Prais-Winsten Model Research Articles

Human Papillomavirus vaccination coverage among the female population living in the state of Goiás, Brazil, 2014-2020: a time series study.

To analyze the temporal trend of human papillomavirus (HPV) vaccination coverage among the female population aged 10 to 14 years, living in the state of Goiás, Brazil, between 2014 and 2022. This was an ecological time series study using data from the Brazilian National Health System Information Technology Department (Departamento de Informática do Sistema Único de Saúde - DATASUS); the annual vaccination coverage rate was calculated based on the number of second doses administered; the trend of the rates was analyzed using the Prais-Winsten model. A total of 407,217 second doses of the quadrivalent HPV vaccine were administered to the female population aged 10-14 years, with annual vaccination coverage rates ranging from 12.3% (2019) to 30.0% (2015), and an annual percentage change (APC) of 0.7% (95%CI 0.9; 0.2; p-value = 0.030). In Góias state, the quadrivalent HPV vaccine coverage rate was below the national target (80%), showing a stationary trend in the time series.

Quality of healthcare services to reduce leprosy in Brazil: a trend analysis from 2001 to 2020.

To analyze the temporal trend of healthcare services quality indicators to reduce leprosy in Brazil, over a 20-year period. This is an epidemiological study with a temporal trend, whose data were extracted from the Notifiable Diseases Information System. Indicators were constructed from the Ministry of Health Technical-Operational Manual that presents the Guidelines for Surveillance, Care and Elimination of Leprosy as a Public Health Problem. For trend analysis of the selected indicators, the Prais-Winsten model was used and the Average Annual Growth Rate (AAGR) was also calculated. In the 20-year time series investigated here, 732,959 cases of leprosy were reported in Brazil. The trend was stationary for: new leprosy cases cure rate (β=-0.000; p=0.196; AAGR=-0.2), new leprosy cases drop out rate (β=-0.001; p=0.147; AAGR=-0.4), new leprosy cases contact tracing rate (β=-0.001; p=0.112; AAGR=1.6), new cases of leprosy with degree physical disability assessment rate among new cases (β=-0.000; p=0.196; AAGR=-0.2) and cases cured in the year with the degree of physical disability assessed (β=0.002; p=0.265; AAGR=0.5); while the indicator of recurrence rate among cases reported in the year (β=0.019; p<0.001; AAGR=0.5) showed an increasing trend. Based on the evaluation of indicators to assess the quality of healthcare services to reduce leprosy, it was evident that Brazil has major challenges for its full implementation, with improvements being necessary in the quality of care service offered to the population.

Tendência temporal da mortalidade por desnutrição proteico-calórica em pessoas idosas no Brasil, no período de 2000 – 2021

Abstract Objective To analyze the temporal trend in mortality from protein-calorie malnutrition among older adults in Brazil from 2000 to 2021. Method An epidemiological study with an ecological, descriptive analytical design was conducted. Annual data were obtained from the Brazilian Mortality Information System (SIM) for the specified period. Crude and age-adjusted mortality rates were calculated using the direct method and the world population as a reference. The Prais-Winsten model and Annual Percentage Change (APC) were used to observe the mortality trend. Results From 2000 to 2021, the general mortality rate from protein-calorie malnutrition in older adults fluctuated, reaching a maximum in 2006 (28.74) and minimum in 2021 (10.64), with a decreasing trend (β=- 0.015; p=0.005; APC=-3.454%). Analysis of standardized mortality rates by sex revealed a decreasing trend for both genders, and higher rates among men throughout the historical series. Regarding age group, a decline in mortality among individuals aged 60-79 years and a stable trend in subjects aged ≥ 80 years was observed. Conclusion The study results showed a drop in the rate of mortality from protein-calorie malnutrition among older adults. However, mortality rates from this modifiable cause remain high, underscoring the need to improve health care for this specific population.

Epidemiological trends of isolated and non-isolated central nervous system congenital malformations in live births in a middle-income setting

ObjectivesThis study aimed to analyze, in the São Paulo state of Brazil, time trends in prevalence, neonatal mortality, and neonatal lethality of central nervous system congenital malformations (CNS-CM) between 2004 and 2015.MethodsPopulation-based study of all live births with gestational age ≥22 weeks and/or birthweight ≥400 g from mothers living in São Paulo State, during 2004–2015. CNS-CM was defined by the presence of International Classification Disease 10th edition codes Q00–Q07 in the death and/or live birth certificates. CNS-CM was classified as isolated (only Q00–Q07 codes), and non-isolated (with congenital anomalies codes nonrelated to CNS-CM). CNS-CM associated neonatal death was defined as death between 0 and 27 days after birth in infants with CNS-CM. CNS-CM prevalence, neonatal mortality, and lethality rates were calculated, and their annual trends were analyzed by Prais-Winsten Model. The annual percent change (APC) with 95% confidence interval (95%CI) was obtained.Results7,237,628 live births were included in the study and CNS-CM were reported in 7526 (0.1%). CNS-CM associated neonatal deaths occurred in 2935 (39.0%). Isolated CNS-CM and non-isolated CNS-CM were found respectively in 5475 and 2051 livebirths, with 1525 (28%) and 1410 (69%) neonatal deaths. CNS-CM prevalence and neonatal lethality were stationary, however neonatal mortality decreased (APC −1.66; 95%CI −3.09 to −0.21) during the study. For isolated CNS-CM, prevalence, neonatal mortality, and lethality decreased over the period. For non-isolated CNS-CM, the prevalence increased, neonatal mortality was stationary, and lethality decreased during the period. The median time of CNS-CM associated neonatal deaths was 18 h after birth.ConclusionsDuring a 12-year period in São Paulo State, Brazil, neonatal mortality of infants with CNS-CM in general and with isolated CNS-CM showed a decreasing pattern. Nevertheless CNS-CM mortality remained elevated, mostly in the first day after birth.

Temporal Trend, Causes, and Timing of Neonatal Mortality of Moderate and Late Preterm Infants in São Paulo State, Brazil: A Population-Based Study.

Moderate and late preterm newborns comprise around 85% of live births < 37 weeks gestation. Data on their neonatal mortality in middle-income countries is limited. This study aims to analyze the temporal trend, causes and timing of neonatal mortality of infants with 320/7-366/7 weeks gestation without congenital anomalies from 2004-2015 in the population of São Paulo State, Brazil. A database was built by deterministic linkage of birth and death certificates. Causes of death were classified by ICD-10 codes. Among 7,317,611 live births in the period, there were 545,606 infants with 320/7-366/7 weeks gestation without congenital anomalies, and 5782 of them died between 0 and 27 days. The neonatal mortality rate decreased from 16.4 in 2004 to 7.6 per thousand live births in 2015 (7.47% annual decrease by Prais-Winsten model). Perinatal asphyxia, respiratory disorders and infections were responsible, respectively, for 14%, 27% and 44% of the 5782 deaths. Median time to death was 24, 53 and 168 h, respectively, for perinatal asphyxia, respiratory disorders, and infections. Bottlenecks in perinatal health care are probably associated with the results that indicate the need for policies to reduce preventable neonatal deaths of moderate and late preterm infants in the most developed state of Brazil.

Greenhouse gas emissions and stock market volatility: an empirical analysis of OECD countries

PurposeThis study aims to explore empirical evidence of the impact of greenhouse gas (GHG) emissions on stock market volatility.Design/methodology/approachUsing panel data of 35 Organization for Economic Co-operation and Development countries from 1992 to 2018, we conduct both fixed effects panel model and Prais-Winsten model with panel-corrected standard errors.FindingsThe authors document that there is a significant positive relationship between GHG emissions and stock market volatility. The results remain robust after controlling for potential endogeneity problems.Originality/valueThis study contributes to the literature in that it provides additional empirical evidence for the financial risk posed by climate change.

Trend in the incidence rates of accidents with venomous animals in children and adolescents in Brazil (2007-2019).

ABSTRACTObjective:To estimate the temporal trend of the incidence rates of accidents with venomous animals in children and adolescents in Brazil.Methods:An ecological time-series study was carried out between 2007 and 2019. Data were obtained from the Brazilian Information System on Diseases of Compulsory Declaration (Sistema de Informação de Agravos de Notificação – SINAN). The time series of incidence rates of accidents with venomous animals were stratified by age group (children aged 0 to 9 years and adolescents aged 10 to 19 years), Brazilian macro-regions (North, Northeast, Midwest, Southeast, and South), and type of accident (snake, scorpion, spider, and caterpillar). For trend analysis, the Prais-Winsten model and the Annual Percent Change (APC) were used.Results:The time series of the incidence rate of accidents with venomous animals in children and adolescents from the North, Northeast, Midwest, and Southeast macro-regions and in children from the South region showed an upward trend. The average annual incidence rates were higher in the age group of 10 to 19 years, except for the South macro-region. Accidents with scorpions, snakes, and spiders, in this order, were the most frequent; the trends in the time series stratified by type of animal varied according to the geographic macro-region.Conclusions:There was an upward trend in the incidence rate of accidents with venomous animals in children and adolescents in Brazil, except for adolescents in the South macro-region of the country.

Trends in mortality from Alzheimer's disease in Brazil, 2000-2019.

to analyze trends in mortality rates due to Alzheimer's disease in Brazil and its macro-regions by age and sex, from 2000 to 2019. this was a time-series study on mortality from Alzheimer's disease in Brazil and its macro-regions by age and sex; data were obtained from the Mortality Information System; a Prais-Winsten model was used to analyze trends. there were 211,658 deaths in the period analyzed, with an increasing trend in Alzheimer's disease mortality in Brazil in elderly people aged 60-69 years (APC = 4.3; 95%CI 2.9;5.9), 70-79 years (APC = 8.1; 95%CI 4.8;11.5) and ≥ 80 years (APC = 11.3; 95%CI 8.1;14.6) and in all macro-regions, age groups and sexes. Brazil and all its macro-regions showed a rising trend in Alzheimer's disease mortality rates, following the global trend.

Data Science: Panel data analysis to determine the effect of intergovernmental transfers on Colombian territorial tax collection.

The fiscal federalism literature studies the decentralization and the budgetary relationship among governmental levels. The first generation seeks to explain the benefits of transfers and decentralization; on the other hand, the second generation seeks an optimal design considering the presence of incentive schemes that depends on different factors and the territorial context. These elements must be analyzed when the goal is an optimal fiscal design of the government structure. This research contributes to the debate measuring the intergovernmental transfer's effect on Colombian municipalities' tax collection, the period between 2000 and 2017 is analyzed. For this purpose, we use logarithmic panel data with the Prais-Winsten model and first-order autocorrelation correction. The results suggest that transfers have a positive impact above municipal collections, in contrast with fiscal laziness arguments. This phenomenon occurs because transfer increases lead to social pressure to maintain public goods; therefore, the local government seeks to enhance local revenue to satisfy the social demand. Also, the transfers impulse the regional economic growth generating a higher tax base.

Tendência de mortalidade por quedas em idosos, no Brasil, no período de 2000–2019

ABSTRACT Objective: To analyze the trend of mortality from falls among older adults in Brazil from 2000 to 2019. Methods: This is an epidemiological, analytical study with an ecological time-series design. A retrospective analysis was performed using secondary health data extracted from the Brazilian Mortality Information System in the specific period. Standardized rates of general and sex- and age-specific mortality were calculated. To observe the mortality trend, the Prais-Winsten model and the Annual Increase Rate (AIR) were used. Results: We identified 135,209 deaths resulting from falls in older adults in the period from 2000 to 2019. Mortality from falls in general, during the study period, had an upward trend (β=0.023; p&lt;0.001; AIR=5.45%). We observed that both men (β=0.022; p&lt;0.001; AIR=5.19%) and women (β=0.024; p&lt;0.001; AIR=5.72%) had an upward trend. Regarding age group, the results also pointed to an upward mortality trend in all age strata, although higher in older people aged ≥80 years (β=0.027; p&lt;0.001; AIR=6.38%). Conclusion: There was an upward trend in mortality rates in Brazil during the time series studied. These findings suggest the importance of defining a line of care for this age group, focusing on promoting health in older adults and preventing the risk of falls, aiming at a reduction in the number of deaths from this cause and favoring the quality of life of this population.

Mortality trend from falls in Brazilian older adults from 2000 to 2019.

To analyze the trend of mortality from falls among older adults in Brazil from 2000 to 2019. This is an epidemiological, analytical study with an ecological time-series design. A retrospective analysis was performed using secondary health data extracted from the Brazilian Mortality Information System in the specific period. Standardized rates of general and sex- and age-specific mortality were calculated. To observe the mortality trend, the Prais-Winsten model and the Annual Increase Rate (AIR) were used. We identified 135,209 deaths resulting from falls in older adults in the period from 2000 to 2019. Mortality from falls in general, during the study period, had an upward trend (β=0.023; p<0.001; AIR=5.45%). We observed that both men (β=0.022; p<0.001; AIR=5.19%) and women (β=0.024; p<0.001; AIR=5.72%) had an upward trend. Regarding age group, the results also pointed to an upward mortality trend in all age strata, although higher in older people aged ≥80 years (β=0.027; p<0.001; AIR=6.38%). There was an upward trend in mortality rates in Brazil during the time series studied. These findings suggest the importance of defining a line of care for this age group, focusing on promoting health in older adults and preventing the risk of falls, aiming at a reduction in the number of deaths from this cause and favoring the quality of life of this population.

Pollutant emissions, energy use and real output in Sub-Saharan Africa (SSA) countries

Industrialisation is pivotal to growth sustainability and this requires intense energy use that may invariably trigger pollutant emissions thereby necessitating some evidence-based policy concerns. This study therefore examines the dynamic connection among pollutant emission, energy use and real output per capita in SSA. Owing to cross-sectional dependence, the Prais-Winsten model with panel-corrected standard error (PCSE) alongside the panel spatial correlation consistent (PSCC) approach is applied and key findings are established. First, the EKC hypothesis holds and this is striking for both oil-rich and oil-poor SSA countries. Second, energy use induces pollutant emissions in oil-rich SSA countries but not in oil-poor SSA countries. Third, pollutant emissions and energy use are real output per capita-enhancing in SSA generally and in oil-poor countries. Thus, policy measures to safeguard efficient optimisation of energy use in ensuring a balance as well as developing SSA’s rich renewable energy sources is imperative for long-run growth.

Perinatal Mortality Analysis in Espírito Santo, Brazil, 2008 to 2017.

This is an ecological and time-series study using secondary data on perinatal mortality and its components from 2008 to 2017 in Espírito Santo, Brazil. The data were collected from the Mortality Information System (SIM) and Live Births Information System (SINASC) of the Unified Health System Informatics Department (DATASUS) in June 2019. The perinatal mortality rate (×1000 total births) was calculated. Time series were constructed from the perinatal mortality rate for the regions and Espírito Santo. To analyze the trend, the Prais–Winsten model was used. From 2008 to 2017 there were 8132 perinatal deaths (4939 fetal and 3193 early neonatal) out of a total of 542,802 births, a perinatal mortality rate of 15.0/1000 total births. The fetal/early neonatal ratio was 1.5:1, with a strong positive correlation early neonatal mortality rate, perinatal mortality rate, r (9) = 0.8893, with a significance level of p = 0.000574. The presence of differences in trends by health region was observed. Risk factors that stood out were as follows: mother’s age ranging between 10 and 19 or 40 and 49 years old, with no education, a gestational age between 22 and 36 weeks, triple and double pregnancy, and a birth weight below 2499 g. Among the causes of death, 49.70% of deaths were concentrated in category of the tenth edition of the International Classification of Diseases, fetuses and newborns affected by maternal factors and complications of pregnancy, labor, and delivery (P00–P04), and 11.03% were in the category of intrauterine hypoxia and birth asphyxia (P20–P21), both related to proper care during pregnancy and childbirth. We observed a slow reduction in the perinatal mortality rate in the state of Espírito Santo from 2008 to 2017.

Analysis of immunization errors in pregnant women.

To analyze immunization errors in pregnant women from Minas Gerais, according to the absence and presence of Adverse Events Following Immunization. This is a cross-sectional study, carried out with data on immunization errors in pregnant women, between 2015 and 2019, registered in the Information System for the Surveillance of Adverse Events, in Minas Gerais. The trend of the incidence rate of immunization error per 100,000 doses applied was checked using Prais-Winsten models. Of all notifications, 3.72% were vaccination errors with adverse events following immunization. The highest proportion of immunization errors with no adverse events (32.40%) was in the macro-region Centro and, with adverse events (27.78%), in Triângulo do Sul, both with a stationary trend in the period. Regarding the incidence rate, the macro-region with the highest immunization errors with no adverse events was Vale do Aço and the macro-region with the highest incidence rate of immunization errors with adverse events was Triângulo do Sul. In this study, the notifications of Adverse Events Following Immunization resulting from vaccination errors with and without adverse events occurred with no significant trend within the years of the study.

Impact of Removal of Automatic 7-Day Stop Orders for Inpatient Antimicrobials

Background: Automatic discontinuation of antimicrobial orders after a prespecified duration of therapy has been adopted as a strategy for reducing excess days of therapy (DOT) as part of antimicrobial stewardship efforts. Automatic stop orders have been shown to decrease antimicrobial DOT. However, inadvertent treatment interruptions may occur as a result, potentially contributing to adverse patient outcomes. To evaluate the effects of this practice, we examined the impact of the removal of an electronic 7-day ASO program on hospitalized patients. Methods: We performed a quasi-experimental study on inpatients in 3 acute-care academic hospitals. In the preintervention period (automatic stop orders present; January 1, 2016, to February 28, 2017), we had an electronic dashboard to identify and intervene on unintentionally missed doses. In the postintervention period (April 1, 2017, to March 31, 2018), the automatic stop orders were removed. We compared the primary outcome, DOT per 1,000 patient days (PD) per month, for patients in the automatic stop orders present and absent periods. The Wilcoxon rank-sum test was used to compare median monthly DOT/1,000 PD. Interrupted time series analysis (Prais-Winsten model) was used to compared trends in antibiotic DOT/1,000 PD and the immediate impact of the automatic stop order removal. Manual chart review on a subset of 300 patients, equally divided between the 2 periods, was performed to assess for unintentionally missed doses. Results: In the automatic stop order period, a monthly median of 644.5 antibiotic DOT/1,000 PD were administered, compared to 686.2 DOT/1,000 PD in the period without automatic stop orders (P &lt; .001) (Fig. 1). Using interrupted time series analysis, there was a nonsignificant increase by 46.7 DOT/1,000 PD (95% CI, 40.8 to 134.3) in the month immediately following removal of automatic stop orders (P = .28) (Fig. 2). Even though the slope representing monthly change in DOT/1,000 PD increased in the period without automatic stop orders compared to the period with automatic stop orders, it was not statistically significant (P = .41). Manual chart abstraction revealed that in the period with automatic stop orders, 9 of 150 patients had 17 unintentionally missed days of therapy, whereas none (of 150 patients) in the period without automatic stop orders did. Conclusions: Following removal of the automatic stop orders, there was an overall increase in antibiotic use, although the change in monthly trend of antibiotic use was not significantly different. Even with a dashboard to identify missed doses, there was still a risk of unintentionally missed doses in the period with automatic stop orders. Therefore, this risk should be weighed against the modest difference in antibiotic utilization garnered from automatic stop orders.Funding: NoneDisclosures: None

Infant Mortality in the Metropolitan Region, Chile 2005-2014.

Infant mortality depends on the economic, social, and cultural level of development of the place of residence. To describe the infant mortality rates (IMR) and the late infant mortality rates (LIMR) of the Metropolitan Region (MR) communes and to evaluate their trend between 2005 and 2014. Ecological study that describes the rates of the 52 communes of the MR. For the analysis, the IMR and LIMR were elaborated for each year and com mune and were compared using population attributable risk (PAR), attributable risk percent (AR%), and rate ratio (RR). Trends were analyzed through the Prais-Winsten model. A value p < 0.05 was considered a statistically significant trend. The commune 'Independencia' presented the hig hest IMR and LIMR with 12.7 and 4.05 per 1000 live births respectively, 1.75 and 2.05 times more compared with the IMR and LIMR of the MR. The commune 'Las Condes' and 'Vitacura' presented the lowest IMR and LIMR respectively. The IMR trend regarding 2005 increased in Lo Barnechea, Lo Espejo, and Recoleta, and decreased in Las Condes, Macul, Pudahuel and San Bernardo. The LIMR decreased in Peñalolén, Puente Alto, Las Condes, Providencia, San Bernardo, Macul, Pudahuel, Tala- gante, Pedro Aguirre Cerda, and Quilicura, and increased in Peñaflor. The regional IMR and LIMR hide the slight increase in rates and the persistence of heterogeneity among communes. This forces us to explore the causes of these inequities through future analytical studies.

Do higher fuel prices help reduce road traffic accidents?

Road traffic accidents have decreased in most developed nations over the last decade. This has been attributed to improvements in vehicle and road design, medical technology and care, and driver education and training. Recent evidence however indicates that fuel price changes also have a significant impact on road traffic accidents through other mediating factors such as reductions in driver exposure through less car travel and more fuel-efficient driving e.g. speed reduction on high-speed roads. So far though, no study has examined the effects of changing fuel prices on road traffic accidents in a country such as Great Britain where fuel prices are kept artificially high for public policy reasons. Consequently, this study was designed to quantify the effects of fuel price on road traffic accident frequency through changes and adjustments in travel behaviour. For this purpose, weekly fuel prices (between 2005–2015) have been used to study the effects on road traffic accidents using the Prais-Winsten model of first order autoregressive (AR1) and the Box and Jenkins seasonal autoregressive integrated moving average models (SARIMA). The study found that with every 1% increase in fuel price there is a 0.4% reduction in the number of fatal road traffic accidents. In light of this, one concern raised was that recent UK government plans to phase out petrol and diesel vehicles by 2040 may also risk a rise in fatal road traffic accidents, and hence this will need to be addressed.

Impact of the ERA and GES health programs on mortality from community-acquired pneumonia in persons aged ≥65 years in ChileImpacto do programa de saúde ERA e do GES na mortalidade por pneumonia adquirida na comunidade em indivíduos com idade acima de 65 anos no Chile

RESUMENObjetivo.Evaluar el impacto del Programa de Enfermedades Respiratorias del Adulto (ERA) y el Régimen General de Garantías Explícitas en Salud (GES) en la mortalidad por neumonía adquirida en la comunidad (NAC) en personas de 65 años o más en Chile.Métodos.En este estudio ecológico se calcularon las tasas anuales y trimestrales de mortalidad por NAC en personas de 65 a 79 años y de 80 años o más entre 1990 y 2014. Las fuentes de información fueron las bases de datos del Departamento de Estadística e Información de Salud y del Instituto Nacional de Estadística de Chile. Como intervenciones se evaluó el Programa ERA (puesto en marcha en el 2001) y la inclusión de la NAC en el GES (a partir del 2005). Los datos se analizaron mediante el método de series de tiempo interrumpidas, según el modelo de Prais-Winsten. Se consideró un nivel de significación del 5%.Resultados.El análisis mostró que después del inicio del programa ERA se observaron disminuciones significativas de la tasa de mortalidad por NAC en los dos grupos de edad estudiados, mientras que a partir de la incorporación de la NAC al programa GES no se encontraron cambios estadísticamente significativos en esas tasas.Conclusiones.La implementación del programa ERA contribuyó a reducir las tasas de mortalidad por NAC en personas de 65 años o más en Chile, no así la incorporación de la NAC al GES.

Trend and spatial distribution of infectious diseases in pregnant women in the state of Paraná-Brazil.

Objective to analyze the trend and spatial distribution of some diseases that require compulsory notification in pregnant women.Method ecological study, with data from the National Notifiable Diseases Surveillance System, of the incidence of the six most frequent diseases that, require compulsory notification, in pregnant women. The Prais-Winsten model was used to analyze the trend classified as stable, decreasing and increasing, according to macro-regions. For the spatial analysis, the incidences distributed in percentiles, in choropleth maps, by Health Regions were calculated.Results the most frequent infections were syphilis, dengue, Human Immunodeficiency Virus, influenza, hepatitis and toxoplasmosis. Incidence increased by 30.8%, 30.4%, 15.4% and 2.6%, on average, for syphilis, toxoplasmosis, dengue and Human Immunodeficiency Virus, respectively. On average, the incidence of syphilis increased by 40.5% in Macro-regional North and 38% in Macro-regional Northwest. The spatial analysis showed, in the last four years, high incidence of dengue, syphilis and infection by Human Immunodeficiency Virus, which reached 180.2, 141.7 and 100.8 cases per 10,000 live births, respectively.Conclusion there were increased incidences of infection in pregnant women due to syphilis, toxoplasmosis and Human Immunodeficiency Virus, with differences in their spatial distribution, indicating that these diseases should be a priority in the care of pregnant women in more affected regions.

Geopolitics of International Relations, Ethnic Polarization and Internal Conflict

Geostrategic position of a country not just creates opportunities in form of bilateral and multilateral collaborations, it may also pose stern long term concerns and spillover effects in terms of insecurity and conflict. Pakistan, if not a classic example, is a typical case of continually high geopolitics of international relations: its geostrategic location had been praised by international players during the cold war regime through financial assistance; it was encouraged to take part during the Russian invasion in Afghanistan in late 70’s; and was compelled to play the role of ‘front line state’ in the war against terrorism, in the aftermath of the 9/ 11 incidence, in 2001. Early attempts of establishing rebel groups based upon ethnic identity to fight in Afghanistan, while launching of ruthless military operations after 9/11 incidence, against same rebel groups who fought in Afghanistan during the Russian invasion, causing either undue leverage to specific ethnic minorities at one point in time or extreme repression at later stage of history. In order to pretest impact of geopolitics of International Relations upon conflict, and if the interplay of geopolitics with ‘ethnic polarization’ affected ‘internal conflict’, several econometric models have been estimated. Along with testing the impact of geopolitical importance and its interplay with ethnic polarization in distressing peace, other important propositions in estimated models include, how ‘external conflict’, ‘institutional efficacies’, and the ‘role of military in politics’, caused adversity of ‘Internal conflict’, in Pakistan. In order to ensure concurrent validity of econometric models, alternative regressands namely ratings of ‘Civil War’ and ‘Internal Conflict’ have been used. Keeping in view ordinal scaling of regressands, cautions in dealing with heteroscedasticity and potentially lagged impact of regressors, Ordered-probit, Ordered Logit, Quantile regression, Robust Regression, and Prais-Winsten models are estimated. Estimated models strongly approved the notion that ‘geopolitics of international relations’ and ‘geopolitics of International Relations’ in interaction with ‘Ethnic polarization’, have had a considerable and statistically significant temporal impact upon ‘internal conflict’ and rating of ‘civil war’, in context of Pakistan. Other significant factors that contributed to adversity of peace are ‘external conflict’, ‘role of military in politics’, ‘illegitimacy of the state actions’/ ‘institutional inefficacies’ and ‘religious polarization’. Keywords: geopolitics of international relations, war against terrorism, internal conflict, ethnic polarization, ordered-probit model, robust regression, Prais-Winsten regression.