quasi-Poisson Model Research Articles

Effect of age, period, and birth cohort on diabetes mellitus mortality rate in Colombia, 1983-2022. An analytical cross-sectional study

Objective: To estimate the contributions of the effects of age, period, and birth cohort on the trend in the mortality rate due to Diabetes Mellitus (DM) in Colombia during the years 1983-2022. Methods: Analytical observational study, with pooled cross-sectional data, using mortality records and population projections from the National Department of Statistics. The count of deaths due to DM for each age group, period and cohort was organized in quinquennia. A multiple quasi-Poisson model was applied using the intrinsic estimator method with collapsing intention. The mortality rate ratio (MRR) of each age group, period, and cohort compared to the overall average rate was reported, along with the 95% confidence interval (CI). Results: A total of 234,117 DM-related deaths were recorded. In general, mortality due to DM increased with age. The lowest mortality was observed in the 5-9 years age group (MRR 0.04; 95% CI 0.03 to 0.06), while the highest occurred in the 85 years and older age group (MRR 18.49; 95% CI 16.88 to 20.25). Regarding the cohort effect, a lower MRR was found as cohorts got younger, with an MRR of 1.58 (95% CI 1.42 to 1.77) for the 1898-1902 cohort and 0.11 (95% CI 0.05 to 0.25) for the 2018-2022 cohort. At the period level, MRR increased between 1983-2002, stabilized between 2003-2007, and decreased between 2008-2017. However, between 2018 and 2022, a further increase was recorded. Conclusion: Public health actions should ensure healthy aging, continuous control of diabetes complications, and health care awareness in new generations.

Pandemic Effect on Healthcare Use and Death in Adults with Epilepsy: A Population Study.

We conducted a population-based study using Ontario health administrative data to describe trends in healthcare utilization and mortality in adults with epilepsy during the first pandemic year (March 2020-March 2021) compared to historical data (2016-2019). We also investigated if changes in outpatient visits and diagnostic testing during the first pandemic year were associated with increased risk for hospitalizations, emergency department (ED) visits, or death. Projected monthly visit rates (per 100,000 people) for outpatient visits, electroencephalography, magnetic resonance, computed tomography, all-cause ED visits, hospitalizations, and mortality were calculated based on historical data by fitting monthly time series autoregressive integrated moving-average models. Two-way interactions were calculated using Quasi-Poisson models. In adults with epilepsy during the first quarter of the pandemic, we demonstrated a reduction in all-cause outpatient visits, diagnostic testing, ED visits and hospitalizations, and a temporary increase in mortality (observed rates of 355.8 vs projected 308.8, 95% CI: 276.3-345.1). By the end of the year, outpatient visits increased (85,535.4 vs 76,620.6, 95% CI: 71,546.9-82,059.4), and most of the diagnostic test rates returned to the projected. The increase in the rate of all-cause mortality during the pandemic, compared to pre-pandemic, was greater during months with the lower frequency of diagnostic tests than months with higher frequency (interaction p-values <.0001). We described the impact of the pandemic on healthcare utilization and mortality in adults with epilepsy during the first year. We demonstrated that access to relevant diagnostic testing is likely important for this population while planning restrictions on non-urgent health services.

Effective Factors in the Number of Children Among Iranian Women: An Application of Poisson Regression Model

Background: The number of children born into a family has a significant impact on a mother’s reproductive system’s physiological health and overall well-being. Objectives: This study aimed to explore the effective factors in the number of living children (NLC) among married women in Semnan, Iran, with a particular focus on social, cultural, and economic influences. Methods: This cross-sectional study examined the reproductive histories of 600 married women aged 15 to 49 years from Semnan, Iran. Sample size calculations were based on the principal variable, the expected number of children, using PASS software. The women were selected through a multistage random sampling method from health center lists in 2018 (April-October). The data were collected through interview questionnaires and analyzed using the Quasi-Poisson model. Results: The mean (standard deviation [SD]) age at first marriage for mothers (MAM) and fathers was estimated to be 21.02 (4.80) and 25.10 (4.70) years, respectively. Additionally, the mean (SD) values for the number of expected children (NCEX), living children, and the number of pregnancies were 2.19 (0.96), 1.85 (0.81), and 2.15 (1.03), respectively. Among the variables of interest, only NCEX, the number of pregnancies (with a positive effect), MAM, father’s education, multiple births, and the desire to have children (with a negative effect) significantly influenced NLC. Conclusions: This study recommends implementing an educational program to promote an optimal and ideal family size to prevent adverse pregnancy outcomes. The age of women at marriage is a significant factor, as an increase in women’s age leads to shorter pregnancy intervals, exposing women to complications, such as premature birth, perinatal death, and intrauterine growth restriction. Policymakers should, therefore, encourage early marriages by fostering a culture and providing supportive facilities.

Dividing out quantification uncertainty allows efficient assessment of differential transcript expression with edgeR.

Differential expression analysis of RNA-seq is one of the most commonly performed bioinformatics analyses. Transcript-level quantifications are inherently more uncertain than gene-level read counts because of ambiguous assignment of sequence reads to transcripts. While sequence reads can usually be assigned unambiguously to a gene, reads are very often compatible with multiple transcripts for that gene, particularly for genes with many isoforms. Software tools designed for gene-level differential expression do not perform optimally on transcript counts because the read-to-transcript ambiguity (RTA) disrupts the mean-variance relationship normally observed for gene level RNA-seq data and interferes with the efficiency of the empirical Bayes dispersion estimation procedures. The pseudoaligners kallisto and Salmon provide bootstrap samples from which quantification uncertainty can be assessed. We show that the overdispersion arising from RTA can be elegantly estimated by fitting a quasi-Poisson model to the bootstrap counts for each transcript. The technical overdispersion arising from RTA can then be divided out of the transcript counts, leading to scaled counts that can be input for analysis by established gene-level software tools with full statistical efficiency. Comprehensive simulations and test data show that an edgeR analysis of the scaled counts is more powerful and efficient than previous differential transcript expression pipelines while providing correct control of the false discovery rate. Simulations explore a wide range of scenarios including the effects of paired vs single-end reads, different read lengths and different numbers of replicates.

Association between air quality index and effects on emergency department visits for acute respiratory and cardiovascular diseases.

Several studies suggest that air pollution, particularly PM2.5, increases morbidity and mortality, Emergency Department (ED) visits, and hospitalizations for acute respiratory and cardiovascular diseases. However, no prior study in Southeastern Asia (SEA) has examined the effects of air pollutants on ED visits and health outcomes. This study focused on the association of the Air Quality Index (AQI) of PM2.5 and other pollutants' effects on ED visits, hospitalization, and unexpected deaths due to acute respiratory disease, acute coronary syndrome (ACS), acute heart failure (AHF), and stroke. We conducted a retrospective study with daily data from ED visits between 2018 and 2019 at Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand. The AQI of air pollution data was collected from outdoor air quality from the Smoke Haze Integrated Research Unit and the Air Quality Index Visual Map. A distributed lag, non-linear and quasi-Poisson models were used to explore the relationship between air quality parameters and ED visits for each disease. 3,540 ED visits were recorded during the study period. The mean daily AQI of PM2.5 was 89.0 ± 40.2. We observed associations between AQI of PM2.5 and the ED visits due to ACS on the following day (RR = 1.023, 95% confidence interval [CI]: 1.002-1.044) and two days after exposure (RR = 1.026, 95% CI: 1.005-1.047). Also, subgroup analysis revealed the association between AQI of PM2.5 and the ED visits due to pneumonia on the current day (RR = 1.071, 95% CI: 1.025-1.118) and on the following day after exposure (RR = 1.024, 95% CI: 1.003-1.046). AQI of PM2.5 associated with increased mortality resulted from ACS on lag day 3 (OR = 1.36, 95% CI: 1.08-1.73). The AQI of PM10 is also associated with increased ED visits due to COPD/asthma and increased hospitalization in AHF. In addition, the AQI of O3 and AQI of NO2 is associated with increased ICU admissions and mortality in AHF. Short-term PM2.5 exposure escalates ED visits for ACS and pneumonia. PM10's AQI associates with COPD/asthma ED visits and AHF hospitalizations. AQI of O3 and NO2's link to increased ICU admissions and AHF mortality. Urgent action against air pollution is vital to safeguard public health.

Association between thermal stress and cardiovascular mortality in the subtropics.

Hazardous thermal conditions resulting from climate change may play a role in cardiovascular disease development. We chose the Universal Thermal Climate Index (UTCI) as the exposure metric to evaluate the relationship between thermal conditions and cardiovascular mortality in Shenzhen, China. We applied quasi-Poisson regression non-linear distributed lag models to evaluate the exposure-response associations. The findings suggest that cardiovascular mortality risks were significantly increased under heat and cold stress, and the adverse effects of cold stress were stronger than heat stress. Referencing the 50th percentile of UTCI (25.4°C), the cumulative risk of cardiovascular mortality was 75% (RRlag0-21 =1.75, 95%CI: 1.32, 2.32) higher in the 1st percentile (3.5°C), and 40% (RRlag0-21=1.40, 95%CI: 1.09, 1.80) higher in the 99th percentile (34.1°C). We observed that individuals older than 65 yearswere more vulnerable to both cold and heat stress, and females were identified as more susceptible to heat stress than males. Moreover, increased mortality risks of hypertensive disease and cerebrovascular disease were observed under cold stress, while heat stress was related to higher risks of mortality for hypertensive disease and ischemic heart disease. We also observed a stronger relationship between cold stress and ischemic heart disease mortality during the cold season, as well as a significant impact of heat stress on cerebrovascular disease mortality in the warm season when compared to the analysis of the entire year. These results confirm the significant relationship between thermal stress and cardiovascular mortality, with age and sex as potential effect modifiers of this association. Providing affordable air conditioning equipment, increasing the amount of vegetation, and establishing comprehensive early warning systems that take human thermoregulation into account could all help to safeguard the well-being of the public, particularly vulnerable populations, in the event of future extreme weather.

Temperature-related emergency injury visits in Hanoi, Vietnam

BackgroundThe short-term association between increasing temperatures and injury has been described in high-income countries, but less is known for low-income and-middle-income countries, including Vietnam.MethodsWe used emergency injury visits (EIV) data...

Impact of the COVID-19 Pandemic on the Management of Juvenile Idiopathic Arthritis: Analysis of United States Commercial Insurance Data.

Given limited information on health care and treatment utilization for juvenile idiopathic arthritis (JIA) during the pandemic, we studied JIA-related health care and treatment utilization in a commercially insured retrospective US cohort. We studied rates of outpatient visits, new disease-modifying antirheumatic drug (DMARD) initiations, intra-articular glucocorticoid injections (iaGC), dispensed oral glucocorticoids and opioids, DMARD adherence, and DMARD discontinuation by quarter in March 2018-February 2021 (Q1 started in March). Incident rate ratios (IRR, pandemic vs prepandemic) with 95% confidence intervals (CIs) were estimated using multivariable Poisson or Quasi-Poisson models stratified by diagnosis recency (incident JIA, <12 months ago; prevalent JIA, ≥12 months ago). Among 1294 children diagnosed with JIA, total and in-person outpatient visits for JIA declined during the pandemic (IRR, 0.88-0.90), most markedly in Q1 2020. Telemedicine visits, while higher during the pandemic, declined from 21% (Q1) to 13% (Q4) in 2020 to 2021. During the pandemic, children with prevalent JIA, but not incident JIA, had lower usage of iaGC (IRR, 0.60; 95% CI, 0.34-1.07), oral glucocorticoids (IRR, 0.47; 95% CI, 0.33-0.67), and opioids (IRR, 0.44; 95% CI, 0.26-0.75). Adherence to and discontinuation of DMARDs was similar before and during the pandemic. In the first year of the pandemic, visits for JIA dropped by 10% to 12% in commercially insured children in the United States, declines partly mitigated by use of telemedicine. Pandemic-related declines in intra-articular glucocorticoids, oral glucocorticoids, and opioids were observed for children with prevalent, but not incident, JIA. These changes may have important implications for disease control and quality of life.

Mortality risks associated with floods in 761 communities worldwide: time series study

ObjectiveTo evaluate lag-response associations and effect modifications of exposure to floods with risks of all cause, cardiovascular, and respiratory mortality on a global scale.DesignTime series study.Setting761 communities in 35 countries...

Cannabis-Involved Traffic Injury Emergency Department Visits After Cannabis Legalization and Commercialization

The impact of nonmedical cannabis legalization on traffic injuries and cannabis involvement in traffic injuries is unclear. To examine changes in the number and characteristics of cannabis-involved traffic injury emergency department (ED) visits from before to after legalization and subsequent commercialization (ie, increased retail store and product availability) of cannabis in Ontario, Canada. This repeated cross-sectional study examined changes in cannabis- and alcohol-involved traffic injury ED visits in Ontario, Canada, during 3 time periods: prelegalization (January 2010-September 2018), legalization with product and retail store restrictions (October 2018-February 2020), and commercialization with new products and expanded number of stores, which coincided with the COVID-19 pandemic (March 2020-December 2021). All individuals aged 16 years and older eligible for Ontario's Universal Health Coverage were included. Season- and time-adjusted quasi-Poisson models were used to generate rate ratios with 95% CIs. Data were analyzed from March to April 2023. Quarterly counts of cannabis-involved ED visits for traffic injury. There were 947 604 traffic injury ED visits, of which 426 (0.04%) had documented cannabis involvement and 7564 (0.8%) had documented alcohol involvement. Of the 418 individuals with documented cannabis involvement, 330 (78.9%) were male, 109 (25.6%) were aged 16 to 21 years (mean [SD] age at visit, 30.6 [12.0] years), and 113 (27.0%) had an ED visit or hospitalization for substance use in the 2 years before their traffic injury ED visit. Annual rates of cannabis-involved traffic injury ED visits increased 475.3% over the study period (0.18 visits per 1000 total motor vehicle collisions in 2010 to 1.01 in 2021). Over the same period, alcohol-involved traffic injury ED visits increased by 9.4% (8.03 in 2010 to 8.79 per 1000 traffic injury ED visits in 2021). Legalization with restrictions was associated with a 94% increase in the quarterly rate of cannabis involvement in traffic injury ED visits relative to prelegalization (adjusted rate ratio [aRR], 1.94; 95% CI, 1.37-2.75). Commercialization/COVID-19 was associated with a greater increase of 223% in rates (aRR, 3.23; 95% CI, 2.42-4.33). After adjusting for time trends before legalization, only commercialization/COVID-19 was associated with increased rates. Male sex (adjusted odds ratio [aOR], 3.38; 95% CI, 2.66-4.29), living in the lowest-income neighborhood (aOR, 1.92; 95% CI, 1.39-2.67), being aged 19 to 21 years (aOR, 4.67; 95% CI, 3.27-6.67), and having a prior cannabis-related ED visit (aOR, 8.03; 95% CI, 5.85-11.02) were all positively associated with cannabis involvement during a traffic injury ED visit. This cross-sectional study found large increases in cannabis involvement in ED visits for traffic injury over time, which may have accelerated following nonmedical cannabis commercialization. Although the frequency of visits was rare, they may reflect broader changes in cannabis-impaired driving. Greater prevention efforts, including targeted education and policy measures, in regions with legal cannabis are indicated.

Excess mortality during the Coronavirus disease pandemic in Korea

BackgroundAlthough the ongoing epidemics of Coronavirus disease 2019 (COVID-19) may have affected the mortality trend of the nation, the national level assessment of excess mortality (changes in overall mortality in the entire population) is still scarce in Korea. Therefore, this study evaluated the excess mortality during the COVID-19 pandemic in Korea using the certified mortality data.MethodsMonthly mortality and population data from January 2013 to June 2022 was obtained from the National Health Insurance Service database and Statistics Korea. A quasi-Poisson interrupted time-series model adjusted for age structure, population, seasonality, and long-term trends was used to estimate the counterfactual projections (expected) of mortality during the COVID-19 pandemic (March 2020 to June 2022). The absolute difference (observed—expected) and ratio (observed / expected) of mortality were calculated. Stratified analysis based on pandemic years (years 2020, 2021, and 2022), sex, and age groups (aged 0–4, 5–19, 20–64, and ≥ 65 years) were conducted.ResultsAn 8.7% increase in mortality was observed during the COVID-19 pandemic [absolute difference: 61,277 persons; ratio (95% confidence interval (CI)): 1.087 (1.066, 1.107)]. The gap between observed and estimated mortality became wider with continuation of the pandemic [ratio (95% CI), year 2020: 1.021 (1.003, 1.040); year 2021: 1.060 (1.039, 1.080), year 2022: 1.244 (1.219, 1.270)]. Although excess mortality across sex was similar, the adult [aged 20–64, ratio (95% CI): 1.059 (1.043, 1.076)] and elderly [aged 65-, ratio (95% CI): 1.098 (1.062, 1.135)] population showed increased excess mortality during the pandemic.ConclusionsDespite Korea's successful quarantine policy response, the continued epidemic has led to an excess mortality. The estimated mortality exceeded the number of deaths from COVID-19 infection. Excess mortality should be monitored to estimate the overall impact of the pandemic on a nation.

Policy Effects on Mixed-Citizenship, Same-Sex Unions: A Triple-Difference Analysis

Abstract After the U.S. Supreme Court struck down the Defense of Marriage Act (DOMA) in 2013, same-sex partners of U.S. citizens became eligible for spousal visas. Since then, the United States has seen a rapid rise in same-sex, mixed-citizenship couples. However, this effect varies greatly depending on the lesbian, gay, and bisexual (LGB) policy context of the noncitizen’s country of origin. Using waves 2008–2019 of the American Community Survey, this study employs a triple-difference design to examine how the policy environment of the origin country moderates the effect of the end of DOMA on incidence of mixed-citizenship, same-sex couples in the United States. Quasi-Poisson models with two-way fixed effects show that, after 2013, individuals in mixed-citizenship, same-sex couples coming from countries with progressive LGB policies saw a more than 60% increase in incidence relative to those in different-sex or same-citizenship couples. Meanwhile, those from countries with regressive laws experienced no significant increase. These results are corroborated by analyses of individual policies. We argue that the country-of-origin policy context affects and is affected by local norms and attitudes as well as individuals’ material circumstances. This nexus of factors leaves a lasting impact on immigrants that shapes migration decisions, union formation, and responses to policy shifts.

Interactions of particulate matter with temperature, heat index and relative humidity on pediatric hand, foot, and mouth disease in a subtropical city

The associations of hand, foot, and mouth disease (HFMD) with meteorological variables and particulate matter (PM) remain controversial, and limited evidence is available on heat index (HI) and coarse particulate (PM10-2.5). Moreover, temperature and humidity are considered major risk factors but their interaction with PM remains unclear. We combined the distributed lag non-linear and quasi-Poisson models to estimate the non-linear and lagged associations of meteorological variables and PM with HFMD based on reported HFMD during 2015–2019 in Fuzhou, China. The multiplicative term of interaction was used to explore the relationship between HFMD and meteorological variables or PM at different levels of another variable. Stratified analyses were used to identify vulnerable subpopulations. We observed inverted-V-shaped relationships between HFMD and temperature and HI, and the W- and N-shaped for relative humidity (RH) and PM, respectively. Extreme high (i.e., the 95th percentile) temperature, HI and RH increased the HFMD with relative risks (RR) of 4.00 (95% confidence interval, 2.79–5.75), 2.20 (1.71–2.83) and 1.54 (1.35–1.75) referent to the minimum effect value of 10.3 °C, 69.4 and 54.8%, respectively. Higher concentrations of PM rapidly increased the HFMD. Infants under 2 years suffered more from temperature, HI and PM. There were synergistic effects between meteorological variables and PM on HFMD. For instance, the RRs of temperature (30 °C) and RH (40%) on HFMD increased from 3.68 (2.24–6.06) to 6.44 (4.29–9.66) and from 0.45 (0.14–1.47) to 2.15 (0.90–5.12) at low (<25%) and high (>75%) categories of PM2.5, respectively. While the RRs of 70 μg/m3 of PM10 and PM10-2.5 increased from 0.65 (0.32–1.31) to 2.93 (1.63–5.26) and from 0.86 (0.23–3.21) to 3.26 (1.23–8.62) at low and high categories of HI. These findings are essential for the development a prediction and warning systems and prevention and control strategies for HFMD.

Gender and maladaptive personality correlates in problem gambling and over-indebtedness: Novel findings from a cross-sectional study in Sweden

Although most individuals consider gambling to be an innocent and fun activity, when it develops into problem gambling, it can have detrimental outcomes to one's life, such as over-indebtedness. This cross-sectional study explores the role of maladaptive personality traits and gender in both problem gambling and over-indebtedness, in an online sample of 1479 adult gamblers (65% males) in Sweden. Participants were administered the Problem Gambling Severity Index (PGSI), the Personality Inventory for DSM-5-Brief Form (PID-5-BF), and questions addressing subjective over-indebtedness and other risk factors. Quasi-Poisson loglinear models and logistic regression analyses demonstrated that Disinhibition (OR = 1.38, 95% CI [1.24, 1.53]), and Antagonism (OR = 1.23, 95% CI [1.14, 1.34]) showed the strongest associations to problem gambling, and that only Disinhibition (OR = 1.72, 95% CI [1.22, 1.43]) and Antagonism (OR = 2.00, 95% CI [1.52, 2.66]) were significantly related to over-indebtedness. The prevalence of problem gambling and over-indebtedness was more common among women, and gender moderated the univariate relationships of Negative Affectivity, Disinhibition and Psychoticism to problem gambling. These findings call for future research addressing maladaptive personality traits, problem gambling and over-indebtedness, and highlight the need for tailored interventions and prevention strategies, particularly for women who may be at higher risk.

Association of birth and childhood weight with risk of chronic diseases and multimorbidity in adulthood

BackgroundLittle is known about the relationship between early life body size and occurrence of life-course multiple chronic diseases (multimorbidity). We aim to evaluate associations of birth weight, childhood body size, and their changes with the risks of chronic diseases and multimorbidity.MethodsThis prospective cohort study included 246,495 UK Biobank participants (aged 40–69 years) who reported birth weight and childhood body size at 10 years old. Birth weight was categorized into low, normal, and high; childhood body size was reported as being thinner, average, or plumper. Multimorbidity was defined as having two or more of 38 chronic conditions retrieved from inpatient hospital data until 31 December, 2020. The Cox regression and quasi-Poisson mixed effects models were used to estimate the associations.ResultsWe show that 57,071 (23.2%) participants develop multimorbidity. Low birth weight (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.26–1.33), high birth weight (HR 1.02, 95% CI > 1.00–1.05), thinner (HR 1.21, 95% CI 1.18–1.23) and plumper body size (HR 1.06, 95% CI 1.04–1.09) are associated with higher risks of multimorbidity. A U-shaped relationship between birth weight and multimorbidity is observed. Changing to be thinner or plumper is associated with multimorbidity and many conditions, compared to changing to be average.ConclusionsLow birth weight, being thinner and changing to have a thinner body size in childhood are associated with higher risks of developing multimorbidity and many chronic conditions in adulthood. Early monitoring and maintaining a normal body size in childhood could have life-course benefits for preventing multimorbidity above and beyond individual conditions.

Incidence of nontuberculous mycobacteria infections among persons with cystic fibrosis in the United States (2010–2019)

BackgroundNontuberculous mycobacteria (NTM) are ubiquitous, environmental bacteria that can cause chronic lung disease. Persons with cystic fibrosis (pwCF) are at high risk for NTM. Approximately 1 in 5 pwCF in the United States (U.S.) is affected by pathogenic NTM species, and incidence rates of NTM have been increasing among pwCF as well as in the general population. Prevalence of NTM pulmonary infections (PI) varies widely across the United States because of geographic variation in environmental exposures. This study will present updated region-level incidence of NTM infections in the cystic fibrosis (CF) population in the U.S.MethodsWe used the Cystic Fibrosis Foundation Patient Registry (CFFPR) data for the period 2010 through 2019. Our study population comprised persons with CF ≥ 12 years of age who had been tested for NTM PI. We included only registry participants with NTM culture results. We defined incident cases as persons with one positive mycobacterial culture preceded by ≥ two negative mycobacterial cultures. We defined non-cases as persons with ≥ two negative mycobacterial cultures. We estimated average annual NTM PI incidence by region. Using quasi-Poisson models, we calculated annual percent change in incidence by region.ResultsWe identified 3,771 incident NTM infections. Of these cases, 1,816 (48.2%) were Mycobacterium avium complex (MAC) infections and 960 (25.5%) were Mycobacterium abscessus infections. The average annual incidence of NTM PI among pwCF in the U.S. was 58.0 cases per 1,000 persons. The Northeast had the highest incidence of MAC (33.5/1,000 persons tested) and the South had the highest incidence of M. abscessus (20.3/1,000 persons tested). From 2010 to 2019, the annual incidence of total NTM PI increased significantly by 3.5% per year in the U.S.ConclusionsNTM PI incidence is increasing among pwCF. Identifying high risk areas and increasing trends is important for allocating public health and clinical resources as well as evaluating interventions.

Effects of low-level air pollution exposures on hospital admission for myocardial infarction using multiple causal models

Myocardial infarctions have been associated with PM2.5, and more recently with NO2 and O3, however counterfactual designs have been lacking and argument continues over the extent of confounding control. Here we introduce a doubly robust, counterfactual-based approach that deals with nonlinearity and interactions in associations between confounders and both outcome and exposure, as well as a double negative controls approach that capture omitted confounders.We used data from over 4 million admissions for myocardial infarction in the US Medicare population between 2000 and 2016 and linked them by ZIP code of residence to high resolution predictions of annual PM2.5, NO2, and O3. We computed the counts of admissions for each ZIP code-year. In the doubly robust approach, we divided each pollutant into deciles, and for each decile, we fitted a gradient boosting machine model to estimate the effects of covariates, including the co-pollutants, on the counts. We used these models to predict, for all ZIP code-years, the expected counts had everyone be exposed in that decile. We also estimated the probability of being in that decile given all covariates, again with a gradient boosting machine, and used inverse probability weights to compute the weighted average rate of MI admission in each decile. In the negative control approach, for each pollutant, we fitted a quasi-Poisson model to estimate the exposure effect, adjusting for covariates including the co-pollutants, and negative exposure and outcome controls to control for unmeasured confounding.Each 1-μg/m3 increase in annual PM2.5 increased the admission for MI by 1.37 cases per 10,000 person-years (95% CI: 1.20, 1.54) in the doubly robust approach, and by 0.69 cases (95% CI 0.60, 0.78) using the negative control approach. Elevated risks were seen even below annual PM2.5 level of 8 μg/m3. Results for NO2 and O3 were inconsistent.

Effect of different heat wave timing on cardiovascular and respiratory mortality in France

BackgroundPrevious epidemiological evidence suggests that the impact of heat waves on mortality may change over time within the summer season. The consideration of heat wave timing could help to optimize the implementation of heat alert systems. We explored the effect of the timing of extreme heat events on mortality risk during the summer season in France. MethodsSummertime daily mortality data for 21 French cities from 2000 to 2015 were obtained from the French National Institute of Health and Medical Research. Heat waves were defined according to the official definition of Météo France. The order of heat wave over time, from June to August, was assessed. We also used ambient temperature and considered different summer periods. To quantify mortality risk (for cardiovascular and respiratory causes) for the first and second or later heat waves, quasi-Poisson models were performed. We used distributed lag non-linear models to estimate whether the non-linear exposure–response associations between temperature and mortality differ across different summer periods. ResultsCompared with non-heat wave days, the second and later heat waves of the summer season were associated with a higher relative risk (RR) for cardiovascular and respiratory mortality (RR, 95%CI: 1.38, 1.23–1.53; RR, 95%CI: 1.74, 1.45–2.08, respectively) as compared to first heat wave (RR, 95%CI: 1.30, 1.17–1.45, RR, 95%CI: 1.56, 1.33–1.83, respectively). Small increase from the median temperature was associated to an increased risk in mortality in the first stage of the summer (from June to mid-July), while only more extreme temperatures were harmful later in the summer. After the exclusion from the analysis of the August 2003 heat-wave, only results for earlier heat waves episodes and first-period exposures were confirmed. ConclusionsThe timing of extreme temperatures modulates heat-related risks in France. Such information could be used to update local heat action plans to optimize health benefits.

A National, County-Level Evaluation of the Association Between COVID-19 and Sexually Transmitted Infections within the United States in 2020.

Shifts in public health infrastructure to respond to one emerging health threat may have unanticipated consequences for pre-existing diseases. Also, previous research evaluating the impact of COVID-19 on sexually transmitted infections (STIs) has been conducted nationally, with little exploration of the impact on a granular geospatial level. This ecological study seeks to quantify the association between COVID-19 cases or deaths and chlamydia, gonorrhea, and syphilis cases for all United States (US) counties in 2020. Separate, adjusted multivariable quasi-Poisson models with robust standard errors modeled the county-level association between 2020 COVID-19 cases and deaths per 100,000 and 2020 chlamydia, gonorrhea, or syphilis cases per 100,000. Models were adjusted for sociodemographic characteristics. Every 1,000 additional COVID-19 cases per 100,000 was associated with a 1.80% increase in the average number of chlamydia cases (P < .001) and 5.00% increase in the average number of gonorrhea cases (P < .001). Every 1,000 additional COVID-19 deaths per 100,000 was associated with a 57.9% increase in the average number gonorrhea cases (P < .001) and 74.2% decrease in the average number of syphilis cases (P = .004). Higher rates of COVID-19 cases and deaths were associated with increased rates of some STIs at the US county-level. The underlying reasons for these associations could not be established by this study. The emergency response to an emerging threat may have unanticipated influence on pre-existing diseases that varies by level of governance.

Intake of sugary beverages with chronic conditions and multimorbidity: a prospective cohort study of UK Biobank.

The burden of chronic conditions associated with sugary beverages is increasing but little is known about the role of different types of sugary beverages in the co-occurrence of multiple chronic conditions ('multimorbidity'). To inform future sugar-reduction guidelines, we aimed to examine the associations of sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB) and natural juices (NJ) with multimorbidity. This prospective cohort study included 184 093 UK Biobank participants aged 40-69years at baseline who completed at least one occasion of 24-h dietary recall between 2009 and 2012. Daily consumptions of SSB, ASB and NJ were assessed using 24-h dietary recall. Participants were followed from the first 24-h assessment until the onset of two or more new chronic conditions, or the end of follow-up (31 March 2017), whichever occurred first. Logistic regression models, Cox proportional hazard models and quasi-Poisson mixed effects models were used to estimate the association of beverages intakes with chronic conditions and multimorbidity. A total of 19 057 participants had multimorbidity at baseline and 19 968 participants developed at least two chronic conditions during follow-up. We observed dose-response relationships of SSB and ASB consumptions with the prevalence and incidence of multimorbidity. For example, the adjusted hazard ratios (HRs) and 95% CIs of the incidence of developing at least two chronic conditions ranged from 1.08 (1.01-1.14) for SSB intake of 1.1-2 units/day to 1.23 (1.14-1.32) for >2 units/day compared with 0 units/day. Also, the adjusted HRs (95% CIs) of ASB consumption ranged from 1.08 (1.03-1.13) for 0.1-1 unit/day to 1.28 (1.17-1.40) for >2 units/day compared with non-consumers. Conversely, moderate consumption of NJ was associated with a smaller risk of the prevalence and incidence of multimorbidity. Moreover, higher intakes of SSB and ASB were positively associated whereas moderate intake of NJ was inversely associated with increased number of new-onset chronic conditions during follow-up. Higher SSB and ASB intakes were positively associated whereas moderate NJ intake was inversely associated with the higher risk of multimorbidity and increased number of chronic conditions. Current and intended policy options to decrease the burden of chronic conditions and multimorbidity need a formulation of SSB and ASB reduction strategies.