American journal of epidemiology最新文献

The Ontario Asbestos Workers Registry is a regulatory exposure registry obligating employers to report the number of work hours with asbestos-containing materials for each of their workers. Currently, each worker is notified of the need for a medical examination once they have accrued 2000 reported hours of work with asbestos. We sought to evaluate the impact on disease prevention of alternative policies limiting asbestos work hours among registry participants. A cohort of 26 164 asbestos workers were followed for cancer and nonmalignant disease diagnoses between 1986 and 2019. Analyses of the association between cumulative asbestos work hours and respiratory disease incidence rates showed substantially elevated disease rates well before reaching 2000 asbestos work hours. Using a simplified application of parametric G-computation (G-POSH), limiting cumulative asbestos work hours to 100 h would have prevented 76 asbestosis, 36 pulmonary fibrosis, 27 mesothelioma, and 79 lung cancer cases at the end of follow-up compared to the observed risk in the cohort. Limiting exposure to 2000 asbestos work hours had a smaller but still substantial impact on disease prevention, particularly among workers in the construction industry. Regulatory agencies should intervene sooner to prevent respiratory disease among workers in the registry.

The desire to age "in place" avoiding nursing homes (NHs) seems universally acknowledged, and the recent COVID-19 pandemic may have encouraged it. Using data from the Survey of Health Ageing and Retirement in Europe (SHARE), we show that those living in NH declared a lower level of life satisfaction than those living in the community. Controlling for demographics, the difference was around -8% over an average score of 6.73/10. Adding controls for the economic situation, health, and disability level the negative association becomes nonsignificant. Functional status seems to explain most of the difference in well-being between nursing and private homes. However, the selection into NH may be linked to unobservable characteristics. We tackle this causality issue in two ways. First by using propensity score matching methods. Living in an NH becomes associated with lower well-being. Finally, we make use of our longitudinal data to further reduce the potential impact of nonobservables. The conclusions are globally reversed: living in an NH is associated with higher well-being. This is coherent with a model of optimal residential choices: living in an NH might not be desired but proves to be the best choice for those who make it. This article is part of a Special Collection on Cross-National Gerontology.

Firearm violence is a public health crisis in the United States and negatively impacts individuals and communities. We used data from The Healthy Chicago Survey, a citywide survey of 8754 respondents from 2020 to 2021, and police-reported shootings to estimate the effect of residential exposure to shootings on sleep duration. Exposure was measured as fatal or non-fatal shootings occurring within 400 meters of the respondent's residence, within 7 days before taking the survey. Sleep was categorized into <6, 6 to <7, 7 to <9 and ≥9 h/day. We used log-binomial regression models to estimate risk ratios (RR). We used probabilistic quantitative bias analysis to estimate the magnitude and direction of the impact of differential outcome misclassification of self-reported sleep on results. Of 8584 survey respondents, 589 (6.9%) were exposed to at least one shooting. The estimated associations between shootings and very short and moderately short sleep duration were null, while the RR for long sleep duration was 1.10 (95% CI, 1.00-1.22); results of the quantitative bias analysis for long sleep duration were null (RR = 1.04 [95% simulation interval: 0.92, 1.15]). Our findings suggest that simply living close to a recent shooting may not affect sleep duration among adults living in Chicago, but further investigation is warranted.

Child maltreatment is a persistent public health problem in the United States. Child Protective Services (CPS) data are the de facto data source for child maltreatment surveillance, despite these data's established limitations. Maltreatment-related mortality could be a complementary source of child maltreatment surveillance data. We calculated trends over time, and patterns across state and by race/ethnicity, comparing child maltreatment report rates to child maltreatment-related mortality rates, between 2005 and 2020. These two measures of maltreatment show different time trends and patterns by state and race/ethnicity. Time trends in maltreatment-related mortality decreased slightly across the study period for all racial/ethnic groups, while maltreatment report rates increased, particularly for Non-Hispanic Black children. Reports and mortality data revealed very different pictures of which states had the highest and lowest maltreatment rates, overall and by race/ethnicity. Only 14 states had report and mortality rates in the same tertile, with less alignment when stratified by race/ethnicity. Patterns in child maltreatment report rates and death rates do not align. Future work should consider additional sources of data to improve maltreatment surveillance. These findings highlight the need to identify a valid and consistent approach to capture patterns of maltreatment in the United States.

Reliable estimates of death rates in complex humanitarian emergencies are critical for assessing the severity of a crisis and for effectively allocating resources. However, in many humanitarian settings, logistical and security concerns make conventional methods for estimating death rates infeasible. We develop and test a new method for estimating death rates in humanitarian emergencies using reports of deaths in survey respondents' social networks. To test our method, we collected original data in Tanganyika Province of the Democratic Republic of the Congo (n = 5311), a setting where reliable estimates of crude death rates (CDR) are in high demand. Qualitative fieldwork suggested testing 2 different types of personal networks as the basis for CDR estimates: deaths among immediate neighbors and deaths among kin. We compare our network-based estimates (0.44 deaths per 10 000 person-days) against a standard retrospective household mortality survey, which estimated a CDR nearly twice as high (0.81 deaths per 10 000 person-days). Given that both methods are equally plausible, our findings highlight the need for further validation and development of both methods.

Section 8 vouchers help low-income families relocate to lower-poverty neighborhoods, potentially altering neighborhood racial/ethnic composition and exposure to perceived discrimination. The Moving to Opportunity study randomized families to a low-poverty voucher, traditional voucher, or control. Low-poverty voucher recipients could use vouchers in neighborhoods with <20% poverty, while traditional voucher recipients had no restrictions. We estimated the effect of voucher receipt at baseline (1994-1998) on non-Hispanic Black and Hispanic adolescents' perceived racial/ethnic discrimination in 2001 to 2002 (n = 2200), and identified heterogeneity across voucher types, cities (Boston, Chicago, New York, Los Angeles), and sexes. We used a doubly robust adaptive shrinkage approach to identify effect modifiers (sex and city) in each voucher comparison group and discrimination setting. On average, across cities, low-poverty voucher receipt reduced risk of perceived police discrimination among boys and girls. In Los Angeles, among boys and girls, low-poverty voucher and traditional voucher receipt, respectively, reduced risk of perceived school and neighborhood discrimination. Receipt of a traditional voucher increased risk of perceived discrimination at stores in Chicago and perceived neighborhood discrimination in Boston, Chicago, and New York. Offering vouchers may affect participants' risk of perceived discrimination, but this effect depends on voucher type and city.

Kidney cancer has been a suspected occupational disease in petroleum workers. Health conditions that are linked to kidney cancer may prompt termination or change of work and thereby restrict occupational exposures in high-risk individuals, creating a healthy worker survivor bias (HWSB). We examined associations between occupational exposures and kidney cancer among males in the Norwegian offshore petroleum workers cohort using a case-cohort design, with 169 incident cancers identified by linkage to national registry data (1999-2021) and a subcohort of 2090 noncases, all employed between 1965 and 1998. Relative risks (hazard ratios [HRs]) by cumulative exposure to benzene, crude oil, chlorinated degreasing agents (CDA), asbestos, welding fumes, or surface treatment (priming, painting) were estimated by weighted Cox regression. Inverse exposure-response trends suggested HWSB, reinforced by analyses of necessary components of HWSB. Bias was partly alleviated by adjustment for total employment duration and by 20-year lagging of cumulative exposure to benzene, crude oil, or CDA. Workers in surface treatment (ever vs never) showed increased HR = 2.22, 95% confidence interval [CI], 1.04-4.72 (9 cases, only). For asbestos and welding fumes, the initial inverse trends largely remained after adjustment. In sum, we could neither confirm nor exclude an occupational impact on kidney cancer.

Deaths due to overdose and suicide together comprise an urgent public health challenge. Using Veterans Health Administration (VHA) electronic health records, we identified patients with high-risk emergency department (ED) visits related to suicidality or overdose between January 2010 and September 2019 using diagnostic codes from the International Classification of Diseases. We calculated standardized mortality ratios (SMR) for 90-day all-cause and cause-specific mortality associated with high-risk VHA ED visits compared with other VHA ED users, all VHA users, and the US general population. Among 20 382 060 ED visits from 3 705 984 unique Veterans, we identified 318 950 high-risk ED visits. The 90-day all-cause mortality rate among Veterans with high-risk ED visits was 2.81 times the expected rate (95% CI, 2.72-2.92) for other VHA ED users after adjusting for sex, race, and age. Rates remained elevated compared to all VHA users and the US general population. By race, mortality rates were markedly elevated among veterans identified as Asian or Pacific Islander (SMR = 3.50, 95% CI, 2.86-4.24) compared to other VHA ED users. The 90-day cause-specific SMRs were most pronounced for suicide, overdose, and accidents or unintentional self-harm. These results suggest that high-risk ED visits should trigger assertive, continued mental health care directed at reducing acute mortality through structured suicide prevention programs.

Type 1 diabetes (T1D) is known to have adverse long-term health and social outcomes, but the modifying factors are largely unknown. We investigate to what extent T1D outcomes are modified by area-, household-, and individual-level social and economic characteristics in Finland. National registers from 1987 to 2020 were used to identify all 3048 children with T1D diagnosed at ages 7-17 years and matched controls (n = 78 883). Using causal forests, we estimated the average association between T1D and adult health, social, and economic outcomes at ages 28-30 years, and the modifying roles of more than 30 covariates. Individuals with T1D were more likely to be deceased (2.3% vs 0.9% in the control group), to use antidepressants (17% vs 13%), and to be unpartnered (36% vs 32%), and had more months of unemployment (1.18 vs 1.02) and lower annual income (25 697 euros vs 27 453 euros), but not significantly lower educational attainment (10.8% vs 10.3% with only basic education). Type 1 diabetes had a heterogenous association with all outcomes except mortality and income, but no specific population subgroup was vulnerable across all outcomes. However, women with T1D had particularly high rates of antidepressant use, and individuals from low socioeconomic families were more likely to be unpartnered.