARIMA model revealed that CRD-related morbidity will continue to increase from 2020 to 2030.

Conclusion: The study revealed that the CRD morbidity rate has shown an increasing trend from 2013 to 2019. Seasonal variation in the CRD morbidity rate was observed, with the highest peak from September to November. The morbidity attributed to CRD will continue to increase for the next ten years (2020-2030). Therefore, this study could potentially play a groundbreaking role. Further study is warranted to understand the risk factors and facility readiness through a further understanding of seasonality and future trends.

Objectives: Surveillance of acute respiratory infection (ARI) informs vaccination, preventive, and management decisions. In many countries, immunofluorescence is the cornerstone for ARI surveillance. We aimed to determine the effect of adding multiplex polymerase chain reaction (mPCR) to conventional surveillance in ARI.

Methods: Respiratory samples from patients with influenza-like illness (ILI) and severe acute respiratory infection (SARI) were tested by a conventional approach [direct immunofluorescence (DIF) and SARS-CoV-2 PCR, and a subset of samples underwent routine testing]. Negative specimens were tested by multiplex PCR (mPCR), and remain negative samples were sequenced. Descriptive, multivariable regression analyses were conducted.

Results: Between March and June 2022, 299 patients were enrolled. Pathogens were detected in 43.8% of samples (131/299) tested by the conventional approach. Of the 168 negatives after the conventional approach, 157 (93.4%) were positive by mPCR, increasing the detection rate to 96.3% (288/299). With the conventional approach, the most frequent pathogen was respiratory syncytial virus (50.3%, 66/131), whereas with mPCR it was Haemophilus influenzae (37.5%, 63/168). mPCR significantly improved pathogen detection in ARI surveillance (Adjusted Incidence Rate Ratios 4.22 95% IC 4.22-5.85).

Conclusion: Adding mPCR to respiratory surveillance conventionally based on DIF significantly enhanced virus and bacteria detection. mPCR should be considered for routine ARI surveillance.

Introduction: Scientific evidence shows that contemporary and emerging factors contribute to high blood lead concentrations in different populations. The study aimed to determine blood lead concentrations and risk factors associated with high blood lead concentrations among young males in conflict with the law.

Methods: A cross-sectional analytical study was conducted among 192 conveniently selected participants from two youth secure (correctional) facilities in Gauteng Province, South Africa.

Results: The study's overall blood lead concentration median was 3.30 μg/dl, ranging from 0.85 to 48.11 μg/dl. Young males born outside of South Africa (median = 8.78 μg/dl) and in villages (median = 4.95 μg/dl), working before coming to the facility (median = 5.23 μg/dl) and involvement in illegal mining (median = 9.00 μg/dl) had high blood lead concentrations in this study. Contemporary and emerging risk factors such as being born outside the country (AOR: 3.10, 95%CI: 1.01-1.88), involvement in illegal mining activities (AOR: 1.36, 95%CI: 1.14-1.91) and staying in a house with peeling paint on the outside (AOR: 2.26, 95%CI: 1.12-4.30) were found to influence blood lead concentration.

Discussion: The study findings show that contemporary (co-existing) and emerging factors influence blood lead concentrations. Therefore, there is a need to investigate these factors further in communities that may be affected. Lastly, there is a need for a holistic approach involving multiple sectors to introduce human lead concentration screening and preventive programmes.

Background: There is limited evidence on prevalence and risk factors for hepatitis C virus (HCV) infection among waste handlers in Sidama region, Ethiopia; however, this knowledge is necessary for effective prevention of HCV infection in the region.

Methods: A cross-sectional study was conducted among randomly selected waste collectors from October 2021 to 30 July 2022 in different public hospitals of Sidama region of Ethiopia. Serum samples were collected from participants and screened for anti-HCV using rapid immunochromatography assay. Socio-demographic and risk factor information of waste handlers was gathered by pretested and well-structured questionnaires The generalized linear model (GLM) was conducted using R software, and P-value <0.05 was declared statistically significant.

Results: From a total of 282 participating waste handlers, 16 (5.7%) (95% CI = 4.2-8.7) were infected with hepatitis C virus. Educational status of waste handlers was the significant demographic variable that was associated with hepatitis C virus (AOR = 0.055; 95% CI = 0.012-0.248; P = 0.000). More married waste handlers, 12 (75%), were HCV positive than unmarried, 4 (25%) and married waste handlers were 2.051 times (OR = 2.051, 95% CI = 0.644-6.527, P = 0.295) more prone to HCV infection, compared to unmarried, which was statistically insignificant. The GLM showed that exposure to blood (OR = 8.26; 95% CI = 1.878-10.925; P = 0.037), multiple sexual partners (AOR = 3.63; 95% CI = 2.751-5.808; P = 0.001), sharp injury (AOR = 2.77; 95% CI = 2.327-3.173; P = 0.036), not using personal protective equipment (AOR = 0.77; 95% CI = 0.032-0.937; P = 0.001), contact with jaundiced patient (AOR = 3.65; 95% CI = 1.093-4.368; P = 0.0048) and unprotected sex (AOR = 11.91; 95% CI = 5.847-16.854; P = 0.001) remained statistically significantly associated with HCV positivity.

Conclusions: The study revealed that there was a high prevalence of hepatitis C virus infection among waste handlers in Sidama region, Ethiopia. This demonstrated that there is an urgent need to increase preventative efforts and strategic policy orientations to control the spread of the hepatitis C virus.

Background: Hepatitis B virus (HBV) infection poses a significant global health challenge, leading to approximately 1.1 million deaths annually. Informal caregivers of HBV patients face an increased risk of exposure, yet there is limited research on their awareness and infection prevention practices. This study aimed to evaluate the awareness and practices regarding HBV among informal caregivers in public hospitals in Addis Ababa, Ethiopia, in 2024.

Methods: An institutional-based cross-sectional study was conducted from May 15 to July 15, 2024, involving 422 informal caregivers selected through a systematic random sampling. Data were collected using structured, interviewer-administered questionnaires that were pretested. The data were analyzed using SPSS version 26, with logistic regression identifying factors influencing awareness and practices, set at p < 0.05.

Results: Out of 414 surveyed caregivers (response rate: 98.1%), the mean age was 34.31 years (±12), with 63% female and 47.6% single. Only 24.9% (95% CI: 20.7-29.1%) showed good awareness, and merely 11.6% (95% CI: 8.5-14.7%) demonstrated good practices. Key factors associated with better awareness included caregivers' positive attitudes (AOR: 2.54) and patient functional levels (AOR: 1.9). Good practices were linked to higher education levels (AORs: 4.84 and 5.3), acute disease status (AOR: 3.6), and positive attitudes (AOR: 4.37).

Conclusions: The study reveals inadequate awareness and practices among informal caregivers compared to national averages. Awareness was linked to caregivers' attitudes and patient activity levels, while education, awareness, attitudes, and disease type significantly influenced good practices.

During the SARS-CoV-2 pandemic, the effective reproduction number (R-eff) has frequently been used to describe the course of the pandemic. Analytical properties of R-eff are rarely studied. We analytically examine how and under which conditions the conventional susceptible-infected-removed (SIR) model (without infection age) serves as an approximation to the infection-age-structured SIR model. Special emphasis is given to the role of R-eff, which is an implicit parameter in the infection-age-structured SIR model and an explicit parameter in the approximation. The analytical findings are illustrated by a simulation study about an hypothetical intervention during a SARS-CoV-2 outbreak and by historical data from an influenza outbreak in Prussian army camps in the region of Arnsberg (Germany), 1918-1919.