Latent Trajectory Model Research Articles

An Advanced Model for Greenhouse Gas Emission Reduction in the Agricultural Sector to Achieve Sustainability for Thailand’s Future

This research aimed to develop an advanced model for sustainably reducing greenhouse gas emissions in the future. The research employs a quantitative research approach, introducing a new model called the Structural Equation Modeling with Vector Autoregressive Latent Trajectory Model (SEM-VALTM). This model differs significantly from previous models as it identifies strategic pathways for effective national administration, ensuring high performance without spurious results, surpassing the efficiency of earlier models. The findings reveal that the environmental sector is directly affected by the economic sector, with the relationship exhibiting an inverse direction. Similarly, the environmental sector is influenced by the social sector, also in an opposing direction. The SEM-VALTM model contributes new knowledge, highlighting that the environmental sector demonstrates the slowest adjustment toward equilibrium (6%). Under a sustainability policy framework, it was found that the economic sector, particularly the industrial rate, has the highest influence on economic changes, which in turn have the most significant negative impact on the environment. The study further projects that from 2025 to 2037, greenhouse gas emissions will rise sharply, reaching 95.05 Mt CO2 Eq., exceeding the carrying capacity threshold of 60.5 Mt CO2 Eq. Based on risk management principles, continuous measures must be implemented to reduce greenhouse gas emissions. Therefore, the government must establish a new scenario policy emphasizing renewable energy and clean technologies as substitutes. The findings suggest that future energy consumption will consistently decrease, resulting in greenhouse gas emissions of 50.04 Mt CO2 Eq. (2025–2037), which is below the carrying capacity.

Dynamics of troponins and 30-day mortality in hospitalized patients with pulmonary embolism.

In patients with pulmonary embolism (PE), the impact of repeated troponin I or T (TnI/TnT) measurements remains unclear. Using Danish national registries, we identified PE patients (≥18years) hospitalized between 2013 and 2018 with initial TnI or TnT measurement within -1/+1day from admission and >1 repeated measurement within three days. Trajectories of TnI and TnT were identified using latent class trajectory modeling. Hazard ratios for 30-day mortality were compared across trajectories via multivariable Cox regression. Among 1539 patients with TnI measurements and 1323 with TnT measurements, three distinct trajectories were identified. Trajectory I (nTnI=286, nTnT=472) exhibited consistently low TnI/TnT concentrations, trajectory II (nTnI=1076, nTnT=724) demonstrated initial elevated TnI/TnT decreasing within 24h, and trajectory III (nTnI=177, nTnT=127) was characterized by elevated index TnI/TnT increasing within 10h. 30-day mortality rates were higher in trajectory II and III compared to I in both the TnI (3%, 7% and 18% across trajectory I to III) and the TnT (1%, 9% and 20% across trajectory I to III) cohort. After adjustment hazard ratio of 30-day mortality for trajectory II vs. I was 7.42 (95% CI 1.00-54.84, p=0.04, TnI) and 2.93 (95% CI 1.17-7.33, p=0.02 TnT); and for trajectory III vs. I, 16.42 (95% CI 2.42-127.29, p=0.007, TnI) and 8.21 (95% CI 2.78-24.19, p<0.001, TnT). A steep increase in TnI or TnT concentration within 10h of PE diagnosis significantly escalates 30-day mortality risk indicating that early serial sampling may enhance risk stratification of PE patients.

BMI trajectories are associated with NAFLD and advanced fibrosis via aging-inflammation mediation

BackgroundAs the global epidemic of obesity fuels metabolic conditions, the burden of nonalcoholic fatty liver disease (NAFLD) will become enormous. Abundant studies revealed the association between high body mass index (BMI) and NAFLD but overlooked the BMI patterns across life stages. We aimed to explore how BMI trajectories over age relate to NAFLD.MethodsSelecting 3212 participants in NHANES 2017–2020, we tracked BMI records at different ages. Using a latent class trajectory model (LCTM), we identified BMI trajectories over age. Multinomial logistic regression assessed their association with NAFLD and advanced fibrosis. Structural equation modeling (SEM) revealed mediation effects.ResultsWe identified 3 BMI trajectories: Steady Progression, Increase to Decrease, and Rapid Ascending. There was no significant difference in NAFLD/advanced fibrosis risk between the increase-to-decrease group and the steady progression group. The Rapid Ascending trajectory significantly correlated with NAFLD (OR = 2.21, 95% CI 1.29–3.77) and advanced fibrosis (OR = 3.04, 95% CI 1.13–8.22). This association was influenced by a chain-mediated process of phenotypic age and C-reactive protein (mediated effect to NAFLD = 0.010, p < 0.01; mediated effect to advanced fibrosis = 0.003, p < 0.05). This mediation on NAFLD was independent of insulin resistance (IR). The association between rapid ascending trajectory and advanced fibrosis was more pronounced among the male subgroup (p for interaction = 0.008).ConclusionThe rapid ascending trajectory of BMI correlates with an increased susceptibility to NAFLD and advanced fibrosis independent of BMI, mediated by aging and inflammation. Our results suggest that long-term maintenance of BMI is pivotal in NAFLD prevention. Aging-inflammation may represent a distinct mechanism of sustained obesity to NAFLD, independent of IR.

Growth dynamics of Indian infants using latent trajectory models in pooled survey datasets.

National survey data show that age- and sex-standardized weight and length measurements decline early in Indian children. In population-level longitudinal data, early detection of growth trajectories is important for the implementation of interventions. We aimed to identify and characterize distinct growth trajectories of Indian children from birth to 12 months of age residing in urban and rural areas. Pooled data from four interventional and non-interventional longitudinal studies across India were used for the analysis. Latent class mixed modeling (LCMM) was employed to identify groups of children with similar trajectories over age. The trajectories named Classes of Children were created for length-for-age Z scores (LAZ) and weight-for-age Z scores (WAZ) based on place of birth, residential area, and maternal education. We identified two latent classes for LAZ in boys and three latent classes for LAZ in girls, and four classes for WAZ were identified in both boys and girls. The first class for LAZ, with the highest proportion of children (>80% of children), did not decline or increase with age; In boys, Class 1 was close to the WHO median, whereas in girls, Class 1 was lower than the WHO median from birth. The LAZ classes of remaining boys and girls declined with age (slope, = - 1.04; 95% CI: -1.09, -0.99 for boys and = - 0.69; 95% CI: -0.76, -0.63 for girls). The first trajectory of WAZ (approximately 50% of children) for boys ( =0.13; 95% CI: 0.11, 0.16) and the second trajectory of WAZ for girls ( =0.24; 95% CI: 0.18, 0.30) increased with age, while the remaining trajectories of WAZ declined with age. There is heterogeneity in the growth of Indian children in the first year of life, which was identified by distinct types of growth trajectories. The predominant trajectories of both LAZ and WAZ did not decline with age, while most other trajectories demonstrated an initial decline.

HIV self-management and associated factors among people living with HIV in Hunan, China: a nine-year longitudinal study

ABSTRACT Self-management refers to the behaviors and strategies individuals employ to manage their health conditions. For people living with HIV (PLWH), it encompasses medication adherence, health monitoring, symptom management, lifestyle maintenance and seeking emotional support. While previous studies on the factors influencing self-management in PLWH are predominantly cross-sectional, longitudinal studies are scarce. This nine-year longitudinal study aimed to investigate the trajectories of psychosocial characteristics in PLWH and their effects on self-management. A total of 265 PLWH were assessed for psychosocial factors, including stigma, depression, anxiety, and social support, at baseline and at one-, five- and nine-year follow-ups. Self-management was evaluated at the nine-year follow-up. Psychosocial trajectories were identified using latent growth trajectory models (LGMM), and associations with self-management were analyzed via multiple linear regression. The majority of participants exhibited a low-level decline in depression (79.6%) and rising social support (54.3%). The high-level decline depression group demonstrated the lowest self-management scores (b = −4.67, 95% CI: −8.166 to −1.175). Multivariate analysis revealed significant associations between self-management and exercise (b = 5.360, 95% CI: 3.934-6.786), depressive symptoms (b = −0.168, 95% CI: −0.305 to −0.031) and social support (b = 0.182, 95% CI: 0.101-0.264). These findings emphasize the need for continuous monitoring and targeted interventions to improve self-management in PLWH.

Association Between Blood Pressure Variation During Dialysis and Cardio-Cerebrovascular Events.

In hemodialysis patients, blood pressure variability (BPV) is associated with cardiovascular events and all-cause mortality. However, previous research has predominantly concentrated on the predialysis BPV. In contrast, intradialytic BPV, reflecting the cardiovascular regulatory function during the process of rapid clearance of volume overload, holds greater relevance to the prognosis of patients. In this study, a latent category trajectory model was used to identify the patterns of intradialytic BPV and analyze the association between intradialytic BPV and the cardio-cerebrovascular events and other clinical outcomes. We found the variation of intradialytic systolic blood pressure (SBP) was associated with the risk of cardio-cerebrovascular events in hemodialysis patients. Patients in "SBP Class 4" and "SBP Class 3" subgroups were associated with the occurrence of cardio-cerebrovascular events and the number of cardio-cerebrovascular event hospitalizations during the follow-up period. This indicates that the variation pattern of intradialytic SBP results from the comprehensive action of various BP regulatory mechanisms in the body, which can reflect the level of cardiovascular regulatory function in hemodialysis patients and serve as a predictor of recent adverse cardio-cerebrovascular events.

Trajectories of Maternal Behavior, Infant's Respiratory Sinus Arrhythmia, and Emotional Recovery Following the Still Face Paradigm.

The development of emotion regulation is integral to children's socioemotional adjustment. Respiratory sinus arrhythmia (RSA) reflects parasympathetic regulation of cardiac arousal and is thought to be an indicator of emotion regulation. However, it is unclear how RSA is associated with positive maternal behaviors and infant emotional recovery in real time over the course of a recovery period following a social stressor. Mothers and their 5- to 6-month-old infants (N=143) completed the Still Face paradigm. Using a series of autoregressive latent trajectory models, the current study aimed to elucidate the associations among observed maternal warmth, infant RSA, and observed infant negative affect across a 5-min observation. The hypotheses were that trajectories of maternal warmth would predict trajectories of infant RSA and negative affect, and that trajectories of RSA would be associated with the infants' observed negative affect. Change in maternal warmth was associated with infant negative affect and RSA at the end of the reunion and change in RSA was associated with ultimate levels of negative affect. The results provide partial support for our hypothesis that maternal warmth supports infant physiological, and in turn, emotional recovery.

Identification of health trajectories of patients with persistent spinal pain syndrome type 2 using latent class trajectory methods.

Persistent spinal pain syndrome Type 2 (PSPS-T2) is a long-lasting condition that consists of persistent pain following spinal surgery. Although this condition has long-term effects, it is currently studied at a given time point or over a limited period of time, which does not reflect the true impact of pain patients. To bridge this gap, we used latent class trajectory models to extract clusters with different trajectories of patients with PSPS-T2. Data from the PREDIBACK study, an observational, multicentric, and longitudinal investigation carried out prospectively, were used. This study focuses on patients with PSPS-T2, tracking their outcomes at 3-month intervals over a one-year period. Health status was evaluated using a novel multidimensional clinical response index (MCRI). The trajectories of patients' health status were extracted using mixture of mixed effect models. Two hundred (200) PSPS-T2 patients were included. Two clusters were identified, including 'persistent low health' trajectories (63.1%) and 'improving health' trajectories (36.9%). Regarding the factors associated with these trajectories, our results showed that lower age, lower body mass index, lower pain intensity, lower functional disability, lower anxiety and less extended pain surface were associated with improving health status. Clustering methods provide an opportunity to identify two distinct clusters of pain-related health trajectories of PSPS-T2 patients. Persistence of the symptoms was not observed in one third of the PSPS-T2 study patients, who belong to the improving pain-related health cluster, while the other two thirds did not achieve improved health over a 1-year follow-up. Our study findings suggest that the use of trajectory-based methods could improve patient evaluation and pain management as it allows for obtaining a global view of patients during their care pathway compared to conventional methods, which only focus on specific visits. Our study also advocates for multidimensional assessment and management of pain by targeting not only pain intensity but also the psychological distress, functional capacity and pain surface at an early stage of pain onset after spine surgery.

Associations of early childhood exposure to severe acute malnutrition and recovery with cardiometabolic risk markers in later childhood: 5-year prospective matched cohort study in Ethiopia.

Impaired fetal and accelerated postnatal growth are associated with cardiometabolic disease. Few studies investigated how recovery from severe acute malnutrition (SAM) is associated with childhood cardiometabolic risk. We evaluated cardiometabolic risk in SAM children treated through community-based management, relative to controls, 5-year post-recovery. Recognizing the heterogeneity of SAM case definitions and patterns of nutritional recovery, we also identified distinct BMI-for-age (BAZ) trajectories of SAM children in the first-year post-recovery and examined their associations with anthropometry, body composition and cardiometabolic risk markers 5-years later. A prospective cohort study in 2013 enrolled children aged 6-59 months, recovered from SAM (n=203), or non-wasted controls (n=202), in Jimma Zone, Ethiopia. Anthropometry, body composition and cardiometabolic markers were assessed 5-year post-recovery. Multiple linear regression models compared outcomes between SAM-recovered children and controls. We used latent class trajectory modelling to identify BAZ trajectories in the first-year post-recovery and compared these trajectory groups with controls. We traced 291 (71.9%) children (mean age 6.2 years) at 5-year follow-up. Overall, compared to controls, SAM-recovered children did not differ in cardiometabolic risk. We identified 4 BAZ trajectories among SAM-recovered children: "Increase" (74.6%), "Decrease" (11.0%), "Decrease-increase" (5.0%), and "Increase-decrease" (9.4%). Compared to controls, all BAZ trajectories except "Decrease-increase" had lower weight, height and fat-free mass index. Compared to controls, the "Decrease-increase" trajectory had lower glucose (-15.8 mg/dL; 95%CI: -31.2, -0.4), while the "Increase-decrease" trajectory had higher glucose (8.1 mg/dL; CI: -0.8, 16.9). Compared to controls, the "Decrease-increase" and "Decrease" trajectories had higher total-cholesterol (24.3 mg/dL; CI: -9.4, 58.4) and LDL-cholesterol (10.4 mg/dL; CI: -3.8, 24.7), respectively. The "Increase" trajectory had lowest cardiometabolic risk. Both rapid BAZ increase and decrease during early post-recovery from SAM were associated with greater cardiometabolic risk 5-years later. The findings indicate the need to target post-recovery interventions to optimize healthy weight recovery.

Effects on HbA1c of referral of type 2 diabetes patients to secondary care

Aim To study trajectories of HbA1c in type 2 diabetes (T2D) patients referred to diabetes outpatient clinics (DOCs), and to explore characteristics of referrals and patient pathways in patients treated in DOCs. Methods We retrospectively followed T2D patients from the Norwegian population-based ROSA 4 study to identify persons with T2D who were referred to a DOC. We used latent class trajectory modelling to identify subgroups of patients with similar patterns of HbA1c one year before to one year after the first consultation at a DOC. We performed multinomial regression analyses to identify baseline characteristics associated with group membership. Results Four hundred and two of 6716 T2D patients started treatment at a DOC, constituting a yearly starting rate of 1.5%. We identified three classes of HbA1c trajectories: (1) stable moderate hyperglycaemia (75%); (2) severe hyperglycaemia with a decline in HbA1c around referral (14%) and (3) severe hyperglycaemia with a decline in HbA1c after starting treatment at the DOC (11%). HbA1c trajectories were associated with diabetes duration RRR 0.92, CI (0.87, 0.97) in class 2 vs. 1 and 0.93 (0.88, 0.98) in class 3 vs. 1. Some differences were found between clinics in rejection rate, processes of care, and duration of follow-up. Conclusions Norwegian GPs handle most T2D patients themselves. Those with T2D and severe hyperglycaemia had a considerable benefit from being referred to a DOC, though with two separate trajectories: One where HbA1c improved around the time of referral, and another that improved after starting in a DOC.

25-year trajectories of physical activity and atrial fibrillation risk: results from the ARIC study.

The relationship between serial changes in physical activity and the risk of developing atrial fibrillation (AF) has been rarely studied. To evaluate the association between changes in physical activity over time and the incidence of AF. A total of 11,828 participants without AF at baseline (visit 1: 1987-1989) from the ARIC Study were included. Physical activity was measured using the modified Baecke Physical Activity Questionnaire at three different visits between 1987 and 2013. Physical activity trajectories over 25 years were identified using latent class trajectory modeling. The primary outcome was the incidence of AF. Multivariable Cox hazard regression models were used to evaluate the relationship between physical activity trajectories and the incidence of AF. Over a median follow-up of 24 years, 2,108 AF cases (17.8%) occurred. Four distinct physical activity trajectories were identified: light [n = 5,266 (43.3%)]; reduced moderate [n = 3,583 (29.0%)]; moderate [n = 2,691 (25.0%)]; and vigorous intensity [n = 288 (2.8%)]. Compared to the light group, the hazard ratio (HR) and 95% confidence interval (CI) for AF were 1.18 (1.07-1.30) (p < 0.001) for the reduced moderate group, 0.61 (0.53-0.70) (p < 0.001) for the moderate group, and 0.82 (0.59-1.12) (p = 0.21) for the vigorous group, after multivariate adjustments. Maintaining moderate levels of physical activity is associated with a lower risk of AF, while a decrease in activity from moderate to light levels increases the risk. These findings highlight the importance of sustaining adequate physical activity levels for the prevention of AF.

Longitudinal change in cervical length measured after prophylactic cerclage in predicting spontaneous preterm birth.

To evaluate the value of serial post-cerclage cervical length measurements in predicting preterm birth. This was a retrospective study of women with a singleton pregnancy who underwent prophylactic transvaginal cerclage from 2017 to 2023. Prophylactic cerclage was performed in women with an obstetric history of cervical insufficiency. After cerclage, all participants underwent routine transvaginal cervical measurement every 2-4 weeks until 32-34 weeks of gestation. Trajectory patterns of changes in cervical length were identified through latent class trajectory modeling. The association of patterns with spontaneous preterm birth and pregnancy interval was analyzed by multivariable logistic regression analysis and Cox proportional hazards regression models. The specific characteristics of changes in cervical length associated with preterm birth were identified. We involved 225 women and acquired a total of 1248 measurements of cervical length. Two distinct trajectories of cervical length change along gestation were identified: Class 1 (persistent shortening of cervix, n = 52 [23.11%]) and class 2 (stable cervix, n = 173 [76.89%]). Women in class 1 were highly associated with spontaneous preterm birth, with a hazard ratio (95% confidence interval [CI]) of 2.00 (1.36, 2.96). The average shortening rate ≥0.24 cm per week and cervical length ≤1.1 cm was significantly associated with spontaneous preterm birth at different gestational age. Serial sonographic cervical length measurements after prophylactic cerclage are valuable in predicting preterm birth.

Using large administrative data for mining patients' trajectories for risk stratification: An example from urological diseases.

To identify latent clusters among urological patients by examining hospitalisation rate trajectories and their association with risk factors and outcome quality indicators. Victorian Admitted Episodes Dataset, containing information on all hospital admissions in Victoria from 2009 to 2019. The top twenty ICD-10 primary diagnosis codes in urology were used to select patients (n = 98,782) who were included in the study. Latent class trajectory modelling (LCTM) was used to cluster urological patient hospitalisation trajectories. Logistic regression was used to find baseline factors that influence cluster membership, the variables tested included comorbidities, baseline diagnosis codes, and socio-demographic factors. The analysis was further stratified into non-surgical procedures and surgical procedures. Five clusters of hospitalisation trajectories were identified based on clustering hospitalisation rates over time. Higher hospitalisation clusters were strongly associated with longer length of stay, higher readmission rates and higher complication rates. Higher-risk groups were strongly associated with comorbidities such as renal disease and diabetes. For surgical procedures, urological cancers (kidney, prostate and bladder cancer) and irradiation cystitis were associated with higher-risk groups. For non-surgical procedures, calculus of the bladder, urethral stricture and bladder neck obstruction were associated with higher-risk groups. For patients with two or more admissions, liver cardiovascular disease and being diagnosed with benign prostatic hyperplasia were also associated with higher risk groups. A novel statistical approach to cluster hospitalisation trajectories for urological patients was used to explore potential clusters of patient risks and their associations with outcome quality indicators. This study supports the observation that baseline comorbidities and diagnosis can be predictive of higher hospitalisation rates and, therefore, poorer health outcomes. This demonstrates that it is possible to identify patients at risk of developing complications, higher length of stay and readmissions by using baseline comorbidities and diagnosis from administrative data.

Long-term characterization of behavior phenotypes in children with seizures: Analytic approach matters.

Behavioral problems in children with new onset epilepsies have been well established in the literature. More recently, the literature indicates the presence of unique behavioral patterns or phenotypes in youth with epilepsy that vary significantly in vulnerability and resilience to behavioral problems. This study contrasts the interpretation of behavioral risk as inferred from cross-sectional versus latent group analytic perspectives, as well as the presence, consistency, stability, and progression of behavioral phenotypes in youth with new onset epilepsy and sibling controls over 3 years. Three hundred twelve participants (6-16 years old) were recruited within 6 weeks of their first recognized seizure along with 223 unaffected siblings. Each child's behavior was recorded by parents and teachers frequently over 36 months using the Child Behavior Checklist (CBCL), and each child completed self-report measures of depression symptoms over 36 months. Measures were evaluated cross-sectionally and longitudinally to identify clusters with prototypical behavioral trajectories. Cross-sectional analyses exhibited a pattern of generalized and undifferentiated behavioral problems compared to sibling controls at baseline and prospectively. In contrast, latent trajectory modeling identified three distinct behavior phenotype clusters across all raters (parents, teachers, and youth) over baseline and longitudinal assessments. CBCL Cluster 1 (~30% of youth with epilepsy) exhibited behavior similar to/better than controls, Cluster 2 (~50%) exhibited moderate behavior issues, and Cluster 3 (~20%) exhibited the most pronounced/problematic behavior, falling into Achenbach's clinically relevant behavior range. Behavior within clusters remained stable and consistent. Teachers' and children's behavior assessments corresponded to these cluster groupings consistently over 36 months. Predictors of cluster membership include seizure syndrome type and social determinants of health. This study demonstrates the varying public health perspectives of behavioral risk in youth with epilepsy that result as a function of analytic approach as well as the presence of distinct latent behavioral trajectory phenotypes over time in youth with new onset epilepsy.

Longitudinal bidirectional relations between psychological maltreatment by teachers and psychosocial adjustment during early adolescence

This study examined three models (relationship-driven model, symptom-driven model and transactional model) testing the across-time bidirectional relations between psychological maltreatment by teachers and early adolescents' psychosocial adjustment (i.e., internalizing problems, externalizing problems, and academic achievement) during early adolescence. A total of 4169 Chinese early adolescents (Mage = 9.93 years, SD = 0.73, 54% males) completed assessments across five waves, every six months. Employing autoregressive latent trajectory models with structured residuals (ALT-SR), the results revealed that adolescents’ internalizing problems and academic achievement were predicted by psychological maltreatment by teachers (supporting the relationship-driven model), whereas externalizing problems and psychological maltreatment by teachers were bidirectionally related (supporting the transactional model). Moreover, sex moderated the relations between psychological maltreatment by teachers and psychosocial adjustment. The finding of differential relations between psychological maltreatment by teachers and three components of psychosocial adjustment (i.e., internalizing problems, externalizing problems, and academic achievement) indicated that prevention and interventions should be tailored to different psychosocial adjustment difficulties.

Prognostic assessment based on the trajectory of artificial intelligence-enabled electrocardiograms for age estimation

Abstract Background Artificial Intelligence (AI) estimation of age using data from the 12-lead electrocardiogram (ECG) has demonstrated its utility as a biomarker in predicting the future risk of cardiac diseases and mortality. However, expected long-term outcomes based on temporal changes in the AI-ECG age gap remain unclear. Purpose This study aims to utilize the difference between ages predicted by AI-ECG and actual ages longitudinally for follow-up and to assess whether there are significant clinical differences in mortality among specific groups. Methods Among patients at a hospital who had not been used for the AI-ECG age prediction model (121,702 individuals, 522,261 ECGs), 6,685 individuals with 31,858 ECGs who had an index ECG and the subsequent ECG in the fifth year, with at least one intervening ECG were included for analysis. The absolute age gap, defined as the absolute difference between ECG-predicted and chronological age, was limited to ±10 for analysis. Latent class trajectory modeling was then utilized to classify groups based on the AI-ECG age gap. Results Data-driven analysis revealed four distinct trajectory groups based on age gap trajectories: Consistently Young ECG (27.2%), Reversed ECG Aging (35.3%), Accelerated ECG Aging (8.0%), and Consistently Old ECG (29.5%). Notably, the Accelerated ECG Aging group exhibited a significantly higher cumulative incidence of all-cause death (adjusted hazard ratio (HR) 1.66 (95% confidence interval (CI) 1.30-2.12, p-value &amp;lt;0.001) and non-cardiac death (adjusted HR 1.83 (95% CI 1.38-2.43, p-value &amp;lt;0.001) compared to the Consistently Young ECG group. Conclusion Among 4 distinct trajectories based on the changes in the AI-ECG age gap, Accelerated ECG Aging was associated with a heightened risk of all-cause mortality. Additional in-depth analysis of factors associated with Accelerated ECG Aging is warranted.

Association between trajectory of systolic blood pressure and outcomes in heart failure patients with preserved ejection fraction (HFpEF)

BackgroundThe optimal systolic blood pressure (SBP) in heart failure patients with preserved ejection fraction (HFpEF) remains controversial. We aim to assess the SBP trajectory and prognosis in HFpEF. Methods and ResultsPatients from Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT) were classified into three SBP trajectory groups according to the follow-up blood pressure using a latent category trajectory model. The primary outcome was composite of cardiovascular death, cardiac arrest, and hospital readmission for heart failure. A total of 3388 patients (mean age 68.6 years, 48.5 % men) were included. Mean SBP maintained 128 mmHg in the stable SBP trajectory group, declined from 129 to 125 mmHg in the decreasing SBP trajectory group and rose from 132 to 143 mmHg in the increasing SBP trajectory group within 6 years. During a mean follow-up of 3.4 years, 654 individuals had a primary outcome. Incidence for both primary and secondary outcomes were higher in increasing SBP trajectory group and decreasing SBP trajectory group compared with stable SBP trajectory group. After adjustments, the decreasing SBP trajectory group was associated with increased risk of all outcomes (hazard ratio ≥1.32), the increasing SBP trajectory group was associated with all-cause hospitalization and stroke (hazard ratio ≥ 1.28). ConclusionThe decreasing or increasing SBP trajectory is associated with a high risk of cardiovascular events in HFpEF, suggesting a stable SBP trajectory group (≈130 mmHg) have lower incidence of cardiovascular events and mortality. Trials are necessary to determine the optimal SBP in HFpEF.

Uptake of biosimilars in China: a retrospective analysis of the case of trastuzumab from 2018 to 2023

BackgroundThe Chinese biosimilar industry has demonstrated rapid growth in recent years. Limited evidence is available about biosimilar uptake at the national level. This study aimed to assess biosimilar uptake in the case of trastuzumab and to explore potential factors influencing the biosimilar penetration at national and provincial levels.MethodsThis study employed an interrupted time series analysis to assess the level and trend changes of national trastuzumab originator consumption and the overall trastuzumab consumption after the price reduction of the originator and the introduction of the first biosimilar using the China Hospital Pharmacy Audit procurement data from March 2018 to February 2023. A latent class trajectory model (LCTM) was also adopted to estimate the biosimilar penetration across 30 provincial-level administrative divisions (PLADs). Based on the LCTM grouping results, provincial characteristics were analyzed.ResultsAfter rapid growth, the penetration of biosimilars demonstrated a moderate ascending trend at the national level, reaching 27% in February 2023. Following the introduction of the first biosimilar in July 2021, the consumption of the originator decreased by 0.5% per month (P = 0.008), and the growth rate of overall trastuzumab consumption decreased by 1.1% per month (P = 0.014). LCTM fit the best when the number of trajectory classes was two, dividing 30 PLADs into a group demonstrating a faster increase in biosimilar penetration and the other with a slower increase. The PLADs in the fast-increasing group had a higher proportion of the population covered by the national basic health insurance, a lower proportion of the urban population, a lower proportion of the population covered by the urban employee health insurance program, a lower gross domestic product per capita, a lower total health expenditure per capita, and a lower out-of-pocket expenditure.ConclusionsThe uptake of trastuzumab biosimilars in China was lower compared with major European countries. The introduction of trastuzumab biosimilars presented a substitutional effect. Perceptions of physicians and patients, the medicines procurement model, competition from other biologics, and health insurance payment methods may influence biosimilar uptake. Enhancing a comprehensive understanding of biosimilars among physicians and patients, including biologics with biosimilars in the national pooled procurement, and implementing provider payment reforms could foster biosimilar penetration.

Negative wealth shocks and subsequent depressive symptoms and trajectories in middle-aged and older adults in the USA, England, China, and Mexico: a population-based, multinational, and longitudinal study.

The association between negative wealth shocks and depression among middle-aged and older individuals remains unclear. Our study aimed to assess the association between negative wealth shocks and depression and its trajectories, and to explore cross-national differences in these associations. Our sample included 21 999 participants, of which 9519 were from the Health and Retirement Study (2012-2020), 4936 from the English Longitudinal Study of Ageing (2012-2020), 2520 from the China Health and Retirement Longitudinal Study (2011-2020), and 5024 from the Mexican Health and Aging Study (2012-2021). We used latent class trajectory models to identify depressive trajectories, alongside mixed-model logistic regression and multinomial logistic regression to evaluate associations. In the USA (OR 1.73, 95% CI 1.40-2.16), England (OR 1.71, 95% CI 1.09-2.70), and China (OR 1.38, 95% CI 1.09-1.75), negative wealth shocks were associated with subsequent depressive symptoms, but not in Mexico (OR 1.06, 95% CI 0.86-1.29). Additionally, negative wealth shocks were associated with several depressive trajectories in the USA and China. This association occurred only in increasing-decreasing trajectory in England, while no significant association was found across any trajectory in Mexico. Negative wealth shocks were associated with subsequent depressive symptoms, with significant associations observed in some specific depressive trajectories. These associations exhibited cross-national differences, underscoring the importance of considering country-specific contexts when addressing the mental health impacts of wealth shocks.

Effects of hemodialysis adequacy on chronic kidney disease complications using latent class trajectory modeling: a real-world study based on long-term observation of Kt/V.

Previous studies on hemodialysis adequacy primarily focused on the association between Kt/V and survival, and low Kt/V is associated with increased mortality. There is a paucity of research on the correlation between Kt/V and chronic kidney disease (CKD) complications. The retrospective study was conducted in the blood purification center of a tertiary hospital in China from July 2020 to September 2022. It aimed to analyze the association between latent Kt/V trajectory categories and CKD complications (hypertension, anemia, mineral and bone disorder) and inflammatory markers. The latent class trajectory model was established to describe the different patterns of Kt/V changes over the observation period. During the 2-year study period, 93 patients on thrice-weekly hemodialysis with residual kidney function <2 mL/min were included. In the 3-class Kt/V trajectory model, 21 patients were in class 1 with a Kt/V trajectory that declined from a higher to lower levels (from >1.6 to <1.4), 59 patients were in class 2 with Kt/V consistently in a relatively low range (around 1.4), and 13 patients were in class 3 with Kt/V stabilized around 1.6. No significant difference in CKD complications or inflammation markers was observed among the three Kt/V trajectories. Under the premise of adequate Kt/V, neither a stable higher Kt/V nor a declined Kt/V significantly influenced CKD complications or inflammatory markers.