Poisson Log-linear Model Research Articles

COVID-19 and sepsis-related excess mortality in the US during the first three years: A national-wide time series study.

The COVID-19 pandemic's global impact has been devastating, causing millions of deaths. Our study investigates excess sepsis-related mortality trends over three years during the pandemic. Using CDC's National Vital Statistics System data from January 2018 to March 2023, we projected sepsis-related deaths during the pandemic using a Poisson log-linear regression model. We compared observed versus predicted deaths and analyzed temporal trends by demographics and regions. Among the 753,160 deaths documented between March 2020 and March 2023, a significant downward trend was noted in sepsis-related mortality rates from March 2022 to March 2023, coinciding with the surge of the Omicron variant. The excess mortality rates were 170.6 per million persons (95% CI: 168.2-172.6), 167.5 per million persons (95% CI: 163.6-170.9), and 73.3 per million persons (95% CI: 69.4-76.6) in the first, second, and third years, respectively. Increased sepsis-related mortality was observed across all age subgroups, with the greatest increase noted in those aged 85 years and above compared to middle- and young-aged decedents. Disparities were also observed across racial/ethnic, sex/gender subgroups, and geographic regions. This study highlights the effectiveness of current policies and prevention measures in response to the long-term circulating of SARS-CoV-2 in the community.

Temporal trends, regional and socio-economic disparities of colorectal cancer burden in Cyprus

Abstract Background Colorectal cancer (CRC) is one of the main causes of mortality and morbidity worldwide and it is the third most common cancer in Cyprus. Previous studies have documented variations in CRC burden over time, across regions and area-based socio-economic deprivation. The aim of this study was to analyse the burden of CRC over time, across regions and area-based socio-economic deprivation in Cyprus for the time period 2000 to 2015. Methods A small area ecological study was performed, with census tracts as units of spatial analysis. The incidence and death date, sex and age of CRC were obtained from the population-based cancer registry of Cyprus. Indirect standardization was used to calculate the sex and age Standardize Incidence Ratios (SIRs) and Standardized Mortality Ratios (SMRs) of CRC while the smoothed estimates of SIRs and SMRs were derived from the Spatiotemporal Bayesian Poisson log-linear model. To investigate temporal trends in the association between area-based socioeconomic deprivation and CRC burden, we have used the national socio-economic index. Results The burden of CRC was rising over time. The CRC cumulative incidence increase from 243.7 in the time period 2000-2007 to 347.3 per 100,000 persons in the time period 2008-2015.There was also a more pronounced geographical variation in SIR and SMR in the time period 2008-2015. Four areas out of 369 had smoothed SIR>1.15 while twenty-six areas had smoothed SMR>1.15, with most of those areas located at the east coast of the island and around the capital city. There was a temporal trend in the socio-economic inequalities of CRC burden. The areas in the third and fourth quartile of the socio-economic index had 23% and 45% lower rates of CRC incidence, and 33% and 47% lower rates of CRC mortality in the period 2008-2015. Conclusions These findings could shape national prevention policies, such as the national screening program of CRC starting in 2025 and protection strategies for CRC mortality. Key messages • Colorectal cancer screening should be geographically targeted for efficient resource allocation. • Public health interventions to improve colorectal-specific mortality risk should be geographically targeted.

The impact of the National Programme to Eliminate Lymphatic Filariasis on filariasis morbidity in Sri Lanka: Comparison of current status with retrospective data following the elimination of lymphatic filariasis as a public health problem.

Sri Lanka implemented the National Programme for Elimination of Lymphatic Filariasis (NPELF) in its endemic regions in 2002. Five annual rounds of mass drug administration using the two-drug combination diethylcarbamazine (DEC) and albendazole led to sustained reductions in infection rates below threshold levels. In 2016, WHO validated that Sri Lanka eliminated lymphatic filariasis as a public health problem. To explore the impact of the NPELF on lymphatic filariasis morbidity in Sri Lanka. Passive Case Detection (PCD) data maintained in filaria clinic registries from 2006-2022 for lymphoedema and hospital admission data for managing hydroceles/spermatoceles from 2007-2022 were analyzed. The morbidity status in 2022 and trends in overall and district-wise PCD rates were assessed. Poisson log-linear models were used to assess the trends in PCD for endemic regions, including district-wise trends and hospital admissions for the management of hydroceles/spermatoceles. In 2022, there were 566 new lymphoedema case visits. The mean (SD) age was 53.9 (16.0) years. The staging was done for 94% of cases, of which 79% were in the early stages (57.3% and 21.4% in stages two and one, respectively). Western Province had the highest caseload (52%), followed by the Southern (32%) and Northwestern (16%) Provinces, respectively. The reported lymphoedema PCD rate in 2022 was 0.61 per 10,000 endemic population. The overall PCD rate showed a decline of 7.6% (95%CI: 4.9% - 10.3%) per year (P < 0.0001) from 2007 to 2022. A steady decline was observed in Colombo, Gampaha and Kurunegala districts, while Kalutara remained static and other districts showed a decline in recent years. Further, admissions for inpatient management of hydroceles/spermatoceles showed a declining trend after 2015. The PCD rates of lymphoedema and hydroceles/spermatoceles showed a declining trend in Sri Lanka after the implementation of the NPELF.

Periconceptional Supplementation with Folic Acid or Multiple Micronutrients Containing Folic Acid and the Risk for Hypertensive Disorders in Pregnancy

Objective: The aim of this study was to investigate the association between supplementation containing folic acid only (FAO) or multiple micronutrients containing folic acid and the risk for hypertensive disorders in pregnancy (HDP). Subjects and Methods: The retrospective cohort study was based on data from women who gave birth from 2016 to 2018 at Tongzhou Maternal and Child Health Care Hospital of Beijing, China. The outcomes were HDP diagnosed after the 20th week of pregnancy, including gestational hypertension (GH), preeclampsia, and eclampsia. Associations between supplementation patterns and HDP were estimated by Poisson loglinear regression models. Sensitivity analyses were based on prepregnancy body mass index (BMI) and maternal age. Results: Among the 25,866 women included in the study, periconceptional use of FA supplementation marginally reduced the risk for HDP (adjusted risk ratio [aRR] = 0.87, 95% confidence interval [CI] 0.73–1.04). Women who began FAO supplementation before conception had a lower risk for GH compared to those who began after conception (aRR = 0.59, 95% CI: 0.45–0.78). The risk for HDP also reduced among FAO users who began supplementation before conception with a normal prepregnancy BMI (aRR = 0.64, 95% CI: 0.49–0.84) and users ≥30 years old (aRR = 0.75, 95% CI: 0.58–0.98). Conclusions: Periconceptional FAO supplementation may reduce the risk for HDP, especially GH. The protective effects are greater among women with a normal prepregnancy BMI and those ≥30 years old.

Oral health status and oral health-related quality of life among children with type 1 diabetes mellitus in the age group of 11-14 years in Delhi-NCR Region.

The purpose of this study was to assess the impact of oral health status (OHS) and sociodemographic indicators on oral health-related quality of life (OHRQoL) among children with type 1 diabetes mellitus (T1DM) aged 11-14 years and compare it with age-matched nondiabetic children. This cross-sectional study included 80 children aged between 11 and 14 years with T1DM and 80 age-matched nondiabetic children. The OHRQoL was measured using a validated structured Hindi version of the child perception questionnaire (CPQ11-14) questionnaire. The clinical OHS was assessed using the decayed, missing, or filled teeth index, plaque index (PI), and gingival index (GI). Associations between OHRQoL and independent predictors were analyzed with the log-linear Poisson model regression method. CPQ11-14 scores were significantly lower in nondiabetic children than diabetic children, indicating better OHRQoL among nondiabetic children than diabetic children (P ≤ 0.05). The GI score exhibited a significantly lower value in nondiabetic children than in diabetic children (P = 0.014). In contrast, the mean decayed, missing, and filled teeth score showed a significantly higher value in nondiabetic children than in diabetic children (P ≤ 0.001). There was no difference in the mean PI of diabetic and nondiabetic children (P = 0.096). The result of the present study highlighted the detrimental effect of T1DM on OHRQoL in children.

Breast cancer treatment access disparities: A retrospective cohort study of breast cancer in patients treated at a high-complex cancer center in southern Brazil.

e13689 Background: More than seventy-three thousand new breast cancer cases are expected in Brazil for the year 2023, representing the most common malignancy in this country. Delaying time to treatment initiation has been associated with increased risk of worse outcomes. The Brazilian government developed several initiatives to accelerate the access of cancer patients to treatment in an adequate time-bound. One of these is a federal law defining that oncological treatment should begin within 60 days of pathological diagnosis. Methods: This retrospective study analyzed data of newly diagnosed breast cancer patients in 2022–2023 in Hospital de Clinicas de Porto Alegre (HCPA), a public hospital in Porto Alegre, Brazil. The primary objective was to build a predictive model of risk factors that could delay the time to first treatment beyond 60 days from diagnosis. The present analysis describes the socio-demographic characteristics of these patients and explores their impact on the time to oncologic treatment initiation. This project was approved by the Ethics and Research Committee (registration CAAE 71160423.7.0000.5327). Results: 184 patients who started their oncological treatment between 2022-2023 in HCPA were enrolled; 32 patients (17,3%) had their first treatment after 60 days from the diagnosis while 152 (82,7%) were treated before 60 days; 106 (57,3%) patients had studied up to elementary school and 32 (17,3%) were non-white; 53 patients (23%) had been submitted to biopsy outside HCPA. Patients who started their first treatment before 60 days had a mean of 38 days from diagnosis to first treatment while those treated after 60 days had a mean of 75,6 days. To evaluate how socio-demographic factors impacted the time to treatment initiation, a multivariate Poisson log-linear model adjusted for race, city of residence, stage of the disease, and type of first treatment considered different variables. Higher educational level had a statistically significant effect, with a rate ratio (RR) of 0.32 (95% CI 0.157 - 0.650, p &lt; 0.05). We also found that performing biopsy in our institution instead of doing it elsewhere had a statistically significant impact on the time to first treatment, with an RR of 0.512 (95% CI 0.274 - 0.957, p = 0.036). Ethnicity was not related to delay of treatment (p-value=0.125). Conclusions: This study identified that socio-demographic factors are crucial to guarantee the appropriate time to start treatment for breast cancer patients in a middle-income country. Higher educational level had a positive impact on time-to-treatment initiation, as well as to perform biopsy in the same institution patients were treated. In this first analysis, ethnicity, clinical staging, and type of first treatment did not meet the statistical criteria to be considered relevant and the accrual of more patients is needed for further conclusions.

Changing Trends in the Global Disease Burden of Pancreatic Cancer from 1990 to 2030.

To explore the global burden of pancreatic cancer (PC) from 1990 to 2019, evaluate independent effects of age, period, and cohort on the incidence of PC, and predict the incidence of PC in the next decade. Data were obtained from the Global Burden of Disease Study 2019. We calculated the age-standardized disability-adjusted life years (DALY) rate, age-standardized mortality rate (ASMR), age-standardized incidence rate (ASIR), and age-standardized prevalence rate (ASPR) of PC. Joinpoint Poisson regression analysis was performed to identify the temporal trends in the incidence of PC. Then, a two-factor model was constructed using the Poisson log-linear model, and a three-factor model was constructed using the intrinsic estimator (IE) method to estimate the independent effects of age, period, and cohort on the incidence of PC. Finally, the Bayesian age-period-cohort (BAPC) model was also used to predict the age-standardized global incidence rate of PC and age-standardized new PC cases from 2020 to 2030. Overall, the DALY rate, ASMR, ASIR, and ASPR all increased from 1990 to 2019. The ASIR in males increased from 6 per 100,000 in 1990 to 7.5 per 100,000 in 2019 and was predicted to rise to 8.2 per 100,000 by 2030. Meanwhile, the ASIR in females rose from 4.5 per 100,000 in 1990 to 5.7 per 100,000 in 2019 and was predicted to rise to 6.3 per 100,000 by 2030. The age effect on the incidence of PC showed sharp increasing trends from 40 to 79years. The period effect continuously increased with advancing periods, but the cohort effect showed substantial decreasing trends. The age and period effect on the incidence of PC presented increasing trends, while the cohort effect showed decreasing trends. All indicators of the global burden of PC are increasing in both males and females, and the ASIR is predicted to rise at an alarming rate by 2030. Thus, timely screening and intervention are recommended, especially for earlier birth cohorts at high risk.

Impact of early MRI in ischemic strokes beyond hyper-acute stage to improve patient outcomes, enable early discharge, and realize cost savings

BackgroundEarly in-patient MR Imaging may assist in identifying stroke etiology, facilitating prompt secondary prevention for ischemic strokes (IS), and potentially enhancing patient outcomes. This study explores the impact of early in patient MRI on IS patient outcomes and healthcare resource use beyond the hyper-acute stage. MethodsIn this retrospective registry-based study, 771 admitted transient ischemic attack (TIA) and IS patients at Halifax's QEII Health Centre from 2015 to 2019 underwent in-patient MRI. Cohort was categorized into two groups based on MRI timing: early (within 48 h) and late. Logistic regression and Poisson log-linear models, adjusted for age, sex, stroke severity, acute stroke protocol (ASP) activation, thrombolytic, and thrombectomy, were employed to examine in-hospital, discharge, post-discharge, and healthcare resource utilization outcomes. ResultsAmong the cohort, 39.6 % received early in-patient MRI. ASP activation and TIA were associated with a higher likelihood of receiving early MRI. Early MRI was independently associated with a lower rate of symptomatic changes in neurological status during hospitalization (adjusted odds ratio [OR], 0.42; 95 % confidence interval [CI], 0.20–0.88), higher odds of good functional outcomes at discharge (1.55; 1.11–2.16), lower rate of non-home discharge (0.65; 0.46–0.91), shorter length of stay (regression coefficient, 0.93; 95 % CI, 0.89–0.97), and reduced direct cost of hospitalization (0.77; 0.75–0.79). ConclusionEarly in-patient MRI utilization in IS patients post-hyper-acute stage was independently associated with improved patient outcomes and decreased healthcare resource utilization, underscoring the potential benefits of early MRI during in-patient management of IS. Further research, including randomized controlled trials, is warranted to validate these findings.

Time-series analysis of temperature variability and cardiovascular emergency department visits in Atlanta over a 27-year period.

Short-term temperature variability, defined as the temperature range occurring within a short time span at a given location, appears to be increasing with climate change. Such variation in temperature may influence acute health outcomes, especially cardiovascular diseases (CVD). Most research on temperature variability has focused on the impact of within-day diurnal temperature range, but temperature variability over a period of a few days may also be health-relevant through its impact on thermoregulation and autonomic cardiac functioning. To address this research gap, this study utilized a database of emergency department (ED) visits for a variety of cardiovascular health outcomes over a 27-year period to investigate the influence of three-day temperature variability on CVD. For the period of 1993-2019, we analyzed over 12million CVD ED visits in Atlanta using a Poisson log-linear model with overdispersion. Temperature variability was defined as the standard deviation of the minimum and maximum temperatures during the current day and the previous two days. We controlled for mean temperature, dew point temperature, long-term time trends, federal holidays, and day of week. We stratified the analysis by age group, season, and decade. All cardiovascular outcomes assessed, except for hypertension, were positively associated with increasing temperature variability, with the strongest effects observed for stroke and peripheral vascular disease. In stratified analyses, adverse associations with temperature variability were consistently highest in the moderate-temperature season (October and March-May) and in the 65 + age group for all outcomes. Our results suggest that CVD morbidity is impacted by short-term temperature variability, and that patients aged 65 and older are at increased risk. These effects were more pronounced in the moderate-temperature season and are likely driven by the Spring season in Atlanta. Public health practitioners and patient care providers can use this knowledge to better prepare patients during seasons with high temperature variability or ahead of large shifts in temperature.

Infant mortality in Italy: large geographic and ethnic inequalities

BackgroundNeonatal and infant mortality rates are among the most significant indicators for assessing a country's healthcare and social development.This study examined the trends in neonatal, post-neonatal, and infant mortality in Italy from 2016 to 2020 and analysed differences between children of Italian and foreign parents based on areas of residence, as well as the leading causes of death. Special attention was given to the analysis of mortality in 2020, the first year of the Covid-19 pandemic, and its comparison with previous years.MethodsData from 2016 to 2020 were collected by the Italian National Institute of Statistics and extracted from two national databases, the Causes of Death register and Live births registered in the population register. Neonatal, post-neonatal, and infant mortality rates were calculated using conventional definitions. The main analyses were conducted by comparing Italian citizens to foreigners and contrasting residents of the North with those of the South. Group comparisons were made using mortality rate ratios. The main causes of death were examined, and Poisson log-linear regression models were employed to investigate the relationships between mortality rate ratios for each cause of death and citizenship, place of residence and calendar year.ResultsIn Italy, in 2020, the neonatal mortality rate was 1.76 deaths per thousand live births and it was 55% higher in foreign children than in Italian children. Foreign children had a higher mortality rate than Italians for almost all significant causes of death. Children born in the South of Italy, both Italian and foreign, had an infant mortality rate about 70% higher than residents in the North. Regions with higher infant mortality were Calabria, Sicily, Campania, and Apulia. In the South, mortality from neonatal respiratory distress and prematurity was higher.In the first months of 2020, between March and June, the first Covid-19 wave, Italy experienced an increase in neonatal and infant mortality compared to the same period in 2016–2019, not directly related to SARS-CoV-19 infection. The primary cause was neonatal respiratory distress.ConclusionsThe neonatal and infant mortality rates indicate the persistence of profound inequalities in Italy between the North and the South and between Italian and foreign children.

Eleven-year trends in socioeconomic inequalities in the prevalence and incidence of pharmacologically treated type 2 diabetes in France, 2010–2020

AimThis study aimed to describe the association between socioeconomic inequalities and the prevalence and incidence of pharmacologically-treated type 2 diabetes in European France over the 2010–2020 period. MethodsDiabetes cases were identified using a validated algorithm from the French National Health Data System. Analysis was restricted to adults aged 45 years and older to focus on type 2 diabetes. Socioeconomic inequalities were measured for all years in European France using the French deprivation index (FDep, 2015 version), which is an area-based deprivation indicator using population-weighted quintiles (Q1 corresponds to the least deprived municipalities). The relative risks of diabetes prevalence and incidence associated with FDep quintiles (Q1 as the reference) were estimated by sex using a log-linear Poisson model adjusted for year, age and French department. The study population was the French health consumers aged 45 years and over (from 24,228,526 in 2010 to 29,772,928 in 2020). ResultsA positive gradient was observed in the relative risks of type 2 diabetes prevalence and incidence by FDep quintiles over the study period. The strength of the estimated associations increased over the last decade for prevalence among men and women and for incidence among men in the two most deprived quintiles. ConclusionThus, type 2 diabetes prevention should include a proportionate universalism approach, proposing actions of greater intensity in the most deprived areas.

Generalization and Maintenance of Participation in Parkour and Team Handball Recess in Elementary Schools

Purpose: We investigated elementary school children’s voluntary participation in parkour and team handball recess during generalization and maintenance by skill level and sex. Methods: In six schools, 45 girls and 68 boys from different classes received a 10-lesson sport education parkour (second grade) and team handball (third grade) season in physical education. Children’s participation in parkour and team handball recess during (generalization) and after the sport education season concluded (maintenance) was recorded and analyzed using the Poisson loglinear regression model to investigate the effects of skill level and sex. Results: Children’s participation in parkour (72%) was higher than team handball recess (47%) during generalization, p &lt; .001. During maintenance, children’s participation in parkour (44%) was lower than team handball recess (49%), p &lt; .001. Effects of skill level and sex were found in both phases. Conclusions: Coordinating physical education with recess can promote children’s participation in physical activity during recess.

Abstract A091: County-level analysis of the link between historical slavery and prostate cancer incidence

Abstract Background: Black individuals with prostate cancer in the US experience the widest racial disparity in both cancer incidence and mortality when compared to the average population. These differences are driven by the intersection of race and a wide range of structural and social determinants of health and equity. Structural and social inequities can drive disproportionate and adverse exposure to violence, poverty, and physical and emotional stress—among other exposures—which may impact biologic risk, health behaviors, and healthcare access. We hypothesize that the impacts of these structural and social determinants are rooted in historical events that continue to inform present day prostate cancer events and outcomes. Methods: This is an ecological study assessing county-level data from 13 states in the Southeastern US. Data on prostate cancer incidence and mortality (NCI: 2018), population estimates (CDC: 2015-2019), structural and social determinants (AHRQ: 2018), and the percentage enslaved individuals (NHGIS: 1860) were obtained. County data were linked across datasets using federal identifiers. Our primary exposure was the legacy of US slavery represented by the percentage of enslaved individuals by county. Random variables such as water access and rail transport (NHGIS: 1860) were used as controls. Variable selection for our multivariable model was informed by a directed acyclical graph that defined the causal relationship between historical slavery and present-day prostate cancer outcomes. Our primary dependent variable was prostate cancer counts per 100,000. We utilized Poisson log-linear regression models to estimate the difference in cancer counts by 10% increase of slave population by county (NHGIS: 1860). Results: Our data included over 3000 counties. In our fully adjusted model, a 10% increase in county slave population was associated with a 1.5% increase in prostate cancer incidence (p&amp;lt;0.001). In this same model, Black race, and age (&amp;gt; 50 years) were associated with a 77% and over 300% increase in cancer incidence (p&amp;lt;0.001). Among Black men, every 10% increase in county slave population was associated with a 1.1% increase in cancer incidence (p &amp;lt; 0.05). Among White men, every 10% increase in county slave population was associated with a 1.5% increase in cancer incidence (p&amp;lt;0.0001). Our adjusted models demonstrated significant increased associations between prostate cancer incidence and education, access to food, segregation index, and social vulnerability index. Conclusions: Our results indicate that a history of slavery is significantly associated with increased county-level prostate cancer incidence for all men in the US, irrespective of their race/ethnicity. The effect of historic slavery persists even after adjusting for present day structural/social determinants of equity and health. These findings demonstrate the importance in acknowledging and incorporating historical inequities and context in evaluating present days inequities in prostate cancer risk, care, and outcomes. Citation Format: Maheetha C. Bharadwaj, Sarah C. Holt, Hari Iyer, John Gore, Tim Rebbeck, Yaw Nyame. County-level analysis of the link between historical slavery and prostate cancer incidence [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A091.

Abstract B112: Disparities in cervical cancer survival among Hispanic subpopulations living in the United States

Abstract Purpose: The Hispanic population bears a high burden of cervical cancer; however, disaggregated data, which is vital in equitable resource allocation, lacks in this group. Our study evaluated disparities in cervical cancer survival among Hispanic subpopulations receiving guideline-concordant care and identified factors affecting survival. Methods: Data from the National Cancer Database was used to identify patients with cervical cancer from 2004-2019. The Hispanic cohort was analyzed in its entirety, and by region of origin. Nine quality metrics were established to assess guideline-concordant care for eligible patients across various cancer stages. Demographic data, treatment modalities, and survival were described. Demographic and clinical variables were stratified by Hispanic subpopulation and compared using chi-squared tests. Kaplan-Meier curves were employed to examine cervical cancer survival among the Hispanic subpopulation for each quality metric. Marginal Poisson log-linear models were utilized to evaluate the association Hispanic subpopulation and the receipt of eligible quality metrics, and obtain adjusted relative risks (aRR), while controlling for potential confounders. Results: A total of 77,567 patients were included, 4363 (5.6%) of which identified as Hispanic. Compared to non-Hispanic White (NHW) and non-Hispanic Black (NHB) populations, larger proportion of the Hispanic population was uninsured (19.16%, p &amp;lt; 0.001) and more likely to live in neighborhoods with lowest rates of high school diploma attainment (61.43%, p &amp;lt;0.001). Significant differences in neighborhood income, education level, insurance status, and stage at presentation among Hispanic subpopulations were identified (p&amp;lt;0.001). Survival among patients with stage IA2-IIA2 patients undergoing radical hysterectomy was lowest among NHB and Cuban patients when compared to NHW and other Hispanic patients (p&amp;lt;0.001). Survival among stage IB2-IVA patients undergoing primary radiation and concurrent chemotherapy was also lowest among Cuban, NHW and NHB patients when compared to other populations, and highest among Mexican populations (p&amp;lt;0.001). Among patients with stage IVB disease receiving chemotherapy, Dominican populations had the highest survival rates p&amp;lt;0.001). Compared to Mexican patients, Cuban patients were 1.18 times as likely to receive timely initiation of treatment in early stage (RR 1.18, 95% CI 1.03-1.34, p=0.01). Patients of South or Central American origin (RR 1.18, 95%CI 1.09-1.28, p&amp;lt; 0.001), Cuban (RR 12.5, 95%CI 1.1-1.43, p&amp;lt;0.001), and Dominican (RR1.19, OR 1.01-1.4, p=0.03) were more likely to undergo timely initiation of treatment in locally advanced disease when compared to Mexican patients. Conclusion: Significant differences in survival outcomes for patients with cervical cancer were identified among our cohort, as well as within the Hispanic population. Variation in initial of treatment, treatment type received, and social factors may contribute to these disparities. Citation Format: Andreea Dinicu, Shayan Dioun, Yongzhe Wang, Yongmei Huang, Jason Wright, Ana Tergas. Disparities in cervical cancer survival among Hispanic subpopulations living in the United States [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B112.

Bootstrapping multiple systems estimates to account for model selection

Multiple systems estimation using a Poisson loglinear model is a standard approach to quantifying hidden populations where data sources are based on lists of known cases. Information criteria are often used for selecting between the large number of possible models. Confidence intervals are often reported conditional on the model selected, providing an over-optimistic impression of estimation accuracy. A bootstrap approach is a natural way to account for the model selection. However, because the model selection step has to be carried out for every bootstrap replication, there may be a high or even prohibitive computational burden. We explore the merit of modifying the model selection procedure in the bootstrap to look only among a subset of models, chosen on the basis of their information criterion score on the original data. This provides large computational gains with little apparent effect on inference. We also incorporate rigorous and economical ways of approaching issues of the existence of estimators when applying the method to sparse data tables.

US air pollution is associated with increased incidence of non-syndromic cleft lip/palate

The incidence of NSCLP and NSCP per 1000 live births from 2016 to 2020 was extracted from the Centers for Disease Control and Prevention Vital Statistics Database and merged with national reports on air pollution using the Environmental Protection Agency Air Quality Systems annual data. The most commonly reported pollutants were analyzed including benzene, sulfur dioxide (SO2), particulate matter (PM) 2.5, PM 10, ozone (O3), and carbon monoxide (CO). Multivariable negative binomial and Poisson log-linear regression models evaluated the incidence of NSCLP and NSCP as a function of the pollutants, adjusting for race. All p-values are reported with Bonferroni correction. The median NSCLP incidence was 0.22/1000 births, and isolated NSCP incidence was 0.18/1000 births. For NSCLP, SO2 had a coefficient estimate (CE) of 0.60 (95% CI [0.23, 0.98], p<0.007) and PM 2.5 had a CE of 0.20 (95% CI [0.10, 0.31], p<0.005). Among isolated NSCP, no pollutants were found to be significantly associated. SO2 and PM 2.5 were significantly correlated with increased incidence of NSCLP. The American people and perinatal practitioners should be aware of the connection to allow for risk reduction and in utero screening.

Cystic echinococcosis in humans and ruminants in Portugal: a one health approach

Abstract Background Cystic echinococcosis or hydatid disease is an important parasitic zoonosis for public health, although neglected. Despite being a mandatory notification disease both in humans and animals, data in Portugal are almost absent. A collaborative One Health retrospective nationwide study was conducted, bringing together the expertise of public health doctors, veterinarians and epidemiologists. Methods Human hospitalizations caused by cystic echinococcosis and slaughterhouse records of echinococcosis from bovine, ovine and caprine species were obtained. Poisson loglinear regression model was used. Occurrence maps were generated combining animal and human cases. Results From 2008 to 2022, 298 cases of echinococcosis were identified in post-mortem inspection in Portuguese slaughterhouses (bovines n = 125, ovines=288 cases, caprines n = 14). Between 2008 and 2018, cystic echinococcosis caused 582 hospitalizations in Portuguese public hospital, with an average length of 11 (± 15.66) days, resulting in 13 deaths (2.23%). Alentejo was the region with the highest hospitalizations. For every infected animal, a 7% increase in the incidence rate of human hospitalization was found (p = 0.002, Exp(B)=1.070, 95% CI: 1.025 - 1.117). Residing in the Alentejo increased the incidence rate of human hospitalizations by 5.3 times when compared to other regions (p = 0.000, Exp(B)=5.290, 95% CI: 3.835 - 7.296). For every 100,000 person-years, there was a total of 0.528 hospitalizations and the risk of death from echinococcosis was 8 times higher for those living in the Alentejo (p &amp;lt; 0.001, Exp(B)=8.259, 95% CI: 2.427 - 28.106). Conclusions Living in the Alentejo region has shown to be a high-risk factor for echinococcosis. This work gives an accurate recognition of the situation in Portugal, allowing the development of effective health control and education programs to face an important but neglected zoonotic disease under a One Health approach. Key messages • Considering that echinococcosis is still one of the 20 neglected tropical diseases of global health importance, is critical to map and monitor its prevalence and trends. • This study highlights the impact of this neglected zoonosis in humans and livestock, allowing the identification of the most problematic areas for echinococcosis in Portugal.

Sinonasal Organizing Hematoma: Demographics, Diagnosis, and Treatment Outcomes of 112 patients.

Sinonasal organizing hematoma (OH) is a rare, nonneoplastic lesion that often presents with epistaxis, a reddish mass, and destruction of the involved sinonasal structures. Due to its rarity, the demographics, diagnostic modalities, treatment strategies, and outcomes have not yet been studied in a large, long-term study. Retrospect cohort of 112 sinonasal OH patients treated between 1997 and 2020 in a tertiary, university hospital were evaluated. Demographics, systemic comorbidities, sinonasal surgery history, serum laboratory tests, radiological findings, and treatment results were collected. The present study aimed to assess the accuracy of preoperative computed tomography (CT), Gadolinum-enhanced magnetic resonance (MR), and punch biopsies in detecting sinonasal OH as the most likely diagnosis. In addition, incidental differences by age and year of diagnosis were calculated using the Poisson log-linear regression model. The median age was 44, and 58% were male. Fewer than 20% of these cases had a chronic systemic comorbidity, bleeding tendency, or sinonasal surgery history. MR had the highest accuracy of (87%) to detect sinonasal OH as the most likely diagnosis, compared with contrast-enhanced-CT (53%), punch biopsy (49%), and non-enhanced-CT (16%) (all <0.05). Sinonasal OH incidence did not vary by age, but the yearly rate significantly increased by 1.05 times over 23 years (p < 0.05). Notably, 84% of 112 patients received surgical removal through the assistance of an endoscope, and none had substantial bleeding without preoperative embolization. Sinonasal OH was observed regardless of age, sex, systemic comorbidities, bleeding tendency, prior sinonasal surgery, or trauma. Preoperative MR gives the highest accuracy for detecting this disease. Sinonasal OH may be safely managed with endoscopic-assisted surgery removal without embolization. 4 Laryngoscope, 134:1581-1590, 2024.

Social indicators and other factors associated with chronic non-communicable diseases in rural quilombolas in the north of Minas Gerais

The aim of this article is to investigate factors associated with self-reported non-communicable chronic diseases (NCDs) in quilombolas from rural communities in the northern region of Minas Gerais, Brazil. It is a cross-sectional study, conducted in 2019 through semi-structured interviews and questionnaire application on 1110 individuals. A log-linear Poisson model was used. Twenty-seven percent of the sample had at least one of the listed NCDs. The highest prevalence was detected in females (PR: 1.31; 95%CI: 1.17-1.48), aged over 60 years (PR: 2.19; 95%CI: 1.77-2.70). There was an increased prevalence of NCDs in people who reported having suffered prejudice while seeking healthcare (PR: 1.17; 95%CI: 1.04-1.31) and who had their last healthcare service more than 12 months ago (PR: 1.22; 95%CI: 1.05-,1.42). This reality demonstrates that, despite advances in specific public policies aimed at these groups, prejudice, difficulty in accessing healthcare, and affirmative action policies still persist.

Two complementary approaches to estimate an excess of mortality: The case of Switzerland 2022.

During the COVID-19 pandemic, excess mortality has generally been estimated comparing overall mortality in a given year with either past mortality levels or past mortality trends, with different results. Our objective was to illustrate and compare the two approaches using mortality data for Switzerland in 2022, the third year of the COVID-19 pandemic. Using data from the Swiss Federal Statistical Office, standardized mortality rates and life expectancies in 2022 were compared with those of the last pre-pandemic year 2019 (first approach), as well as with those that would be expected if the pre-pandemic downward trend in mortality had continued during the pandemic (second approach). The pre-pandemic trend was estimated via a Poisson log-linear model on age-specific mortality over the period 2010-19. Using the first approach, we estimated in Switzerland in 2022 an excess mortality of 2.6% (95%CI: 1.0%-4.1%) for men and 2.5% (95%CI: 1.0%-4.0%) for women, while the excess mortality rose to 8.4% (95%CI: 6.9%-9.9%) for men and 6.0% (95%CI: 4.6%-7.5%) for women using the second approach. Age classes over 80 were the main responsible for the excess mortality in 2022 for both sexes using the first approach, although a significant excess mortality was also found in most age classes above 30 using the second approach. Life expectancy in 2022 has been reduced by 2.7 months for men and 2.4 months for women according to the first approach, whereas it was reduced by respectively 8.8 and 6.0 months according to the second approach. The excess mortality and loss of life expectancy in Switzerland in 2022 are around three times greater if the pre-pandemic trend is taken into account than if we simply compare 2022 with 2019. These two different approaches, one being more speculative and the other more factual, can also be applied simultaneously and provide complementary results. In Switzerland, such a dual-approach strategy has shown that the pre-pandemic downward trend in mortality is currently halted, while pre-pandemic mortality levels have largely been recovered by 2022.