Zero-inflated Poisson Regression Research Articles

Examining the Impact of Race and Poverty on the Relationship Between Purpose in Life and Functional Health: Insights from the HANDLS Study.

While research has shown a positive association between a higher sense of purpose in life and functional health, there is a gap in understanding its benefits for racially minoritized and low SES individuals. This study aimed to investigate the correlation between purpose in life and physical functional health in a diverse sample, hypothesizing that purpose in life would be negatively associated with functional difficulties, with potentially stronger associations in White and high SES groups. Data from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were utilized (166 participants, mean age 59.44 [SD = 8.28], 59.6% females, 65.06% Black participants, 40.36% below poverty). Purpose in life was measured by Ryff's Psychological Well-being Purpose in Life subscale. Functional health was measured by functional difficulties in mobility and daily living. Race (Black and White) and poverty status (above and below) were used as moderators to probe the purpose-functional health association using zero-inflated Poisson regression while adjusting for age, education, depressive symptomology, and previous functional difficulties in four hierarchical models. Results showed that purpose in life was negatively associated with functional difficulty, indicating fewer difficulties in mobility and daily activities among those with a high sense of purpose. While the association did not remain significant after including previous functional difficulty as a covariate in Model 4, suggesting that race may not be a consistent moderator, poverty status remained a consistent moderator. The association was stronger for individuals above the poverty level. These findings underscore the complex interplay between purpose in life, race, poverty status, and functional health, emphasizing the importance of considering socioeconomic factors in interventions aimed at eliminating functional health disparities among diverse adult populations.

Spatial analysis of cholangiocarcinoma in relation to diabetes mellitus and Opisthorchis viverrini infection in Northeast Thailand

Cholangiocarcinoma (CCA) exhibits a heightened incidence in regions with a high prevalence of Opisthorchis viverrini infection, with previous studies suggesting an association with diabetes mellitus (DM). Our study aimed to investigate the spatial distribution of CCA in relation to O. viverrini infection and DM within high-risk populations in Northeast Thailand. Participants from 20 provinces underwent CCA screening through the Cholangiocarcinoma Screening and Care Program between 2013 and 2019. Health questionnaires collected data on O. viverrini infection and DM, while ultrasonography confirmed CCA diagnoses through histopathology. Multiple zero-inflated Poisson regression, accounting for covariates like age and gender, assessed associations of O. viverrini infection and DM with CCA. Bayesian spatial analysis methods explored spatial relationships. Among 263,588 participants, O. viverrini infection, DM, and CCA prevalence were 32.37%, 8.22%, and 0.36%, respectively. The raw standardized morbidity ratios for CCA was notably elevated in the Northeast’s lower and upper regions. Coexistence of O. viverrini infection and DM correlated with CCA, particularly in males and those aged over 60 years, with a distribution along the Chi, Mun, and Songkhram Rivers. Our findings emphasize the association of the spatial distribution of O. viverrini infection and DM with high-risk CCA areas in Northeast Thailand. Thus, prioritizing CCA screening in regions with elevated O. viverrini infection and DM prevalence is recommended.

Enhancing engagement in parenting programs: A comparative study of in-person, online, and telehealth formats

IntroductionParenting programs are widely used to prevent and ameliorate children’s emotional, and behavioral problems but low levels of engagement undermine intervention effectiveness and reach within and beyond research settings. Technology can provide flexible and cost-effective alternate service-delivery formats for parenting programs, and studies are needed to assess the extent to which parents are willing to engage with digitally assisted formats. MethodsAfter Deployment, Adaptive Parenting Tools (ADAPT) is an evidence-based parenting program for military families. In the current comparative effectiveness trial, families were randomly assigned to either an in-person group (n = 95), self-directed online (n = 78), or individual telehealth (n = 71) formats of ADAPT. We explored whether children’s initial problem severity, parenting efficacy, parental depression, household income, child age, child gender, parental deployment length, and waiting time were related to parental engagement across different delivery formats. Zero-inflated Poisson regressions were used due to the distribution of the number of attended sessions. ResultsCompared to the in-person group format, parents in the individual telehealth and self-directed online formats had higher engagement levels. For the in-person format, parents who perceived their children as having more severe problems were more likely to enroll and families with a father deployed for longer time attended fewer sessions. In the self-directed online format, families with less depressed fathers were more likely to enroll. No predictors were found for the telehealth format. For all three formats, once parents took the first step to engage, they were likely to finish all sessions. DiscussionTechnology-assisted delivery formats have the potential to improve program engagement. Results from this study will help facilitate the development of specific strategies to promote engagement in the future.

The influence of neighborhood income on healthcare utilization in pediatric liver transplant.

Neighborhood contextual factors are associated with liver transplant outcomes. We analyzed associations between neighborhood-level socioeconomic status and healthcare utilization for pediatric liver transplant recipients. We merged the Pediatric Health Information System and Scientific Registry of Transplant Recipients databases and included liver transplant recipients ≤21 years hospitalized between January 2004 and May 2022. Outcomes were annual inpatient bed-days, risk of hospitalizations, and risk of liver biopsies. The primary exposure was zip code-based neighborhood income at transplant. We applied causal inference for variable selection in multivariable analysis. We modeled annual inpatient bed-days with mixed-effect zero-inflated Poisson regression, and rates of hospitalization and liver biopsy with a Cox-type proportional rate model. We included 1006 participants from 29 institutions. Children from low-income neighborhoods were more likely to be publicly insured (67% vs. 46%), Black (20% vs. 12%), Hispanic (30% vs. 17%), and have higher model for end-stage liver disease/pediatric end-stage liver disease model scores at transplant (17 vs. 13) than the remaining cohort. We found no differences in inpatient bed-days or rates of hospitalization across neighborhood groups. In univariable analysis, low-income neighborhoods were associated with increased rates of liver biopsy (RR: 1.57, 95% CI: 1.04-2.34, p = 0.03). These findings persisted after adjusting for insurance, race, and ethnicity (RR: 1.86, 95% CI: 1.23-2.83, p < 0.01). Children from low-income neighborhoods undergo more liver biopsies than other children. These procedures are invasive and potentially preventable. In addition to improving outcomes, interventions to mitigate health inequities among liver transplant recipients may reduce resource utilization.

4-factor prothrombin complex concentrate is not inferior to andexanet alfa for the reversal or oral factor Xa inhibitors: An Eastern Association for the Surgery of Trauma multicenter study.

Andexanet Alfa (AA) is the only FDA approved reversal agent for apixaban and rivaroxaban (DOAC). There are no studies comparing its efficacy with 4-Factor Prothrombin Complex Concentrate (PCC). This study aimed to compare PCC to AA for DOAC reversal, hypothesizing non-inferiority of PCC. We performed a retrospective, non-inferiority multicenter study of adult patients admitted from July 1, 2018 to December 31, 2019 who had taken a DOAC within 12 hours of injury, were transfused red blood cells (RBCs) or had traumatic brain injury, and received AA or PCC. Primary outcome was PRBC unit transfusion. Secondary outcome with ICU length of stay. MICE imputation was used to account for missing data and zero-inflated poisson regression was used to account for an excess of zero units of RBC transfused. 2 Units difference in RBC transfusion was selected as non-inferior. Results: From 263 patients at 10 centers, 77 (29%) received PCC and 186 (71%) AA. Patients had similar transfusion rates across reversal treatment groups (23.7% AA vs 19.5% PCC) with median transfusion in both groups of 0 RBC. According to the Poisson component, PCC increases the amount of RBC transfusion by 1.02 times (95% CI: 0.79-1.33) compared to AA after adjusting for other covariates. The averaged amount of RBC transfusion (non-zero group) is 6.13. Multiplying this number by the estimated rate ratio, PCC is estimated to have an increase RBC transfusion by 0.123 (95% CI: 0.53-2.02) units compared to AA. PCC appears non-inferior to AA for reversal of DOACs for RBC transfusion in traumatically injured patients. Additional prospective, randomized trials are necessary to compare PCC and AA for the treatment of hemorrhage in injured patients on DOACs. Therapeutic/Care Management, Level III.

Participation and Persistence in High School Elective Music Ensembles

In this study, we examined demographic patterns of participation and persistence in high school elective music ensembles. We extend prior research that has only compared music and non-music students by explicitly modeling persistence across multiple years of ensemble enrollment. The research draws on data from the High School Longitudinal Study of 2009 and employs a zero-inflated Poisson regression model to analyze the data. This hurdle model, suitable for count data with a large number of zero observations, allows us to jointly examine factors related to enrolling in at least 1 year of a music ensemble (moving from 0 years to 1 year of music) and those factors related to accruing additional years of music ensemble enrollment (moving beyond 1 year to multiple years). We found that family socioeconomic status, birth-assigned sex, academic achievement, shared parent/student outside arts event attendance, and out-of-school arts engagement were significant predictors of both students’ music participation and persistence. By examining persistence, we add important nuance to the prior research examining demographic predictors of elective high school music enrollment, particularly for issues of birth-assigned sex and socioeconomic status in the choral context.

Social isolation and mental well-being among Korean older adults: a focus on living arrangements.

The aging population in South Korea, characterized by an increasing number of older adults living alone, has raised concerns about its implications on mental health, specifically social isolation and loneliness that accompanies solitary living arrangements. This study explores the impact of living arrangements on the mental well-being of Korean older adults by focusing on the prevalence of depression and the role of social isolation in the context of evolving family structures and the COVID-19 pandemic. This cross-sectional study analyzed the responses of older adults aged 65 years and above (mean: 73.1, SD: 5.1) by using data from the Korea National Health and Nutrition Examination Survey conducted in 2018 and 2020. In total, responses from 3,365 older adults (1,653 in 2018 and 1,712 in 2020) were employed in this research. The participants' mental health status was assessed using the Patient Health Questionnaire-9, with living arrangements categorized by household size. A zero-inflated Poisson regression analysis was employed to investigate the relationship between living arrangements and depression severity, controlling for demographic, socioeconomic, and psychological factors. The study found that older adults living with others exhibited a lower depression severity than those living alone. Notably, the severity of depression decreased as the number of household members increased up to a certain threshold. Socio-economic factors, such as income level, marital status, and psychological stress were also identified as significant predictors of depression severity. However, the COVID-19 pandemic did not have a statistically significant impact on depression rates among older adults during the study period. Living arrangements play a critical role in the mental health of Korean older adults, with solitary living being associated with higher levels of depression. These findings underscore the importance of social support systems and suggest the need for policies and interventions that promote social connectivity and address the challenges of loneliness faced by them. Future research should explore longitudinal and qualitative studies to further understand causal relationships and develop targeted interventions to improve the mental well-being of the aging population.

Large-scale data decipher children's scale errors: A meta-analytic approach using the zero-inflated Poisson models.

Scale errors are intriguing phenomena in which a child tries to perform an object-specific action on a tiny object. Several viewpoints explaining the developmental mechanisms underlying scale errors exist; however, there is no unified account of how different factors interact and affect scale errors, and the statistical approaches used in the previous research do not adequately capture the structure of the data. By conducting a secondary analysis of aggregated datasets across nine different studies (n=528) and using more appropriate statistical methods, this study provides a more accurate description of the development of scale errors. We implemented the zero-inflated Poisson (ZIP) regression that could directly handle the count data with a stack of zero observations and regarded developmental indices as continuous variables. The results suggested that the developmental trend of scale errors was well documented by an inverted U-shaped curve rather than a simple linear function, although nonlinearity captured different aspects of the scale errors between the laboratory and classroom data. We also found that repeated experiences with scale error tasks reduced the number of scale errors, whereas girls made more scale errors than boys. Furthermore, a model comparison approach revealed that predicate vocabulary size (e.g., adjectives or verbs), predicted developmental changes in scale errors better than noun vocabulary size, particularly in terms of the presence or absence of scale errors. The application of the ZIP model enables researchers to discern how different factors affect scale error production, thereby providing new insights into demystifying the mechanisms underlying these phenomena. A video abstract of this article can be viewed at https://youtu.be/1v1U6CjDZ1Q RESEARCH HIGHLIGHTS: We fit a large dataset by aggregating the existing scale error data to the zero-inflated Poisson (ZIP) model. Scale errors peaked along the different developmental indices, but the underlying statistical structure differed between the in-lab and classroom datasets. Repeated experiences with scale error tasks and the children's gender affected the number of scale errors produced per session. Predicate vocabulary size (e.g., adjectives or verbs) better predicts developmental changes in scale errors than noun vocabulary size.

Relationships between climate change distress, generalized anxiety, and climate-related symptoms of mental disorders

ABSTRACT Background and Objective: We examined the possibility that reactions to climate change take two forms: distress, which may be adaptive, and symptoms of mental disorders, which may not be. Design and Method: In a national sample of Polish adults (n = 1133), we measured climate change distress (experiencing unpleasant emotions and feelings due to climate change), climate-related symptoms of mental disorders (e.g., problems sleeping and problems working and planning), generalized anxiety, and depression. Results: Zero-inflated Poisson regression analyses of the occurrence of climate-related symptoms of mental disorders found two latent classes: People who experienced symptoms of the disorder and those who did not. For all eight symptoms, climate change distress predicted membership in the latent class of people who experienced a symptom, whereas how often people in the non-zero latent class experienced each symptom was positively related to generalized anxiety but was not related to distress or depression. Conclusions: These results suggest that reactions to climate change take two forms. Some people do not experience climate change-related symptoms of mental disorders, and some do. People who experience symptoms have higher levels of climate change distress, and the frequency with which they experience these symptoms is determined by their dispositional, generalized anxiety.

Rural-Urban Differences in HIV Sexual Risk Behaviors and HIV Service Utilization Among Adolescent Sexual Minority Males in the United States.

In the United States, HIV prevalence is increasing in rural areas, specifically among rural adolescent sexual minority males (ASMM). However, it is unclear what HIV sexual risk behaviors rural ASMM engage in and what HIV preventative services they utilize. This study aimed to (1) document the lifetime HIV sexual risk behaviors and service utilization of rural ASMM and (2) compare rural-urban differences in the prevalence of HIV sexual risk behaviors and service utilization. We analyzed data collected from 1615 ASMM who participated in a baseline survey for an online HIV prevention program from April 2018 to June 2020. We compared the prevalence of lifetime HIV sexual risk behaviors and HIV healthcare utilization among rural and urban participants via descriptive statistics, chi-square tests, linear and logistic regressions, and zero-inflated Poisson regressions. These analyses indicated that rural ASMM were more likely than urban ASMM to engage in condomless sex when they had anal sex. Rural ASMM could benefit from offline and online evidence-based HIV prevention interventions, especially interventions that increase condom use.

Predicting the multivariate zero-inflated counts: A novel model averaging method under Pearson loss.

Excessive zeros in multivariate count data are often observed in scenarios of biomedicine and public health. To provide a better analysis on this type of data, we first develop a marginalized multivariate zero-inflated Poisson (MZIP) regression model to directly interpret the overall exposure effects on marginal means. Then, we define a multiple Pearson residual for our newly developed MZIP regression model by simultaneously taking heterogeneity and correlation into consideration. Furthermore, a new model averaging prediction method is introduced based on the multiple Pearson residual, and the asymptotical optimality of this model averaging prediction is proved. Simulations and two empirical applications in medicine are used to illustrate the effectiveness of the proposed method.

Variation by race/ethnicity-gender in the relationship between arrest history and alcohol use.

Alcohol use contributes to the national burden of morbidity and mortality in the United States. Arrest, as a unique form of criminal justice system involvement, may be related to alcohol use from adolescence to adulthood. This study investigates the relationship between arrest and alcohol use across race/ethnicity-gender (R/E-G) status (e.g., Black, Latinx, and White men and women) as youth age. Data from 17 waves (1997-2015) of the National Longitudinal Survey of Youth, 1997 cohort (N = 8901) were used to explore how variation in R/E-G moderates the relationship between arrest history and alcohol use trajectories from 13 to 30 years old. Multilevel zero-inflated Poisson and Poisson regression were used to assess R/E-G variation in the relationship between arrest history and days of alcohol consumption, drinks per drinking occasion, and days of binge drinking after accounting for covariates, including incarceration. The findings indicate that an arrest history is associated with alcohol use, and these results varied by R/E-G status, age, and alcohol use outcome. Those with an arrest history reported more days of drinking than their counterparts without an arrest; yet, the magnitude and direction of average drinks per occasion and binge drinking days varied by R/E-G status and age. Paradoxically, Black men, Black women, and Latinx men with an arrest history reported fewer days of binge drinking as they aged than their counterparts without an arrest. A history of arrest is important for alcohol use from adolescence to adulthood and varies by R/E-G status, age, and alcohol use outcome. This work confirms previous scholarship showing that arrest and alcohol use are socially patterned and R/E-G status is an essential consideration in understanding the relationship. Future work should include additional identities and health behaviors and the consequences related to alcohol use outcomes.

Modeling clustered count data using mixed effect discrete Weibull regression model with cubic splines

This paper investigates the use of mixed-effect discrete Weibull (DW) regression model with cubic splines for clustered count data. DW regression model can be used for both over and under-dispersed data thus, it can be an appropriate choice for researchers to use without having the risk to violate assumptions for using a particular model distribution. We used a cubic spline function to model the non-linear relationship between the outcome variable and the covariate. The proposed model is applied to a clustered dataset from the eighth Korean National Health and Nutrition Examination Survey (KNHANES VIII) from 2019 to assess the factors influencing the amount of alcohol drink in 17 different regions. We compared the results with our proposed model with those of Poisson, negative binomial, zero-inflated Poisson and zero-inflated negative binomial regression models in the presence of spline function. The results show that using DW regression model with cubic spline gives the best fit. We also held a simulation study to investigate the performance and the robustness of DW with a spline function. It turns out that DW regression model with a spline function can flexibly model clustered count data with various dispersion and data with many zeros.

Long-term effects of childhood difficulties on depressive symptoms among older adults: Role of adulthood income and income satisfaction.

This study examines how childhood difficulties are associated with late-life depression. Using the concept of agency within the structure of the life course perspective, this study investigates how subjective income satisfaction in adulthood plays a role in the relationship between adulthood objective income and late-life depressive symptoms among older adults who have experienced childhood difficulties. Using data from two waves (2006, 2021) of the Korean Welfare Panel Study (N = 1822), we identified respondents with and without childhood difficulties, and performed a series of hierarchical zero-inflated Poisson regression models. Childhood difficulties (β, 0.07; 95% confidence interval [CI], 0.04-0.11), adulthood low income (β, 0.17; 95% CI, 0.13-0.21), and low income satisfaction (β, 0.16; 95% CI, 0.12-0.21) are associated with an increased level of depressive symptoms in late life. In the context of the association between objective income level and late-life depressive symptoms, the buffering effect of income satisfaction in adulthood was found among the respondents who had experienced childhood difficulties (β, 0.22; 95% CI, 0.09-0.34). Childhood difficulties are a critical risk factor impacting late-life psychological well-being. How an individual subjectively evaluates his or her economic status in adulthood plays a major role in mitigating the negative impact of childhood difficulties on late-life health inequality. Interventions to reduce the risk of childhood difficulties and their negative long-lasting impact may alleviate individuals' exposure to depression in late life. Geriatr Gerontol Int 2024; 24: 246-252.

Evaluating the Performance of Mixed Zero-Inflated Poisson Regression Models with Time-dependent and Time-independent Covariates

One of the issues that researchers may encounter in count data is having many zeros. One of the solutions to model these data is using zero-inflated Poisson (ZIP) regression models. Recently, researchers have started to model longitudinal count data with time-dependent covariates. However, it has not been considered whether a model with time-dependent covariates provides a better fit than a model with time-independent covariates. In this paper, the fit between a mixed ZIP model with time-dependent covariates and a mixed ZIP model with time-independent covariates is compared using simulation. Using the deviance information criterion as a measure of fit, we found that the model with time-dependent covariates exhibits a better fit than the model with time-independent covariates. KEYWORDS correlated data, count data, excess zeros, longitudinal, mixed models, model fit

Associations between screen viewing at 2 and 3.5 years and drawing ability at 3.5 years among children from the French nationwide Elfe birth cohort

The effect of screen viewing on children’s cognitive development has been of concern among parents and researchers. This study investigated the association between children screen time, as reported by parents, and drawing ability, and the confounding effects of socioeconomic characteristics (such as parental education, household income, migration status) and children’s competing activities (such as drawing practice, extracurricular activity, outdoor time, sleep time, time playing with parents). Participants included 7577 children aged 3.5 years (50% girls) who underwent the Draw-a-person test (McCarthy score [range = 0–12 points]) in the French nationwide Elfe birth cohort, initiated in 2011. Sex-stratified zero-inflated Poisson regression models were used. Increased screen time was associated with a higher likelihood to obtain a null score in boys (OR 1.15, 95% CI 1.07–1.23) and girls (1.13 [1.03–1.24]) and a lower score in girls only (β = − 0.02, 95% CI − 0.04; − 0.01). After adjusting for SES, associations were no longer observed, indicating that the association between screen time and drawing abilities was confounded by socioeconomic characteristics.

INDICATORS OF WELLBEING AND SELF- AND INFORMANT-REPORTED COGNITIVE DECLINE IN OLDER ADULTS

Abstract Wellbeing has been associated with objective cognitive decline and is a promising target for dementia prevention. Less is known about associations between wellbeing and subjective cognitive decline (SCD), an early indicator for progression to Alzheimer’s Disease and related dementias (ADRD). Given the importance of early detection and intervention in ADRD, the current study assessed whether positive and negative indicators of wellbeing were associated with SCD via self- and informant-reports using zero-inflated Poisson regressions. A total of 1,014 participants (MAge=71.8, SD=3.1) were included in analyses. The sample was representative of both males (55%) and females (45%) and was racially diverse (65% White, 32% Black/African American, 2% other races). SCD was assessed with the AD8 Dementia Screening Interview (self- and informant-report versions), sense of purpose with the Life Engagement Test, life satisfaction with the Satisfaction with Life Scale, depressive symptoms with the Beck Depression Inventory-II, and loneliness with the UCLA Loneliness scale. Higher positive indicators of wellbeing were associated with lower SCD via self- and informant-reports. Higher levels of depression were associated with greater SCD via self-report. Higher levels of life satisfaction attenuated the association between depressive symptoms and SCD via self-report. These associations were statistically significant (p &amp;lt; .05) and held after applying False Discovery Rate correction. Effect sizes ranged from small to medium (ORPositive Wellbeing Indicators = 0.84-0.89, ORDepression = 1.34). These findings extend past wellbeing and objective cognitive decline research by demonstrating that positive and negative indicators of wellbeing are also associated with SCD assessed via self- and informant-reports.

New antipsychotic prescription and recurrent infections among adult sepsis survivors: A population-based cohort study.

Antipsychotic agents, which may increase the risk of infection through dopaminergic dysregulation, are prescribed to a fraction of patients following critical illness. We compared the rate of recurrent sepsis among patients who filled a prescription for antipsychotics with high- or low-D2 affinity. Population-based cohort with active comparator design. We included sepsis survivors older than 65 years with intensive care unit admission and new prescription of antipsychotics in Ontario 2008-2019. The primary outcome were recurrent sepsis episodes within 1 year of follow-up. Patients who filled a prescription within 30 days of hospital discharge for high-D2 affinity antipsychotics (e.g., haloperidol) were compared with patients who filled a prescription within 30 days of hospital discharge for low-D2 affinity antipsychotics (e.g., quetiapine). Multivariable zero-inflated Poisson regression models with robust standard errors adjusting for confounding at baseline were used to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI). Overall, 1879 patients filled a prescription for a high-D2, and 1446 patients filled a prescription for a low-D2 affinity antipsychotic. Patients who filled a prescription for a high-D2 affinity antipsychotic did not present a higher rate of recurrent sepsis during 1 year of follow-up, compared with patients who filled a prescription for a low-D2 affinity antipsychotic (IRR: 1.12; 95% CI: 0.94, 1.35). We did not find conclusive evidence of a higher rate of recurrent sepsis associated with the prescription of high-D2 affinity antipsychotics (compared with low-D2 affinity antipsychotics) by 1 year of follow-up in adult sepsis survivors with intensive care unit admission.

Epidemiology of engagement in physical activity behaviors in people with epilepsy from National Health Interview Survey 2017

ObjectivePhysical activity (PA) participation may be beneficial for people with epilepsy (PWE) but has been discouraged due to a fear that it may induce seizures. Using data from the 2017 National Health Interview Survey, we aimed to describe current rates of PA sufficient to meet US PA Aerobic and Strength Training Guidelines (Aim #1), compare the average time PWE spend on aerobic activity and strength training activity (Aim #2), and compare rates of engagement with various types of PA (e.g., moderate, vigorous, strength training, and mind–body activities) among PWE to the general population (Aim #3). MethodsCross-sectional data (n = 26,728) were analyzed via logistic and zero-inflated Poisson regression models. PA participation was analyzed based on the US PA Guidelines (neither, strength training [≥2 times/wk], moderate to vigorous physical activity [MVPA; ≥ 150 min/wk], or both; Aim #1), time spent on activity/week (Aim #2), and activity participation (yes/no; Aim #3). Epilepsy status was coded as active epilepsy (doctor-diagnosed and either taking antiepileptic medication or had at least one seizure in 12 months; n = 335), inactive epilepsy (doctor-diagnosed, not taking antiepileptic medication nor had a seizure in 12 months; n = 213), and no history of epilepsy (n = 26,180). ResultsPeople with active epilepsy were more likely to report meeting neither (68 %, 95 % CI = 63–74 %) of the PA Guidelines compared to people with no history of epilepsy (59 %, 58–60 %). The mean duration of time reported on vigorous activity for people with inactive epilepsy was significantly higher than people with no history of epilepsy (p = 0.01). People with active epilepsy were 32–39 % less likely to report participating in any moderate or vigorous activity compared to people with no history of epilepsy. SignificanceThis study highlights activity disparities among PWE and the general population, indicating substantially lower activity and higher likelihood of inactivity in PWE, particularly active epilepsy.

Prescribed fires, smoke exposure, and hospital utilization among heart failure patients

BackgroundPrescribed fires often have ecological benefits, but their environmental health risks have been infrequently studied. We investigated associations between residing near a prescribed fire, wildfire smoke exposure, and heart failure (HF) patients’ hospital utilization.MethodsWe used electronic health records from January 2014 to December 2016 in a North Carolina hospital-based cohort to determine HF diagnoses, primary residence, and hospital utilization. Using a cross-sectional study design, we associated the prescribed fire occurrences within 1, 2, and 5 km of the patients’ primary residence with the number of hospital visits and 7- and 30-day readmissions. To compare prescribed fire associations with those observed for wildfire smoke, we also associated zip code-level smoke density data designed to capture wildfire smoke emissions with hospital utilization amongst HF patients. Quasi-Poisson regression models were used for the number of hospital visits, while zero-inflated Poisson regression models were used for readmissions. All models were adjusted for age, sex, race, and neighborhood socioeconomic status and included an offset for follow-up time. The results are the percent change and the 95% confidence interval (CI).ResultsAssociations between prescribed fire occurrences and hospital visits were generally null, with the few associations observed being with prescribed fires within 5 and 2 km of the primary residence in the negative direction but not the more restrictive 1 km radius. However, exposure to medium or heavy smoke (primarily from wildfires) at the zip code level was associated with both 7-day (8.5% increase; 95% CI = 1.5%, 16.0%) and 30-day readmissions (5.4%; 95% CI = 2.3%, 8.5%), and to a lesser degree, hospital visits (1.5%; 95% CI: 0.0%, 3.0%) matching previous studies.ConclusionsArea-level smoke exposure driven by wildfires is positively associated with hospital utilization but not proximity to prescribed fires.