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Fronek E, Martins S, Contag S. Prevalence of hypertensive disorders of pregnancy at or beyond 39 weeks gestational age and associated maternal complications. Hypertens Pregnancy 2023; 42:2217452. [PMID: 37272659 DOI: 10.1080/10641955.2023.2217452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Estimate the prevalence of hypertensive disorder of pregnancy (HDP) at term, define population characteristics, and calculate adverse maternal outcomes. METHODS Retrospective study. RESULTS We included 4,702,468 pregnancies. HDP increased linearly from 4.5% (2014) to 6.0% (2018). HDP was more frequent among black (PR 1.19), obese (PR 2.31 to 3.70), with gestational (PR 1.87) or pregestational diabetes (PR 2.16). Increased transfusion (PR 2.52), intensive care unit admission (PR 3.38), and unplanned hysterectomy (PR 1.78) with HDP. CONCLUSION Our study quantifies the increased risks for maternal and neonatal complications related to the development of HDP at or beyond 39 weeks among nulliparous women.
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Affiliation(s)
- Elizabeth Fronek
- Obstetrics and Gynecology, Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, USA
| | - Summer Martins
- Obstetrics and Gynecology, Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, USA
| | - Stephen Contag
- Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, USA
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Hwang Y, Ahuja KR, Haque SM, Jones GF, Naseer A, Shechter O, Siddiqui S, Qayyum R. Anemia prevalence time trends and disparities in the US population: examination of NHANES 1999-2020. J Investig Med 2023; 71:286-294. [PMID: 36803039 DOI: 10.1177/10815589221140597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
While a rising prevalence of anemia in the United States was reported in older studies, recent data are lacking. To estimate the prevalence and time trends of anemia in the United States and to examine how these estimates differ by gender, age, race, and household income to poverty threshold ratio (HIPR), we used the National Health and Nutrition Examination Surveys from 1999 to 2020. The presence of anemia was determined using the World Health Organization criteria. Survey-weighted raw and adjusted prevalence ratios (PRs) were determined using generalized linear models for the overall population and by gender, age, race, and HIPR. In addition, an interaction between gender and race was explored. Complete data on anemia, age, gender, and race were available on 87,554 participants (mean age = 34.6 years, women = 49.8%, Whites = 37.3%). Anemia prevalence increased from 4.03% during the 1999-2000 survey cycle to 6.49% during 2017-2020. In adjusted analyses, anemia prevalence was higher in >65 than in 26-45 years old (PR = 2.14, 95% confidence interval (CI) = 1.95, 2.35), in Blacks than Whites (PR = 3.97, 95% CI = 3.63, 4.35), in women than men (PR = 1.98, 95% CI = 1.83, 2.13), and in those with HIPR ≤ 1 than >4 (PR = 0.68, 95% CI = 0.61, 0.75). Gender modified the relationship between anemia and race; when compared to their male counterparts, Black, Hispanic, and other women had higher anemia prevalence than White women (all interaction p values <0.05). The anemia prevalence in the United States has risen from 1999 to 2020 and remains high among the elderly, minorities, and women. The difference in anemia prevalence between men and women is larger in non-Whites.
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Affiliation(s)
- Yunjoo Hwang
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Kripa R Ahuja
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Syed M Haque
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - George F Jones
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Adan Naseer
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Oren Shechter
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Simrah Siddiqui
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Rehan Qayyum
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
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Kukimoto I, Onuki M, Yamamoto K, Yahata H, Aoki Y, Yokota H, Konnai K, Nio A, Takehara K, Kamiura S, Tsuda N, Takei Y, Shimada M, Nakai H, Yoshida H, Motohara T, Yamazaki H, Nakamura K, Okunomiya A, Tasaka N, Ishikawa M, Hirashima Y, Shimoji Y, Mori M, Iwata T, Takahashi F, Yoshikawa H, Yaegashi N, Matsumoto K. Regional differences in human papillomavirus type 52 prevalence among Japanese women with cervical intraepithelial neoplasia†. Jpn J Clin Oncol 2022; 52:1242-1247. [PMID: 35938523 DOI: 10.1093/jjco/hyac127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
Although geographical differences in the distribution of human papillomavirus genotypes have been observed worldwide, no studies have reported on national differences in the prevalence of human papillomavirus types in Japan. Here, we report a cross-sectional study to explore regional differences in the prevalence of human papillomavirus types among Japanese women with cervical intraepithelial neoplasia or invasive cervical cancer. Using human papillomavirus genotyping data from the nationwide prospective study on human papillomavirus vaccine effectiveness, we compared the frequency of detection of 15 high-risk and two low-risk human papillomavirus types in each disease category between the women who visited hospitals located in eastern Japan and those who visited hospitals located in western Japan. The risk of cervical intraepithelial neoplasia progression was assessed by calculating a prevalence ratio of each human papillomavirus type for cervical intraepithelial neoplasia grade 2/3 versus grade 1. Among the human papillomavirus types studied, human papillomavirus 52 was detected significantly more frequently in western hospitals than in eastern hospitals in cervical intraepithelial neoplasia grade 1 patients, but was less frequent in cervical intraepithelial neoplasia grade 2/3. The prevalence of particular human papillomavirus types was not significantly different between patients in hospitals in eastern Japan and those in hospitals in western Japan for invasive cervical cancer. In both eastern and western hospitals, a higher risk of cervical intraepithelial neoplasia progression was observed in patients infected with human papillomavirus 16, 31 or 58. In contrast, there was a significantly higher prevalence of human papillomavirus 52 infection in women with cervical intraepithelial neoplasia grade 2/3 than in those with cervical intraepithelial neoplasia grade 1 in eastern hospitals (prevalence ratio, 1.93; 95% confidence interval, 1.48-2.58), but not in western hospitals (prevalence ratio, 1.03; 95% confidence interval, 0.83-1.30). Regional differences of human papillomavirus 52 prevalence in cervical intraepithelial neoplasia lesions may exist and emphasize the importance of continuous monitoring of human papillomavirus type prevalence throughout the country in order to accurately assess the efficacy of human papillomavirus vaccines.
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Affiliation(s)
- Iwao Kukimoto
- Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Mamiko Onuki
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Kasumi Yamamoto
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Hideaki Yahata
- Department of Gynecology and Obstetrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoichi Aoki
- Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan
| | | | - Katsuyuki Konnai
- Department of Gynecology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Ai Nio
- Gynecology Service, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Kazuhiro Takehara
- Department of Gynecologic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Shoji Kamiura
- Department of Gynecology, Osaka International Cancer Institute, Osaka, Japan
| | - Naotake Tsuda
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan
| | - Yuji Takei
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Muneaki Shimada
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hidekatsu Nakai
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hiroyuki Yoshida
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Takeshi Motohara
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Yamazaki
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Keiichiro Nakamura
- Department of Obstetrics and Gynecology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Asuka Okunomiya
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nobutaka Tasaka
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuyuki Hirashima
- Division of Gynecology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yuko Shimoji
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Mayuyo Mori
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Iwata
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Fumiaki Takahashi
- Division of Medical Engineering, Department of Information Science, Iwate Medical University, Yahaba, Japan
| | - Hiroyuki Yoshikawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koji Matsumoto
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
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Mu XM, Wang W, Wu FY, Jiang YY, Ma LL, Feng J. Comorbidity in Older Patients Hospitalized with Cancer in Northeast China based on Hospital Discharge Data. Int J Environ Res Public Health 2020; 17:E8028. [PMID: 33142785 PMCID: PMC7663481 DOI: 10.3390/ijerph17218028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/24/2022]
Abstract
Patients with cancer often carry the dual burden of the cancer itself and other co-existing medical conditions. The problems associated with comorbidities among elderly cancer patients are more prominent compared with younger patients. This study aimed to identify common cancer-related comorbidities in elderly patients through routinely collected hospital discharge data and to use association rules to analyze the prevalence and patterns of these comorbidities in elderly cancer patients at different cancer sites. We collected the discharge data of 80,574 patients who were diagnosed with cancers of the esophagus, stomach, colorectum, liver, lung, female breast, cervix, and thyroid between 2016 and 2018. The same number of non-cancer patients were randomly selected as the control group and matched with the case group by age and gender. The results showed that cardiovascular diseases, metabolic diseases, digestive diseases, and anemia were the most common comorbidities in elderly patients with cancer. The comorbidity patterns differed based on the cancer site. Elderly patients with liver cancer had the highest risk of comorbidities, followed by lung cancer, gastrointestinal cancer, thyroid cancer, and reproductive cancer. For example, elderly patients with liver cancer had the higher risk of the comorbid infectious and digestive diseases, whereas patients with lung cancer had the higher risk of the comorbid respiratory system diseases. The findings can assist clinicians in diagnosing comorbidities and contribute to the allocation of medical resources.
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Affiliation(s)
- Xiao-Min Mu
- Department of Medical Informatics, School of Public Health, Jilin University, Changchun 130021, China; (X.-M.M.); (W.W.); (Y.-Y.J.); (L.-L.M.)
| | - Wei Wang
- Department of Medical Informatics, School of Public Health, Jilin University, Changchun 130021, China; (X.-M.M.); (W.W.); (Y.-Y.J.); (L.-L.M.)
| | - Fang-Yi Wu
- Information Research Center of Military Sciences, Academy of Military Sciences, Beijing 100039, China;
| | - Yu-Ying Jiang
- Department of Medical Informatics, School of Public Health, Jilin University, Changchun 130021, China; (X.-M.M.); (W.W.); (Y.-Y.J.); (L.-L.M.)
| | - Ling-ling Ma
- Department of Medical Informatics, School of Public Health, Jilin University, Changchun 130021, China; (X.-M.M.); (W.W.); (Y.-Y.J.); (L.-L.M.)
| | - Jia Feng
- Department of Medical Informatics, School of Public Health, Jilin University, Changchun 130021, China; (X.-M.M.); (W.W.); (Y.-Y.J.); (L.-L.M.)
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Altman E, Mounir I, Najid FZ, Perlaza SM. On the True Number of COVID-19 Infections: Effect of Sensitivity, Specificity and Number of Tests on Prevalence Ratio Estimation. Int J Environ Res Public Health 2020; 17:E5328. [PMID: 32722110 PMCID: PMC7432803 DOI: 10.3390/ijerph17155328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 12/28/2022]
Abstract
In this paper, a formula for estimating the prevalence ratio of a disease in a population that is tested with imperfect tests is given. The formula is in terms of the fraction of positive test results and test parameters, i.e., probability of true positives (sensitivity) and the probability of true negatives (specificity). The motivation of this work arises in the context of the COVID-19 pandemic in which estimating the number of infected individuals depends on the sensitivity and specificity of the tests. In this context, it is shown that approximating the prevalence ratio by the ratio between the number of positive tests and the total number of tested individuals leads to dramatically high estimation errors, and thus, unadapted public health policies. The relevance of estimating the prevalence ratio using the formula presented in this work is that precision increases with the number of tests. Two conclusions are drawn from this work. First, in order to ensure that a reliable estimation is achieved with a finite number of tests, testing campaigns must be implemented with tests for which the sum of the sensitivity and the specificity is sufficiently different than one. Second, the key parameter for reducing the estimation error is the number of tests. For a large number of tests, as long as the sum of the sensitivity and specificity is different than one, the exact values of these parameters have very little impact on the estimation error.
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Affiliation(s)
- Eitan Altman
- INRIA, Centre de Recherche de Sophia Antipolis-Mediterranee, 2004 Route des Lucioles, BP 93, 06902 Sophia Antipolis CEDEX, France;
- Laboratoire Informatique d’Avignon, Campus Jean-Henri Fabre, Avignon Universite, 84 911 Avignon, France
- Laboratory of Information, Network and Communication Sciences, Avignon Universite, 75013 Paris, France
| | - Izza Mounir
- Centre Hospitalier Universitaire de Nice, School of Medicine, Université Côte D’Azur, 30 Voie Romaine, 06000 Nice, France;
| | - Fatim-Zahra Najid
- Centre Hospitalier Universitaire Amiens Picardie, School of Medicine, Université de Picardie Jules Verne, 1 Rue du Professeur Christian Cabrol, 80054 Amiens, France;
| | - Samir M. Perlaza
- INRIA, Centre de Recherche de Sophia Antipolis-Mediterranee, 2004 Route des Lucioles, BP 93, 06902 Sophia Antipolis CEDEX, France;
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González G, Vives A. Work Status, Financial Stress, Family Problems, and Gender Differences in the Prevalence of Depression in Chile. Ann Work Expo Health 2020; 63:359-370. [PMID: 30624612 DOI: 10.1093/annweh/wxy107] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/24/2018] [Accepted: 12/06/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION It is widely known that women have a higher prevalence of depression than men. These differences may be explained by social differences between women and men due to gender roles. In Chile, as elsewhere, women have greater household responsibilities, lower job incomes, and especially low labor market participation. However, the incidence of these gender differences on the higher prevalence of depression in women requires further study in the Chilean context. OBJECTIVE To identify main social differences between women and men associated with gender differences in the prevalence of depression in middle-aged Chilean men and women. DATA SOURCE Data comes from the second Chilean National Health Survey (2009-2010), a cross-sectional, nationally representative sample (n = 2771) composed of 1103 men and 1668 women (39.8 and 60.2%, respectively), whose age range goes from 25 to 55 years old. This study was approved by the Ethics Committee of Pontificia Universidad Católica de Chile. METHODS Prevalence ratios were calculated through Poisson regression models to estimate associations between the prevalence of past episodes of depression and social stressful life events variables for men and women separately. Gender prevalence ratios of depression (Gender PR) adjusted for age and subsequently adjusted by the social and stressful life events variables. The analyses considered factors such as age, educational level, per-capita household income, work status, role as the head of household, marital status, events of violence, family problems, personal health problems or accidents, and self-reported financial stress. RESULTS This study finds that doing housework, reporting a serious family problem and having high financial stress were associated with a higher prevalence of depression in both genders. Whereas, health problems were only associated with prevalence in men. The age-adjusted gender PR was 2.84 [confidence interval (CI): 2.0-4.1], and when all selected variables were included attenuated to a PR of 1.86 (CI 1.3-2.7). The variable most strongly associated with depression in the fully-adjusted model was housework (PR: 5.3; CI: 1.3-21.0). CONCLUSION In conclusion, this study finds that depression in in Chile is associated with social factors such as participation in housework, family problems, and financial stress, all of which are more common in women. To make further progress in the study of this public health problem in Chile, it is essential to incorporate more detailed characterization of gender roles in surveys and other studies. Likewise, social policies and interventions that contribute to reduce gender social inequalities in the exposure to adverse life circumstances can contribute to reduce unnecessary and avoidable gender disparities in health.
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Affiliation(s)
- Gabriel González
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,School of Psychology, Universidad de las Américas, Providencia, Chile
| | - Alejandra Vives
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,CEDEUS (Conicyt/Fondap/15110020), ACCDIS (Conicyt/Fondap/15130011), Providencia, Chile
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Lee SJ, Kim EM, Cho SH, Song J, Jang TW, Lee MY. Risk of olfactory dysfunction of the workers in the automobile repair, printing, shoemaking and plating industries in Korea: a cross-sectional study. BMJ Open 2018; 8:e022678. [PMID: 30391915 PMCID: PMC6231553 DOI: 10.1136/bmjopen-2018-022678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The present study was performed to investigate the prevalence of olfactory dysfunction in workers exposed to hazardous substances in a variety of occupations in Korea. METHODS We designed a cross-sectional study. The exposed group (n=296) consisted of Korean workers in the automobile repair, printing, shoemaking and plating industries and was compared with office workers (non-exposed group, n=99). A self-report questionnaire was administered to the subjects for demographic characteristics. In addition, olfactory function was evaluated using the Korean version of Sniffin's Stick (KVSS) I and II test, which has been reported to be valid and reliable in Korean subjects. KVSS I score ≥7 or KVSS II score ≥30 was classified as normal, KVSS I score <7 or KVSS II score <30 was classified as oflactory dysfunction. The statistical analyses were performed with olfactory dysfunction as a dependent variable to calculate prevalence ratio (PR) of the exposed group. RESULTS The prevalence of olfactory dysfunction was 21.2% in office, 45.1% in automobile repair, 69.7% in printing and 88.9% in shoemaking and plating workers. The adjusted PR was highest in plating (3.589, 95% CI 1.957 to 6.583), followed by shoemaking (3.136, 95% CI 1.763 to 5.579), printing (2.669, 95% CI 1.610 to 4.424) and automobile repair (1.914, 95% CI 1.105 to 3.317) workers. CONCLUSIONS In comparison with office workers, the prevalence of olfactory dysfunction and the PR of olfactory dysfunction were very high in the four occupational groups. This finding could be an important basis for establishing the olfactory dysfunction prevention policy for workers who are exposed to hazardous substances or work in high-risk occupations.
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Affiliation(s)
- Soo-Jin Lee
- Department of Occupational and Environmental Medicine, Hanyang University Medical Center, Seoul, Korea
| | - Eun-Mi Kim
- Graduate School of Public Health, Hanyang University, Seoul, Korea
| | - Seok-Hyun Cho
- Department of Otolaryngology, Hanyang University College of Medicine, Seoul, Korea
| | - Jaechul Song
- Department of Occupational and Environmental Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Tae-Won Jang
- Department of Occupational and Environmental Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Mi-Young Lee
- Occupational Health Research Bureau, Occupational Safety and Research Institute, Ulsan, Korea
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Martinez BAF, Leotti VB, Silva GDSE, Nunes LN, Machado G, Corbellini LG. Odds Ratio or Prevalence Ratio? An Overview of Reported Statistical Methods and Appropriateness of Interpretations in Cross-sectional Studies with Dichotomous Outcomes in Veterinary Medicine. Front Vet Sci 2017; 4:193. [PMID: 29177157 PMCID: PMC5686058 DOI: 10.3389/fvets.2017.00193] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 10/25/2017] [Indexed: 11/26/2022] Open
Abstract
One of the most commonly observational study designs employed in veterinary is the cross-sectional study with binary outcomes. To measure an association with exposure, the use of prevalence ratios (PR) or odds ratios (OR) are possible. In human epidemiology, much has been discussed about the use of the OR exclusively for case–control studies and some authors reported that there is no good justification for fitting logistic regression when the prevalence of the disease is high, in which OR overestimate the PR. Nonetheless, interpretation of OR is difficult since confusing between risk and odds can lead to incorrect quantitative interpretation of data such as “the risk is X times greater,” commonly reported in studies that use OR. The aims of this study were (1) to review articles with cross-sectional designs to assess the statistical method used and the appropriateness of the interpretation of the estimated measure of association and (2) to illustrate the use of alternative statistical methods that estimate PR directly. An overview of statistical methods and its interpretation using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted and included a diverse set of peer-reviewed journals among the veterinary science field using PubMed as the search engine. From each article, the statistical method used and the appropriateness of the interpretation of the estimated measure of association were registered. Additionally, four alternative models for logistic regression that estimate directly PR were tested using our own dataset from a cross-sectional study on bovine viral diarrhea virus. The initial search strategy found 62 articles, in which 6 articles were excluded and therefore 56 studies were used for the overall analysis. The review showed that independent of the level of prevalence reported, 96% of articles employed logistic regression, thus estimating the OR. Results of the multivariate models indicated that logistic regression was the method that most overestimated the PR. The findings of this study indicate that although there are methods that directly estimate PR, many studies in veterinary science do not use these methods and misinterpret the OR estimated by the logistic regression.
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Affiliation(s)
- Brayan Alexander Fonseca Martinez
- Laboratory of Veterinary Epidemiology, Faculty of Veterinary, Department of Preventive Veterinary Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Vanessa Bielefeldt Leotti
- Faculty of Medicine, Department of Statistics, Institute of Mathematics and Statistics and Post-Graduate Program of Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gustavo de Sousa E Silva
- Laboratory of Veterinary Epidemiology, Faculty of Veterinary, Department of Preventive Veterinary Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Luciana Neves Nunes
- Faculty of Medicine, Department of Statistics, Institute of Mathematics and Statistics and Post-Graduate Program of Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gustavo Machado
- Laboratory of Veterinary Epidemiology, Faculty of Veterinary, Department of Preventive Veterinary Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Luís Gustavo Corbellini
- Laboratory of Veterinary Epidemiology, Faculty of Veterinary, Department of Preventive Veterinary Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Ndukwe HC, Wang T, Tordoff JM, Croucher MJ, Nishtala PS. Geographic variation in psychotropic drug utilisation among older people in New Zealand. Australas J Ageing 2016; 35:242-248. [PMID: 26991493 DOI: 10.1111/ajag.12298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To examine psychotropic drug utilisation in older people in New Zealand by age, sex, health board domicile and deprivation status. METHODS A repeated cross-sectional analysis of population-based drug utilisation data stratified by age, sex, ethnicity, health board and deprivation status was conducted from 2005 to 2013. RESULTS Psychotropic utilisation increased between 2005 and 2013 (ranging from 7.0 to 74.0%) across all the health boards. In people aged 85 years and above, the hypnotic and sedative prevalence ratio compared to the 65- to 69-year age group was 1.45 (95% CI 1.44, 1.46). Between 2005 and 2013, the antidepressants prevalence ratio increased (1.27 (95% CI 1.22, 1.33)) relative to anxiolytics. CONCLUSIONS Overall psychotropic drug utilisation increased over time. Despite safety concerns, hypnotic and sedative utilisation increased in the oldest vulnerable group. Shifts from anxiolytics to antidepressants in some health boards were consistent with guidelines for extended indications of antidepressant drug use.
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Affiliation(s)
- Henry C Ndukwe
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Ting Wang
- Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - June M Tordoff
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Matthew J Croucher
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Reiczigel J, Singer J, Lang ZS. Exact inference for the risk ratio with an imperfect diagnostic test. Epidemiol Infect 2017; 145:187-93. [PMID: 27608542 DOI: 10.1017/S0950268816002028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The risk ratio quantifies the risk of disease in a study population relative to a reference population. Standard methods of estimation and testing assume a perfect diagnostic test having sensitivity and specificity of 100%. However, this assumption typically does not hold, and this may invalidate naive estimation and testing for the risk ratio. We propose procedures that control for sensitivity and specificity of the diagnostic test, given the risks are measured by proportions, as it is in cross-sectional studies or studies with fixed follow-up times. These procedures provide an exact unconditional test and confidence interval for the true risk ratio. The methods also cover the case when sensitivity and specificity differ in the two groups (differential misclassification). The resulting test and confidence interval may be useful in epidemiological studies as well as in clinical and vaccine trials. We illustrate the method with real-life examples which demonstrate that ignoring sensitivity and specificity of the diagnostic test may lead to considerable bias in the estimated risk ratio.
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Tamhane AR, Westfall AO, Burkholder GA, Cutter GR. Prevalence odds ratio versus prevalence ratio: choice comes with consequences. Stat Med 2016; 35:5730-5735. [PMID: 27460748 DOI: 10.1002/sim.7059] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 06/20/2016] [Accepted: 07/05/2016] [Indexed: 11/11/2022]
Abstract
Odds ratio, risk ratio, and prevalence ratio are some of the measures of association which are often reported in research studies quantifying the relationship between an independent variable and the outcome of interest. There has been much debate on the issue of which measure is appropriate to report depending on the study design. However, the literature on selecting a particular category of the outcome to be modeled and/or change in reference group for categorical independent variables and the effect on statistical significance, although known, is scantly discussed nor published with examples. In this article, we provide an example of a cross-sectional study wherein prevalence ratio was chosen over (Prevalence) odds ratio and demonstrate the analytic implications of the choice of category to be modeled and choice of reference level for independent variables. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ashutosh R Tamhane
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - Andrew O Westfall
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, U.S.A.,Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - Greer A Burkholder
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, U.S.A
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Woolcott OO, Gutierrez C, Castillo OA, Elashoff RM, Stefanovski D, Bergman RN. Inverse association between altitude and obesity: A prevalence study among andean and low-altitude adult individuals of Peru. Obesity (Silver Spring) 2016; 24:929-37. [PMID: 26935008 PMCID: PMC4814295 DOI: 10.1002/oby.21401] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/21/2015] [Accepted: 10/24/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the association between altitude and obesity in a nationally representative sample of the Peruvian adult population. METHODS This is a cross-sectional analysis of publicly available data from the Food and Nutrition National Center (CENAN, Peru), period 2009-2010. The Prevalence ratio of obesity and abdominal obesity was determined as a measure of association. Obesity and abdominal obesity were diagnosed based on direct anthropometric measurements. RESULTS The final data set consisted of 31,549 individuals ≥20 years old. The prevalence ratio of obesity was as follows: 1.00 between 0 and 499 m (reference category), 1.00 (95% confidence interval 0.87-1.16) between 500-1,499 m, 0.74 (0.63-0.86) between 1,500-2,999 m, and 0.54 (0.45-0.64) at ≥3,000 m, adjusting for age, sex, self-reported physical activity, out-migration rate, urbanization, poverty, education, and geographical latitude and longitude. In the same order, the adjusted prevalence ratio of abdominal obesity was 1.00, 1.01 (0.94-1.07), 0.93 (0.87-0.99), and 0.89 (0.82-0.95), respectively. We found an interaction between altitude and sex and between altitude and age (P < 0.001, for both interactions) on the association with obesity and abdominal obesity. CONCLUSIONS Among Peruvian adult individuals, we found an inverse association between altitude and obesity, adjusting for multiple covariates. This adjusted association varied by sex and age.
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Affiliation(s)
- Orison O. Woolcott
- Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Cesar Gutierrez
- Instituto de Medicina Tropical Daniel A. Carrión, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Oscar A. Castillo
- Instituto Nacional de Biología Andina, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Robert M. Elashoff
- Department of Biomathematics, University of California, Los Angeles, California, USA
| | - Darko Stefanovski
- Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Richard N. Bergman
- Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Azuma Y, Kusumoto-Matsuo R, Takeuchi F, Uenoyama A, Kondo K, Tsunoda H, Nagasaka K, Kawana K, Morisada T, Iwata T, Aoki D, Kukimoto I. Human papillomavirus genotype distribution in cervical intraepithelial neoplasia grade 2/3 and invasive cervical cancer in Japanese women. Jpn J Clin Oncol 2014; 44:910-7. [PMID: 25156680 DOI: 10.1093/jjco/hyu112] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Human papillomavirus vaccines are being introduced worldwide and are expected to reduce the incidence of cervical cancer. Here we report a cross-sectional study using a validated human papillomavirus genotyping method to reveal the human papillomavirus prevalence and genotype distribution in Japanese women with cervical intraepithelial neoplasia Grade 2/3 and invasive cervical cancer. METHODS Cervical exfoliated cells were collected from 647 patients with abnormal cervical histology (cervical intraepithelial neoplasia Grade 2, n = 164; cervical intraepithelial neoplasia Grade 3, n = 334; and invasive cervical cancer, n = 149), and subjected to the PGMY-PCR-based genotyping assay. The association between human papillomavirus infection and lesion severity was calculated using a prevalence ratio. RESULTS Overall, the prevalence of human papillomavirus deoxyribonucleic acid was 96.3% in cervical intraepithelial neoplasia Grade 2, 98.8% in cervical intraepithelial neoplasia Grade 3 and 88.0% in invasive cervical cancer (97.8% in squamous cell carcinoma and 71.4% in adenocarcinoma). The three most prevalent types were as follows: human papillomavirus 16 (29.3%), human papillomavirus 52 (27.4%) and human papillomavirus 58 (22.0%) in cervical intraepithelial neoplasia Grade 2; human papillomavirus 16 (44.9%), human papillomavirus 52 (26.0%) and human papillomavirus 58 (17.4%) in cervical intraepithelial neoplasia Grade 3; and human papillomavirus 16 (47.7%), human papillomavirus 18 (23.5%) and human papillomavirus 52 (8.7%) in invasive cervical cancer. The prevalence ratio of human papillomavirus 16 was significantly higher in cervical intraepithelial neoplasia Grade 3 compared with cervical intraepithelial neoplasia Grade 2 (prevalence ratio, 1.62; 95% confidence interval, 1.26-2.13) and in squamous cell carcinoma compared with cervical intraepithelial neoplasia Grade 3 (prevalence ratio, 1.55; 95% confidence interval, 1.25-1.87). Multiple infections decreased from cervical intraepithelial neoplasia Grade 2/3 (38.4/29.6%) to invasive cervical cancer (14.1%), whereas co-infections with human papillomavirus 16/52/58 were found in cervical intraepithelial neoplasia Grade 2/3. CONCLUSIONS The results of this study provide pre-vaccination era baseline data on human papillomavirus type distribution in Japanese women and serve as a reliable basis for monitoring the future impact of human papillomavirus vaccination in Japan.
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Affiliation(s)
- Yukari Azuma
- WHO HPV LabNet Regional Reference Laboratory, WHO Western Pacific Region, Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo
| | - Rika Kusumoto-Matsuo
- WHO HPV LabNet Regional Reference Laboratory, WHO Western Pacific Region, Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo
| | - Fumihiko Takeuchi
- WHO HPV LabNet Regional Reference Laboratory, WHO Western Pacific Region, Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo
| | - Asami Uenoyama
- Department of Obstetrics and Gynecology, NTT Medical Center Tokyo, Tokyo
| | - Kazunari Kondo
- Department of Obstetrics and Gynecology, NTT Medical Center Tokyo, Tokyo
| | - Hajime Tsunoda
- Department of Obstetrics and Gynecology, NTT Medical Center Tokyo, Tokyo
| | - Kazunori Nagasaka
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Kei Kawana
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Tohru Morisada
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Iwata
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Iwao Kukimoto
- WHO HPV LabNet Regional Reference Laboratory, WHO Western Pacific Region, Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo
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Shi R, Devarakonda S, Liu L, Taylor H, Mills G. Factors associated with genital human papillomavirus infection among adult females in the United States, NHANES 2007-2010. BMC Res Notes 2014; 7:544. [PMID: 25134828 PMCID: PMC4141114 DOI: 10.1186/1756-0500-7-544] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 08/12/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with human papillomavirus (HPV) infection are at risk of developing cancer later in their life. Current research estimates the prevalence of genital HPV infection and explores the factors that are associated with the infection. FINDINGS The National Health and Nutrition Examination Survey 2007-2010 was used in this research study. The study population included females in the United States aged 18-59 years. The weighted prevalence of HPV infection was 41.9%. An estimated 59.4% of non-Hispanic black females had HPV infection. In a multivariate analysis, number of sexual partners, race, age, education level, marital status, income, smoking, and insurance status were associated with HPV infection. HPV infection was 5.77 times more likely for women with >11 sexual partners compared to women with 0-1 partners. Non-Hispanic black females were 1.87 times more likely to have HPV infection compared to non-Hispanic white females. Participants with only a high school degree had a 58% increased prevalence compared to college-educated women. Uninsured women had a 39% increased prevalence compared to those with insurance. CONCLUSION This study found that 41.9% of U.S. females aged 18-59 years tested positive for genital HPV infection. We determined that individuals with more sexual partners, with a lower education level, with non-Hispanic black race, and with no insurance were the populations at greatest risk. It is necessary to continue monitoring the prevalence of this infection in the general population to provide a basis for effective treatment and prevention in the target populations.
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Affiliation(s)
- Runhua Shi
- Department of Medicine, Feist-Weiller Cancer Center, LSU Health Shreveport, Shreveport, LA USA
| | - Srinivas Devarakonda
- Department of Medicine, Feist-Weiller Cancer Center, LSU Health Shreveport, Shreveport, LA USA
| | - Lihong Liu
- Department of Medicine, Feist-Weiller Cancer Center, LSU Health Shreveport, Shreveport, LA USA
| | - Hannah Taylor
- Department of Medicine, Feist-Weiller Cancer Center, LSU Health Shreveport, Shreveport, LA USA
| | - Glenn Mills
- Department of Medicine, Feist-Weiller Cancer Center, LSU Health Shreveport, Shreveport, LA USA
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Zuccotti G, Mameli C, Daprai L, Garlaschi ML, Dilillo D, Bedogni G, Faccini M, Gramegna M, Torresani E, Ballerini E, Benincaso A, Bonvissuto M, Bricalli D, Brioschi M, Calloni CS, Camiletti MI, Colella G, De Angelis L, Decarlis S, Di Nello F, Dozzi M, Galli E, Gandini V, Giuliani MG, Laviola F, Loda B, Macedoni M, Mazzucchi E, Metta MG, Moscatiello A, Nannini P, Petruzzi M, Picicco D, Picciotti M, Pisanelli S, Porta N, Ramponi G, Redaelli F, Rubini R, Sala N, Saitta V, Scelza G, Tiso RM, Tomasetto M, Torcoletti M, Travaini M, Valentini M, Vessia C. Serotype distribution and antimicrobial susceptibilities of nasopharyngeal isolates of Streptococcus pneumoniae from healthy children in the 13-valent pneumococcal conjugate vaccine era. Vaccine 2013; 32:527-34. [PMID: 24342249 DOI: 10.1016/j.vaccine.2013.12.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/25/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022]
Abstract
Few epidemiological data are available since the introduction of 13-valent pneumococcal vaccine (PCV13) in 2010. We conducted a cross-sectional study to estimate the prevalence of Streptococcus pneumoniae (SP) nasopharyngeal carriage in healthy Italian infants and young children and to evaluate the impact of PCV13 on pneumococcal colonization. In the trimester September-December 2011 nasopharyngeal swabs were collected from healthy children aged 3-59 months presenting for routine well careat 16 primary care pediatricians in Milan. SP carriage isolates were serotyped and tested for antimicrobial resistance using EUCAST breakpoints. Among 1250 enrolled children, 618 had received at least 1 dose of PCV13, 292 at least 1 dose of PCV7, 94 a combination of the two vaccines and 246 were not vaccinated. The prevalence of SP carriage was 27% (95% confidence interval [CI] 25-30). At multivariable analysis, age≥25 months (prevalence ratio [PR]=0.74) and use of antibiotics in the previous 3 months (PR=0.67) were associated with lower SP carriage prevalence. Having siblings (PR=1.79 for 1 sibling and PR=2.23 for ≥2 siblings), day-care attendance (PR=2.27) and respiratory tract infections in the previous 3 months (PR=1.39) were associated with higher SP carriage prevalence. The immunization status for SP was not associated with SP carriage at univariable or at multivariable analysis. The most common carriage isolates were 6C, 19A and 23A. The prevalence of the six additional PCV13 serotypes carriage in children appropriately vaccinated with PCV13 was lower than in children appropriately vaccinated with PCV7 (0 vs. 0.060); the greater reduction in prevalence of carriage was observed for serotype 19A (0 vs. 0.041). Serotype 6C was the most common drug-resistant serotype (17.2%). Further epidemiological studies are needed to assess changes in circulating SP serotypes following the large-scale introduction of PCV13.
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Affiliation(s)
| | - Chiara Mameli
- Department of Paediatrics, L. Sacco Hospital, University of Milan, Italy
| | - Laura Daprai
- Microbiology Laboratory, Policlinico, Cà Granda Ospedale Maggiore Foundation, Milan, Italy
| | - Maria Laura Garlaschi
- Microbiology Laboratory, Policlinico, Cà Granda Ospedale Maggiore Foundation, Milan, Italy
| | - Dario Dilillo
- Department of Paediatrics, L. Sacco Hospital, University of Milan, Italy
| | - Giorgio Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Trieste, Italy
| | - Marino Faccini
- Prevention Department, Local Health Authority, Milan, Italy
| | - Maria Gramegna
- Unità Organizzativa Governo della prevenzione e tutela sanitaria, Direzione Generale Sanità, Regione Lombardia, Milan, Italy
| | - Erminio Torresani
- Microbiology Laboratory, Policlinico, Cà Granda Ospedale Maggiore Foundation, Milan, Italy
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Ma CC, Burchfiel CM, Grove J, Fekedulegn D, Lu Y, Andrew ME, Willcox B, Masaki KH, Curb JD, Rodriguez BL. Risk factors for fractures among Japanese-American men: The Honolulu Heart Program and Honolulu-Asia Aging Study. Arch Osteoporos 2011; 6:197-207. [PMID: 22886106 PMCID: PMC3565433 DOI: 10.1007/s11657-011-0068-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 09/26/2011] [Indexed: 02/03/2023]
Abstract
UNLABELLED Baseline risk factors were associated with fractures that developed after 29-31 years among Japanese-American men. Hip fracture risk increased with increasing BMI (28% increase for 1 U increase), physical activity (7% increase for 1 U increase), and was decreased with increasing arm girth (27% decrease for 1 U increase). PURPOSE The objective of this study was to identify risk factors among Japanese-American men aged 45-68 years at baseline that were associated with prevalence and incidence of fractures at advanced age. METHODS We used baseline information from Honolulu Heart Program (HHP) and Honolulu-Asia Aging Study (HAAS). The HHP was a prospective study with primary focus on risk factors for cardiovascular disease. A cohort of 8,006 men of Japanese ancestry aged 45-68 years residing on Oahu was recruited in 1965 and followed for 31 years. The HAAS started in 1991 in conjunction with the HHP with a focus on age-related health conditions. Self-reported hip, spine, and forearm fracture prevalence was ascertained in 1991-1993 among 3,845 men aged 71-93 years. Incidence was obtained during the period (1994-1999) among 2,737 men aged 74-98 years. Poisson regression models were used to determine multi-variable adjusted prevalence and incidence ratios for fracture. RESULTS Incident hip fracture was directly associated with baseline body mass index (BMI) and physical activity, and inversely associated with left upper arm girth. Incident spine fracture was directly associated with baseline age. Prevalent hip fracture was directly associated with baseline pack-years of smoking. Prevalent spine fracture was inversely associated with baseline education, and directly associated with standing height and use of medication for diabetes. Prevalent forearm fracture was inversely associated with baseline age, and directly associated with education. CONCLUSIONS Results indicated that multiple baseline demographic lifestyle and anthropometric characteristics predict fracture risk at advanced age. In addition, associations varied by fracture location.
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Affiliation(s)
- Claudia C Ma
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV 26505-2888, USA.
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Yu B, Wang Z. Estimating relative risks for common outcome using PROC NLP. Comput Methods Programs Biomed 2008; 90:179-186. [PMID: 18291556 PMCID: PMC2365041 DOI: 10.1016/j.cmpb.2007.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Revised: 12/03/2007] [Accepted: 12/15/2007] [Indexed: 05/25/2023]
Abstract
In cross-sectional or cohort studies with binary outcomes, it is biologically interpretable and of interest to estimate the relative risk or prevalence ratio, especially when the response rates are not rare. Several methods have been used to estimate the relative risk, among which the log-binomial models yield the maximum likelihood estimate (MLE) of the parameters. Because of restrictions on the parameter space, the log-binomial models often run into convergence problems. Some remedies, e.g., the Poisson and Cox regressions, have been proposed. However, these methods may give out-of-bound predicted response probabilities. In this paper, a new computation method using the SAS Nonlinear Programming (NLP) procedure is proposed to find the MLEs. The proposed NLP method was compared to the COPY method, a modified method to fit the log-binomial model. Issues in the implementation are discussed. For illustration, both methods were applied to data on the prevalence of microalbuminuria (micro-protein leakage into urine) for kidney disease patients from the Diabetes Control and Complications Trial. The sample SAS macro for calculating relative risk is provided in the appendix.
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Affiliation(s)
- Binbing Yu
- Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, MD 20892, USA.
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