Multivariable Multinomial Logistic Regression Research Articles

Dengue hospitalizations and in-hospital mortality changes in trend in Ecuador: a nationwide study from 2015 to 2022

During recent years, dengue infection has spread rapidly within countries and between regions. Rapid rise in the global burden has been related to sociodemographic changes. Objective This study aimed to analyze dengue hospitalizations and in-hospital mortality trends in Ecuador, along with sociodemographic factors influencing adverse outcomes. Methods This study included 31,616 dengue hospitalizations in Ecuador during 2015–2022, of which 115 (0.36%) died. Data were extracted from national hospital registries. Age adjusted rates were calculated, and for the analysis of changes in trend, a Joinpoint regression was performed. Multivariate binary and multinomial logistic regressions were performed for assessing sociodemographic factors influencing dengue adverse outcomes. Results During 2015–2022, the mean age adjusted dengue hospitalization rate was 22.3 per 100,000 inhabitants with 49.41% annual decrease during 2015–2017 and 31.73% annual increase during 2017–2022 with higher rates in 2020 with 31.61, 2021 with 34.42, and 2022 with 25.81. The mean dengue in-hospital mortality rate was 0.08, mortality rates did not show significant changes during 2015–2022. Higher probability of death was observed in ages ≥50 years and ethnic minorities. People living in rural areas exhibited a 64% higher risk for complicated dengue hospitalization. Conclusions It was observed as an important accomplishment in Ecuador’s ongoing efforts to improve healthcare regarding dengue. 0.36% of dengue hospitalizations ended in death which is below the recommended 1%. The increase in dengue hospitalizations in Ecuador during recent years remains a concern. The COVID-19 pandemic might have influenced dengue prevention and vector control to be neglected leading to an increase in cases.

Impact of Chronic Disease Self-Management Program on the Self-Perceived Health of People in Areas of Social Vulnerability in Asturias, Spain.

The Chronic Disease Self-Management Program (CDSMP) focuses on a health promotion perspective with a salutogenic approach, reinforcing the pillars of self-efficacy. The aim of this study was to assess the impact of the CDSMP on Self-perceived Health (SPH) in disadvantaged areas of Asturias, España. The study included vulnerable adults with experience of chronic diseases for over six months, along with their caregivers. The intervention consisted of a six-session workshop led by two trained peers. SPH was evaluated by administering the initial item of the SF-12 questionnaire at both baseline and six months post-intervention. To evaluate the variable "Change in SPH" [improvement; remained well; worsening/no improvement (reference category)], global and disaggregated by sex multivariate multinomial logistic regression models were applied. There were 332 participants (mean = 60.5 years; 33.6% were at risk of social vulnerability; 66.8% had low incomes). Among the participants, 22.9% reported an improvement in their SPH, without statistically significant sex-based differences, while 38.9% remained in good health. The global model showed age was linked to decreased "improvement" probability (RRRa = 0.96), and the "remaining well" likelihood drops with social risk (RRRa = 0.42). In men, the probability of "remaining well" decreased by having secondary/higher education (RRRa = 0.25) and increased by cohabitation (RRRa = 5.11). Women at social risk were less likely to report "remaining well" (RRRa = 0.36). In conclusion, six months after the intervention, 22.9% of the participants had improved SPH. Age consistently decreased the improvement in the different models.

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.

Barriers and facilitators to using ophthalmic clinical health services following school vision screening: a mixed-methods study

ObjectiveTo identify determinants of the utilisation of ophthalmic clinical health services among students who failed school vision screening.MethodsThis study employed a sequential explanatory mixed methods design, underpinned by Andersen’s Behavioural...

A Cross-sectional Study on Women Empowerment among Residents of Different Slum Settlements in a Ward of Kolkata, West Bengal

Abstract Background: The Sustainable Development Goal 5 focuses to “Achieve gender equality and empower all women and girls.” Promoting women’s empowerment is essential for reducing violence against women, decision-making in health and well-being, and proper upbringing of children, thereby reducing maternal and child mortality. Objectives: The objectives of this study were to assess the level of empowerment among married women residing in selected slum settlements of Kolkata, to estimate the proportion of employed women, to describe the pattern of decision-making among them, and to find the sociodemographic factors (if any) associated with the level of empowerment. Materials and Methods: A cross-sectional observational study was carried out among 350 married women using face-to-face interviews from October 2022 to September 2023. The study utilized a predesigned, pretested, and structured schedule consisting of questions adapted from the National Family Health Survey-5 women’s questionnaire. Data analysis was conducted using SPSS version 25.0. Multivariable multinomial logistic regression was employed to identify factors associated with low and medium women empowerment. Results: Of the 334 participants surveyed, approximately half exhibited low levels of empowerment (49.7%). The majority of study participants reported that decisions pertaining to their own health care, significant household purchases, visits to family or relatives, and voting in elections were made jointly by both spouses. The age of the respondent between 19 and 28 years (adjusted odds ratio [AOR] 4.54 [1.09–18.80]) and the age of husband between 35 and 48 years (AOR 4.48 [1.46–8.28]) had statistically significant higher AOR of low women empowerment. Conclusion: A substantial proportion of women in the study had low empowerment scores and less than one-fifth were employed. Increasing employment opportunities for women and promoting their social participation is recommended.

Incidence of hospital-acquired pressure injuries and predictors of severity in a paediatric hospital.

Hospital-acquired pressure injuries (HAPIs) pose significant challenges in healthcare and cause increased patient suffering, longer hospital stays, and higher healthcare costs. Paediatric patients face unique risks, but evidence remains scarce. This study aimed to identify and describe HAPI admission incidence and severity predictors in a large Australian children's hospital. This retrospective cohort study investigated all paediatric patients between January 2020 and December 2021 using a census approach. Demographic and clinical data including HAPI-related data were accessed from the incident monitoring and hospital administration databases. The incidence rate (per 1000 patient admissions) was calculated based on all admissions. Predictors of HAPI severity were identified using multivariable multinomial logistic regression. The study adhered to the STROBE guidelines for retrospective cohort studies. The HAPI incidence rate was 6.96 per 1000 patient admissions. Of the age groups, neonates had the highest HAPI incidence (15.5 per 1000 admissions). Critically ill children had the highest rate for admission location (12.8 per 1000 patient admissions). Most reported cases were stage I (64.2%). Age was associated with injury severity, with older paediatric patients more likely to develop higher-stage HAPIs. Additionally, Aboriginal and/or Torres Strait Islander patients had a higher HAPI severity risk. HAPI injuries in paediatric patients are unacceptably high. Prevention should be prioritized, and the quality of care improved in Australia and beyond. Further research is needed to develop targeted prevention strategies for these vulnerable populations. This research emphasizes the need for standardized reporting, culturally sensitive care and tailored prevention strategies. The research has the potential to influence healthcare policies and practices, ultimately enhancing the quality of patient care. STROBE guidelines. There was no patient or public contribution to the conduct of this study.

A cross-sectional study determining prevalence and factors associated with ST-segment elevation myocardial infarction and non-ST segment elevation myocardial infarction in Iran: results from fasa registry on acute myocardial infarction (FaRMI)

BackgroundAcute myocardial infarction is still a leading cause of death worldwide, accounting for roughly three million deaths yearly. This study aimed to investigate the prevalence and factors associated with ST-Segment Elevation Myocardial Infarction and Non-ST Segment Elevation Myocardial Infarction in Iran.MethodsThis cross-sectional study was conducted using the databases of the Fasa Registry on Acute Myocardial Infarction (FaRMI) and the Fasa Adult Cohort Study (FACS). chi-squared and one-way ANOVA tests were utilized to calculate the unadjusted associations between the study variables. A multivariate multinomial logistic regression model was also employed to determine the adjusted association of each independent variable with the risk of ST-elevation myocardial infarction (STEMI).ResultsThe prevalence of STEMI and non-STEMI was 31.60% and 11.80%, respectively. Multinomial logistic regression showed that older age, anemia, high WBC, and high creatinine levels were associated with higher odds of STEMI and non-STEMI compared to healthy individuals. In addition, based on the analysis being a woman(OR = 0.63,95%CI:0.51–0.78), anemia(OR = 0.67,95%CI:0.54–0.63)and hypertension (OR = 0.80,95%CI:0.65–0.97)decreased the likelihood of STEMI occurrence compared to non-STEMI, while high WBC(OR = 1.19,95%CI:1.15–1.23)increased the odds.ConclusionIn this study, significant predictors of MI risk included age, gender, anemia, lipid profile, inflammation, and renal function. Subsequent investigations ought to prioritize the comprehensive understanding of the underlying mechanisms that drive these connections and assess the effectiveness of specific interventions aimed at diminishing the occurrence of MI and improving patient outcomes.

Association between tuberculosis and psychotic experiences: Mediating factors and implications for patient care in low- and middle-income countries.

Tuberculosis may play a role in the aetiology of psychosis. However, little is known about the association between tuberculosis and psychotic experiences (PEs) or the mediating factors of this association. We analysed cross-sectional data from 48 low- and middle-income countries of the World Health Survey (WHS). Tuberculosis assessment was based on past 12-month symptoms of active tuberculosis. We assessed four types of past 12-month PEs with the Composite International Diagnostic Interview. We performed multivariable multinomial logistic regression and mediation analysis. We analysed data on 224 842 individuals aged ≥18 years (mean age = 38.3 years, standard deviation = 16.0; 50.7% women). Tuberculosis was associated with 1.84 (95% confidence interval (CI) = 1.41-2.40), 2.18 (95%CI = 1.58-3.03), and 3.79 (95%CI = 2.88-4.98) times higher odds for 1, 2, and ≥3 PEs, respectively. The mediation analysis showed that the association between tuberculosis and at least one PE is mainly explained by anxiety (31.5%), sleep/energy (27.8%), and pain/discomfort (23.5%). Tuberculosis was associated with increased odds of PEs. Factors such as affect, sleep, and pain should be considered in tuberculosis patients to target those who might be particularly vulnerable to PEs, and consequently, to psychotic disorders and other adverse effects of PE.

Characteristics for Low, High and Very High Emergency Department Use for Mental Health Diagnoses from Health Records and Structured Interviews.

Patients with mental health diagnoses (MHD) are among the most frequent emergency department (ED) users, suggesting the importance of identifying additional factors associated with their ED use frequency. In this study we assessed various patient sociodemographic and clinical characteristics, and service use associated with low ED users (1-3 visits/year), compared to high (4-7) and very high (8+) ED users with MHD. Our study was conducted in four large Quebec (Canada) ED networks. A total of 299 patients with MHD were randomly recruited from these ED in 2021-2022. Structured interviews complemented data from network health records, providing extensive data on participant profiles and their quality of care. We used multivariable multinomial logistic regression to compare low ED use to high and very high ED use. Over a 12-month period, 39% of patients were low ED users, 37% high, and 24% very high ED users. Compared with low ED users, those at greater probability for high or very high ED use exhibited more violent/disturbed behaviors or social problems, chronic physical illnesses, and barriers to unmet needs. Patients previously hospitalized 1-2 times had lower risk of high or very high ED use than those not previously hospitalized. Compared with low ED users, high and very high ED users showed higher prevalence of personality disorders and suicidal behaviors, respectively. Women had greater probability of high ED use than men. Patients living in rental housing had greater probability of being very high ED users than those living in private housing. Using at least 5+ primary care services and being recurrent ED users two years prior to the last year of ED use had increased probability of very high ED use. Frequency of ED use was associated with complex issues and higher perceived barriers to unmet needs among patients. Very high ED users had more severe recurrent conditions, such as isolation and suicidal behaviors, despite using more primary care services. Results suggested substantial reduction of barriers to care and improvement on both access and continuity of care for these vulnerable patients, integrating crisis resolution and supported housing services. Limited hospitalizations may sometimes be indicated, protecting against ED use.

Cesarean sections and sociodemographic disparities in Ecuador: A nationwide study from hospital registries between 2015 and 2022.

This study aimed to analyze sociodemographic factors associated with cesarean sections (c-sections) in Ecuador. Data were extracted from the Ecuadorian National Institute of Statistics and Censuses (INEC). Multivariate binary and multinomial logistic regression analyses were performed to assess sociodemographic factors associated with c-sections overall and with each type of c-section (elective or emergency c-section). This study included 1 118 842 in-hospital deliveries during 2015-2022 in Ecuador, of which 41.3% were c-sections. This exceeds the recommended levels of medical justified c-sections. Those who were older than 20-29 years showed a higher probability for c-sections overall. Regarding ethnicity, Montubios had 57% higher probability for c-sectioned with an adjusted odds ratio (aOR) of 1.57 and a 95% confidence interval (CI) of 1.45-1.71; while indigenous, black, and white individuals exhibited 73%, 29%, and 21% lower probabilities, respectively. However, this varied according to specific type of c-sections: black individuals had 11% higher probability of elective c-section but 44% lower probability of emergency c-section. Deliveries in private healthcare facilities exhibited significantly higher probabilities of c-sections overall (aOR 15.38, 95% CI 15.20-15.56). Higher probability of emergency c-section was also observed during 2020-2022. Cesarean sections in Ecuador still exceed the recommended levels of medically justified c-sections, highlighting the importance of adopting an approach to childbirth that reduces unnecessary interventions. These results suggest an important role of sociodemographic factors, which aligns with the reported need for multicomponent and locally tailored strategies for addressing c-section overuse. The increase in c-sections during the COVID-19 pandemic (2020-2022) might suggest the influence of external health crises on maternal healthcare.

Access to healthcare and depression severity in vulnerable groups the US: NHANES 2013–2018

BackgroundAccess to healthcare is essential for managing chronic diseases, yet it often poses a barrier, contributing to a significant burden of conditions like depression. This study aimed to investigate the association between healthcare access and depression severity in contemporary free-living adults in the US, with a focus on identifying vulnerable populations. MethodData from the National Health and Nutrition Examination Survey cycles 2013–2018 were utilized, involving 13,689 participants aged 20 years or older. Multivariable multinomial logistic regression models were conducted, adjusting for various confounding variables. ResultsApproximately 17 % of US adults lacked access to healthcare, while 24 % experienced varying levels of depression severity, with 8 % having moderate-to-severe depression. More males faced challenges accessing healthcare, while more females reported diverse levels of depression. Both healthcare access and depression severity were associated with low educational attainment, low familial income, lacking spousal support, lacking health insurance coverage, and worse self-reported overall health. We found a higher vulnerability to moderate-to-severe depression among females (OR (95 % CI): 1.20 (0.91, 1.59)), individuals identifying as the Other ethnic group (1.69 (1.02, 2.79)), and those living without a spouse (1.57 (1.10, 2.26)). LimitationsOur cross-sectional study cannot establish causality, and potential biases related to self-reported data exist. ConclusionsAccess to healthcare emerged as a crucial predictor of moderate-to-severe depression among females, individuals of the Other ethnic group, and those without a spouse. Longitudinal research is needed to confirm and enhance our understanding of factors that shape the relationship between healthcare access and depression in free-living US adults.

Relationship Between Ultra-Processed and Minimally Processed Food Intake and Cardiovascular Health Among US Women of Reproductive Age.

Objectives: Ultra-processed food (UPF) intake is associated with worse cardiovascular health (CVH), but associations between unprocessed/minimally processed foods (MPFs) and CVH are limited, especially among women of reproductive age (WRA). Materials and Methods: For 5,773 WRA (20-44 years) in National Health and Nutrition Examination Survey (NHANES) 2007-2018, we identified UPFs and MPFs using the Nova classification and based on 24-hour dietary recalls. We calculated usual percentages of calories from UPFs and MPFs using the National Cancer Institute's usual intake method. Seven CVH metrics were scored, and CVH levels were grouped by tertile. We used multivariable linear and multinomial logistic regression to assess associations between UPFs and MPFs and CVH. Results: The average usual percentage of calories from UPFs and MPFs was 57.2% and 29.3%, respectively. There was a graded, positive association between higher UPF intake and higher odds of poor CVH: adjusted odds ratios (aORs) for the lowest versus highest CVH were 1.74 (95% confidence interval: 1.51-2.01), 2.67 (2.07-3.44) and 4.66 (3.13-6.97), respectively, comparing quartile 2 (Q2)-Q4 to the lowest quartile (Q1) of UPF intake. Higher MPF intake was associated with lower odds of poor CVH: aORs for the lowest CVH were 0.61 (0.54-0.69), 0.39 (0.31-0.50), and 0.21 (0.14-0.31). Patterns of association remained consistent across subgroups and in sensitivity analyses. Conclusions: Higher UPF intake was associated with worse CVH, while higher MPF intake was associated with better CVH among WRA in the United States. Our analyses highlight an opportunity for WRA to improve nutrition and their CVH.

Loneliness is associated with smoking and alcohol consumption in older adults: Findings from the Chinese Longitudinal Healthy Longevity Survey

IntroductionDespite the well-known health risks associated with tobacco smoking and alcohol consumption, this study explores the association between loneliness and these behaviors specifically among the elderly in the Chinese context. It examines the relationship between loneliness and the tendency to smoke and drink among this demographic. Additionally, the research investigates how these associations vary between genders among the elderly, identifying distinct patterns in the relationship between loneliness and smoking and alcohol consumption among elderly men and women. MethodThis secondary cross-sectional analysis used data from the 2017–2018 Chinese Longitudinal Healthy Longevity Survey. We employed multivariate multinomial logistic regression to analyze these relationships, including sex-specific associations, and reported adjusted odds ratios (AOR), confidence intervals (CI), and p-values. The analysis was conducted using STATA version 18, with significant p-values set at 0.05. ResultOur analysis included 15,874 participants, of which 6.4% (95% CI: 6.0 – 6.8; N=1015) were categorized as Always Lonely, indicating frequent loneliness, and 17.0% (95% CI: 16.4 – 17.6; N=2702) as Sometimes Lonely, indicating occasional loneliness, with 76.6% (95% CI: 75.9 – 77.2; N=12,157) not experiencing loneliness. The mean age was 85.5 years with a standard deviation of 11.7. Gender distribution showed that 43.6% (n=6925) were male and 56.4% (n=8949) were female. Frequently lonely participants had increased odds of current smoking (AOR = 1.26; 95% CI: 1.01–1.57; p = 0.040), while those occasionally lonely were less inclined towards current drinking (AOR = 0.81; 95% CI: 0.70–0.94; p = 0.005). Gender-specific outcomes indicated that often lonely men were more likely to smoke (AOR = 1.43; 95% CI: 1.10–1.87; p = 0.008) and were also less likely to be current drinkers (AOR = 0.74; 95% CI: 0.55–0.98; p = 0.038). No significant associations were found for women in smoking or drinking behaviors relative to loneliness levels. ConclusionOur study identified a significant relationship between loneliness and a higher likelihood of smoking in elderly Chinese men, not women, and observed gender-specific differences in alcohol use, with men showing a lower likelihood of drinking when occasionally lonely, a pattern absent in women. Future prospective studies are required to confirm these findings.

Maternal Mental Health in Pregnancy and Its Impact on Children's Cognitive Development at 18 Months, during the COVID-19 Pandemic (CONCEPTION Study).

The COVID-19 pandemic has significantly affected the mental health of pregnant persons. We aimed to evaluate the impact of maternal mental health and antidepressant use on children's cognitive development. We followed a cohort of children born during the COVID-19 pandemic. Maternal mental health was self-reported during pregnancy (Edinburgh Postnatal Depression Scale, General Anxiety Disorder-7, stress levels, and antidepressant use). The child's cognitive development was measured using the third edition of the Ages & Stages Questionnaires® (ASQ-3) at 18 months. Multivariate multinomial logistic regression models were built to assess the association between in utero exposure to maternal mental health and ASQ-3 domains: communication, gross motor, fine motor, problem-solving, and personal-social. Overall, 472 children were included in our analyses. After adjusting for potential confounders, a need for further assessment in communication (adjusted odds ratio (aOR) 12.2, 95% confidence interval (CI) (1.60;92.4)), and for improvement in gross motricity (aOR 6.33, 95%CI (2.06;19.4)) were associated with in utero anxiety. The need for improvement in fine motricity (aOR 4.11, 95%CI (1.00; 16.90)) was associated with antidepressant exposure. In utero depression was associated with a decrease in the need for improvement in problem solving (aOR 0.48, 95%CI (0.24; 0.98)). During the COVID-19 pandemic, maternal mental health appears to be associated with some aspects of children's cognitive development.

Late Neonatal Sepsis in Very-low-birth-weight Premature Newborns Is Associated With Alterations in Neurodevelopment at Twenty-five Months of Age.

To evaluate the impact of late-onset sepsis (LOS) on the neurodevelopment of very-low-birth-weight (VLBW) premature infants. This is a retrospective cohort study of VLBW premature infants. The Mental Development Index (MDI) was determined for a population of 546 VLBW infants, at 14 and 25 months of age, and evaluated using the Bayley test. A history of meningitis or early neonatal sepsis was considered an exclusion criterion. The study parameters analyzed included perinatal variables, the development of neonatal comorbidities and a history of LOS. Multivariate linear regression and multinomial logistic regression analyses were performed. LOS was observed in 115 newborns, among whom microbiological testing showed that 65.0% presented Gram-positive bacteria, with Staphylococcus epidermidis being responsible for 55.4%. There was a significant association between the 25-month MDI and a history of LOS. This represents a decrease of 7.9 points in the MDI evaluation of newborns with a history of LOS. The latter history is also associated with the following neurodevelopmental alternations: mild motor disorders [odds ratio (OR): 2.75; 95% confidence intervals (CI): 1.07-7.05], moderate cognitive delay (OR: 3.07; 95% CI: 1.17-8.00) and cerebral palsy (OR: 2.41; 95% CI: 1.09-5.35). In our study cohort, LOS was associated with alterations in neurodevelopment, including reduced MDI, together with motor and cognitive disorders and cerebral palsy. To improve neurodevelopmental outcomes in this group of newborns, neonatal intensive care unit personnel should focus attention on preventing hospital-acquired infections.

Child Marriage and Cardiovascular Risk: An Application of the Non-laboratory Framingham Risk Score.

Child marriage, defined as marriage before the age of 18 years, is a precocious transition from adolescence to adulthood, which may take a long-term toll on health. This study aims to assess whether child marriage was associated with added risk of adverse cardiovascular outcomes in a nationally representative sample of Indian adults. Applying the non-laboratory-based Framingham algorithm to data on 336,953 women aged 30-49 years and 49,617 men aged 30-54 years, we estimated individual's predicted heart age (PHA). Comparing the PHA with chronological age (CA), we categorized individuals in four groups: (i) low PHA: PHA < CA, (ii) equal PHA: PHA = CA (reference category), (iii) high PHA: PHA > CA by at most 4 years, and (iv) very high PHA: PHA > CA by 5 + years. We estimated multivariable multinomial logistic regressions to obtain relative risks of respective categories for the child marriage indicator. We found that women who were married in childhood had 1.06 (95% CI 1.01-1.10) and 1.22 (95% CI 1.16-1.27) times higher adjusted risks of having high and very high PHA, respectively, compared to women who were married as adults. For men, no differential risks were found between those who were married as children and as adults. These results were generally robust across various socioeconomic sub-groups. These findings add to the relatively new and evolving strand of literature that examines the role of child marriage on later life chronic health outcomes and provide important insights for public health policies aimed at improving women's health and wellbeing.

Prescription Opioid Use before and after Diagnosis of Cancer Among Older Cancer Survivors With Non-Cancer Chronic Pain Conditions (NCPCs): An Application of Group-Based Trajectory Modeling (GBTM).

Prescription opioids are essential in managing pain among adults with chronic pain conditions. However, persistent use over time can lead to negative health consequences. Identifying individuals with persistent use over time and their characteristics can inform clinical decision-making and aid in reducing the risk of abuse and overdose deaths. This study aims to examine trajectories of prescription opioid use over time and factors associated with these trajectories among older cancer survivors with any non-cancer pain conditions (NCPC). We conducted a retrospective cohort study design with longitudinal data of older (age at cancer diagnosis ≥67years) cancer (incident breast, colorectal, and prostate cancers, or non-Hodgkin lymphoma) survivors with any NCPC. Data were derived from the 2007-2015 linked Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset (N = 35,071). Group-Based Trajectory Modeling (GBTM) was used to identify homogeneous subgroups (distinct trajectories) of individuals based on every 90-day prescription opioid use during pre-cancer diagnosis (t1-t4), acute cancer treatment (t5-t8), and post-cancer treatment (t9-t12) periods. Biological factors, social determinants of health (SDoH), physical and mental health, medication use, health care use, and external factors associated with a trajectory membership were analyzed with multivariable multinomial logistic regressions. Four distinct trajectories of opioid use were identified: (1) increase-decrease use (6.1%); (2) short-term use after cancer diagnosis (40.6%); (3) low-use (41.0%); and (4) persistent use (12.3%). In the fully-adjusted multinomial logistic regression, the SDoH such as Non-Hispanic Black [adjusted odds ratios (AOR) = 1.69; 95%CI = 1.48, 1.93)] and rural residence (AOR = 1.49; 95%CI = 1.15, 1.94)], comorbid anxiety (AOR = 1.33; 95%CI = 1.18, 1.51), and medication use (NSAIDs - AOR = 1.20; 95%CI = 1.10, 1.30) were associated with membership in the persistent use group. Persistent use was less likely among those with higher fragmented care index (AOR = 0.95, 95%CI = 0.93, 0.97) and those living in counties with higher Medicare advantage penetration (AOR = 0.96; 95%CI = 0.95, 0.97). One in eight older adults had persistent opioid use over time. The profile characteristics of this group were different from the other trajectory groups. Policies and programs to reduce chronic opioid use need to consider the intra- and inter-individual variability to reduce opioid-related morbidity and mortality.

Demographics, distance to gastrointestinal specialists, and social deprivation are associated with advanced stage of gastrointestinal cancer diagnosis.

Gastrointestinal (GI) luminal cancers can be detected at early stages by endoscopic procedures. Place-based factors, such as social deprivation and distance to specialist care, are under-investigated with regard to the stage of diagnosis. This was a retrospective cohort study among persons ≥18 years of age in the Florida Cancer Data System, a population-based cancer incidence registry. We included persons diagnosed with esophageal cancer, gastric canceror colorectal cancer, with at least 1 measure of geographic location during the period January 1, 1981, to December 31, 2016. Multivariate multinomial logistic regression was used to identify factors associated with the stage of diagnosis, including social deprivation and proximity to GI care. Among 379,054 persons, the median age was 71 years, and 54% were male. Distant stage disease was significantly less likely than local stage in those of non-Hispanic/Latino ethnicity (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.89-0.94, P<0.001). Distant disease was more likely in African Americans (OR 1.30, 95%CI 1.26-1.34) and Asians (OR 1.41, 95%CI 1.27-1.56, P<0.001), with each 5-min increase in travel time to specialists, (OR 1.02, 95%CI 1.01-1.02, P<0.001), and with each 10-point increase in Social Deprivation Index (OR 1.01, 95%CI 1.01-1.02, P<0.001). A greater distance from care and living in areas with increased deprivation are associated with an advanced stage of diagnosis and should be recipients of policy-driven efforts to improve access to care. That the strongest risk factors include minority race and ethnicity underlines the complexity of healthcare disparities.

Unmet need for family planning and associated factors among currently married women in Nepal: A further analysis of Nepal Demographic and Health Survey-2022.

Family planning (FP) is crucial for improving maternal and newborn health outcomes, promoting gender equality, and reducing poverty. Unmet FP needs persist globally, especially in South Asia and Sub-Saharan Africa leading to unintended pregnancies, unsafe abortions, and maternal fatalities. This study aims to identify the determinants of unmet needs for FP from a nationally representative survey. We analyzed the data of 11,180 currently married women from nationally representative Nepal Health Demographic Survey 2022. We conducted weighted analysis in R statistical software to account complex survey design and non-response rate. We conducted univariate and multivariable binary and multinomial logistic regression to assess association of unmet need for FP with independent variables including place of residence, province, ecological belt, ethnicity, religion, current age, participant's and husband's education, occupation, wealth quintile, parity, desire for child, and media exposure. The total unmet FP need was 20.8% (95%CI: 19.7, 21.9) accounting 13.4% (95%CI: 12.5, 14.4) for unmet need for limiting and 7.4% (95%CI: 6.8, 8.0) for unmet for spacing. Lower odds of total unmet need for FP were present in 20-34 years and 35-49 years compared to <20 years, women belonging to Madhesi ethnic group (AOR: 0.78; 95%CI: 0.64, 0.95) compared to Brahmin/Chhetri, women from richest (AOR: 0.69; 95%CI: 0.56, 0.84), richer (AOR: 0.82; 95%CI: 0.68, 0.97) and middle wealth quintile (AOR: 0.82; 95%CI:0.70, 0.98) groups compared poorest wealth quintile group and women belonging to rural area (AOR: 0.89; 95%CI: 0.80, 0.99) compared to urban area. Higher odds of unmet need for FP were present among women with basic (AOR: 1.34; 95%CI: 1.17, 1.54), and secondary level (AOR: 1.32; 95%CI: 1.12, 1.56) education compared to women without education, among women from Madhesh (AOR: 1.56; 95%CI: 1.22, 1.98), Gandaki (AOR: 2.11; 95%CI: 1.66, 2.68), Lumbini (AOR: 1.97; 95%CI: 1.61, 2.42) and Sudurpashchim province (AOR: 1.64; 95%CI: 1.27, 2.10) compared to Koshi province and among women whose husband education was basic level (AOR:1.37; 95%CI: 1.15, 1.63), or secondary level (AOR: 1.32; 95%CI: 1.09, 1.60) education. Nepal faces relatively high unmet FP needs across various socio-demographic strata. Addressing these needs requires targeted interventions focusing on age, ethnicity, religion, education, and socio-economic factors to ensure universal access to FP services.

Timing of sexual debut and associated sociodemographic and HIV risk factors among young people in Eswatini.

Young people in sub-Saharan Africa and specifically in Eswatini (previously Swaziland), continue to be disproportionately affected by HIV despite having equitable access to antiretroviral treatment. Early sexual debut is one of the many factors linked to HIV infection that is discussed in the context of general public health. Monitoring this behavior is essential for developing preventative, evidence-based interventions. This study aims to describe the early and/or typical sexual debut among young people in Eswatini and examines sociodemographic and HIV risk factors associated with early and typical sexual debut timing. We analyzed cross-sectional secondary data from the 2016/17 Swaziland HIV Incidence Measurement Survey (SHIMS), which had a representative sample of 2,383 young people aged 18-24. Respondents were selected using a two-stage stratified probability sampling design. We applied descriptive statistics and multivariable multinomial logistic regressions to examine the data. Out of the 2,383 respondents, 71.3% had sexual experience, with 4.1% and 26.5% reporting early sexual debut (<15 years) and typical sexual debut (<18 years), respectively. Our study found that age, sex, education, marital status, wealth, sexual partners in the past 12 months, and alcohol use were significantly associated with early and/or typical sexual debut. It is crucial to consider the sociodemographic factors and HIV risk factors of young people when designing programs and interventions aimed at preventing early sexual debut or transition. This approach is necessary to promote better sexual and reproductive health in alignment with sustainable development goals.