Multilevel Multinomial Logistic Regression Research Articles

Antenatal Care Services Uptake and Associated Factors in Somaliland: Further Analysis of the 2020 Somaliland Demographic Health Survey

Purpose Antenatal care (ANC) is vital to maintain the health of pregnant women and their unborn babies. It was linked to a positive pregnancy experience. However, ANC uptake remained low in Somaliland, and no study has been conducted to assess possible predictors. Hence, the current study aimed to determine the level of ANC utilization and to identify its associated factors in Somaliland. Materials and Methods Somaliland Demographic Health Survey (SLDHS) Data 2020 were used. A weighted sample of 3,192 women aged 15-49 years participated in the study. The survey used a two-stage cluster design for sample selection. Descriptive statistics in the form of frequency and percentage and multilevel multinomial logistic regression analysis were carried out to determine associated factors and statistical significance was declared by p< 0.05. Results The findings showed that 62.4% (95% CI: 60.7-64.1) of the women did not utilize ANC services, while 23.4% (95% CI: 21.9, 24.9) partially utilized and 14.2% (95% CI: 13.0, 15.4) adequately utilized ANC services. The odds of adequately utilizing ANC service decreased by a factor of 0.88 for women aged 35 and above compared to 15 - 24 year old women (AOR= 0.88, 95% CI: 0.61, 1.26). Women with higher educational levels had significantly higher odds (AOR=4.31, 95% CI: 1.54, 12.02) of adequately utilizing ANC compared to those with no formal education. The employment status, marital status, household wealth index, residence and region were also found to be associated with the utilization of Antenatal care. Conclusion The study showed low adequate utilization of ANC services in Somaliland. The variables, including age, education, wealth index, marital status, employment status, residence and region, were significantly associated with ANC utilization. Governmental and non-governmental organizations should enact a strategy with targeted intervention focusing on women from nomadic and rural communities, those from poor households, and low educational levels.

Trends and social determinants of the obesity epidemic among reproductive-age women in ten Asian countries

The rapid epidemiological transition in Asian countries, resulting from the rising trend of urbanisation and lifestyle changes, is associated with an increasing risk of obesity in women of reproductive age. This is the first study to investigate the trends and population-attributable fraction (PAF) of obesity, and the interaction effects of education and wealth on obesity among reproductive-age women aged 15–49 years in ten Asian countries. This cross-sectional study examined the most recent (2000 to 2022) Demographic and Health Surveys (DHS) data from ten Central and Southeast Asian countries. Multilevel multinomial logistic regression models were used to compute odds ratios (ORs). PAFs adjusted for communality were calculated using adjusted ORs and prevalence estimates for each risk factor. This study included a weighted sample of 743,494 reproductive-age women. All the countries showed an increasing trend for obesity and a decreasing trend for underweight, except for the Maldives. The highest PAFs of obesity were associated with women who were married (PAF = 22.2%; 95% CI 22.1, 22.4), aged 35–49 years (PAF = 16.4%; 95% CI 15.5, 17.1), resided in wealthy households (PAF = 14.5%; 95% CI 14.4, 14.5), watched television regularly (PAF = 12.5%; 95% CI 12.1, 12.8), and lived in urban areas (PAF = 7.8%; 95% CI 7.7, 8.0). The combined PAF showed that these five risk factors were associated with 73.3% (95% CI 71.8, 74.9) of obesity among reproductive-age women. Interaction analysis between women’s education and household wealth revealed that having a secondary or higher level of education and residing in a wealthier household was associated with a lower risk of obesity (OR = 0.71, 95% CI 0.66, 0.76). The findings of this study suggest that, in order to address the rising rate of obesity among women in Asian countries, education and lifestyle modifications in urban areas should be a priority. Pakistan and the Maldives need to be a priority given the rapidly increasing trends in obesity and underweight subpopulations in their respective countries.

Containment Measures and Alcohol Consumption Among Drinking Higher Education Students Before and During the COVID-19 Pandemic: A Multilevel Analysis in 25 Countries.

Hazardous alcohol use tends to be more prominent among higher education students. The COVID-19 pandemic severely altered student life, raising questions on its impact on students' alcohol use patterns. The current study examined cross-country variations in drinking behaviors (weekly drinking and binge drinking), and the extent to which these variations were associated with containment measures implemented during the first wave of the COVID-19 pandemic. Data were obtained from the COVID-19 International Student Well-being Study, covering students in 25 middle- and upper-high income countries. Data on government responses were retrieved from the Oxford COVID-19 Government Response Tracker. Multilevel multinomial logistic regression analyses were performed on weekly drinking (n = 44,212) and binge drinking (n = 32,785). Considerable cross-country variation existed for weekly drinking and binge drinking. In the majority of countries, a self-reported decrease in weekly drinking and a substantial self-reported decrease in binge drinking were observed. Closings of schools were associated with decreases in weekly drinking, while limitations on social gatherings were associated with increases in weekly drinking. The stringency index was associated with reporting decreased binge drinking. The study findings demonstrate a number of small yet significant associations between containment measures and changes in student drinking behaviors. Future studies are required to uncover why some students increased their alcohol consumption, particularly in countries with stricter limitations on social gatherings.

Understanding community hate crimes as an incorrigible proposition: Local political attitudes, path dependence, and the ceremonious reporting of hate crime statistics

AbstractThe Hate Crime Statistics Act (HCSA) of 1990 requires the federal government to publicly release official hate crime statistics annually; the HCSA does not, however, mandate that local agencies submit hate crime reports to the government in the first place. Although research has evaluated the reporting of hate crime statistics in a dichotomous fashion (compliance vs. noncompliance), the current study suggests that the consistent and invariable reporting of zero hate crimes in a particular jurisdiction over time is unlikely and thus better conceptualized as a third response strategy: ceremonious compliance. We examine this strategy as a potentially unique institutional behavior, structured by local political and historical contexts, including discursive differences in the identification of hate crime as an important social problem, and localized histories of racial oppression. This research then uses multilevel multinomial logistic regression models to estimate variation in the likelihood of differential compliance strategies (i.e., true compliance, ceremonious compliance, noncompliance), according to several political and historical factors, including Republican vote share, location in the Confederate South, and historical lynchings. Findings reveal that political and historical contexts are important predictors of agency responses to hate crime, with a particular tendency toward ceremonious compliance in Republican‐leaning locales.

School leadership and students’ decisions about further education: exploring the roles of goal setting and school socioeconomic composition

ABSTRACT This study focuses on the relationship between various leadership goal setting and students’ decisions about further education in the context of the Danish educational system. Furthermore, the potential of school leadership to reduce social disparities in such decisions is explored. The data set is based on repeated measurements of school leaders’ attitudes and practices from 819 schools over 4 years, merged with administrative register data. Multilevel multinomial logistic regression and two-way fixed effects multinomial regression were applied. We find no relationship between achievement goals and educational decisions. Depending on modeling choices, results indicate that leadership goal setting concerning transition is associated with a small increase in the chance of students choosing the academic track, and the goal of promoting citizenship among students was associated with a slightly higher probability of choosing the vocational track. Furthermore, transition goals moderate the relationship between school socioeconomic status and students’ probability of choosing the academic track.

Convention, Protest, or Violence? Estimating the Influence of Repertoires of Contention over Tactical Choice

Why do people opt for different forms of collective action, like lobbying, marching, or rioting, to voice contentious claims? The patterns of these collective action forms, or “tactics” exhibit variations among groups, regions, and nations, evolving over time. Current explanations for such tactical patterns are unsatisfactory due to limited theoretical and empirical exploration of the concept of repertoires of contention. This paper presents a comprehensive theoretical model drawing on social practice and learning theories, centered around the notion of tactical familiarity. The central idea posits that people in diverse societies have learned distinct ways of doing politics, gaining varying familiarity and proficiency with different tactics, developed through three mechanisms: feedback, diffusion, and memory. These mechanisms contribute to the formation of notably distinct repertoires of contention. Based on this theoretical model, this study develops an empirical measure of tactical familiarity. The novel measure allows comparing the impact of tactical familiarity with other factors, like political regime characteristics. Previous research has not conducted such comparisons, as it often focuses on particular tactics, like protests or violence, without delving into the full array of potential tactical choices, including conventional-institutional ones. Using quantitative event analysis and a dataset of 10 Million International Dyadic Events, the paper examines 17,575 global political events from 2000 to 2004. Multilevel multinomial logistic regression highlights repertoires of contention’s significant influence on tactical choices, potentially outweighing political regime characteristics.

Who believes in a just world? A multilevel latent profile analysis of Justice Capital using the European Social Survey.

Justice Capital provides a theoretical framework for explaining individual differences in the belief in a just world (BJW). However, this framework has yet to receive empirical validation. Using Round 9 of the European Social Survey, a large (n = 43,209) multi-country (N = 29) sample, I conduct multilevel latent profile analysis and multilevel multinomial logistic regression to determine the latent profiles that emerge at a population level and map the demographic and experiential covariates of these profiles. Incorporating measures of general BJW, distributive and procedural justice, and the belief in equality of opportunity, I find three latent profiles: meritocrats, moderates, and egalitarians. Compared with egalitarians, meritocrats (strong just world believers) are more likely to be male; younger; have a higher income; have attained more years of education; to be politically conservative; and have no recent experience of discrimination or crime. Meritocrats were overrepresented in countries with a higher Human Development Index. This study demonstrates the feasibility of Justice Capital for understanding individual variation in general BJW and related justice beliefs; discussion centers on anomalous findings and extension of this theoretical framework.

Multilevel multinomial regression analysis of factors associated with birth weight in sub-Saharan Africa

Birth weight significantly determines newborns immediate and future health. Globally, the incidence of both low birth weight (LBW) and macrosomia have increased dramatically including sub-Saharan African (SSA) countries. However, there is limited study on the magnitude and associated factors of birth weight in SSA. Thus, thus study investigated factors associated factors of birth weight in SSA using multilevel multinomial logistic regression analysis. The latest demographic and health survey (DHS) data of 36 sub-Saharan African (SSA) countries was used for this study. A total of a weighted sample of 207,548 live births for whom birth weight data were available were used. Multilevel multinomial logistic regression model was fitted to identify factors associated with birth weight. Variables with p-value < 0.2 in the bivariable analysis were considered for the multivariable analysis. In the multivariable multilevel multinomial logistic regression analysis, the adjusted Relative Risk Ratio (aRRR) with the 95% confidence interval (CI) was reported to declare the statistical significance and strength of association. The prevalence of LBW and macrosomia in SSA were 10.44% (95% CI 10.31%, 10.57%) and 8.33% (95% CI 8.21%, 8.45%), respectively. Maternal education level, household wealth status, age, and the number of pregnancies were among the individual-level variables associated with both LBW and macrosomia in the final multilevel multinomial logistic regression analysis. The community-level factors that had a significant association with both macrosomia and LBW were the place of residence and the sub-Saharan African region. The study found a significant association between LBW and distance to the health facility, while macrosomia had a significant association with parity, marital status, and desired pregnancy. In SSA, macrosomia and LBW were found to be major public health issues. Maternal education, household wealth status, age, place of residence, number of pregnancies, distance to the health facility, and parity were found to be significant factors of LBW and macrosomia in this study. Reducing the double burden (low birth weight and macrosomia) and its related short- and long-term effects, therefore, calls for improving mothers' socioeconomic status and expanding access to and availability of health care.

Predictors of maternal health services uptake in West African region: a multilevel multinomial regression analysis of demographic health survey reports

BackgroundPursuant to studies, receiving the three key maternal health services (Antenatal Care, Skilled Delivery Service, and Postnatal Care) in a continuum could prevent 71% of global maternal deaths. Despite the Western African region being known for its high maternal death and poor access to maternal health services, there is a dearth of studies that delve into the spectrum of maternal health services uptake. Hence, this study aimed to assess the level and predictors of partial and adequate utilization of health services in a single analytical model using the most recent Demographic and Health Survey (DHS) data (2013–2021).MethodsThis study was based on the appended women's (IR) file of twelve West African countries. STATA software version 16 was used to analyze a weighted sample of 89,504 women aged 15–49 years. A composite index of maternal health service utilization has been created by combining three key health services and categorizing them into ‘no’, ‘partial’, or ‘adequate’ use. A multilevel multivariable multinomial logistic regression analysis was carried out to examine the effects of each predictor on the level of service utilization. The degree of association was reported using the adjusted relative risk ratio (aRRR) with a corresponding 95% confidence interval, and statistical significance was declared at p < 0.05.Results66.4% (95% CI: 64.9, 67.7) and 23.8% (95% CI: 23.3, 24.2) of women used maternal health services partially and adequately, respectively. Togo has the highest proportion of women getting adequate health care in the region, at 56.7%, while Nigeria has the lowest proportion, at 11%. Maternal education, residence, wealth index, parity, media exposure (to radio and television), enrolment in health insurance schemes, attitude towards wife beating, and autonomy in decision-making were identified as significant predictors of partial and adequate maternal health service uptake.ConclusionThe uptake of adequate maternal health services in the region was found to be low. Stakeholders should plan for and implement interventions that increase women's autonomy. Program planners and healthcare providers should give due emphasis to those women with no formal education and from low-income families. The government and the private sectors need to collaborate to improve media access and increase public enrolment in health insurance schemes.

Local and long-distance migration among young people in rural Malawi: importance of age, sex and family.

In sub-Saharan Africa, migration of young people is common and occurs for a variety of reasons. Research focus is often on international or long-distance internal migration; however, shorter moves also affect people's lives and can reveal important information about cultures and societies. In rural sub-Saharan Africa, migration may be influenced by cultural norms and family considerations: these may be changing due to demographic shifts, urbanisation, and increased media access. We used longitudinal data from a Health and Demographic Surveillance Site in rural northern Malawi to present a detailed investigation of migration in young people between 2004-2017. Our focus is on the cultural effects of gender and family, and separate migrations into short and long distance, and independent and accompanied, as these different move types are likely to represent very different events in a young person's life. We use descriptive analyses multi-level multinomial logistic regression modelling. We found two key periods of mobility 1) in very young childhood and 2) in adolescence/young adulthood. In this traditionally patrilocal area, we found that young women move longer distances to live with their spouse, and also were more likely to return home after a marriage ends, rather than remain living independently. Young people living close to relatives tend to have lower chances of moving, and despite the local patrilineal customs, we found evidence of the importance of the maternal family. Female and male children may be treated differently from as young as age 4, with girls more likely to migrate long distances independently, and more likely to accompany their mothers in other moves.

Disparities in Access to Multidisciplinary Cancer Consultations and Treatment for Patients With Early-Stage Non-Small Cell Lung Cancer: A SEER-Medicare Analysis

PurposeDisparities in access to multidisciplinary cancer consultations (MDCc) persist, and the role of physician relationships remains understudied. This study examined the extent to which multilevel factors, including patient characteristics and patient-sharing network measures reflecting the structure of physician relationships, are associated with MDCc and receipt of stereotactic body radiation therapy (SBRT) versus surgery among early-stage non-small cell lung cancer (NSCLC) patients. Materials and MethodsIn this cross-sectional study, we analyzed Surveillance, Epidemiology, and End-Result (SEER)-Medicare data for patients diagnosed with stage I-IIA NSCLC in 2016-2017. We assembled patient-sharing networks and identified cancer specialists who were locally unique for their specialty, herein referred to as “linchpins”. The proportion of linchpin cancer specialists for each hospital referral region (HRR) was calculated as a network-based measure of specialist scarcity. We used multilevel multinomial logistic regression to estimate associations between study variables and the receipt of MDCc and multilevel logistic regression to examine the relationship between MDCc and patient's first treatment. ResultsOur study included 6,120 patients with stage I-IIA NSCLC, of which 751 (12.3%) received MDCc, 1,729 (28.3%) only consulted a radiation oncologist, 2,010 (32.8%) only consulted a surgeon, and 1,630 (26.6%) had no consultations with either specialist within two months following diagnosis. Compared with patients residing in an HRR with a low proportion of linchpin surgeons, those in an HRR with a high proportion of linchpin surgeons had a 2.99 (95% CI: 1.87-4.78) greater relative risk of exclusively consulting a radiation oncologist (vs. MDCc) and a 2.70 (95% CI: 1.68-4.35) greater relative risk consulting neither specialist (vs. MDCc). Patients who received MDCc were 5.32 (95% CI: 4.27-6.63) times more likely to receive SBRT (vs. surgery). ConclusionsPhysician networks are associated with receipt of MDCc and treatment, underscoring the potential for leveraging patient-sharing network analysis to improve access to lung cancer care.

Daily Stress, Drinking Motives and Alcohol Co-Use with Other Drugs

Background: Recent evidence indicates that alcohol and other substance co-use, compared to alcohol-only use, might be more closely associated with negative reinforcement processes, and thus more likely during periods of increased stress. The present study examined this possibility by using data from an intensive longitudinal (daily) study of college student drinkers (N = 1461, 54% women). We also examined individual differences in coping and enhancement drinking motives as predictors of alcohol and other substance co-use. Results: We used multilevel multinomial logistic regression to predict, relative to alcohol-only days, the likelihood of alcohol co-use with either cigarettes or marijuana, along with alcohol use with multiple substances and other substance-only use from daily interpersonal and academic stress, day-of-the-week, sex, and individual differences in coping and enhancement drinking motives. We found that, relative to alcohol-only, alcohol and marijuana co-use was more likely, and non-alcohol related substance use was less likely, on weekends. Alcohol and marijuana co-use was less likely, and other substance-only use was more likely, on days characterized by greater academic stress, whereas alcohol and cigarette co-use was more likely on days characterized by greater interpersonal stress. Individuals with higher levels of drinking to cope motivation were more likely to engage in alcohol and cigarette co-use, other substance-only use, and alcohol plus multiple substances, relative to alcohol-only. Individuals with higher levels of enhancement motives were more likely to engage in all types of alcohol and other substance co-use and other substance-only use relative to alcohol-only. Conclusions: Findings are discussed in terms of the complex nature of different patterns of co-use patterns when evaluating indicators of positive- and negative-reinforcement processes.

Double burden of malnutrition and associated factors among women of reproductive age in sub-Saharan Africa: a multilevel multinomial logistic regression analysis

BackgroundGlobally, malnutrition among women of reproductive age is on the rise and significantly contributing to non-communicable disease, deaths and disability. Even though the double burden of malnutrition (DBM) is a...

Multidimensional Deprivations and Associated Factors Among Older Adults in Urban Geographies of Nigeria: Implications for Poor Health Outcomes in Later Life.

Objectives: Many urban-dwelling older Nigerians are multidimensionally deprived and are unable to meet their daily financial, nutritional, and healthcare needs. This has implications for their health outcomes, yet it has been under-researched. This study assessed the multidimensional deprivation index (MDI) of urban-dwelling older Nigerians and the associated factors. Methods: The study analysed a weighted sample of 5,225 older persons aged ≥60 years from Nigeria's Demographic and Health Survey, 2018. MDI was estimated, and associations were examined using a multilevel multinomial logistic regression model. Results: Nationally, 75% of the older persons were multidimensionally deprived, with 27% severely deprived. Women (36%) were more severely deprived than men (20%). Those in the Northern regions (38%-40%) were the most deprived. Higher MD risk was associated with female gender and older ages ≥70-79years. Conversely, lower risk was associated with households headed by family and residence in educated communities. Community variation accounts for 10.4% and 35.9% of the MD and severe MD risks, respectively. Conclusion: This study suggests socioeconomic interventions that address gender disparities and target highly deprived regions, with consideration for individual and community characteristics.

Relationship between area-level socioeconomic status and health-related quality of life among cancer survivors.

Area-level socioeconomic status (SES) impacts cancer outcomes, such as stage at diagnosis, treatments received, and mortality. However, less is known about the relationship between area-level SES and health-related quality of life (HRQOL) for cancer survivors. To assess the additive value of area-level SES data and the relative contribution of area- and individual-level SES for estimating cancer survivors' HRQOL, we conducted a secondary analysis of data from a population-based survey study of cancer survivors (the Measuring Your Health [MY-Health] Study). Multilevel multinomial logistic regression models were used to examine the relationships between individual-level SES, area-level SES as measured by the Centers for Disease Control and Prevention's Social Vulnerability Index, and HRQOL group membership (high, average, low, or very low HRQOL). Area-level SES did not significantly increase model estimation accuracy compared to models using only individual-level SES. However, area-level SES could be an appropriate proxy when the individual-level SES is missing.

889. The age of RSV cases changes consistently over the course of annual epidemics: potential insights into RSV transmission dynamics based on surveillance data from seven countries.

Abstract Background RSV infections affects people of all ages but the seasonality of RSV among different age groups have not been thoroughly examined. In this study, we investigated changes in the age distribution of RSV cases during the course of annual epidemics. Methods We analyzed surveillance data (2008-2019) from the Netherlands, the city of Lyon (France), Portugal, Singapore, Ecuador, South Africa, and New Zealand using the Global Epidemiology of RSV (GERi) study database. We defined annual RSV seasons as the period from July to June in the Northern hemisphere, or the calendar year in the tropics and Southern hemisphere. Within each season, we divided the data into “epidemic quartiles”, corresponding to each quartile of RSV cases in the season. We used multilevel multinomial logistic regression models with season as the higher-level variable to assess whether the likelihood of RSV cases being aged &amp;lt; 1 year or ≥5 years (vs. those aged 1 to &amp;lt; 5 years) changed over time during the season. Results A total of 27,391 RSV cases were included. Across all countries, the odds of RSV cases being aged &amp;lt; 1 year (vs. 1 to &amp;lt; 5 years) were significantly higher in the fourth epidemic quartile compared to the first quartile; the relative risk ratio (RRR) ranged between 1.35 in Lyon, France, and 2.56 in the Netherlands. Similarly, the odds of RSV cases being aged ≥5 years (vs. 1 to &amp;lt; 5 years) were significantly higher in the fourth epidemic quartile compared to the first quartile (except in Singapore); the RRR ranged from 1.75 in Ecuador to 6.70 in Lyon, France. The results were consistent when stratifying the data by level of care (primary vs. secondary) or using a lower cut-off of six months of age. Conclusion The age distribution of RSV cases changes over the course of a season, with infants (&amp;lt; 1 year) and older children (≥5 years), adults, and elderly people constituting a higher proportion of RSV cases in the later phases of annual epidemics. These findings provide potential insights into the transmission dynamics of RSV and may inform prevention and control measures, e.g. the implementation of targeted age-specific interventions. Funding: This research was funded by a collaborative agreement with Sanofi / AstraZeneca and is part of the RODEO research program for RSV disease. Disclosures Mathieu Bangert, PhD, Sanofi: Staff member Rolf Kramer, n/a, Sanofi: Stocks/Bonds John Paget, n/a, Sanofi Pasteur: Grant/Research Support

Continuation of education after marriage and its associated factors among young adult women: findings from the Bangladesh Demographic and Health Survey 2017–2018

ObjectiveTo identify the individual and community-level variables associated with the continuation of education among currently married young adult women in Bangladesh.DesignCross-sectional data extracted from the Bangladesh Demographic and Health Survey...

Prevalence and determinants of food insecurity among pregnant women in Nigeria: A multilevel mixed effects analysis.

Food insecurity (FI) remains a key priority for sustainable development. Despite the well-known consequences of food insecurity on health and well-being, evidence regarding the burden and determinants of FI among pregnant women in Nigeria is limited. Framed by the social-ecological model, this study aimed to determine the prevalence of FI, and its associations with individual-/household-level and contextual-level factors among pregnant women in Nigeria. A cross-sectional study based on the Nigerian Multiple Indicator Cluster Survey (2021 Nigerian MICS6) was conducted among a sample of 3519 pregnant women aged 15-49 years. Several weighted multilevel multinomial logistic regression models were fitted to assess the association between individual-/household-s level and community-level characteristics with FI. We estimated and reported both fixed effects and random effects to measure the associations and variations, respectively. Results: The prevalence of FI among pregnant women in Nigeria was high, with nearly 75% of the participants reporting moderate to severe FI in the past 12 months (95% CI = 71.3%-75.8%) in 2021. There were also significant differences in all the experiences of food insecurity due to lack of money or resources, as measured by the Food Insecurity Experience Scale (FIES), except for feeling hungry but not eating because of lack of money or resources (p < 0.0001). Multivariate analysis revealed that higher parity, households with 5 or more members, household wealth index, urban residence, and community-level poverty were significantly associated with FI. Our study demonstrates a significantly high prevalence of FI among pregnant women in Nigeria in 2021. Given the negative consequences of FI on maternal and child health, implementing interventions to address FI during pregnancy remains critical to improving pregnancy outcomes.

Chewing difficulty and frailty trajectories in Chinese nursing home residents: A prospective cohort study.

To investigate frailty trajectories in nursing home residents, and to test whether chewing difficulty was a significant factor associated with frailty trajectories. This is a 1-year prospective cohort study. Data were collected from 27 nursing home residents in China at baseline, 6 months, and 12 months. Latent class growth modeling was used to identify frailty trajectories. Multilevel multinomial logistic regression was used to test the relative risk ratios (RRRs) with 95% confidence intervals (CIs) of the chewing difficulty assessed at baseline on frailty trajectories. In total, 269 nursing home residents were included in the analysis. Three frailty trajectories identified were non-frailty trajectory (n = 181, 67.3%), stable frailty trajectory (n = 52, 19.3%), and progressive frailty trajectory (n = 36, 13.4%). Chewing difficulty was found among 138 (51.3%) nursing home residents. With the non-frailty trajectory group as the reference, residents with chewing difficulty were more likely to demonstrate stable frailty trajectory (RRR = 2.55, 95% CI [1.28-5.11]) or progressive frailty trajectory (RRR = 3.46, 95% CI [1.47-8.15]). Changes in the frailty of nursing home residents are heterogeneous and chewing difficulty should be assessed and addressed on a routine basis in nursing homes to prevent the deterioration of frailty or reverse it. Geriatr Gerontol Int 2023; 23: 803-808.

Spirometric patterns in young and middle-aged adults: a 20-year European study

BackgroundUnderstanding the natural history of abnormal spirometric patterns at different stages of life is critical to identify and optimise preventive strategies. We aimed to describe characteristics and risk factors of...