bluuebunny/crossref_metadata_2025 huggingface dataset:
726Examining mediation effect of comprehensive knowledge on people’s attitudes towards HIV-infected people in India
Authors: Pandey Arvind , Khatri Robin , Sharma Dhananjay , Kansal Anshum , Singh Niraj Kumar , Narayan Padum
Published: September 2021

Background

Improvement in people’s knowledge of HIV/AIDS and reduction in stigma and discrimination have been key factors in the fight against HIV/AIDS. The objective of the present paper is to examine the mediation effect of comprehensive knowledge on people’s attitudes towards HIV positives in India.

Methods

Data for the study have been drawn from nationally representative India’s National Family Health Survey, 2015-16. Statistical methods of data analysis included odds ratio and logistic regression models.

Results

Two in every five men and of women with comprehensive knowledge held a positive attitude towards PLHIVs. The people in rural areas and females against their counterparts are less likely (OR: 0.85, p < 0.05) to have positive attitude. The mediation by comprehensive knowledge, contributed to 46% of direct effect from gender perspective on comprehensive positive attitude. Among males, aged group 25-44 and among females age <25 had most positive attitude towards people living with HIV (PLHIV) as compared to their counterparts.

Conclusions

There existed a difference between males and females in attaining comprehensive knowledge and having comprehensive positive attitude. The mediation by comprehensive knowledge contributed, though partially, direct effects from gender perspective on comprehensive positive attitude. The findings are programmatically relevant to device content analysis of the material in the information, education and communication strategies.

Key messages

The mediation effect of comprehensive knowledge on people’s attitudes towards HIV positives has been substantial in India.
1378The effect of vitamin D supplementation on acute respiratory infection -analysis of the D-Health Trial
Authors: Pham Hai , Waterhouse Mary , Baxter Catherine , Romero Briony , McLeod Donald , Armstrong Bruce , Ebeling Peter , English Dallas , Hartel Gunter , Kimlin Michael , Martineau Adrian , O'Connell Rachel , Pols Jolieke van der , Venn Alison , Webb Penelope , Whiteman David , Neale Rachel
Published: September 2021

Background

Observational studies link vitamin D deficiency with acute respiratory tract infection (ARTI) but results from randomised controlled trials are heterogeneous.

Methods

We used data from The D-Health Trial (N = 21,315); ARTI was a pre-specified trial outcome. Participants were men and women aged 60 to 79 years (with volunteers aged up to 84 years), supplemented with monthly doses of 60,000 international units of vitamin D and followed for up to 5 years. Participants were asked to report occurrence of ARTI over the previous month via annual surveys, and a subset of participants completed 8-week respiratory symptom diaries in winter. We used regression models to estimate odds ratios, rate ratios and rate differences.

Results

Vitamin D supplementation did not reduce the risk of ARTI (survey OR 0.98, 95% CI 0.93 to 1.02; diary OR 0.98, 95% CI 0.83 to 1.15). Analyses of diary data showed that vitamin D reduced the average duration by 0.5 days (95% CI 0.2 to 0.7 days) and the average number of days with severe symptoms by 0.4 days (95% CI 0.3 to 0.6 days).

Conclusions

Monthly bolus doses of 60,000 IU of vitamin D did not reduce the overall risk of ARTI but slightly reduce the duration of symptoms in the general population.

Key messages

The reduction in the duration of symptoms suggests a potential impact of vitamin D on the immune response to infection.
646Coffee, Brain Volume and Risk of Dementia and Stroke
Authors: Pham Kitty , Mulugeta Anwar , Zhou Ang , O'Brien John T , Llewellyn David J , Hyppönen Elina
Published: September 2021

Background

Coffee is a highly popular beverage worldwide, containing caffeine which is a central nervous system stimulant. The aim was to examine whether habitual coffee consumption is associated with differences in brain volumes or the risk odds of dementia or stroke.

Methods

Prospective analyses of habitual coffee consumption were conducted in 398,646 participants (age 37-73 years) within the UK Biobank, including 17,702 participants with volumetric MRI information. We examined associations between coffee consumption and brain volume using covariate adjusted linear regression, and with odds of dementia and stroke using logistic regression. All participants were free of dementia and stroke at baseline. We obtained 4,333 incident dementia and 6,181 incident stroke cases.

Results

There were inverse linear associations between coffee consumption and total brain (β per cup -1·42, p = 1·4x10-8), grey matter (-0·92, p = 5·2x10-10), white matter (-0·50, p = 0·002) and hippocampal volumes (-0·01, p = 0·009), but no evidence to support associations with white matter hyperintensity volume (-0·01, p = 0·72). After full covariate adjustment, consumption of > 6 cups/day of coffee was associated with 53% higher odds of dementia compared to consumption of 1-2 cups/day (OR 1.53, 95% CI 1.28, 1.83), with less evidence for an association with stroke (OR 1.17, 95% CI 1.00, 1.37, p = 0.055).

Conclusions

High coffee consumption was associated with smaller total brain volumes and increased odds of dementia.

Key messages

The findings suggest caution at higher levels of coffee consumption, however further studies are required to establish causality, and to explore the clinical relevance of brain volume changes.
307Association between patterns of comorbid mental disorders and mortality-related estimates. A Danish register-based cohort study
Authors: Plana-Ripoll Oleguer , McGrath John J
Published: September 2021

Background

Comorbidity within mental disorders is common, and people with two or more types of mental disorders have shorter life expectancy compared to those with exactly one type. The aims of this study were to: (a) describe the prevalence of combinations of mental disorders; and (b) estimate the excess mortality for each of these combinations.

Methods

We conducted a population-based cohort study including all 7,505,576 persons living in Denmark in 1995-2016. Using national registers, we described the most common combinations of mental disorders and investigated excess mortality by means of mortality rate ratios (MRRs) and differences in life expectancy.

Results

At the end of the 22-year observation, 6.2% individuals were diagnosed with exactly one disorder, and 5.3% with two or more types. People with any combination of disorders had higher mortality rates than those without any diagnosis (MRRs ranging from 1.10 [95% CI 0.67 – 1.84] to 5.97 [95% CI 5.52 – 6.45]) and shorter life expectancies compared to the general population (estimates ranging from 5.06 years [95% CI 5.01 – 5.11] to 17.46 years [95% CI 16.86 – 18.03]).

Conclusions

Mood disorders and neurotic disorders commonly co-occur, and contribute to many different sets of comorbid mental disorders. The association between mental disorders comorbidity and mortality revealed the prominent role of substance use disorders.

Key messages

Our study provides prevalence estimates of the most common sets of mental disorders. In light of the substantial contribution of substance use disorders to premature mortality, efforts related to the ‘primary prevention of secondary comorbidity’ warrant added scrutiny.
588Plasma concentrations of persistent organic pollutants and pancreatic cancer risk
Authors: Porta Miquel , Gasull Magda , Pumarega José , Kiviranta Hannu , Rantakokko Panu , Raaschou-Nielsen Ole , Bergdahl Ingvar , Sandanger Torkjel Manning , Rylander Charlotta , Nøst Therese Haugdahl , Duell Eric , Katzke Verena , Gunter Marc , Vineis Paolo
Published: September 2021

Background

Findings and limitations of previous studies on persistent organic pollutants (POPs) and pancreatic cancer risk support conducting further research in prospective cohorts.

Objective

To investigate the association between plasma concentrations of selected POPs and pancreatic cancer risk.

Methods

Prospective case-control study nested within the EPIC cohort. Participants were 513 pancreatic cancer cases and 1020 matched controls. Concentrations of 22 POPs (organochlorine pesticides, polychlorinated biphenyls, and polybrominated diphenyl ethers) were measured in plasma collected at baseline by GC-MS/MS.

Results

Some, generally moderate effects were observed at higher concentrations of p,p’-DDT, trans-nonachlor, β-hexachlorocyclohexane, and the sum of 6 organochlorine pesticides and of 16 POPs. The odds ratio (OR) for the upper quartile of trans-nonachlor was 1.55 (95% confidence interval 1.06 to 2.26; P for trend=0.025). Associations were stronger in the groups predefined as most valid or relevant. Among participants having fasted >6 hours at blood collection, the ORs were significant for 10 of 11 exposure categories. Higher ORs were also observed among cases with microscopic confirmation than in cases with a clinical diagnosis. Higher ORs were also observed among normal-weight participants, with relevant estimates for all 11 exposure categories. Among participants with a follow-up ≥10 years, estimates were also higher (e.g., for trans-nonachlor: OR = 2.14, 1.01 to 4.53, P for trend=0.035). Overall, trans-nonachlor, 3 PCBs, and the 2 sums of POPs were the exposures more clearly associated with pancreatic cancer risk.

Conclusions

A few moderately increased risks were apparent for the highest concentrations of certain POPs, sometimes with a dose-response relationship.
1169Impact of sex-specific growth centiles in utero - a statewide population cohort study
Authors: Pritchard Natasha , Walker Susan , Tong Stephen , Lindquist Anthea
Published: September 2021

Background

Sex impacts birthweight, with male babies heavier on average. However, growth charts in pregnancy are often sex-neutral. Small babies (<10th centile) are at risk of adverse outcomes. We aimed to identify the impact of using sex-specific charts during pregnancy, and if this detected more babies at risk of stillbirth.

Methods

Retrospective cohort study including all infants born in Victoria from 2005-2015 (n = 529,261). We applied the same growth centiles, either adjusted or not adjusted for fetal sex. We compared overall <10th centile populations, populations of males considered small by sex-specific charts only, and populations of females considered small by sex-neutral charts only. Stillbirth risk was our primary outcome.

Results

Of those <10th centile by sex-neutral charts, 39.6% were male and 60.5% female, but using sex-specific charts, 50.3% were male and 49.7% female. 19.2% of < 10th centile females were reclassified as > 10th centile using sex-specific charts. These females were not at increased risk of stillbirth or adverse outcomes compared with a healthy weight infant, but were at greater risk of being delivered by obstetricians on suspicion of growth restriction. A further 25.0% of male infants were reclassified as < 10th centile by sex-specific charts. These male newborns, compared to a healthy weight baby, were at greater risk of stillbirth (RR 1.94, 95%CI 1.30-2.90) and other adverse outcomes.

Conclusions

Use of growth centiles not adjusted for fetal sex disproportionately classifies female infants as < 10th centile, increasing their risk of unnecessary intervention, and fails to identify a cohort of male infants at increased risk of adverse outcomes, including stillbirth.

Key messages

Male babies are heavier than female babies. Thus, ultrasound charts growth charts should be sex-specific.
676The impact of alcohol tax elimination policy on population health in Hong Kong
Authors: Quan Jianchao , Ng Carmen , Leung Gabriel
Published: September 2021

Background

Extensive research has shown that taxes on alcohol reduces consumption and alcohol-related harm. Uniquely among high-income economies, the Hong Kong Government reduced alcohol taxes on wine and beer by half in 2007; and entirely waived all alcohol-related taxes in 2008.

Methods

We adapted the International Model of Alcohol Harms and Policies (InterMAHP) using Hong Kong data to evaluate the health impact of the tax elimination policy changes on alcohol pricing. Prevalence and consumption estimates were calculated from serial Behavioural Risk Factor surveys of health behaviours among the Hong Kong population. We applied the linear approximation of the Almost Ideal Demand System (AIDS) econometric model to estimate the elasticity of demand for on-trade and off-trade sales of alcohol (beer, wine, and spirits) using Euromonitor market sales data. We derived population attributable fractions and relative risks estimates from Hospital Authority morbidity and mortality records.

Results

Alcohol consumption and alcohol-related harms were higher for males. We found the policy change increased alcohol-attributable mortalities, predominately due to increases in cancer, cardiovascular disease, and injuries. The burden of disease was higher in older age groups.

Conclusions

Hong Kong pursued a policy of eliminating taxes on alcohol despite extensive evidence on the effectiveness of taxation as a policy tool. We find empirical evidence this policy change was associated with an increase in alcohol-related harms and detrimental to population health.

Key messages

The alcohol tax elimination policy in Hong Kong was associated with an increase in alcohol-related burden of disease. Reintroduction of alcohol taxes merits consideration.
1156Associations between internet use and overweight/obesity in Nepal: Do gender and urbanity modify these associations?
Authors: Rana Juwel
Published: September 2021

Background

Overweight and obesity, a major risk factor for non-communicable disease (NCD), premature deaths, and disability-is exponentially increasing globally, especially in people in low and middle-income countries (LIMCs). This study, thus, examined the associations between internet use and overweight/obesity in Nepal, and the extent to which these associations vary by gender and urbanity.

Methods

We extracted data available from the nationally representative Nepal Demographic and Health Survey (NDHS) 2016. Body Mass Index (BMI) was the outcome of interest. The use of internet (IU) in the last twelve months and frequency of using internet (IUF) in the last month were the primary exposure of interest. Multivariable ordinal logistic regression models at different levels were fitted to obtain the adjusted effects of exposures.

Results

Of 10,380 study participants, 38.5% were males, and 61.5% were females. About 33% of the respondents were overweight and obese (SA cut-off). The prevalence of IU was 31.3% among adults in Nepal. Results show that the risk of overweight and obesity-SA was significantly 1.79 (95% CI: 1.56, 2.05; p < 0.001) times higher among respondents who used internet less than/at least once in a week, and 2.16 (95% CI: 1.88, 2.48; p < 0.0001) times higher among respondents who used internet almost every day compared to non-users of internet. These associations significantly varied by gender.

Conclusion

Higher frequency of internet exposure has detrimental effect on overweight and obesity in Nepal.

Key messages

Effective public health intervention is essential regarding the detrimental health effects of sedentary lifestyle due to the overuse of internet.
1155Effect of household air pollution on infant and child-mortality in Myanmar
Authors: Rana Juwel , Khan Nuruzzaman , Aliani Razia , Islam Rakibul
Published: September 2021

Background

Household air pollution (HAP) from solid fuel use (SFU) for cooking has been considered as a public health threat, particularly for women and children in low and middle-income countries (LMICs), with limited evidence. Hence, this study investigated the effects of HAP on neonatal, infant, and under-five child mortality in Myanmar.

Methods

The cross-sectional study employed data from the Myanmar Demographic and Health Survey (MDHS), the first nationally representative survey conducted in 2016.

The sample consists of 3249 ever-married mothers with under-five children in the household with a 98% response rate. HAP (coal and biomass), and level of exposure to HAP (no exposure, moderate and high exposure) were exposures. Outcomes were self-reported neonatal, infant, and under-five mortality.

Results

The prevalence of SFU was 79.0%. The neonatal, infant, and the under-five mortality rates were 26, 45, and 49 per 1,000 live births, respectively. The odds of infant (aOR 2.17, 95% CI: 1.21, 3.88) and under-five child (aOR 2.22, 95% CI: 1.24, 3.95) mortality were higher in households with SFU compared with clean fuel use. When applying an augmented measure of exposure to HAP by incorporating both SFU and the kitchen’s location, the likelihoods of infant and under-five mortality were even higher among moderate and highly exposed children compared with unexposed children with similar trends.

Conclusion

Infants and under-five children are at higher risk of mortality from exposure to HAP.

Key messages

Increasing access to cookstoves and clean fuels is imperative to reduce the risk of infants and under-five child mortality in LMICs, including Myanmar.
933Outbreak investigation of canine acquired idiopathic megaoesophagus in Australia, 2017-2018
Authors: Renwick Michelle , Stevenson Mark , Wiethoelter Anke , Mansfield Caroline
Published: September 2021

Background

VetCompass Australia collects de-identified data from primary-care, companion animal practices across Australia, providing a large, representative database. VetCompass data were used to investigate an outbreak of megaoesophagus in dogs in Australia in 2017/2018. A specific proprietary dogfood was hypothesized as the cause.

Methods

The instantaneous daily hazard of megaoesophagus for the period January 2012 to February 2018 was plotted using survival analyses. A case-control study focused on dog demographics and management practices was performed to determine risk factors for megaoesophagus.

Results

There was a 7-fold increase in the incidence rate of canine megaoesophagus from 2014 (0.11 [95% CI 0.02 to 0.58] cases per 100,000 dogs per day) to 2018 (0.82 [95% CI 0.19 to 4.2] cases per 100,000 dogs per day) with greater numbers diagnosed during summer months of the year. The odds of feeding one specific dry dogfood was 325 (95% CI 64 to 1644) times greater for cases, compared with controls.

Conclusions

Evidence obtained through this study strongly suggests that a specific dogfood was responsible for most cases. The food was recalled prior to completion of this research. Further investigation into incidence rates and seasonal patterns of canine megaoesophagus are ongoing.

Key messages

Use of aggregated, de-identified data collected across small animal practices in Australia allowed identification of trends and seasonal patterns of a rare disease in dogs for the first time and provides opportunity for surveillance of this and other companion animal diseases.
86Segmenting persistently high-cost individuals into actionable groups
Authors: Ronksley Paul , Wick James , Campbell Dave , Beall Reed , Hemmelgarn Brenda , Tonelli Marcello , Manns Braden
Published: September 2021

Background

Despite growing evidence describing high cost patients, decision-makers struggle to implement effective strategies to improve care and curb spending in this population. Using a multi-phased approach, we aimed to classify high cost patients into homogeneous subgroups amenable to targeted interventions.

Methods

We linked population-level administrative health data in Alberta, Canada from 2012-2017. We defined “persistently high-cost” as those in the top 1% of cumulative inpatient, outpatient and medication cost in at least two consecutive years. We used latent class analysis to separate this persistent high-cost population into potentially actionable subgroups.

Results

Of the 3,795,067 adults residing in Alberta, 21,361 were ‘persistently high-cost’. Latent class models identified 10 high-cost subgroups: individuals with CKD (19.3% of persistent high-cost individuals), those undergoing joint surgery/replacement and rehabilitation (18.6%), individuals with IBD (11.6%), patients receiving biologics for autoimmune conditions (11.3%), patients receiving high cost drugs for other conditions (11.1%), community-dwelling individuals with multimorbid chronic conditions (9.0%), individuals with schizophrenia (6.8%), individuals with other mental health issues (6.2%), rural individuals with COPD (3.4%), and frail elderly in institutional settings (2.7%).

Conclusions

Latent class analysis was able to identify 10 persistently high-cost groups based on meaningful differences in health care spending, demographics, and clinical diagnoses.

Key messages

This taxonomy will inform the identification of interventions shown to improve care and reduce cost for each subgroup in addition to consultation with key stakeholders to identify and reflect on key barriers and facilitators to implementing identified interventions within the local context.
1026Female-Headed Households: Gender and Health Inequalities
Authors: Saad Ghada , DeJong Jocelyn , Ghattas Hala , Barros Aluisio , Wendt Andrea , Hellwig Franciele
Published: September 2021

Background

Gender norms greatly affect who is the main breadwinner and decision maker in a household. Commonly, in the Middle East and North Africa (MENA) region, males are the household heads and it is believed that female-headed households (FHH) are more disadvantaged compared to male-headed households (MHH). Our analysis identifies a household typology and illustrates differences in social inequalities and child health outcomes by headship gender.

Methods

We used DHS/MICS surveys in MENA to identify three types: MHH, and FHH with/without males. We analyzed differentials in birth registration, care-seeking for health treatment, obesity, stunting and full vaccination, wealth quintiles, head’s education and residence.

Results

Among nine countries with surveys since 2010, the average prevalence of FHH was 12%. Female heads were generally over 50 years and had no or primary education. FHH are generally poorer, especially FHH with no males. In Algeria, Iraq, Morocco and Yemen, the proportions of FHH with males present were larger in the richer quintiles, compared to other household types. Disparities in child indicators varied by country, and were not evident for birth registration, vaccination and obesity. Care-seeking was higher among FHH. Stunting was higher among FHH without males.

Conclusions

Disparities in child health indicators are not evident across the household types. However, there were differences in household wealth and head’s education by household type. Female headship is an important dimension of inequality, but there are differences within that category.

Key messages

Despite being socially disadvantaged, children in FHH received similar healthcare compared to children in MHH.
686Evaluation of the impact of National Health Mission on maternal health outcomes
Authors: Sangwan Garima , Lakshmi P.V.M. , Goel Aarti , Gupta Madhu , Prinja Shankar , Kumar Rajesh
Published: September 2021

Background

The National Health Mission (NHM) was launched in 2005 by the Government of India. As NHM has completed about 15 years (2005-2020), there is a need to review the impact of NHM on health measures.

Methods

Logic model (input-process-output-outcome-impact) was used to measure the impact of National Health Mission on maternal health outcomes in India. We studied the impact of NHM by comparing the proportion of women who had first-trimester registration, institutional delivery, postnatal check-ups before NHM (NFHS- 3 data) and after NHM (NFHS-4 data) among those who had a delivery in the last five years preceding the date of the survey after adjusting for sociodemographic factors, road density, telephone density and health worker density.

Results

The Health worker density increased from 32.67 to 50.29 per 10000 population in post NHM period as compared to pre NHM period. Beds per 10,000 population increased from 4.43 in 2005 to 5.96 in 2015. There was a significant increase in the proportion of first-trimester registration from 57.3% to 67.4%, in institutional delivery rate from 41.6% to 87.7% and postnatal check-ups from 42.4% to 72.3% from the year, 2005 to 2015. The Maternal mortality ratio declined from 250 to 130 per lakh childbirths between 2005 and 2015.

Conclusions

NHM has led to an improvement in maternal health-related outcomes in the country.

Key messages

The learnings from NHM can be utilized to improve further the outcomes for achieving Universal Health Coverage (UHC) by 2030.
863Alcohol and cancer in an Australian cohort of 226,162 participants aged 45 years and over
Authors: Sarich Peter , Canfell Karen , Egger Sam , Banks Emily , Joshy Grace , Grogan Paul , Beral Valerie , Weber Marianne
Published: September 2021

Background

Australia has a relatively high level of alcohol consumption. Although alcohol consumption is known to increase the risk of several cancer types internationally, local evidence for Australia is limited.

Methods

Cox proportional hazards regressions were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for cancer risk in relation to weekly alcohol consumption among 226,162 participants aged ≥45 years (2006-2009) in the 45 and Up Study, an Australian prospective cohort study. Incident cancer cases were ascertained by linkage to the New South Wales Cancer Registry to December 2013 by the Centre for Health Record Linkage.

Results

Over a median 5.4 years, 17,332 cancers were diagnosed. Increasing levels of alcohol intake were associated with increased risk of any cancer (HR per seven drink increase in weekly consumption: 1.02; 95% CI: 1.00-1.04), and cancers of the upper aerodigestive tract (1.19;1.10-1.29), mouth/pharynx (1.18;1.08-1.29), oesophagus (1.22;1.04-1.43), colorectum (1.09;1.04-1.15), colon (1.13;1.06-1.20), liver (1.22;1.04-1.44), breast (1.09;1.00-1.18), and melanoma (1.05;1.00-1.10); whereas an inverse association was observed for thyroid cancer (0.80;0.64-1.00). We estimated that by age 85 years, Australian men and women who consume >14 drinks/week increase their absolute risk of alcohol-attributable cancer by 4.4% and 5.4%, respectively, compared to non-drinkers.

Conclusions

We report relative risks of cancer incidence in relation to alcohol consumption that match the international evidence. In Australia, a nation with relatively high alcohol consumption, these risks may translate into a significant public health burden.

Key messages

We have generated estimates for the relationship between alcohol consumption and cancer risk in Australia.
874Impact of overweight on diabetes prevalence: 20-year trends in National Health and Nutrition Survey, Japan
Authors: Sata Mizuki , Sugiyama Daisuke , Hirata Takumi , Horie Saki , Takimoto Hidemi , Okamura Tomonori
Published: September 2021

Background

Increasing trend of diabetes is significant public health threats. This is a consecutive cross-sectional study aimed to estimate the attribution of overweight for diabetes prevalence in Japan.

Methods

We used individual data aged 20 years and older of National Health and Nutrition Survey in 1997 (2349 men and 3588 women), 2002 (2075 and 3087), 2007 (1614 and 2346), 2012 (5538 and 7981), and 2016 (4327 and 6270). Diabetes was defined as glycated haemoglobin (HbA1c) >6.5% or currently being treated. We estimated multivariable-adjusted odds ratio (OR) and 95% confidence interval (CI) for the association between diabetes and overweight (body mass index >25kg/m2) after adjusting for the number of steps per day, total energy intake (kcal/kg), fat energy ratio (%), smoking and drinking status by logistic regression.

Results

There was significant association between diabetes and overweight in all years: multivariable-adjusted OR (95%CI) were 1.78 (1.32-2.40) in 1997, 1.46 (1.10-1.93) in 2002, 1.77 (1.35-2.32) in 2007, 1.79 (1.55-2.07) in 2012, and 2.15 (1.82-2.54) in 2016 for men and 2.53 (1.92-3.32), 2.53 (1.87-3.42), 2.91 (2.15-3.95), 2.94 (2.51-3.45), and 2.72 (2.27-3.25), for women, respectively. The estimated population attribution on diabetes prevalence due to overweight was 14.8%, 11.9%, 18.1%, 18.0%, and 24.6% for men and 27.0%, 29.4%, 29.9%, 29.5%, and 26.7% for women.

Conclusions

Overweight was a risk factor for diabetes consistently for 20 years. That attribution was increasing among men but decreasing after peaking in 2007 among women.

Key messages

The present study suggested a high burden of diabetes due to overweight in Japan.
1161Educational level, attention problems, and externalizing behaviour in adolescence – Social causation versus health-related selection
Authors: Schmengler Heiko , Peeters Margot , Stevens Gonneke W.J.M. , Kunst Anton E. , Hartman Catharina A. , Oldehinkel Albertine J. , Vollebergh Wilma A.M.
Published: September 2021

Background

Social causation and health-related selection may contribute to educational gradients in adolescents’ attention problems (AP) and externalizing behaviour (EB). From past studies it is unclear which of these mechanisms predominates, as AP and EB have the potential to interfere with educational performance, but may also be affected by differences in the educational context. Furthermore, gradients in AP and EB may reflect confounding by stable background characteristics, which are often unmeasured (e.g. genetics). We investigated social causation and health-related selection in the development of educational differences in EB and AP.

Methods

We used data from a Dutch population-based cohort (TRAILS Study; n = 2,229), including measurements of educational level, EB, and AP at ages around 14, 16, 19, 22, and 26 years. We employed cross-lagged panel models with fixed effects. This novel method allowed to evaluate the directionality in longitudinal associations between education, EB, and AP, whilst simultaneously controlling for time-stable individual differences.

Results

AP, but not EB, consistently predicted decreases in subsequent educational level throughout all of adolescence and young adulthood. Regarding social causation, only lower education around age 14 predicted increases in AP around age 16, though this effect was not robust in sensitivity analyses.

Conclusions

AP interfere with educational performance and have the potential to negatively affect adolescents’ educational attainment throughout all phases of adolescence and young adulthood.

Key messages

Interventions to address the impact of AP on education are necessary in all age groups. Hereby, it is important to take developmental differences into account.
1462Second hand smoke exposure in pregnant women in Dehradun, Uttrakhand: A Cross Sectional Study
Authors: Sharma Twinkle
Published: September 2021

Focus of Presentation

Tobacco has always been a major public health issue. Being tobacco a major risk factor for so many diseases, it has also become a matter of concern in current situation of the pandemic. Tobacco smoking is not only harmful for the person who is actively smoking but also to ones who are in the vicinity of that smoke. There is plenty of evidence regarding harmful effects of both tobacco and inhaling tobacco smoke passively. This passive smoke is known as Second Hand Smoke.

The aim of the study was to estimate percentage and sources of Second Hand Smoke exposure among pregnant women. It was a cross sectional study conducted among pregnant women registered at a Primary health centre.

Findings

Out of total participants, 62% were exposed to Second hand smoke. 33% participants were exposed to SHS at home only, 24% at public places only and 5 % were the one exposed both at home and public places. More than half (69%) of the participants were having inadequate knowledge about the harms caused by Second hand smoke

Conclusions/Implications

More than half of the participants were exposed to Second hand smoke. Inadequate knowledge among the participants about adverse effects of SHS exposure and insufficient

Key messages

Smoke-free homes should be promoted and health-care providers should ask pregnant women about their exposure to SHS and inform about the harms of SHS exposure during anti natal visits.
1323Trends in the incidence rates of keratinocyte carcinomas from 1978 to 2018 in Tasmania, Australia
Authors: Ragaini Bruna , Blizzard Leigh , Newman Leah , Stokes Brian , Albion Tim , Venn Alison
Published: September 2021

Background

Keratinocyte carcinomas (KCs), namely basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are the most common cancers in Australia. We describe trends in the incidence of KCs in the state of Tasmania over 41 years.

Methods

We identified histologically confirmed KCs within the Tasmanian Cancer Registry. Age-standardised incidence rates were calculated for first (1985-2018) and annual KCs (1978-2018). Average annual percentage changes were computed using Joinpoint regression models.

Results

A total of 83,536 people were registered with a KC between 1978 and 2018. Age-standardised incidence rates of first KCs increased on average by 3% per annum for BCCs and 4% per annum for SCCs, reaching 363/100,000 and 249/100,000 in 2018, respectively. Age-standardised incidence rates of annual KCs increased on average by 5% per annum for BCCs and 6% per annum for SCCs, up to 891/100,000 and 514/100,000 in 2018, respectively. This increase was steeper for females than males and highest during the late 1980s and early 1990s. A change in trend around 2014 suggested that incidence rates have started to decline.

Conclusions

While the incidence of KCs in Tasmania increased substantially since 1978, it has recently plateaued and started to decline. The findings may reflect changes in sun exposure behaviours due to awareness campaigns.

Key messages

Incidence of KCs has increased in 41 years and despite a recent plateau and decline, KCs still pose a substantial burden to the Tasmanian population.
102Assessing the characteristics of health state utilities among people living with multiple sclerosis
Authors: Campbell Julie , Jelinek George , Weiland Tracey , Nag Nupur , Neate Sandra , Palmer Andrew , Mulhern Brendan , Livera Alysha De , Simpson-Yap Steve
Published: September 2021

Background

While many studies have examined the impacts of multiple sclerosis (MS) on health-related quality-of-life (HRQoL), none have used the SF-6D multi-attribute utility instrument in a large international cohort (>2,000 subjects) of people with MS. Our objective was to derive SF-6D health state utilities (HSUs) for participants of the HOLISM international cohort and to describe the distribution and determinants thereof.

Methods

HSUs were generated using the SF-6D for the Version-1 United States SF-36 for participants with sufficient SF-36 data (n = 2,185/2,466 (88.6%)). Determinants of HSU were evaluated by linear regression, adjusted for age, sex, MS type, disability (Patient-Determined MS Severity Scale), fatigue (Fatigue Severity Scale), and prescription antidepressant use.

Results

Mean HSU for the sample was 0.67 (SD = 0.13) and diminished with increasing MS-related disability. These findings were robust to adjustment, supporting the SF-6D’s discriminatory power in people with MS. Severe disability and clinically significant fatigue were each associated with 11%-lower HSU (95%CI=-0.13,-0.10 & -0.12,-0.10), and depression risk (Patient Health Questionnaire-2) with 10%-lower HSU (95%CI=-0.11,-0.08). Employment, higher socioeconomic and married/partnered statuses, larger social-network size, greater physical activity, vitamin D and omega-3 supplementations were associated with significantly higher HSU, and overweight/obese BMI and tobacco smoking with lower HSU. Age, sex, and education were not associated.

Conclusions

The SF-6D revealed significant discriminatory power for the HOLISM international cohort. Modifiable lifestyle factors including diet, physical activity and supplement use for the international cohort were robustly associated with increased HSU and thus HRQoL. Confirmatory longitudinal HSU evidence could provide further support to our baseline findings using the SF-6D.

Key messages

Health state utilities in this sample of people living with MS were moderate and were significantly lower among those with greater disability, fatigue, and depression, while some lifestyle factors like physical activity and supplement use were associated with higher utility scores.
99Increasing prevalence of primary biliary cholangitis in Victoria, Australia
Authors: French Janine , van der Mei Ingrid , Simpson-Yap Steve , Ng Justin , Angus Peter , Lubel John , Nicholl Amanda , Sood Siddharth , Roberts Stuart , Kemp William , Arachchi Niranjan , Dev Anouk , Thompson Alexander , Gow Paul
Published: September 2021

Background

The prevalence of primary biliary cholangitis (PBC) reported in different countries varies significantly and in some parts of the world appears to be increasing.

The aim of this study was to determine the 2013 prevalence of PBC in Victoria, Australia, and to determine the time trend by comparing it with previous studies undertaken in 1991 and 2002.

Methods

Four case-finding methods were used to identify cases of PBC in Victoria: (1) physicians’ survey; (2) tertiary hospital search; (3) liver transplant database search; and (4) private pathology antimitochondrial antibody search.

Results

The prevalence of PBC in Victoria, Australia, is 189.0 per million using all four methods. The average annual increase in prevalence from 1991 to 2013 was 7.7 per million per year. Using the same case-finding methods as the 1991 Victorian prevalence study (methods 1 and 2), the prevalence of PBC increased from 19.1 per million in 1991 to 49.4 per million in 2002 (P < 0.001) and to 80.7 per million in 2013 (P < 0.001).

Conclusions

The current prevalence of PBC in Victoria is significantly higher than previously reported. The use of private pathology-based case-finding methods is important in identifying the maximum number of PBC cases.

Key messages

PBC prevalence in Victoria increased significantly since previous surveys, to 189 per million persons. Including pathology-based case ascertainment yields improved identification of cases.
1392Decline in current tobacco use and socio-economic inequalities in 22 Sub-Saharan African countries- 2003-2018
Authors: Sreeramareddy Chandrashekhar
Published: September 2021

Background

Tobacco companies have shifted their marketing and production to Sub-Saharan African countries which are in an early stage of tobacco epidemic. We report changes in current tobacco use and socio-economic inequalities between 2003 and 2019.

Methods

We estimated country-level, sex-wise, age-standardized prevalence estimates of current tobacco use in 22 SSA countries using sequential Demographic and Health Survey data. On pooled baseline (2003-11) and most recent survey (2011-19) data, prevalence by education, wealth, and age groups; Slope index of inequality and relative index of inequality were estimated. Change in prevalence in each country and by socio-economic subgroups and change in socio-economic inequalities (pooled data) were calculated.

Results

Tobacco use among men ranging [6·1% (Ghana) to 38·3 (Lesotho)] at baseline and [4·5% (Ghana) to 46·0% (Lesotho)] most recent surveys. Decline in prevalence points ranged from 1·5% (Ghana) to 9·6% (Sierra Leone). For women countries where prevalence was <1% rose from nine to 15. In most countries prevalence of current tobacco use significantly declined. WHO target of 30% decline was achieved in 15 and 10 countries for women and men, respectively. In both sexes, tobacco use rate and decline were higher among less educated and poor while magnitude and direction of inequalities were consistently declined. Absolute inequalities three-fold higher among men, while relative inequalities were nearly twice higher among women.

Conclusions

Tobacco use declined in a third of SSA countries. Persistence of socio-economic inequalities warrants stricter implementation of tobacco control measures to reach the vulnerable groups and continued monitoring of inequalities.

Key messages

Contrary to the projections, tobacco use had significantly declined in most of the countries, and many achieved the WHO target of 30% reduction.

Country-level monitoring by regular surveys is needed to track the equitable progress to international goals.
669Rheumatic Heart Disease outcomes in Australia: a linked data analysis
Authors: Stacey Ingrid , Bond-Smith Daniela , Seth Rebecca , Cannon Jeffrey , Murray Kevin , Ralph Anna , Carapetis Jonathan , Hung Joe , Katzenellenbogen Judith
Published: September 2021

Background

Rheumatic Heart Disease (RHD), a chronic acquired heart-valve disease, is a major contributor to morbidity and mortality among Indigenous Australians. We estimate the probability and determinants of progressing from RHD diagnosis to cardiovascular complications/death in the Australian population, addressing methodological shortcomings in existing evidence.

Methods

This retrospective cohort study used linked RHD register, hospital and death data from five Australian jurisdictions. Cardiovascular complications (heart failure, stroke, endocarditis, atrial fibrillation) and all-cause mortality were measured for people aged <35years diagnosed with first-ever RHD (2010-2018; minimum 8.5year look-back; maximum 8year follow-up). Probability of cardiovascular complications were determined with competing risk of death. Proportional cause-specific hazard regression measured independent predictors of outcomes.

Results

1718 RHD cases aged <35years were identified (85% Indigenous, 11% migrant, 63% women, 40% 5-14years, 16% metropolitan). Within 8years, 22% experienced a cardiovascular complication (50% heart failure) and 3.2% died. Age ≥14years (Hazard Ratio,HR:2.0, 95% Confidence Interval,CI:1.4-3.0) and metropolitan residence (HR:3.2, 95%CI:2.0-5.1) were associated with increased risk of cardiovascular complications in cases (relative to < 14years and non-metropolitan). Record of ARF prior to RHD was protective (HR:0.6, 95%CI:0.4-0.8).

Conclusions

Competing risks methods applied to linked data have provided the most comprehensive multi-jurisdictional estimates of RHD progression to cardiovascular complications/death in Australia. Risk of cardiovascular events was highest in metropolitan areas but clinical history of ARF was associated with reduced risk of progression.

Key messages

Despite access to the world-class Australian healthcare system, one-fifth of initially uncomplicated RHD diagnoses will progress to one of the complications examined within 8years
1391Is outdoor artificial light at night confounding spatial epidemiological studies on greenspace and health?
Authors: Stanhope Jessica , Liddicoat Craig , Weinstein Philip
Published: September 2021

Background

There is a growing body of evidence that exposure to greenspace is good for our health: spending time in greenspace can improve depressive symptoms, obesity, and sleep problems, and reduce the risk of breast and prostate cancer. We also know that exposure to outdoor artificial light at night (O-ALAN) is associated with increased risk of breast and prostate cancer, and can worsen depression, obesity and sleep problems. As both greenspace exposure and O-ALAN have been implicated in the same health outcomes, we aimed to establish if O-ALAN was itself correlated with greenspace, potentially confounding spatial epidemiological studies of greenspace and health outcomes (and vice versa).

Methods

We investigated the correlation between greenspace diversity (Shannon diversity index of National Vegetation Information System’s vegetation classes within 3 km radius buffer zones), and night-time light data (NOAA/NCEI Nighttime Visible Infrared Imaging Radiometer Suite Day/Night Band 2015 Annual Composite product), in Australian major cities.

Results

We identified an inverse correlation between O-ALAN and greenspace diversity.

Conclusions

The finding makes intuitive sense because more developed areas are likely to have fewer trees and more artificial light, which is consistent with our hypothesis that that O-ALAN could be confounding studies of the relationship between greenspace and health. Without considering the potential confounding effects of O-ALAN, public health-driven initiatives such as greenspace conservation and restoration in urban environments may not be optimised for health benefits.

Key messages

Spatial epidemiological studies of greenspace exposure and health should include O-ALAN as a potential confounder (and vice versa).
311Effective prospective study sampling from an existing large-scale national survey using propensity score methods
Authors: Stanley James , Harris Ricci , Cormack Donna , Waa Andrew , Edwards Richard
Published: September 2021

Focus of Presentation

Cohort study recruitment can be complex, often requiring extensive pre-screening to recruit sufficient numbers of exposed and unexposed participants. We discuss a prospective study of the impact of racism on adult health in New Zealand (NZ), with emphasis on propensity-score based sampling and recruitment methods accessing participants from a national survey (NZ Health Survey 2017/18, n = 12,530 eligible adults).

Discussion will cover sampling design, response rate, and confounder balance in the final sample. Key empirical results will be summarised.

Findings

The NZHS provided a sampling frame with complete baseline exposure and covariate data, giving n = 2,099 exposed individuals (reported racial discrimination on NZHS). A propensity-score model (stratified by ethnicity) allowed invitation of unexposed individuals balanced on key sociodemographic confounders.

Recruitment used postal invitations with telephone follow-up: individuals could respond by paper survey, online questionnaire or telephone interview. Response rate was 54%, with comparable rates in exposed/unexposed individuals, with key sociodemographic factors well-balanced by exposure status.

Conclusions/Implications

Racism is an important determinant of health inequity, with limited prospective research in New Zealand. Our approach enabled appropriate recruitment from a sampling frame with baseline exposure status (NZHS), including allowance for exposure variability by ethnicity. Propensity-score matching on baseline covariates allowed for balance on key confounders at invitation, with balance maintained in the final sample.

Key messages

Secondary sampling from large national surveys can provide efficient recruitment for prospective studies. We achieved a highly satisfactory response rate, and propensity-score based sampling substantially balanced confounders between exposed and unexposed groups, enhancing study validity.