American journal of epidemiology最新文献

This study examines the impact of temporary school closures on influenza transmission and respiratory mortality, leveraging a natural experiment from winter break timings in Polish schools. Using causal inference methods on 12 years of ILI (Influenza-Like Illness) data and two decades of respiratory death records, the analysis shows significant reductions in ILI incidence within four weeks post-closures in an average season: 75% among school-aged children, 55% in adults, 26% in pre-school children, and 31% in the elderly, compared to pre-vacation averages. Notably, a 7% decrease in respiratory mortality was observed among the elderly, highlighting school closures as an effective public health intervention for reducing influenza spread and mortality among high-risk groups.

Although some case reports have reported gastrointestinal perforation after COVID-19, epidemiological studies investigating this association are scarce. We aimed to assess the risk of gastrointestinal perforation associated with COVID-19. We conducted a self-controlled case series (SCCS) study using a Japanese nationwide, large-scale claims database. We identified patients diagnosed with COVID-19 between March 2020 and October 2022 who had undergone surgery for gastrointestinal perforation. Conditional Poisson regression was used to estimate the incidence rate ratio (IRR) and 95% confidence intervals (CIs) of gastrointestinal perforation during the 4-week risk period compared with the control period. Our SCCS study included 276 patients. The IRR for gastrointestinal perforation was 6.62 (95% CI 3.52 to 12.47) for the first week, 3.27 (95% CI 1.51 to 7.09) for the second week, and 1.45 (95% CI 0.63 to 3.33) for the third and fourth weeks following COVID-19. The risk was lower in female patients than in male patients. In a subgroup analysis, the results were consistent regardless of age. This study suggests a significant association between COVID-19 and gastrointestinal perforation, particularly during the first 2 weeks. These findings highlight the need to recognize COVID-19 as a risk factor for gastrointestinal perforation.

The objective of this study was to estimate the effect of geographic variation in historic slavery on perinatal outcomes (chronic hypertension, hypertensive disorders of pregnancy [HDP], very preterm birth [VPTB], or very low birth weight birth [VLBW]) among Black people living in states where slavery was legal in 1860; and to test mediation by Black homeownership. We linked data on the proportion of enslaved residents from the 1860 Census to natality data on outcomes (2013-2021) using resident county. The percentage of Black residents in a county who owned their home was a potential mediator. We fit log binomial models to estimate risk ratios (RRs) representing total and controlled direct effects (accounting for Black homeownership) of the proportion enslaved on outcomes, accounting for potential confounding, using marginal structural models. Among 2 443 198 included births, 8.8% (213 829) experienced HDP, 4.1% (100 549) chronic hypertension, 3.3% (81 072) VPTB, and 2.6% (62 538) VLBW. There was an increase in chronic hypertension and VPTB risk, but not HDP or VLBW, in counties with a 10% greater proportion of enslaved residents in 1860 (adjusted RR [95% CI], chronic hypertension: 1.06 [1.02-1.1]; VPTB: 1.02 [1.00-1.05]; HDP: 1.00 [0.98-1.02]; and VLBW: 1.01 [1.00-1.03]). There was not evidence of mediation by Black homeownership. We conclude that historic slavery remains relevant for perinatal health.

Traffic-related air pollution is a major concern for perinatal health. Determining causal associations, however, is difficult because high-traffic areas tend to correspond with lower socioeconomic neighborhoods and other environmental exposures. To overcome confounding, we compared pregnant individuals living downwind and upwind of the same high-traffic road. We leveraged vital statistics data for Texas from 2007 to 2016 (n = 3 570 272 births) and computed hourly wind estimates for residential addresses within 500 m of high-traffic roads (ie, annual average daily traffic >25 000 vehicles) (10.9% of births). We matched pregnant individuals predominantly upwind with pregnant neighbors downwind of the same road segment (n = 37 631 pairs). Living downwind was associated with a decrease of 11.6 g (95% CI, -18.01 to -5.21) in term birth weight. No associations were observed with low term birth weight, preterm birth, or very preterm birth. In distance-stratified models, living downwind within 50 m was associated with a decrease of 36.3 g (95% CI, -67.74 to -4.93) in term birth weight and living 51-100 m downwind was associated with an odds ratio of 3.68 (95% CI, 1.71-7.90) for very preterm birth. These results suggest traffic air pollution is associated with adverse birth outcomes, with steep distance decay gradients around major roads. This article is part of a Special Collection on Environmental Epidemiology.

Prior infection with SARS-CoV-2 can provide protection against infection and severe COVID-19. We aimed to determine the impact of preexisting immunity on vaccine effectiveness (VE) estimates. We systematically reviewed and meta-analyzed 66 test-negative design studies that examined VE against infection or severe disease (hospitalization, intensive care unit admission, or death) for primary vaccination series. Pooled VE among studies that included people with prior COVID-19 infection was lower against infection (77%; 95% CI, 72-81) and severe disease (86%; 95% CI, 83-89) compared with studies that excluded people with prior COVID-19 infection (pooled VE against infection: 87% [95% CI, 85-89]; pooled VE against severe disease: 93% [95% CI, 91-95]). There was a negative correlation between VE estimates against infection and severe disease, and the cumulative incidence of cases before the start of the study or incidence rates during the study period. We found clear empirical evidence that higher levels of preexisting immunity were associated with lower VE estimates. Prior infections should be treated as both a confounder and effect modificatory when the policies target the whole population or are stratified by infection history, respectively.

Older individuals residing in long-term care facilities (LTCFs) are often living with multimorbidity and exposed to polypharmacy, and many experience medication-related problems. Because randomized controlled trials seldom include individuals in LTCFs, pharmacoepidemiological studies using real-world data are essential sources of new knowledge on the utilization, safety, and effectiveness of pharmacotherapies and related health outcomes in this population. In this commentary, we discuss recent pharmacoepidemiological research undertaken to support the investigations and recommendations of a landmark public inquiry into the quality and safety of care provided in the approximately 3000 Australian LTCFs that house more than 240 000 residents annually, which informed subsequent national medication-related policy reforms. Suitable sources of real-world data for pharmacoepidemiological studies in long-term care cohorts and methodological considerations are also discussed. This article is part of a Special Collection on Pharmacoepidemiology.

Detecting and quantifying changes in the growth rates of infectious diseases is vital to informing public health strategy and can inform policymakers' rationale for implementing or continuing interventions aimed at reducing their impact. Substantial changes in SARS-CoV-2 prevalence with the emergence of variants have provided an opportunity to investigate different methods for doing this. We collected polymerase chain reaction (PCR) results from all participants in the United Kingdom's COVID-19 Infection Survey between August 1, 2020, and June 30, 2022. Change points for growth rates were identified using iterative sequential regression (ISR) and second derivatives of generalized additive models (GAMs). Consistency between methods and timeliness of detection were compared. Of 8 799 079 study visits, 147 278 (1.7%) were PCR-positive. Change points associated with the emergence of major variants were estimated to occur a median of 4 days earlier (IQR, 0-8) when using GAMs versus ISR. When estimating recent change points using successive data periods, 4 change points (4/96) identified by GAMs were not found when adding later data or by ISR. Change points were detected 3-5 weeks after they occurred under both methods but could be detected earlier within specific subgroups. Change points in growth rates of SARS-CoV-2 can be detected in near real time using ISR and second derivatives of GAMs. To increase certainty about changes in epidemic trajectories, both methods could be used in parallel.

Despite increasing prevalence of hypertension in youth and high adult cardiovascular mortality rates, the long-term consequences of youth-onset hypertension remain unknown. This is due to limitations of prior research, such as small sample sizes, reliance on manual record review, and limited analytic methods, that did not address major biases. The Study of the Epidemiology of Pediatric Hypertension (SUPERHERO) is a multisite, retrospective registry of youth evaluated by subspecialists for hypertension disorders. Sites obtain harmonized electronic health record data using standardized biomedical informatics scripts validated with randomized manual record review. Inclusion criteria are index visit for International Classification of Diseases, 10th Revision (ICD-10) code-defined hypertension disorder on or after January 1, 2015, and age < 19 years. We exclude patients with ICD-10 code-defined pregnancy, kidney failure on dialysis, or kidney transplantation. Data include demographics, anthropomorphics, US Census Bureau tract, histories, blood pressure, ICD-10 codes, medications, laboratory and imaging results, and ambulatory blood pressure. SUPERHERO leverages expertise in epidemiology, statistics, clinical care, and biomedical informatics to create the largest and most diverse registry of youth with newly diagnosed hypertension disorders. SUPERHERO's goals are to reduce CVD burden across the life course and establish gold-standard biomedical informatics methods for youth with hypertension disorders.

We examined associations between modifiable and nonmodifiable cancer-related risk factors measured at endometrial cancer diagnosis and during early survivorship (~3 years postdiagnosis) with second primary cancer (SPC) risk among 533 endometrial cancer survivors in the Alberta Endometrial Cancer Cohort using Fine and Gray subdistribution hazard models. During a median follow-up of 16.7 years (IQR, 12.2-17.9), 89 (17%) participants developed an SPC; breast (29%), colorectal (13%), and lung (12%) cancers were the most common. Dietary glycemic load before endometrial cancer diagnosis (≥90.4 vs < 90.4 g/day: subhazard ratio [sHR] = 1.71; 95% CI, 1.09-2.69), as well as older age (≥60 vs < 60 years: sHR = 2.48; 95% CI, 1.34-4.62) and alcohol intake (≥2 drinks/week vs none: sHR = 3.81; 95% CI, 1.55-9.31) during early survivorship, were associated with increased SPC risk. Additionally, reductions in alcohol consumption from prediagnosis to early survivorship significantly reduced SPC risk (sHR = 0.34; 95% CI, 0.14-0.82). With 1 in 6 survivors developing an SPC, further investigation of SPC risk factors and targeted surveillance options for high-risk survivors could improve long-term health outcomes in this population. Reductions in dietary glycemic load and alcohol intake from prediagnosis to early survivorship showed promising risk reductions for SPCs and could be important modifiable risk factors to target among endometrial cancer survivors. This article is part of a Special Collection on Gynecological Cancer.