Population-based Longitudinal Analysis Research Articles

Sleep duration, sleep disturbances and skeletal muscle mass change over time: A population-based longitudinal analysis in Peru

Sleep duration, sleep disturbances and skeletal muscle mass change over time: A population-based longitudinal analysis in Peru

Perceived gender discrimination in the workplace and onset of depressive symptoms in women: A population-based longitudinal analysis in South Korea.

Discrimination is a major cause of mental health problems; however, there is a limited understanding of the mental health consequences specifically associated with workplace gender discrimination (WGD). We explored the association between WGD and the onset of depressive symptoms among Korean female employees. This study included 3536 female employees (6223 observations) who participated in the Korean Longitudinal Survey of Women & Family (2014-2018). The respondents' perceptions of WGD were measured across six dimensions: hiring, promotion, wage, work assignments, training opportunities, and termination. The outcome was the onset of depressive symptoms after a 2-year follow-up assessed using the 10-item version of the Center for Epidemiological Studies-Depression Scale. To account for repeated measurements in each participant, we employed generalized estimating equations to estimate the risk ratios (RRs) and 95% confidence intervals (CIs). Approximately 15-20% of female employees reported WGD across each dimension. The overall incidence rate of depressive symptoms during the study period was 9.6%. In the regression analysis, female employees who responded that they experienced WGD with respect to wages were more likely to develop depressive symptoms at follow-up (adjusted RR: 1.49; 95% CI: 1.09-2.04). The other dimensions of WGD did not show a clear association with the onset of depressive symptoms. WGD is an important risk factor for onset of depressive symptoms in women. Our study suggests that proactive policy interventions are required to promote gender equality in the workplace and protect mental well-being of female workers.

Sleep duration, sleep disturbances and skeletal muscle mass change over time: A population-based longitudinal analysis in Peru.

The skeletal muscle has mainly a structural function and plays a role in human's metabolism. Besides, the association between sleep quality and muscle mass, in the form of sarcopenia, has been reported. This study aimed to assess whether changes of skeletal muscle mass (SMM) over time are associated with baseline sleep duration and disturbances in a resource-constrained adult Peruvian population. Secondary analysis using information of a population-based intervention. The outcome was SMM assessed using bioimpedance and the second version of the Lee's formula. The exposures were baseline self-reported sleep duration (normal, short and long sleepers) and disturbances (sleep difficulties and awakening at nights). Crude and adjusted linear mixed models were used to assess the associations of interest, and coefficients (β) and 95% confidence intervales (95% CI) were reported. Data from 2,310 individuals at baseline, mean age 43.4 (SD: 17.2), and 1,163 (50.4%) females were analyzed. Sleep duration was 7.8 (SD: 1.3) hours/day, with 15.3% short sleepers and 11.6% long sleepers, whereas 24.2% reported sleep difficulties and 25.1% awakening at nights. In multivariable model, SMM among short and long sleepers did not vary significantly over time using the Lee's formula; however, SMM was lower at the end of follow-up for long sleepers using bioimpedance (-0.26 kg; 95% CI: -0.47 to -0.06). Sleep disturbances were associated with a gradual SMM reduction: 0.36 kg using bioimpedance and 0.25 kg using the formula at the end of follow-up. Using bioimpedance and formula estimations, sleep disturbances were associated with a reduction of SMM over a period of 2.4 years. Regarding sleep duration, no SMM changes over time were seen in short sleepers, but findings were discordant in long sleepers: a reduction of SMM using bioimpedance, but no change using the formula.

Sleep duration, sleep disturbances and skeletal muscle mass change over time: A population-based longitudinal analysis in Peru

Background The skeletal muscle has mainly a structural function and plays a role in human’s metabolism. Besides, the association between sleep quality and muscle mass, in the form of sarcopenia, has been reported. This study aimed to assess whether changes of skeletal muscle mass (SMM) over time are associated with baseline sleep duration and disturbances in a resource-constrained adult Peruvian population. Materials and Methods Secondary analysis using information of a population-based intervention. The outcome was SMM assessed using bioimpedance and the second version of the Lee’s formula. The exposures were baseline self-reported sleep duration (normal, short and long sleepers) and disturbances (sleep difficulties and awakening at nights). Crude and adjusted linear mixed models were used to assess the associations of interest, and coefficients (β) and 95% confidence intervales (95% CI) were reported. Results Data from 2,310 individuals at baseline, mean age 43.4 (SD: 17.2), and 1,163 (50.4%) females were analyzed. Sleep duration was 7.8 (SD: 1.3) hours/day, with 15.3% short sleepers and 11.6% long sleepers, whereas 24.2% reported sleep difficulties and 25.1% awakening at nights. In multivariable model, SMM among short and long sleepers did not vary significantly over time using the Lee’s formula; however, SMM was lower at the end of follow-up for long sleepers using bioimpedance (-0.26 kg; 95% CI: -0.47 to -0.06). Sleep disturbances were associated with a gradual SMM reduction: 0.36 kg using bioimpedance and 0.25 kg using the formula at the end of follow-up. Conclusions Using bioimpedance and formula estimations, sleep disturbances were associated with a reduction of SMM over a period of 2.4 years. Regarding sleep duration, no SMM changes over time were seen in short sleepers, but findings were discordant in long sleepers: a reduction of SMM using bioimpedance, but no change using the formula.

Association between precarious employment and emergence of food insecurity in Korean adults: A population-based longitudinal analysis (2008–2022)

BackgroundPrecarious employment (PE) represents an important social determinant of health. This study examined the association between PE and the emergence of food insecurity among Korean adults. MethodsThis study included a nationwide sample of 10,481 adults (49,907 observations). PE was characterized as a multifaceted concept that included insecure employment, inadequate wages, the absence of worker rights and protection, and work environments. PE was divided into four groups according to quartile values: lowest, low, high, and highest. Food insecurity was measured using the Six-Item Short Form of the Household Food Security Survey Module. Time-lagged generalized estimating equations were utilized to examine whether engaging in PE was associated with the emergence of food insecurity in the subsequent year. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated. Results: In total, 1.0% of participants experienced food insecurity in the subsequent year. Individuals with low, high, and highest PE levels demonstrated positive associations with food insecurity onset in the following year compared to those with the lowest PE level. After adjusting for socio-demographic variables, the RRs of the association between each PE category and food insecurity were 1.49 (95% CI: 0.99–2.25) for the low PE group, 2.74 (95% CI: 1.83–4.09) for the high PE group, and 5.71 (95% CI: 3.86–8.45) for the highest PE group, respectively. ConclusionPE, a multidimensional concept, was positively associated with food insecurity among Korean workers. Therefore, policy measures to improve employment quality within the workforce are necessary.

Sleep duration, sleep disturbances and skeletal muscle mass change over time: A population-based longitudinal analysis in Peru

Background The skeletal muscle has mainly a structural function and plays a role in human’s metabolism. Besides, the association between sleep quality and muscle mass, in the form of sarcopenia, has been reported. This study aimed to assess whether changes of skeletal muscle mass (SMM) over time are associated with baseline sleep duration and disturbances in a resource-constrained adult Peruvian population. Materials and Methods Secondary analysis using information of a population-based intervention. The outcome was SMM assessed using bioimpedance and the second version of the Lee’s formula. The exposures were baseline self-reported sleep duration (normal, short and long sleepers) and disturbances (sleep difficulties and awakening at nights). Crude and adjusted linear mixed models were used to assess the associations of interest, and coefficients (β) and 95% confidence intervales (95% CI) were reported. Results Data from 2,310 individuals at baseline, mean age 43.4 (SD: 17.2), and 1,163 (50.4%) females were analyzed. Sleep duration was 7.8 (SD: 1.3) hours/day, with 15.3% short sleepers and 11.6% long sleepers, whereas 24.2% reported sleep difficulties and 25.1% awakening at nights. In multivariable model, SMM among short and long sleepers did not vary significantly over time using the Lee’s formula; however, SMM was lower at the end of follow-up for long sleepers using bioimpedance (-0.26 kg; 95% CI: -0.47 to -0.06). Sleep disturbances were associated with a gradual SMM reduction: 0.36 kg using bioimpedance and 0.25 kg using the formula at the end of follow-up. Conclusions Using bioimpedance and formula estimations, sleep disturbances were associated with a reduction of SMM over a period of 2.4 years. Regarding sleep duration, no SMM changes over time were seen in short sleepers, but findings were discordant in long sleepers: a reduction of SMM using bioimpedance, but no change using the formula.

Child Telomere Length at 11–12 Years of Age Is Not Associated with Pregnancy Complications

Children born from pregnancy complications are at higher risk of chronic diseases in adulthood. Identifying which children born from a complicated pregnancy are likely to suffer from later chronic disease is important in order to intervene to prevent or delay the onset of disease. This study examined the associations between the major pregnancy complications (gestational diabetes, high blood pressure, small- and large for gestational age, and preterm birth) and child telomere length, a biomarker of chronic disease risk. This was a population-based longitudinal analysis using data from the Longitudinal Study of Australian Children. The primary outcome is telomere length, measured in 11–12-year-old children. Multivariable linear regression was used to estimate the association between pregnancy complications and child telomere length, adjusting for a range of a priori confounders. Data from 841 families were used. One in four pregnancies (27.1%) featured a pregnancy complication. In the adjusted analysis, there was no association between pregnancy complications and child telomere length (high blood pressure: mean difference (95% CI): 0.00 (−0.12, 0.12); gestational diabetes (0.05 (−0.10, 0.19)); small for gestational age (0.07 (−0.04, 0.19)); large for gestational age (−0.06 (−0.15, 0.03)); and preterm birth (−0.10 (−0.21, 0.01)). Our results do not support the notion that telomere length is shorter in children born to mothers after a pregnancy complication. Methodological considerations should be rigorous to improve the reproducibility of findings.

Impact of health risk factors on healthcare resource utilization, work-related outcomes and health-related quality of life of Australians: a population-based longitudinal data analysis.

Health risk factors, including smoking, excessive alcohol consumption, overweight, obesity, and insufficient physical activity, are major contributors to many poor health conditions. This study aimed to assess the impact of health risk factors on healthcare resource utilization, work-related outcomes and health-related quality of life (HRQoL) in Australia. We used two waves of the nationally representative Household, Income, and Labor Dynamics in Australia (HILDA) Survey from 2013 and 2017 for the analysis. Healthcare resource utilization included outpatient visits, hospitalisations, and prescribed medication use. Work-related outcomes were assessed through employment status and sick leave. HRQoL was assessed using the SF-6D scores. Generalized estimating equation (GEE) with logit or log link function and random-effects regression models were used to analyse the longitudinal data on the relationship between health risk factors and the outcomes. The models were adjusted for age, sex, marital status, education background, employment status, equilibrium household income, residential area, country of birth, indigenous status, and socio-economic status. After adjusting for all other health risk factors covariates, physical inactivity had the greatest impact on healthcare resource utilization, work-related outcomes, and HRQoL. Physical inactivity increased the likelihood of outpatient visits (AOR = 1.60, 95% CI = 1.45, 1.76 p < 0.001), hospitalization (AOR = 1.83, 95% CI = 1.66-2.01, p < 0.001), and the probability of taking sick leave (AOR = 1.31, 95% CI = 1.21-1.41, p < 0.001), and decreased the odds of having an above population median HRQoL (AOR = 0.48, 95% CI = 0.45-0.51, p < 0.001) after adjusting for all other health risk factors and covariates. Obesity had the greatest impact on medication use (AOR = 2.02, 95% CI = 1.97-2.29, p < 0.001) after adjusting for all other health risk factors and covariates. Our study contributed to the growing body of literature on the relative impact of health risk factors for healthcare resource utilization, work-related outcomes and HRQoL. Our results suggested that public health interventions aim at improving these risk factors, particularly physical inactivity and obesity, can offer substantial benefits, not only for healthcare resource utilization but also for productivity.

COVID Vaccine Hesitancy and Long-Term Traffic Risks

BackgroundCOVID vaccine hesitancy identifies a discrepancy between personal decisions and public guidelines. We tested whether COVID vaccine hesitancy was associated with the long-term risks of a traffic crash. MethodsWe conducted a population-based longitudinal cohort analysis of adults by determining COVID vaccination status through linkages to electronic medical records. Traffic crashes requiring emergency medical care were defined by multicenter outcome ascertainment of all hospitals throughout the region over the subsequent year. ResultsWe identified 11,598,549 total individuals, of whom 1,210,754 had not received a COVID vaccine. A total of 54,558 were subsequently injured in traffic crashes during the 1-year follow-up interval, equal to a risk of 4704 per million. Those who had not received a COVID vaccine had a 58% higher risk than those who had received a COVID vaccine (6983 vs 4438 per million, P < .001). The increased traffic risks among unvaccinated individuals included diverse subgroups, were accentuated for single-vehicle crashes, extended to fatal outcomes, exceeded the risks associated with sleep apnea, and persisted after adjustment for baseline characteristics. The increased risks were validated in analyses using Artificial Intelligence techniques and generally larger than the risks of other adverse events frequently ascribed to COVID vaccination. ConclusionsCOVID vaccine hesitancy is associated with significant increased long-term risks of a traffic crash. A greater awareness of traffic risks might encourage patients to take protective actions for personal safety.

Association between long working hours and the onset of problematic alcohol use in young workers: A population-based longitudinal analysis in South Korea

BackgroundLong working hours can negatively impact mental health. We examined the association between long working hours and problematic alcohol use among young Korean workers. MethodsWe included a nationally representative sample of workers below the age of 40 from the Youth Panel between 2016 and 2020 (N = 7846; observations: 27,646). The exposure variable was working hours per week. Problematic alcohol use was assessed using the CAGE questionnaire, and generalized estimating equations were used to account for repeated measurements. ResultsObservations of the participants revealed that 5 % worked < 35 h/week, 51 % worked 35–40 h/week, 24 % worked 41–48 h/week, 11 % worked 49–54 h/week, and 9 % worked ≥55 h/week. The prevalence of problematic alcohol use among the workers was 2 % for <35 h/week, 2 % for 35–40 h/week, 3 % for 41–48 h/week, 4 % for 49–54 h/week, and 4 % for ≥55 h/week. The adjusted odds ratios (95 % confidence intervals) for the association between working hours per week and the onset of problematic alcohol use in the following year were 0.86 (0.45–1.66) for <35 h, 1.56 (1.22–1.99) for 41–48 h, 2.03 (1.49–2.75) for 49–54 h, and 1.68 (1.17–2.42) for ≥55 h, compared to 35–40 h. LimitationsThe observational design of the study prevented the establishment of a causal relationship between working hours and the onset of problematic alcohol use. ConclusionLong working hours were associated with the development of problematic alcohol use. Policy interventions should promote healthier drinking habits among workers with long work hours.

Green and blue spaces, COVID-19 lockdowns, and mental health: An Australian population-based longitudinal analysis.

Australia experienced some of the world's longest and most stringent lockdowns during the COVID-19 pandemic. While lockdown measures had consequences for mental health, investigation is lacking on the potential for green and blue space coverage within people's local environments to ameliorate the impact of lockdowns with varied lengths using longitudinal cohorts. This study examined the impact of lockdown durations on population mental health and tests the effect modification of neighbourhood green and inland and coastal blue space coverage in metropolitan areas. We merged population-based longitudinal data on more than 11,000 individuals collected over a ten-year period from 2012 to 2021 with national land use data describing green and blue space coverage. We used fixed effect models to estimate the relationship between lockdowns (with different durations and staggered introduction) and mental health, controlling for sociodemographic, health, and geographical confounders, and tested the significance of effect modification of green and blue space. Results show that extended lockdowns led to considerably larger decreases in mental health (COVID-y1: -2.66, 95%CI: -3.43, -1.89; COVID-y2: -2.65, 95%CI: -3.33, -1.97) relative to short lockdowns. The mental health effect of lockdowns was smaller where green spaces and inland and coastal blue spaces were available. Effect modification was statistically significant for green space, with smaller negative mental health effects observed where there was sizeable green space coverage, particularly during long lockdowns (COVID-y1: -2.69, 95%CI: -3.63, -1.76 for coverage <5%; -3.27, 95%CI: -4.70, -1.84 for coverage 5%-10%; -0.60, 95%CI: -2.03, 0.83 for coverage ≥30%; COVID-y2: -2.74, 95%CI: -3.62, -1.87 for coverage <5%, -2.95, 95%CI: -3.98, -1.92 for coverage 5%-10%; -2.08, 95%CI: -3.28, -0.88 for coverage ≥30%). Findings support the consideration of nature exposure to improve people's mental wellbeing and resilience when designing lockdown measures in response to future public health emergencies.

COVID Vaccine Hesitancy and Risk of a Traffic Crash

BackgroundCoronavirus disease (COVID) vaccine hesitancy is a reflection of psychology that might also contribute to traffic safety. We tested whether COVID vaccination was associated with the risks of a traffic crash. MethodsWe conducted a population-based longitudinal cohort analysis of adults and determined COVID vaccination status through linkages to individual electronic medical records. Traffic crashes requiring emergency medical care were subsequently identified by multicenter outcome ascertainment of all hospitals in the region over a 1-month follow-up interval (178 separate centers). ResultsA total of 11,270,763 individuals were included, of whom 16% had not received a COVID vaccine and 84% had received a COVID vaccine. The cohort accounted for 6682 traffic crashes during follow-up. Unvaccinated individuals accounted for 1682 traffic crashes (25%), equal to a 72% increased relative risk compared with those vaccinated (95% confidence interval, 63-82; P < 0.001). The increased traffic risks among unvaccinated individuals extended to diverse subgroups, was similar to the relative risk associated with sleep apnea, and was equal to a 48% increase after adjustment for age, sex, home location, socioeconomic status, and medical diagnoses (95% confidence interval, 40-57; P < 0.001). The increased risks extended across the spectrum of crash severity, appeared similar for Pfizer, Moderna, or other vaccines, and were validated in supplementary analyses of crossover cases, propensity scores, and additional controls. ConclusionsThese data suggest that COVID vaccine hesitancy is associated with significant increased risks of a traffic crash. An awareness of these risks might help to encourage more COVID vaccination.

Mortality trend of heart diseases in China, 2013–2020

Background and purpose: Heart diseases are the leading cause of death in China. Understanding of the secular trend of different subcategories of heart disease is important for policy making. The purpose of this study is to analyze the mortality trend of heart diseases in China from 2013 to 2020. Methods: A population-based longitudinal analysis was conducted using the China National Mortality Surveillance System to examine heart disease mortality change during a period from 2013 to 2020. The causes of death were coded using the International Classification of Diseases-10th Revision. The number of deaths and mortality rate were calculated based on sex, subcategories of heart disease, urban versus rural setting, and across different geographic locations. Data from the sixth census in China in 2010 was used as the standard population, and the mortality rates were adjusted based on the under-reporting rate. Results: Ischemic heart disease (IHD), hypertensive heart disease (HHD), and rheumatic heart disease (RHD) are the three leading causes of heart disease deaths during 2013–2020. There was a trend for increased age-standardized mortality rate (ASMR) of cardiac arrest, aortic aneurysm (AA), and nonrheumatic valvular heart diseases (NRVHDs) during the study period. In comparison to men, women had higher ASMR of RHD, and lower ASMR of IHD, HHD, cardiac arrest, AA, and NRVHDs. In comparison to rural areas, urban areas had lower ASMR of IHD, HHD, and RHD, and higher ASMR of cardiac arrest, AA, and NRVHDs. The spectrum of heart diseases differed significantly across age groups. In 2020, the percentages of IHD and HHD in the ≥65-year age group were higher than in other age groups. Significant differences in ASMR were noted across different geographic locations, with the highest in Xinjiang (198.14/100,000) and the lowest in Shanghai (62.19/100,000) in 2020. Conclusions: The mortality rate decreased for IHD, HHD, and RHD during the study period, but remained the leading causes of heart disease death in China. There was a trend for increasing mortality of cardiac arrest, AA, and NRVHDs, and significant difference across different geographic locations.

Relationships between changes in HIV risk perception and condom use in East Zimbabwe 2003\u20132013: population-based longitudinal analyses

BackgroundPerceiving a personal risk for HIV infection is considered important for engaging in HIV prevention behaviour and often targeted in HIV prevention interventions. However, there is limited evidence for assumed causal relationships between risk perception and prevention behaviour and the degree to which change in behaviour is attributable to change in risk perception is poorly understood. This study examines longitudinal relationships between changes in HIV risk perception and in condom use and the public health importance of changing risk perception.MethodsData on sexually active, HIV-negative adults (15–54 years) were taken from four surveys of a general-population open-cohort study in Manicaland, Zimbabwe (2003–2013). Increasing condom use between surveys was modelled in generalised estimating equations dependent on change in risk perception between surveys. Accounting for changes in other socio-demographic and behavioural factors, regression models examined the bi-directional relationship between risk perception and condom use, testing whether increasing risk perception is associated with increasing condom use and whether increasing condom use is associated with decreasing risk perception. Population attributable fractions (PAFs) were estimated.ResultsOne thousand, nine hundred eighty-eight males and 3715 females participated in ≥2 surveys, contributing 8426 surveys pairs. Increasing risk perception between two surveys was associated with higher odds of increasing condom use (males: adjusted odds ratio [aOR] = 1.39, 95% confidence interval [CI] = 0.85–2.28, PAF = 3.39%; females: aOR = 1.41 [1.06–1.88], PAF = 6.59%), adjusting for changes in other socio-demographic and behavioural factors. Those who decreased risk perception were also more likely to increase condom use (males: aOR = 1.76 [1.12–2.78]; females: aOR = 1.23 [0.93–1.62]) compared to those without change in risk perception.ConclusionsResults on associations between changing risk perception and increasing condom use support hypothesised effects of risk perception on condom use and effects of condom use on risk perception (down-adjusting risk perception after adopting condom use). However, low proportions of change in condom use were attributable to changing risk perception, underlining the range of factors influencing HIV prevention behaviour and the need for comprehensive approaches to HIV prevention.

Children with hearing impairment in Malawi, a cohort study.

ObjectiveTo assess the outcomes of children diagnosed with hearing impairment 3 years earlier in terms of referral uptake, treatment received and satisfaction with this treatment, and social participation.MethodsWe conducted a population-based longitudinal analysis of children with a hearing impairment in two rural districts of Malawi. Key informants within the community identified the cohort in 2013 (baseline). Informants clinically screened children at baseline, and by questionnaires at baseline and follow-up in 2016. We investigated associations between sociodemographic characteristics and outcomes by multivariate logistic regression.ResultsWe diagnosed 752 children in 2013 as having a hearing impairment and traced 307 (40.8%) children of these for follow-up in 2016. Referral uptake was low (102/184; 55.4%), more likely among older children (odds ratio, OR: 3.5; 95% confidence interval, CI: 1.2–10.2) and less likely for those with an illiterate caregiver (OR: 0.5; 95% CI: 0.2–0.9). Few of the children who attended hospital received any treatment (33/102; 32.4%) and 63.6% (21/33) of caregivers reported satisfaction with treatment. Difficulty making friends and communicating needs was reported for 10.0% (30/299) and 35.6% (107/301) of the children, respectively. Lack of school enrolment was observed for 29.5% (72/244) of children, and was more likely for older children (OR: 28.6; 95% CI: 10.3–79.6), girls (OR: 2.4; 95% CI: 1.2–4.8) and those with an illiterate caregiver (OR: 2.1; 95% CI: 1.0–4.1).ConclusionMore widespread and holistic services are required to improve the outcomes of children with a hearing impairment in Malawi.

Glucocorticoid Dose-Dependent Risk of Type 2 Diabetes in Six Immune-Mediated Inflammatory Diseases: A Population-Based Cohort Analysis

Background: In immune-mediated inflammatory diseases, there is a lack of precise estimates of glucocorticoid dose-response diabetes risk that consider changes in prescribed dose over time and disease activity. Methods: Population-based longitudinal analysis of electronic health records from the UK Clinical Practice Research Datalink, linked to hospital admissions and the mortality registry (1998-2017). We included 100,722 adult patients without prior diabetes history, diagnosed with giant cell arteritis or polymyalgia rheumatica (n=32,593), inflammatory bowel disease (n=29,272), rheumatoid arthritis (n=28,365), vasculitis (n=6,082), or systemic lupus erythematosus (n=4,410). We estimated risks and hazard ratios of type 2 diabetes associated with time-variant daily and total cumulative prednisolone-equivalent glucocorticoid dose using Cox regression methods. Findings: Average patient age was 58·6 years, 65,469 (65·0%) were women and 8,858 (22·6%) had a BMI ≥30 kg/m2. Overall, 8,137 (8·1%) people developed type 2 diabetes after a median follow-up of 4·9 years. At 1 year, the cumulative risk of diabetes increased from 0·9% during periods of non-use to 5·0% when the daily prednisolone-equivalent dose was ≥25·0mg. We found strong dose-dependent associations for all immune-mediated diseases, BMI levels and underlying disease duration, even after controlling for periods of active systemic inflammation. Adjusted hazard ratio [HR] for a <5·0mg daily dose vs. non-use was 1·90, 95%CI 1·44-2·50; range 1·70 for rheumatoid arthritis to 2·93 for inflammatory bowel disease. Interpretation: We report dose-dependent risks of type 2 diabetes associated with glucocorticoid use for six common immune-mediated inflammatory diseases. These results underline the need for regular diabetic risk assessment and testing during glucocorticoid therapy in these patients. Funding Statement: This work was partly supported by the Medical Research Council TARGET Partnership Grant (Treatment According to Response in Giant cEll arTeritis) (MR/N011775/1). JW is supported by the NIHR infrastructure @ Leeds. SLM was supported by a NIHR Clinician Scientist Fellowship. Declaration of Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare no support from any organisation for the submitted work except for SLM who received: salary support from NIHR (Clinician Scientist Fellowship) during the period of work reported here; advisory board fees from Roche in 2015 and conference attendance from Roche in 2019; investigator or sub-investigatory on industry-sponsored clinical trials (Sanofi, Roche, GSK) and consultancy on behalf of the University of Leeds (without receiving personal income) to Roche and Sanofi. SLM is Patron of the patient support charity PMRGCAuk. Ethics Approval Statement: The Independent Scientific Advisory Committee for Medicines and Healthcare products Regulatory Agency database research (ISAC) approved the study (reference 16_146).

Type 2 Diabetes Mellitus in Patients with Sickle Cell Disease: A Population-Based Longitudinal Analysis of Three Cohorts

IntroductionThe prevalence and incidence of type 2 diabetes mellitus (T2DM) in the United States (U.S.) is increasing with more than 100 million adults living with diabetes or pre-diabetes. Population-based evidence on the prevalence and risks for T2DM in patients with sickle cell disease (SCD) is limited. This study measured the prevalence of T2DM in patients with SCD and clinical characteristics associated with its incidence in a large commercially insured adult SCD cohort and also an academic institution-based clinical cohort.MethodsWe performed a population-based cohort study of commercially-insured health plan enrollees using the Truven MarketScan® Research Databases. Patients with SCD (1 inpatient or 2 outpatient claims that are at least 30 days apart) were identified and sampled each calendar year between 2009 and 2014. Prevalence in each closed cohort of continuously enrolled patients was determined per calendar year. Incidence rates of T2DM were estimated and compared with adult non-Hispanic Black respondents to the National Health and Nutrition Examination Survey (NHANES) over the same study period (2009-2014). Among SCD patients, multivariable Cox proportional hazard models were used to identify factors associated with incident T2DM, adjusting for relevant patient characteristics. Finally, prevalence of T2DM was measured in a cohort of patients with SCD aged ≥20 years at first medical encounter at the University of Illinois at Chicago (UIC) from January 2008 to December 2017. Prevalent T2DM was identified through a combination of diagnosis codes, self-reporting, anti-diabetic medications excluding insulin and glucose tests in outpatient settings.ResultsAmong 7,070 health plan enrollees with SCD, the median age (mean) was 37.0 (38.9) years and 60.8% were female. Compared to SCD patients without T2DM, more SCD patients with T2DM had nephropathy (28.0% vs. 9.5%; p<0.001), neuropathy (17.7% vs. 5.2%; p<0.001), and history of stroke (24.1% vs. 9.2%; p<0.001). The standardized prevalence of T2DM among patients with SCD showed a modest increase from 15.7% to 16.5% from 2009 to 2014 (p trend=0.0259), and SCD patients had comparable prevalence of T2DM compared to the NHANES subjects (18.2%). [Figure A] Over 17,024 person-years, we observed a crude incidence rate for T2DM of 25.4 per 1,000 person-years. Risk of developing T2DM in patients with SCD increased with age, and incident T2DM was associated with comorbid hypertension (HR=1.45, 95%CI 1.14-1.83) and dyslipidemia (HR=1.43, 95%CI 1.04-1.96). [Figure B]Of the 672 adults in the UIC cohort of patients with SCD, 61.1% were female, the median (mean) age was 30.0 [32.9] years, and 478 (71.1%) had homozygous HbS disease (HbSS). A total of 76 (11.3%) patients had T2DM, with the highest prevalence among SCD patients ages ≥ 40 years (50/190, 26.3%). [Figure C] Abnormal glucose test results (≥200 mg/dl) were documented in 41 patients with mean (SD) of 294 (94) mg/dl. Among 31 patients with abnormal fructosamine tests (>285 µmol/L), the mean (SD) fructoasmine value was 392 (90) µmol/L.ConclusionWe present evidence describing the prevalence of T2DM in patients with SCD both in a commercially-insured population and from an institution-based clinical cohort. These findings were similar to a general African American population with an increasing trend in T2DM over recent years. These trends support the routine screening for T2DM in patients with SCD, especially those of older age and with presence of comorbid hypertension and/or dyslipidemia. DisclosuresNo relevant conflicts of interest to declare.

Cancer screening inequities in a time of primary care reform: a population-based longitudinal study in Ontario, Canada

BackgroundPrimary care has been reformed in recent years in Ontario, Canada, with a move away from traditional fee-for-service to enhanced fee-for-service and capitation-based models. It is unclear how new models have affected disparities in cancer screening. We evaluated whether Ontario’s enhanced fee-for-service model was associated with a change in the gaps in cancer screening for people living with low income and people who are foreign-born.MethodsWe conducted a population-based longitudinal analysis from 2002 to 2013 of Ontario family physicians who transitioned from traditional fee-for-service to enhanced fee-for-service. The binary outcomes of interest were adherence to cervical, breast and colorectal cancer screening recommendations. Outcomes were analyzed using mixed-effects logistic regression. Analyses produced annual odds ratios comparing the odds of being up-to-date for screening among patients in enhanced fee-for-service versus patients in traditional fee-for-service for each social stratum separately. We calculated the ratios of stratum-specific odds ratios to assess whether the transition from traditional to enhanced fee-for-service was associated with a change in screening gaps between immigrants and long-term residents, and between people in the lowest and highest neighbourhood income quintiles.ResultsThroughout the study period, cancer screening was consistently lower among immigrants and among people in the lowest income quintile. Transition to enhanced fee-for-service was generally associated with increased screening uptake for all, however for most years, ratios of ratios were significantly less than 1 for all three cancer screening types, indicating that there was a widening of the screening gap between immigrants and long-term residents and between people living in the lowest vs. highest income quintile associated with transitions.ConclusionThe transition to enhanced fee-for-service in Ontario was generally associated with a widening of screening inequities for foreign-born and low-income patients.

Trends in traumatic brain injury mortality in China, 2006-2013: A population-based longitudinal study.

BackgroundTraumatic brain injury (TBI) is a significant global public health problem, but has received minimal attention from researchers and policy-makers in low- and middle-income countries (LMICs). Epidemiological evidence of TBI morbidity and mortality is absent at the national level for most LMICs, including China. Using data from China’s Disease Surveillance Points (DSPs) system, we conducted a population-based longitudinal analysis to examine TBI mortality, and mortality differences by sex, age group, location (urban/rural), and external cause of injury, from 1 January 2006 to 31 December 2013 in China.Method and findingsMortality data came from the national DSPs system of China, which has coded deaths using the International Classification of Diseases–10th Revision (ICD-10) since 2004. Crude and age-standardized mortality with 95% CIs were estimated using the census population in 2010 as a reference population. The Cochran–Armitage trend test was used to examine the significance of trends in mortality from 2006 to 2013. Negative binomial models were used to examine the associations of TBI mortality with location, sex, and age group. Subgroup analysis was performed by external cause of TBI. We found the following: (1) Age-adjusted TBI mortality increased from 13.23 per 100,000 population in 2006 to 17.06 per 100,000 population in 2008 and then began to fall slightly. In 2013, age-adjusted TBI mortality was 12.99 per 100,000 population (SE = 0.13). (2) Compared to females and urban residents, males and rural residents had higher TBI mortality risk, with adjusted mortality rate ratios of 2.57 and 1.71, respectively. TBI mortality increased substantially with older age. (3) Motor vehicle crashes and falls were the 2 leading causes of TBI mortality between 2006 and 2013. TBI deaths from motor vehicle crashes in children aged 0–14 years and adults aged 65 years and older were most often in pedestrians, and motorcyclists were the first or second leading category of road user for the other age groups. (4) TBI mortality attributed to motor vehicle crashes increased for pedestrians and motorcyclists in all 7 age groups from 2006 to 2013. Our analysis was limited by the availability and quality of data in the DSPs dataset, including lack of injury-related socio-economic factors, policy factors, and individual and behavioral factors. The dataset also may be incomplete in TBI death recording or contain misclassification of mortality data.ConclusionsTBI constitutes a serious public health threat in China. Further studies should explore the reasons for the particularly high risk of TBI mortality among particular populations, as well as the reasons for recent increases in certain subgroups, and should develop solutions to address these challenges. Interventions proven to work in other cultures should be introduced and implemented nationwide. Examples of these in the domain of motor vehicle crashes include policy change and enforcement of laws concerning helmet use for motorcyclists and bicyclists, car seat and booster seat use for child motor vehicle passengers, speed limit and drunk driving laws, and alcohol ignition interlock use. Examples to prevent falls, especially among elderly individuals, include exercise programs, home modification to reduce fall risk, and multifaceted interventions to prevent falls in all age groups.

Female sexual function varies over time and is dependent on partner-specific factors: a population-based longitudinal analysis of six sexual function domains.

Most studies examining female sexual functions (FSFs) have used cross-sectional designs, not allowing for studying temporal stability and possible relationships between different FSFs over time. Our aim was to study these relationships using a longitudinal approach. The study sample consisted of 2173 Finnish women from two large-scale, population-based data collections 7 years apart. The Female Sexual Function Index was used. Analyses were further conducted separately for women in different relationship constellations. Standardized autoregressive paths ranged from 0.136 (sexual satisfaction) to 0.447 (orgasm function) in the full sample, suggesting that most of the variance in FSF was explained by something other than previous function. Orgasm, desire and satisfaction were the strongest predictors of other functions in the full sample and for women in the same relationship at both time points (higher orgasm function predicted higher function in other domains; greater sexual desire and satisfaction predicted lower function in other domains), however, with small effects sizes. For single women, orgasm function and sexual desire were the only significant autoregressive paths. Significant unidirectional cross-domain paths were found for women in the same relationship at both time points. One significant cross-domain path, not confirmed as unidirectional, was found for single women. FSFs varied considerably over 7 years and relationship status was of importance when assessing temporal stability and cross-domain effects. Our results advocate tailored psychobehavioural treatment interventions for female sexual dysfunctions that take partner-specific factors into account.