American journal of epidemiology最新文献

Cancer patients face a suicide risk 2 to 4 times higher than the general population. This study examines trends in suicide mortality among cancer patients in Taiwan and explores potential links with national suicide prevention efforts and advancements in cancer care. Data from the Taiwan Cancer Registry and mortality files were analyzed for invasive cancer cases diagnosed from 1985 to 2018. Trends of age-standardized suicide rates were analyzed using joinpoint regression, and standardized mortality ratios compared rates between cancer patients and the general population, stratified by sex, age, cancer type, stage, and time since diagnosis. Suicide mortality declined in the general population after 2005 [annual percent change, APC(95% confidence interval): -1.98(-2.61,-1.43) for men; -1.69(-2.31,-1.15) for women; both P < 0.0001], with a greater decline among cancer patients, particularly women [APC: -2.74(-5.09,1.70) for men, P = 0.0652; -5.46(-7.94,-1.27) for women, P = 0.0436]. Pancreatic, lung, and oral cancers had higher suicide rates but showed steady declines. Elevated risks persisted in subgroups such as male stomach cancer patients. Suicide rates generally decreased over time postdiagnosis but remained higher in advanced-stage cancers. National suicide prevention efforts and improved cancer care appear linked to reduced suicide mortality among cancer patients. However, high-risk subgroups require targeted interventions.

Structural racism has likely shaped the geographic distribution and resource allocation of rural populations and marginalized racial/ethnic groups. We sought to (1) quantify disparities in severe maternal morbidity (SMM) and distributions of resources by race and racial composition of county, and (2) determine whether a hypothetical intervention on resources would reduce racial disparities in SMM, using linked birth certificates and claims from Medicaid beneficiaries giving birth from 2014 to 2019 in rural North Carolina (61 rural counties, 77 665 births). We used ratio of mediator probability weights to enact a hypothetical intervention that would equalize distributions of pregnancy care provider ratios and obstetric units across race and racial composition of county. Despite observed disparities in the distributions of resources and SMM, we were unable to demonstrate that the hypothetical interventions would reduce SMM. This may be due to a lack of common support-marginalized groups never experienced the more optimal extremes of the healthcare resources distributions that privileged groups did. Our findings may have implications for the use of causal inference methods for addressing health disparities more broadly: if distributions of resources among privileged groups are outside those that marginalized groups experience, hypothetical interventions on these distributions cannot be emulated with data.

Comparing seasonal variations in mortality across regions is challenging due to differences in methodologies, including variations in modeling strategies and data availability. Most existing studies focus on temperate regions, with limited research on equatorial and tropical areas. To address this gap, we propose a new Peak Season Excess Death index (PSEDi), which accounts for climate differences across multiple latitudes. This index serves as an alternative to the traditional Excess Winter Death index and peak-to-trough ratio, offering a more adaptable approach for diverse climatic regions. Our study demonstrates the effectiveness of PSEDi in uncovering mortality seasonality trends across regions with varying climatic profiles and excess mortality periods. The proposed index performs well not only in areas where previous indexes have been applied but also in nontemperate regions such as Latin America, Africa, and Southeast Asia, providing a more comprehensive perspective on seasonal mortality patterns.

Whether fetal lung development may be vulnerable to gestational exposure to metals is unknown. We analyzed mother-child pairs in Project Viva, a prospective prebirth cohort in eastern Massachusetts, USA. Concentrations of 11 essential and nonessential metals were measured in maternal first-trimester erythrocytes (~10 weeks). Measures of lung function were obtained by spirometry, and asthma status by recall, at the mid-childhood visit (~8 years). We fit both Bayesian hierarchical models with weakly informative priors and conventional multivariable linear and logistic regressions (MLRs) to estimate associations of the metals with lung function and asthma. The analytic sample included 804 mother-child pairs (76.0% non-Hispanic White; 16.7% of children had current asthma). Each standard deviation increase in magnesium was associated with higher forced vital capacity (mean difference: 26 mL, 95% credible interval (CrI); 5, 47), higher forced expiratory volume in 1 second (FEV1) (25 mL, 95% CrI: 6, 44), and lower odds of current asthma (odds ratio: 0.88, 95% CrI: 0.71, 1.1). BHMs provided more modest and precise estimates than MLRs. Our results suggest early pregnancy intake of magnesium may enhance fetal lung development and may confer a modest reduction in the risk of asthma.

Multimorbidity has become a global public health concern, yet cross-national comparisons remain limited, especially in longitudinal settings. This study investigates the longitudinal patterns and transitions of multimorbidity status of people over age 50 in 34 countries. Utilizing comparable health indicators across countries, we examine chronic health conditions (hypertension and diabetes), cognitive function, physical ability, and self-report of general health. Using latent transition analysis, we identify a pattern of multimorbidity and classify it into three classes: mild, moderate, and severe multimorbidity. Mild multimorbidity is characterized by a lower prevalence of 3 morbidities out of 5, while severe multimorbidity is characterized by a higher prevalence across all health conditions. Moderate multimorbidity falls between these 2 extremes. Our findings reveal substantial variation in these classes across countries, with diabetes and hypertension emerging as the predominant condition among older adults with severe and moderate multimorbidity, respectively. Over time, both severe and moderate multimorbidity tend to increase, with similar transition probabilities from mild to more severe categories across countries. Covariate analysis indicates that men and low-educated individuals are more likely to experience severe multimorbidity. These results underscore the importance of understanding multimorbidity patterns and dynamics for effective public health planning and healthcare services. This article is part of a Special Collection on Cross-National Gerontology.

Socioeconomic disadvantage at individual level is associated with poor cognitive outcomes but the link of neighborhood disadvantage with cognitive function is unclear. We used data from Young Finns Study, a population-based cohort, to examine the associations of neighborhood and individual-level disadvantage in childhood (age 3-21 years) and adulthood (age 22 up to the time of cognitive assessment) with cognitive function in mid-adulthood (age 35-49 years). Neighborhood disadvantage was ascertained based on register data, including geo-coded address history. Compared to individuals who experienced neither individual-level nor neighborhood disadvantage in childhood, those who experienced both had, on average, 0.236 SDs lower overall cognitive function scores (95% CI: -0.355 to -0.116) and those who experienced individual-level but not neighborhood disadvantage had 0.196 SDs lower scores (95% CI, -0.323 to -0.070). The estimates were slightly larger for adult individual-level and neighborhood disadvantage. The findings were similar across the cognitive domains and robust to adjustment for a polygenic risk score for cognitive ability. We found no clear evidence of sleep difficulties, depressive symptoms or cardiovascular health mediating the associations. Our findings suggest that socioeconomic disadvantage at individual-level but not neighborhood-level, from childhood to adulthood, may impact on cognitive function in mid-adulthood.

In 2016, the National Institutes of Health designated LGBTQ+ individuals (ie, lesbian, gay, bisexual, transgender, queer, and all sexual and gender minorities) as a health disparities population. The growing interest in studying the health of LGBTQ+ populations merits revisiting the methodological approaches researchers employ. We elucidate how researchers can identify appropriate adjustment sets for causal questions using directed acyclic graphs (DAGs). To illustrate these points, we simulated a simplified example using pregnancy loss as the outcome wherein we generate 1000 datasets with a sample size of 10 000 individuals. We motivate why covariates that are commonly used in LGBTQ+ health disparities research (eg, use of medically assisted reproduction) are mediators, not confounders, and how adjusting for these variables in causal research can induce bias by blocking part of the indirect effect of exposure on the outcome. Next, we illustrate the complexity of mediation analyses with social exposures due to mediator-outcome confounding induced by exposure and compare potential approaches. Then we demonstrate how collider stratification bias can arise from our sample recruitment and selection. Finally, we demonstrate how incorporating heterosexism (ie, stigma and discrimination) as an unobserved node in our DAG can guide decision-making on appropriate adjustment sets. This article is part of a Special Collection on Methods in Social Epidemiology.

In colorectal cancer (CRC) screening settings offering both colonoscopy and fecal immunochemical test (FIT), guidance on who should get colonoscopy could optimize resource use. This study aimed to identify efficient guidance strategies, maximizing quality-adjusted lifeyears (QALYs) gained for given colonoscopy demand. Using the MISCAN-Colon microsimulation model for Switzerland, we evaluated 3 strategy types: age-based, starting biennial FIT and switching to 10-yearly colonoscopy at a certain age; risk score-based, where only individuals with high CRC risk scores undergo colonoscopy; FIT-based, switching to colonoscopy after a quantitative FIT result just below the positivity cut-off and, in some strategies, also at a certain age. Reference strategies included (1) colonoscopy only and (2) equal proportions of individuals choosing FIT or colonoscopy at age 50. Age- and risk score-based strategies with switches or risk assessments at ages 54, 64, or 74 were efficient. Compared to the reference strategies, QALYs gained could increase by (1) 10.0% or (2) 6.7% without increasing colonoscopy demand. The FIT-based switching strategies were not efficient. Therefore, screening programs like those in Switzerland and the United States can improve efficiency by guiding individuals toward FIT or colonoscopy simply based on age. More complex approaches using prior FITs or risk scores would not outperform age-based approaches.

Real-world evidence assessing dipeptidyl peptidase-4 inhibitors (DPP4i)'s risk of inflammatory bowel disease (IBD) is conflicting. One study modeling DPP4i as a time varying exposure (TVE) observed a harmful effect in a UK population, while an active comparator new-user (ACNU) study observed a null effect in a US population. To assess the impact of study design in estimating treatment effect, we implemented both designs in the UK Clinical Practice Research Datalink population from 2007 to 2022. We conducted three ACNU analyses: DPP4i vs sulfonylureas (SU) (43 204 vs 86 411), DPP4i vs thiazolidinediones (TZD) (67 288 vs 22 474), and DPP4i vs sodium-glucose transport protein 2 inhibitors (SGLT2i) (54 253 vs 30 993). The propensity score adjusted hazard ratios (aHRs) for DPP4i were 1.12 (95% CI, 0.83-1.50) vs SU, 1.15 (0.66-2.01) vs TZD, and 1.43 (0.83-2.48) vs SGLT2i, over a median follow-up of 2.2 to 6.1 years. In TVE analyses, patients who switched from the comparator to DPP4i were censored at switching and accrued person-time on DPP4i thereafter. We observed similar or higher aHRs for DPP4i vs SU 1.06 (0.80-1.41), TZD 1.76 (0.84-3.78), and SGLT2i 1.62 (0.91-2.90). Our findings suggest DPP4i does not increase IBD risk and emphasize the crucial role of study design in assessing treatment effect.

Many developed countries are raising their state pension age (SPA), thereby delaying retirement. However, existing evidence on the impact of retirement on health yields inconsistent results. This study aims to explore heterogeneous associations of retirement with health and behaviors using harmonized datasets of the Health and Retirement Study and its sister surveys in 35 countries. The data comprises 396 904 observations from 106 927 individuals aged 50-70 years. On average, participants were followed up for 6.7 years, and 50.5% of them consisted of men. This study employed the SPA of each country as an instrument for retirement and performed fixed-effects instrumental variable (IV) regression. Among women, retirement was associated with a 0.100 SD increase in cognitive function and a 3.8%-point increase in physical independence. In both genders, retirement was associated with increased self-rated health, with women indicating a larger point estimate than men. Additionally, retirement was associated with a 4.3%-point decrease in physical inactivity and a 1.9%-point decrease in smoking among women, while no such associations were observed among men. Heterogeneity was not found across countries, educational levels, and pre-retirement job characteristics. Gender differences in post-retirement health behaviors may contribute to heterogeneous associations between retirement and health. This article is part of a Special Collection on Cross-National Gerontology.