Annals of Epidemiology

PURPOSE: Preterm delivery is a major cause of child mortality. While the relationship between parity and preterm delivery is known, its association with gestational duration and variability remains underexplored. Differences in variance may suggest interaction with other well-established risk factors. METHODS: With 1.1 million spontaneous deliveries (1990-2012) from the Swedish Medical Birth Register, we assessed while accounting for potential confounders the effects of parity on the mean and variance of gestational duration, and its possible interactions with history of preterm delivery...

OBJECTIVE-: To assess changes in COVID-19 mortality rate and disparities over variants/waves by industry groups. METHODS-: We used a population-based retrospective cohort study approach. We identified COVID-19 deaths that occurred between January 2020 and May 2022 among the California working population age 18-64 years using death certificates. We used the Current Population Survey to derive estimates for working-age Californians at risk of COVID-19 mortality. The waves in deaths were categorized as Wave 1: March -June 2020, Wave 2: July -November 2020, Wave 3/Epsilon & Alpha variants: December 2020-May 2021, Wave 4/Delta variant: June 2021-January 2022, and Wave 5/Omicron variant: February -May 2022...

PURPOSE: The resident deaths among Long Term Care Home (LTCH) accounted for more than 65% of total deaths in the province of Ontario, Canada, during March 29 to June 3, 2020, yet not all LTCHs were severely affected. METHODS: We carried out a retrospective cohort study, with case control for questions for which data allowed, with LTCH COVID-19 databases obtained from Ontario's Ministry of Long Term Care. We performed a combined temporal and spatial data analysis of COVID-19 cases and deaths among LTCH residents, identified trends, contributing factors, and early markers of LTCH outbreak severity...

PURPOSE: Hospital visits for drug use-related bacterial and fungal infections have increased alongside overdose deaths. The incidence of mortality from these infections and the comparison to overdose mortality is not established. METHODS: This cohort study examined mortality outcomes among adults with drug use diagnoses who were insured by public and private plans during 2007 through 2018 in North Carolina. We examined bacterial and fungal infection-related mortality and overdose mortality using cumulative incidence functions...

PURPOSE: Our goal was to estimate differences in perinatal outcomes by racial differences in political representation, a measure of structural racism. METHODS: We gathered data on the racial composition of county-level elected officials for all counties in Georgia (n=159) in 2022. We subtracted the percent of non-white elected officials from the percent of non-white residents to calculate the "representation difference", with greater positive values indicating a larger disparity...

PURPOSE: To evaluate if changes in preterm birth (PTB, <37 weeks of gestation) incidence differed between non-Hispanic (NH) Black and NH white births following the July 1995 Chicago heat wave-among the most severe US heat waves since 1950. METHODS: We used an ecologic study design. We obtained birth data from January 1990-December 1996 from the National Vital Statistics File to calculate the mean monthly PTB incidence in Chicago's Cook County, Illinois. Births between July 1995-February 1996 were potentially exposed to the heat wave in utero...

PURPOSE: This study investigated the potential heterogeneity by employment status in the relationship between body mass index (BMI) trajectory and cognitive function among an aging population. METHODS: We analyzed 2010-2018 cohort data from the Korean Longitudinal Study of Aging for individuals aged > 45 years (N = 4,889). We used quadratic terms, interaction terms, time-invariant unobserved fixed effects, and time-lag effects to estimate the dynamic and interactive relationships among study variables...

PURPOSE: To examine risks of attention-deficit/hyperactivity disorder (ADHD) in preterm and early term birth survivors, and potential sex-specific differences. METHODS: A national cohort study was conducted of all 4,061,795 singletons born in Sweden in 1973-2013 who survived infancy, followed up for ADHD identified from nationwide diagnoses and medications through 2018. Poisson regression was used to compute prevalence ratios (PRs), adjusting for sociodemographic and perinatal factors...

PURPOSE: Many chronic diseases such as Alzheimer's and hypertension have detrimental impact on the physical activity (PA) patterns of older adults. Often such diseases have different degrees of severity in males and females, although this gender bias often remains unacknowledged while designing PA interventions. Quantifying this gender difference would not only enhance our understanding of diseases but would also help design individual-specific preventative and rehabilitating PA interventions, thereby improving health outcomes for patients across both genders...

OBJECTIVES: Our study aimed to quantitatively estimate the association of age at menarche with the risk of childhood- and adult-onset asthma separately. METHODS: A retrospective cohort study of 24,282 US girls and women aged less than 80 years was conducted using continuous NHANES data from 2001-2018, and Cox proportional hazards regression models with censoring ages of 19 and 79 years were employed to separately estimate hazard ratios of childhood- and adult-onset asthma associated with age at menarche...

PURPOSE: Low early-life absolute and relative socioeconomic status (SES) may contribute to socioeconomic disparities in pregnancy complications (i.e., gestational diabetes [GDM], preeclampsia-eclampsia [PE], hypertensive disorders of pregnancy [HDP; preeclampsia-eclampsia, gestational hypertension, chronic hypertension]) but their independent associations with pregnancy complications have not been studied. This study investigated associations of early-life poverty and relative SES with risks of GDM, PE, and HDP...

Epidemiologic research questions often focus on evaluating binary outcomes, yet curricula and scientific literature do not always provide clear guidance or examples on selecting and calculating an appropriate measure of association in these scenarios. Reporting inappropriate measures may lead to misleading statistical conclusions. We present a hands-on tutorial that includes annotated code written in an open-source statistical programming language (R) showing readers how to apply, compare, and understand four methods used to estimate a risk or prevalence ratio (or difference), rather than presenting an odds ratio...

Deaths among those lost to follow-up (LTFU) in the Cystic Fibrosis Foundation Patient Registry (CFFPR) are critically important to the epidemiology of cystic fibrosis (CF). Unreported deaths could impact estimates of survival if LTFU is associated with disease trajectory. We characterized the LTFU population (1986-2017) from the CFFPR and identified deaths via linkage with the National Death Index (NDI). Median predicted survival age was estimated using a Cox proportional hazards model and calculated with and without additional deaths and person-time from the NDI...

In an effort to decrease transmission during the first years of the COVID-19 pandemic, public health officials encouraged masking, social distancing, and working from home, and restricted travel. However, many studies of the effectiveness of these measures had significant methodologic limitations. In this analysis, we used data from the TrackCOVID study, a longitudinal cohort study of a population-based sample of 3,846 adults in the San Francisco Bay Area, to evaluate the association between self-reported protective behaviors including masking, physical distancing, travel and working outside the home, and incidence of SARS-CoV-2 infection...

PURPOSE: The U.S. Food and Drug Administration's Sentinel System is a national medical product safety surveillance system consisting of a large multi-site distributed database of administrative claims supplemented by electronic healthcare record (EHR) data. The program seeks to improve data capture of race and ethnicity for pharmacoepidemiology studies. METHODS: We conducted a narrative literature review of published research on data augmentation and imputation methods to improve race and ethnicity capture in U...

PURPOSE: Estimating the potential impact on infant mortality of increasing Bacille Calmette-Guérin (BCG) vaccination coverage and BCG scar prevalence. METHODS: Guinea-Bissau Health and Demographic Surveillance System (HDSS) data on BCG vaccination coverage, scar status and all-cause mortality was used for this study. Mortality risk (MR) by scar status was assessed in Cox models providing adjusted Mortality Rate Ratios (aMRRs). Distributions were fitted for survival, vaccination coverage and scar prevalence...

PURPOSE: Although increasing vaccine uptake is a key strategy to minimize COVID-19 deaths, evidence of the role of vaccination rates in attenuating the socioeconomic disparity in COVID-19 deaths is limited. We thus aimed to quantify the extent to which vaccination rates contribute to the association between US county-level poverty rates and COVID-19 mortality rates. METHODS: This nationwide study analyzed data on 3,142 US counties. We conducted mediation analyses to calculate the proportions eliminated (PE) of the association between poverty rate and COVID-19 deaths per 100,000 population by setting the COVID-19 vaccination rate (the proportion of fully vaccinated individuals as of December 31st , 2021) to different observed values...

PURPOSE: Quality control in longitudinal cohort studies is critical for valid epidemiological inference. Conditional studentized residuals (CSRs) derived from linear mixed effects models offer efficient individual-specific quality control. We present the utility of CSRs for outlier detection in an applied example using data from the Chronic Kidney Disease in Children (CKiD) cohort. METHODS: Longitudinal linear mixed effects models with glomerular filtration rate (GFR) as the outcome were fit for observations prior to kidney replacement therapy, stratified by non-glomerular or glomerular diagnosis, and for a subset after receiving a kidney transplant...

PURPOSE: We examine how various PrEP accessibility measures impact the detection of PrEP shortage areas and the relation of shortage areas to social determinants of health (SDOH). METHODS: Using ZIP Code Tabulation Areas (ZCTAs) in New York City as a case study, we compared 25 measures of spatial PrEP accessibility across four categories, including density, proximity, two-step floating catchment area (2SFCA), and Gaussian 2SFCA (G2SFCA). Bayesian spatial regression models were used to examine how PrEP accessibility is associated with SDOH...

PURPOSE: We described the impact of alcohol use on longitudinal engagement in HIV care including loss to follow-up, durability of viral suppression, and death. METHODS: We followed a cohort of 1,781 people with HIV from enrolled in care at one of seven US clinics, 2011-2019 through 102 months. We used a multistate, time-varying Markov process and restricted mean time to summarize engagement in HIV care over follow-up according to baseline self-reported alcohol use (none, moderate, or unhealthy)...