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Pelgrims I, Devleesschauwer B, Vandevijvere S, De Clercq EM, Van der Heyden J, Vansteelandt S. The potential impact fraction of population weight reduction scenarios on non-communicable diseases in Belgium: application of the g-computation approach. BMC Med Res Methodol 2024; 24:87. [PMID: 38616261 PMCID: PMC11016220 DOI: 10.1186/s12874-024-02212-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 04/04/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Overweight is a major risk factor for non-communicable diseases (NCDs) in Europe, affecting almost 60% of all adults. Tackling obesity is therefore a key long-term health challenge and is vital to reduce premature mortality from NCDs. Methodological challenges remain however, to provide actionable evidence on the potential health benefits of population weight reduction interventions. This study aims to use a g-computation approach to assess the impact of hypothetical weight reduction scenarios on NCDs in Belgium in a multi-exposure context. METHODS Belgian health interview survey data (2008/2013/2018, n = 27 536) were linked to environmental data at the residential address. A g-computation approach was used to evaluate the potential impact fraction (PIF) of population weight reduction scenarios on four NCDs: diabetes, hypertension, cardiovascular disease (CVD), and musculoskeletal (MSK) disease. Four scenarios were considered: 1) a distribution shift where, for each individual with overweight, a counterfactual weight was drawn from the distribution of individuals with a "normal" BMI 2) a one-unit reduction of the BMI of individuals with overweight, 3) a modification of the BMI of individuals with overweight based on a weight loss of 10%, 4) a reduction of the waist circumference (WC) to half of the height among all people with a WC:height ratio greater than 0.5. Regression models were adjusted for socio-demographic, lifestyle, and environmental factors. RESULTS The first scenario resulted in preventing a proportion of cases ranging from 32.3% for diabetes to 6% for MSK diseases. The second scenario prevented a proportion of cases ranging from 4.5% for diabetes to 0.8% for MSK diseases. The third scenario prevented a proportion of cases, ranging from 13.6% for diabetes to 2.4% for MSK diseases and the fourth scenario prevented a proportion of cases ranging from 36.4% for diabetes to 7.1% for MSK diseases. CONCLUSION Implementing weight reduction scenarios among individuals with excess weight could lead to a substantial and statistically significant decrease in the prevalence of diabetes, hypertension, cardiovascular disease (CVD), and musculoskeletal (MSK) diseases in Belgium. The g-computation approach to assess PIF of interventions represents a straightforward approach for drawing causal inferences from observational data while providing useful information for policy makers.
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Affiliation(s)
- Ingrid Pelgrims
- Department of Chemical and Physical Health Risks, Sciensano, Rue Juliette Wytsman 14, 1050, Brussels, Belgium.
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Krijgslaan 281, S9, BE-9000, Ghent, Belgium.
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, 1050, Brussels, Belgium.
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, 1050, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Salisburylaan 133, Hoogbouw, B-9820, Merelbeke, Belgium
| | - Stefanie Vandevijvere
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, 1050, Brussels, Belgium
| | - Eva M De Clercq
- Department of Chemical and Physical Health Risks, Sciensano, Rue Juliette Wytsman 14, 1050, Brussels, Belgium
| | - Johan Van der Heyden
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, 1050, Brussels, Belgium
| | - Stijn Vansteelandt
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Krijgslaan 281, S9, BE-9000, Ghent, Belgium
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De Meyst A, Alexiou Z, Lernout T, Morré SA, Vanrompay D. Challenges in Chlamydial Serology: Insights from a Belgian and a Dutch Population Cohort. Microorganisms 2024; 12:658. [PMID: 38674603 PMCID: PMC11052210 DOI: 10.3390/microorganisms12040658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024] Open
Abstract
Serology routinely serves as a diagnostic tool to confirm Chlamydia infections in humans. Particularly in delayed settings, such as post-outbreak scenarios where the acute phase of infection has subsided, serology is invaluable. Multiple studies, nonetheless, indicate deficiencies in specificity and sensitivity of current chlamydial antibody detection assays. Incorporation of multiple antigens per target is known to improve the accuracy of chlamydial serological assays. We, therefore, used the recomLine test (Mikrogen diagnostics) on serological samples of two cohorts, as it is the only commercially available test allowing detection of antibodies against three human pathogenic Chlamydia species (C. trachomatis, C. pneumoniae and C. psittaci) using multiple antigens per target. The first cohort (n = 156; samples collected between 2008 and 2022 during a C. trachomatis screening initiative) comprised women from the Netherlands (NL) with past exposure to C. trachomatis, while the second cohort (n = 44; samples collected in 2018 in a health examination survey) consisted of Belgian citizens (BE) with occupational or recreational exposure to chickens, representing a risk population for C. psittaci. The test indicated a statistically equivalent C. pneumoniae seroprevalence in both cohorts (39.10% in NL and 34.09% in BE; p = 0.337). As expected C. trachomatis seroprevalence was significantly higher (p < 0.001) in the Dutch cohort (48.72%), as compared to the Belgian cohort (4.55%). Lastly, C. psittaci seroprevalence did not significantly differ between the two groups (2.27% in BE and 1.92% in NL; p = 0.633), even though a higher prevalence was expected for the Belgian cohort. This prompts us to question whether the Belgian cohort truly constituted a C. psittaci risk population or whether the recomLine test is susceptible to cross-reaction of species-specific antibodies, thereby increasing C. psittaci prevalence in the Dutch cohort. We advocate for the development of affordable, highly sensitive antibody detection assays that can effectively distinguish between chlamydial species, addressing the increasing demand for enhanced serological testing methodologies.
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Affiliation(s)
- Anne De Meyst
- Laboratory of Immunology and Animal Biotechnology, Department of Animal Sciences and Aquatic Ecology, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium;
| | - Zoïe Alexiou
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands;
- Institute for Public Health Genomics (IPHG), GROW Research Institute for Oncology and Reproduction, Maastricht University, 6211 LK Maastricht, The Netherlands;
| | - Tinne Lernout
- Epidemiology of Infectious Diseases, Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium;
| | - Servaas A. Morré
- Institute for Public Health Genomics (IPHG), GROW Research Institute for Oncology and Reproduction, Maastricht University, 6211 LK Maastricht, The Netherlands;
- Dutch Chlamydia trachomatis Reference Laboratory, Deptartment Medical Microbiology, Faculty of Health, Medicine & Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad 211007, Uttar Pradesh, India
| | - Daisy Vanrompay
- Laboratory of Immunology and Animal Biotechnology, Department of Animal Sciences and Aquatic Ecology, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium;
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Tran PB, Nikolaidis GF, Abatih E, Bos P, Berete F, Gorasso V, Van der Heyden J, Kazibwe J, Tomeny EM, Van Hal G, Beutels P, van Olmen J. Multimorbidity healthcare expenditure in Belgium: a 4-year analysis (COMORB study). Health Res Policy Syst 2024; 22:35. [PMID: 38519938 PMCID: PMC10960468 DOI: 10.1186/s12961-024-01113-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/24/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND The complex management of health needs in multimorbid patients, alongside limited cost data, presents challenges in developing cost-effective patient-care pathways. We estimated the costs of managing 171 dyads and 969 triads in Belgium, taking into account the influence of morbidity interactions on costs. METHODS We followed a retrospective longitudinal study design, using the linked Belgian Health Interview Survey 2018 and the administrative claim database 2017-2020 hosted by the Intermutualistic Agency. We included people aged 15 and older, who had complete profiles (N = 9753). Applying a system costing perspective, the average annual direct cost per person per dyad/triad was presented in 2022 Euro and comprised mainly direct medical costs. We developed mixed models to analyse the impact of single chronic conditions, dyads and triads on healthcare costs, considering two-/three-way interactions within dyads/triads, key cost determinants and clustering at the household level. RESULTS People with multimorbidity constituted nearly half of the study population and their total healthcare cost constituted around three quarters of the healthcare cost of the study population. The most common dyad, arthropathies + dorsopathies, with a 14% prevalence rate, accounted for 11% of the total national health expenditure. The most frequent triad, arthropathies + dorsopathies + hypertension, with a 5% prevalence rate, contributed 5%. The average annual direct costs per person with dyad and triad were €3515 (95% CI 3093-3937) and €4592 (95% CI 3920-5264), respectively. Dyads and triads associated with cancer, diabetes, chronic fatigue, and genitourinary problems incurred the highest costs. In most cases, the cost associated with multimorbidity was lower or not substantially different from the combined cost of the same conditions observed in separate patients. CONCLUSION Prevalent morbidity combinations, rather than high-cost ones, made a greater contribution to total national health expenditure. Our study contributes to the sparse evidence on this topic globally and in Europe, with the aim of improving cost-effective care for patients with diverse needs.
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Affiliation(s)
- Phuong Bich Tran
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.
- Department of Epidemiology and public health, Brussels, Belgium.
| | | | - Emmanuel Abatih
- Department of Applied Mathematics, Computer Sciences and Statistics, Ghent University, Ghent, Belgium
| | - Philippe Bos
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Finaba Berete
- Department of Epidemiology and public health, Brussels, Belgium
| | - Vanessa Gorasso
- Department of Epidemiology and public health, Brussels, Belgium
| | | | - Joseph Kazibwe
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Ewan Morgan Tomeny
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Guido Van Hal
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research & Modelling Infectious Diseases (CHERMID), University of Antwerp, Antwerp, Belgium
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
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Pelgrims I, Devleesschauwer B, Vandevijvere S, De Clercq EM, Vansteelandt S, Gorasso V, Van der Heyden J. Using random-forest multiple imputation to address bias of self-reported anthropometric measures, hypertension and hypercholesterolemia in the Belgian health interview survey. BMC Med Res Methodol 2023; 23:69. [PMID: 36966305 PMCID: PMC10040120 DOI: 10.1186/s12874-023-01892-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/16/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND In many countries, the prevalence of non-communicable diseases risk factors is commonly assessed through self-reported information from health interview surveys. It has been shown, however, that self-reported instead of objective data lead to an underestimation of the prevalence of obesity, hypertension and hypercholesterolemia. This study aimed to assess the agreement between self-reported and measured height, weight, hypertension and hypercholesterolemia and to identify an adequate approach for valid measurement error correction. METHODS Nine thousand four hundred thirty-nine participants of the 2018 Belgian health interview survey (BHIS) older than 18 years, of which 1184 participated in the 2018 Belgian health examination survey (BELHES), were included in the analysis. Regression calibration was compared with multiple imputation by chained equations based on parametric and non-parametric techniques. RESULTS This study confirmed the underestimation of risk factor prevalence based on self-reported data. With both regression calibration and multiple imputation, adjusted estimation of these variables in the BHIS allowed to generate national prevalence estimates that were closer to their BELHES clinical counterparts. For overweight, obesity and hypertension, all methods provided smaller standard errors than those obtained with clinical data. However, for hypercholesterolemia, for which the regression model's accuracy was poor, multiple imputation was the only approach which provided smaller standard errors than those based on clinical data. CONCLUSIONS The random-forest multiple imputation proves to be the method of choice to correct the bias related to self-reported data in the BHIS. This method is particularly useful to enable improved secondary analysis of self-reported data by using information included in the BELHES. Whenever feasible, combined information from HIS and objective measurements should be used in risk factor monitoring.
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Affiliation(s)
- Ingrid Pelgrims
- Service Risk and Health Impact Assessment, Sciensano, Rue Juliette Wytsman 14, 1050, Brussels, Belgium.
- Applied Mathematics, Computer Science and Statistics, Ghent University, Krijgslaan 281, S9, BE-9000, Ghent, Belgium.
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, 1050, Brussels, Belgium.
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, 1050, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Salisburylaan 133, Hoogbouw, B-9820, Merelbeke, Belgium
| | - Stefanie Vandevijvere
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, 1050, Brussels, Belgium
| | - Eva M De Clercq
- Service Risk and Health Impact Assessment, Sciensano, Rue Juliette Wytsman 14, 1050, Brussels, Belgium
| | - Stijn Vansteelandt
- Applied Mathematics, Computer Science and Statistics, Ghent University, Krijgslaan 281, S9, BE-9000, Ghent, Belgium
| | - Vanessa Gorasso
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, 1050, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Johan Van der Heyden
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, 1050, Brussels, Belgium
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De Pauw R, Claessens M, Gorasso V, Drieskens S, Faes C, Devleesschauwer B. Past, present, and future trends of overweight and obesity in Belgium using Bayesian age-period-cohort models. BMC Public Health 2022; 22:1309. [PMID: 35799159 PMCID: PMC9263047 DOI: 10.1186/s12889-022-13685-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background Overweight and obesity are one of the most significant risk factors of the twenty-first century related to an increased risk in the occurrence of non-communicable diseases and associated increased healthcare costs. To estimate the future impact of overweight, the current study aimed to project the prevalence of overweight and obesity to the year 2030 in Belgium using a Bayesian age-period-cohort (APC) model, supporting policy planning. Methods Height and weight of 58,369 adults aged 18+ years, collected in six consecutive cross-sectional health interview surveys between 1997 and 2018, were evaluated. Criteria used for overweight and obesity were defined as body mass index (BMI) ≥ 25, and BMI ≥ 30. Past trends and projections were estimated with a Bayesian hierarchical APC model. Results The prevalence of overweight and obesity has increased between 1997 and 2018 in both men and women, whereby the highest prevalence was observed in the middle-aged group. It is likely that a further increase in the prevalence of obesity will be seen by 2030 with a probability of 84.1% for an increase in cases among men and 56.0% for an increase in cases among women. For overweight, it is likely to see an increase in cases in women (57.4%), while a steady state in cases among men is likely. A prevalence of 52.3% [21.2%; 83.2%] for overweight, and 27.6% [9.9%; 57.4%] for obesity will likely be achieved in 2030 among men. Among women, a prevalence of 49,1% [7,3%; 90,9%] for overweight, and 17,2% [2,5%; 61,8%] for obesity is most likely. Conclusions Our projections show that the WHO target to halt obesity by 2025 will most likely not be achieved. There is an urgent necessity for policy makers to implement effective prevent policies and other strategies in people who are at risk for developing overweight and/or obesity. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13685-w.
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Affiliation(s)
- Robby De Pauw
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, BE-1050, Brussels, Belgium. .,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Manu Claessens
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, BE-1050, Brussels, Belgium
| | - Vanessa Gorasso
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, BE-1050, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sabine Drieskens
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, BE-1050, Brussels, Belgium
| | - Christel Faes
- Data Science Institute, the Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, BE-1050, Brussels, Belgium.,Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
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Mertens E, Sagastume D, Peñalvo JL. Quantification of disparities in the distribution of lifestyle and metabolic risk factors, prevalence of non-communicable diseases and related mortality: the Belgian Health Interview Surveys 1997-2018. BMJ Open 2021; 11:e053260. [PMID: 34810190 PMCID: PMC8609944 DOI: 10.1136/bmjopen-2021-053260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Comprehensively measure the trends in health disparities by sociodemographic strata in terms of exposure to lifestyle and metabolic risks, and prevalence and mortality of non-communicable diseases (NCDs) during the last 20 years in Belgium. DESIGN Cross-sectional analysis of periodic national-representative health interview surveys and vital statistics. SETTING Population-based study of adult residents in Belgium between 1997 and 2018. PARTICIPANTS Adults aged 25-84 years and resident in Belgium in the years 1997 (7256 adults), 2001 (8665), 2004 (9054), 2008 (7343), 2013 (7704) and 2018 (8358). MAIN OUTCOME MEASURE Age-standardised prevalence rates of modifiable lifestyle risks (poor diet, smoking, excessive alcohol use and leisure-time physical inactivity), metabolic risks (high body mass index (BMI), blood pressure and cholesterol levels) and major NCDs (type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVDs), cancer, asthma and chronic obstructive pulmonary disease (COPD)), with their relative health disparities across strata by age, sex, region of residence, nationality, education and income level, and according to high versus low engagement in the four lifestyle risks, calculated from a survey-weighted age-adjusted logistic regression. RESULTS Greater avoidable disparities were observed between extremes of education and income strata. The most marked disparities were found for exposure to lifestyle risks (except excessive alcohol use), prevalence of high BMI as well as T2DM, asthma and COPD, with disparities of daily smoking and COPD worsening over time. Still, NCD-specific mortality rates were significantly higher among men (except asthma), residents of Wallonia and Brussels (except cerebrovascular disease), and among the native Belgians (except T2DM and asthma). High engagement in lifestyle risks was generally observed for men, residents of the region Wallonia, and among lower education and income strata. This subgroup (20%) had a worse health profile as compared with those who had a low-risk lifestyle (25%), shown by prevalence ratios varying between 1.1 and 1.6 for metabolic risks, and between 1.8 and 3.7 for CVD, asthma and COPD. CONCLUSIONS Improving population health, including promoting greater health equity, requires approaches to be tailored to high-risk groups with actions tackling driving root causes of disparities seen by social factors and unhealthy lifestyle.
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Affiliation(s)
- Elly Mertens
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Diana Sagastume
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - José L Peñalvo
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Hepatitis C virus prevalence in Belgium. EXPERIMENTAL RESULTS 2021. [DOI: 10.1017/exp.2021.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
Reliable hepatitis C prevalence estimates are crucial for a good follow-up of the indicators to eliminate hepatitis by 2030 as set by the World Health Organization. In Belgium, no recent national population-based hepatitis C virus (HCV) seroprevalence estimate is available. The current study estimated HCV prevalence as part of the first Belgian Health Examination Survey, which was organized in 2018 as a second stage of the sixth Belgian Health Interview Survey. This national population-based cross-sectional study resulted in a weighted national HCV seroprevalence of 0.02% (95% CI 0.00–0.07%). The results show a much lower HCV seroprevalence compared to previous studies.
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Fischer N, Peeters I, Klamer S, Montourcy M, Cuylaerts V, Van Beckhoven D, De Baetselier I, Van der Heyden J, Vanden Berghe W. Prevalence estimates of genital Chlamydia trachomatis infection in Belgium: results from two cross-sectional studies. BMC Infect Dis 2021; 21:947. [PMID: 34521367 PMCID: PMC8439092 DOI: 10.1186/s12879-021-06646-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/01/2021] [Indexed: 01/06/2023] Open
Abstract
Background Chlamydia trachomatis (chlamydia) is the most diagnosed sexually transmitted infection in Belgium. Screening programs focus on young women, due to the implications of chronic asymptomatic infections for reproductive health. Thereby, the frequency of infections in men and older adults is underestimated. This study aimed to estimate the point-prevalence of chlamydia in the broader Belgian population, to inform evidence-based prevention and control strategies. Methods We conducted two cross-sectional prevalence studies of chlamydia infection in the population of Belgium aged 16–59 years, 2018–2020. In the CT1 study 12,000 representative individuals were randomly selected from the national register and invited by letter to collect a urine sample at home. The CT2 study used urine samples collected through the Belgian Health Examination Survey. Molecular detection of chlamydia DNA was performed using Xpert® or Abbott Real-Time CT/NG assays. Weighted estimated prevalence and 95% confidence interval (CI) was calculated per gender and age groups of 16/18–29, 30–44 and 45–59 years, relative to the general Belgian population. Data collected on sociodemographic variables and sexual behavior were used to identify potential risk factors for chlamydia infection through calculation of the odds ratio (OR). Results The population-wide weighted estimated prevalence was 1.54% (95% CI 0.78–3) in CT1 and 1.76% (95% CI 0.63–4) in CT2. We observed no statistically significant difference between men and women or age groups. Civil relationship status (OR = 14.1 (95% CI 1.78–112), p < 0.01), sexual intercourse with a casual partner (OR = 6.31 (95% CI 1.66–24.1), p < 0.01) and > 3 sexual partners in the last 12 months (OR = 4.53 (95% CI 1.10–18.6), p = 0.02) were associated with higher relative risk for chlamydia infection. Conclusion Nationwide prevalence studies are relevant to assess the distribution of chlamydia and inform public health actions. The overall low prevalence and heterogeneous distribution of chlamydia in the general Belgian population needs to be considered for future strategies and potential harm of testing and treating asymptomatic individuals need to be taken into account. Effective case management should include appropriate treatment of symptomatic patients and partner notification, and prevention strategies should encourage behaviors such as condom use. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06646-y.
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Affiliation(s)
- Natalie Fischer
- Service Epidemiology of Infectious Diseases, Sciensano, Rue Ernest Blerot 1, 1070, Anderlecht, Belgium. .,European Programme for Public Health Microbiology (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Gustav III:s Boulevard 40, 169 73, Solna, Sweden.
| | - Ilse Peeters
- Service Epidemiology of Infectious Diseases, Sciensano, Rue Ernest Blerot 1, 1070, Anderlecht, Belgium
| | - Sofieke Klamer
- Service Epidemiology of Infectious Diseases, Sciensano, Rue Ernest Blerot 1, 1070, Anderlecht, Belgium
| | - Marion Montourcy
- Service Epidemiology of Infectious Diseases, Sciensano, Rue Ernest Blerot 1, 1070, Anderlecht, Belgium
| | - Vicky Cuylaerts
- Department of Clinical Sciences, National Reference Centre for Sexually Transmitted Infections, Clinical Reference Laboratory, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Dominique Van Beckhoven
- Service Epidemiology of Infectious Diseases, Sciensano, Rue Ernest Blerot 1, 1070, Anderlecht, Belgium
| | - Irith De Baetselier
- Department of Clinical Sciences, National Reference Centre for Sexually Transmitted Infections, Clinical Reference Laboratory, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Johan Van der Heyden
- Service Lifestyle and Chronic Diseases, Sciensano, Rue Ernest Blerot 1, 1070, Anderlecht, Belgium
| | - Wim Vanden Berghe
- Service Epidemiology of Infectious Diseases, Sciensano, Rue Ernest Blerot 1, 1070, Anderlecht, Belgium
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Hautekiet P, Nawrot TS, Demarest S, Van der Heyden J, Van Overmeire I, De Clercq EM, Saenen ND. Environmental exposures and health behavior in association with mental health: a study design. Arch Public Health 2020; 78:105. [PMID: 33093954 PMCID: PMC7576706 DOI: 10.1186/s13690-020-00477-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/22/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Air pollution, green space and smoking are known to affect human health. However, less is known about their underlying biological mechanisms. One of these mechanisms could be biological aging. In this study, we explore the mediation of biomarkers of exposure and biological aging to explain the associations between environmental exposures, health behavior and mental health. METHODS The study population of this cross-sectional study (n = 1168) is a subsample of the Belgian 2018 Health Interview Survey (BHIS). Mental health indicators including psychological and severe psychological distress, life satisfaction, vitality, eating disorders, suicidal ideation, subjective health and depressive and anxiety disorders, demographics and health behavior such as smoking are derived from the BHIS. Urine and blood samples are collected to measure respectively the biomarkers of exposure (urinary black carbon (BC) and (hydroxy)cotinine) and the biomarkers of biological aging (mitochondrial DNA content (mtDNAc) and telomere length (TL)). Recent and chronic exposure (μg/m3) to nitrogen dioxide (NO2), particulate matter ≤2.5 μm (PM2.5) and ≤ 10 μm (PM10) and BC at the participants' residence are modelled using a high resolution spatial temporal interpolation model. Residential green space is defined in buffers of different size (50 m - 5000 m) using land cover data in ArcGIS 10 software. For the statistical analysis multivariate linear and logistic regressions as well as mediation analyses are used taking into account a priori selected covariates and confounders. RESULTS As this study combined data of BHIS and laboratory analyses, not all data is available for all participants. Therefore, data analyses will be conducted on different subsets. Data on air pollution and green space exposure is available for all BHIS participants. Questions on smoking and mental health were answered by respectively 7829 and 7213 BHIS participants. For biomarker assessment, (hydroxy) cotinine, urinary BC and the biomarkers of biological aging are measured for respectively 1130, 1120 and 985 participants. CONCLUSION By use of personal markers of air pollution and smoking, as well as biological aging, we will gain knowledge about the association between environmental exposures, health behavior, and the mental health status. The results of the study can provide insights on the health of the Belgian population, making it a nationwide interesting study.
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Affiliation(s)
- Pauline Hautekiet
- Sciensano, Brussels, Belgium
- Centre for Environmental Sciences, Hasselt University, Agoralaan gebouw D, BE-3590 Hasselt, Belgium
| | - Tim S. Nawrot
- Centre for Environmental Sciences, Hasselt University, Agoralaan gebouw D, BE-3590 Hasselt, Belgium
- Centre for Environment and Health, Leuven University, Leuven, Belgium
| | | | | | | | | | - Nelly D. Saenen
- Sciensano, Brussels, Belgium
- Centre for Environmental Sciences, Hasselt University, Agoralaan gebouw D, BE-3590 Hasselt, Belgium
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Urinary sodium and iodine concentrations among Belgian adults: results from the first national Health Examination Survey. Eur J Clin Nutr 2020; 75:689-696. [PMID: 33033379 DOI: 10.1038/s41430-020-00766-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 08/11/2020] [Accepted: 09/22/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND/OBJECTIVES Iodine deficiency and excessive salt intakes have adverse health consequences. The objective was to measure sodium and iodine concentrations in urine spot samples among a representative sample of Belgian adults and compare those to World Health Organization (WHO) recommendations. SUBJECTS/METHODS Spot urine samples were collected in 2018 from participants of the Belgian Health Examination Survey. Iodine and sodium concentrations were measured by inductively coupled plasma mass spectrometry and ion selective electrodes respectively. Tanaka and INTERSALT equations were used to predict 24-h urinary sodium excretion using sodium and creatinine concentration in spot samples, sex, and measured height and weight. RESULTS Median urinary iodine concentration (UIC) among adults (n = 1092) was 93.6 µg/L, indicating mild iodine deficiency according to WHO thresholds. Median UIC among participants who reported thyroid problems over the last year was significantly higher than among those who did not report thyroid problems (104.1 µg/L versus UIC = 92.2 µg/L, p < 0.001). There were no significant differences in median UIC between sexes, age groups, and regions. The average salt intake among Belgian adults (n = 1120) was 8.3 ± 0.1 g/day using the Tanaka equation and 9.4 ± 0.1 g/day using the INTERSALT equation. For both equations, <5% of the population met the recommended WHO upper salt intake level of 5 g/day. CONCLUSIONS Iodine nutrition in the Belgian adult, nonpregnant population likely indicates mild iodine deficiency as the median UIC was below the WHO threshold for iodine sufficiency. Salt intake was substantially higher than the WHO recommendations. Further policy efforts are needed to optimize iodine and reduce salt intake in Belgium.
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