bluuebunny/crossref_metadata_2025 huggingface dataset:
1376Modern concepts in the handling and reporting of missing data
Authors: Lee Katherine , Carpenter James , Little Roderick , Nguyen Cattram , Cornish Rosie
Published: September 2021

Focus and outcomes for participants

Missing data are ubiquitous in observational studies, and the simple solution of restricting the analyses to the subset with complete records will often result in bias and loss of power. The seriousness of these issues for resulting inferences depends on both the mechanism causing the missing data and the form of the substantive question and associated model. The methodological literature on methods for the analysis of partially observed data has grown substantially over the last twenty years, and although there is increasing guidance on how to handle missing data, practice is changing slowly and misapprehensions abound, particularly in observational research. Importantly, the lack of transparency around methodological decisions regarding the analysis is threatening the validity and reproducibility of modern research. In this symposium leading researchers in missing data methodology will present practical guidance on how to select an appropriate method to handle missing data, describe how to report the results from such an analysis and describe how to conduct sensitivity analyses in the multiple imputation framework.

Rationale for the symposium, including for its inclusion in the Congress

One of the sub-themes of WCE 2021 is “Translation from research to policy and practice”. Although there is a growing body of literature surrounding missing data methodology, evidence from systematic reviews suggests that missing data is still often not handled appropriately. If practice is to change, it is important to educate applied researchers regarding the available methodology and provide practical guidance on how to determine the best method for handling missing data. An important part of this is providing guidance on the reporting of results from analyses with missing data. This is particularly pertinent given the current emphasis on reproducibility of research findings. In this symposium we bring some of the latest research from the Missing Data Topic Group of the STRengthening Analytical Thinking for Observational Studies (STRATOS) initiative whose aim is to provide accessible and accurate guidance in the design and analysis of observational studies in order to increasie the reliability and validity of observational research.

Presentation program

Names of presenters
1234Smoking, infectious mononucleosis, early-life exposures and risk of progressive-onset Multiple Sclerosis: a case-control study
Authors: Li Ying , Saul Alice , Blizzard Leigh , Taylor Bruce , Ponsonby Anne-Louise , Mei Ingrid van der
Published: September 2021

Background

Risk factors in Multiple Sclerosis (MS) have been identified in samples that contain predominantly cases with relapse-onset MS (ROMS). It is unknown whether the risk factors differ in people with a progressive-onset MS (POMS).

Methods

The case-control study included 147 POMS cases, 264 ROMS cases and 558 community controls. Questionnaires were used to collect information on smoking, infections, breastfeeding and vitamin use in early life. Logistic regression was used to examine associations. Odds ratios (ORs) were adjusted for age, sex and latitude band.

Results

Compared with controls, POMS cases were more likely to have smoked ≥20 pack-years (AOR 2.83, 1.53-5.24) and ROMS cases were more likely to have ever been a smoker (AOR 1.48, 1.09-2.01). POMS cases (AOR 1.75, 1.05-2.93) and ROMS cases (AOR 1.74, 1.21-2.49) were both more likely to have had infectious mononucleosis. In childhood, POMS cases were less likely to use vitamin supplements (AOR 0.52, 0.30-0.91) or being breastfed (AOR 0.49, 0.31-0.79).

Conclusions

Smoking and infectious mononucleosis are associated with increased risk of both POMS and ROMS. Vitamin supplements in early life and being breastfed are associated with reduced risk of POMS, but there is no association in ROMS.

Key messages

POMS and ROMS share some commonly known risk factors. Some protective factors were identified in POMS that were not observed in ROMS.
239Incidence and potential risk factors of a second primary cancer among 217,702 colorectal cancer survivors
Authors: Tseng Yingju , Liang Linda , Klug Stefanie J
Published: September 2021

Background

Survival of colorectal cancer (CRC) has improved markedly but risk of an independent second primary cancer (SPC) increases. We determined incidence and potential risk factors of SPC following CRC.

Methods

We obtained data from 217,202 CRC cases (ICD-10 C18-C20, aged ≥20 years) diagnosed between 1990-2013 from the German Centre for Cancer Registry Data. Cancers arising in a distinct site (excluding non-melanoma skin cancer) and/or of a different histology group were classified as SPCs. Standardised incidence ratios (SIR) and 95% confidence intervals compared the excess risk to the general population, stratified by age, sex and CRC sub-site. Cox proportional hazards models identified potential risk factors of SPC.

Results

Following CRC (median age 70 years), 18,751 SPCs occurred (8.63%; median age 69 years). SPC incidence increased by 36% in males (SIR: 1.36 [1.34-1.38]), 46% in females (SIR: 1.46 [1.43-1.49]) and doubled for cases <65 years (SIR: 2.08 [1.99-2.17]). Common SPC sites following colon cancer included the small intestine, stomach, liver, pancreas, bladder and kidney. Common male-specific sites included prostate and in females: breast, uterus and ovary. Similar sites were observed following rectal cancer, particularly in cases <65 years. Age, male sex and tumour size (T1, T2) were potential risk factors of SPC. Therapy of CRC (including radiotherapy) did not demonstrate an elevated risk.

Conclusions

CRC survivors have an increased risk of SPC, particularly due to age, sex and tumour size.

Key messages

Colorectal cancer survivors have an increased risk of a SPC. Age, sex and tumour size are associated risk factors.
1446Forgoing needed medical care among long-term survivors of childhood cancer: Racial/ethnic-insurance disparities
Authors: Lindsey Lauren , Baedke Jessica , James Aimee , Huang I-Chan , Ness Kirsten , Howell Carrie , Brinkman Tara , Bhakta Nickhill , Ehrhardt Matthew , Im Cindy , Letsou William , Liu Qi , Robison Leslie , Hudson Melissa , Yasui Yutaka
Published: September 2021

Background

Among adult childhood cancer survivors, the relationship between race/ethnicity and health insurance status, as a contributor to disparities in healthcare utilization, is poorly understood.

Methods

We examined racial/ethnic-related disparities by insurance status in “forgoing needed medical care in the last year due to finances” using 3,964 adult childhood cancer survivors (3310 non-Hispanic/Latinx White, 562 non-Hispanic/Latinx Black, and 92 Hispanic/Latinx) participating in the St. Jude Lifetime Cohort Study (SJLIFE). Multivariable logistic regression analyses, guided by Andersen’s Healthcare Utilization Model, were adjusted for “predisposing” (age, sex, childhood cancer diagnosis, cancer treatment, surgery, and treatment era) and “need” (perceived health status) factors. Additional adjustment for income/education and chronic health conditions was considered.

Results

The risk of forgoing care was highest among non-Hispanic/Latinx Blacks and lowest among Hispanics/Latinxs for each insurance status. Among privately-insured survivors, relative to non-Hispanic/Latinx Whites, non-Hispanic/Latinx Blacks were more likely to forgo care (adjusted OR: 1.82, 95% CI: 1.30–2.54): this disparity remained despite additional adjustment for income/education (adjusted OR: 1.43, 95% CI: 1.01–2.01). In contrast, publicly-insured survivors, regardless of race/ethnicity, had similar risk of forgoing care as privately-insured non-Hispanic/Latinx Whites. All uninsured survivors had high risk of forgoing care. Additional adjustment for chronic health conditions did not alter these results.

Conclusions

The findings of this study show that provision of public insurance to all childhood cancer survivors may diminish racial/ethnic disparities in forgoing care that exist among the privately-insured and reduce the risk of forgoing care among uninsured survivors to that of privately-insured non-Hispanic/Latinx Whites.

Key messages

Providing publicly funded health insurance coverage to childhood cancer survivors can reduce disparities in forgoing medical care.
842Prevention of severe preeclampsia at term gestation among women with chronic hypertension
Authors: Lisonkova Sarka , Bone Jeffrey , Muraca Giulia , Razaz Neda , Boutin Amelie , Sabr Yasser , Joseph K.S.
Published: September 2021

Background

Chronic hypertension is a strong risk factor for severe preeclampsia/eclampsia (SPE), and timely obstetric intervention can prevent SPE and reduce perinatal complications. We quantified gestational age-specific rates of SPE and estimated the benefits of preventive interventions among women with chronic hypertension at term gestation (≥37 weeks).

Methods

Women with chronic hypertension and a term, singleton, hospital delivery in Washington State, 2003-2013, were included in the study (N = 9697) with data obtained from birth certificates and hospital records. Adverse outcomes included SPE and composite severe neonatal morbidity (e.g., seizures, intracranial hemorrhage) and perinatal death (SNMM). Preventive interventions included labour induction and pre-labour cesarean delivery.

Results

There were 1026 cases of SPE (10.6 per 100 women with chronic hypertension). Gestational age-specific SPE rates ranged between 2.8 and 4.1 per 100 ongoing pregnancies; the frequency of preventive intervention at each gestational week ranged between 58% and 66%. Gestational age-specific SPE and SNMM rates were lower following preventive intervention: such intervention reduced the frequency of SPE/SNMM by 28 per 100 additional interventions at 37 weeks, 22 per 100 at 38 weeks, 17 per 100 at 39 weeks, 13 at 40 weeks and 6 per 100 additional interventions at 41 weeks’ gestation.

Conclusions

Labour induction and pre-labour cesarean delivery at term gestation can prevent a substantial proportion of severe preeclampsia/eclampsia and perinatal death/severe neonatal morbidity among women with chronic hypertension.

Key messages

SPE occurs in approximately 11% of women with chronic hypertension at term gestation. Obstetric interventions can prevent SPE and improve adverse pregnancy outcomes.
225Association between phytosterol consumption esophageal cancer risk
Authors: Liu Xudong , Sun Liping , Zhao Wenjing
Published: September 2021

Background

Phytosterols have anticancer effects and have been shown to inhibit various forms of cancer. However, epidemiological studies on the relationship between phytosterols and esophageal cancer risk are quite limited. The aim of this study was to investigate dietary phytosterol intake in relation to esophageal squamous cell carcinoma (ESCC) in the Chinese population.

Methods

A case–control study was conducted from July 2011 to June 2013, recruiting 856 eligible ESCC cases plus 856 controls. Dietary information was collected by using a validated food frequency questionnaire. The OR and 95% CI of ESCC risk were assessed by multivariable logistic regression models.

Results

The total phytosterols was found to be associated with a 56% (95% CI: 0.32- 0.61) reduction in ESCC risk when comparing the highest with the lowest tertiles, after adjusting for various confounders. An inverse association was also found between the consumption of β-sitostanol, β-sitosterol, campesterol and ESCC risk. No statistically significant association was found between rapesanol and ESCC risk.

Conclusions

These data indicated that the consumption of total phytosterols, β-sitostanol, β-sitosterol, campesterol is inversely associated with ESCC risk in a Chinese population

Key messages

Phytosterols consumption may contribute to the prevention of esophageal squamous cell carcinoma
464Basics of survival analysis: age is not appropriate as time scale in Cox regression model
Authors: Liu Yangyang , Zhang Jingjing , Mitsuhashi Toshiharu , Matsuo Toshihiko , Yorifuji Takashi , Hamada Jun
Published: September 2021

Background

Many previous methodological studies suggested to use age as time scale in Cox regression model, and some statistical analyses directly applied this conclusion. In the present study, we explain why age is not a more appropriate time scale compared to the time-on-study time scale.

Methods

We address this argument based on five aspects: Cox regression model, conditional likelihood estimation, dataset of left-truncation or right-censoring, algorithms and software for Cox model, and inferring survival function. Furthermore, logical and algorithmic errors arise in the procedure of parameter inference with age time scale, and that certain evaluation indicators proposed by previous studies are inappropriate.

Results

The function of time scale is mainly a sampling method for maximum likelihood estimation to infer coefficient of Cox regression model, and the method defined by the age time scale is incorrect in logics and algorithms. Furthermore, age as time scale creates new problems, such as the omission of covariates, loss of information as a continuous variable, increase in dropout, and inability to obtain the survival function.

Conclusions

For the Cox regression model, the classic time-on-study time scale is more appropriate compared to age as time scale.

Key messages

It is an important discussion because using age as time scale was first proposed decades ago, meaning that lots of turnovers in researchers, newbies tend to accept the assumptions of their predecessors, but the suitability has never been rigorously verified.
294Epidemiological characteristics of falls among older people: results from Chinese National Injury Surveillance System
Authors: Lu Zhiming ,   Yuan Wang,   Pengpeng Ye,   Yuliang Er,   Leilei Duan
Published: September 2021

Background

Falls are among the most frequent critical health problems for older people. Fall-related injuries are a significant cause of mortality in older people. Understanding the epidemiological characteristics of falls among older people in China is an important basis for falls prevention.

Methods

Descriptive analysis was applied on general information, injury occurrence and injury clinical characteristics by using the data of people □ 60 years of age from National Injury Surveillance System (NISS).

Results

In total, 205 670 cases of falls were collected by NISS from 2015 to 2018, with the gender ratio of 1.37. Falls mainly occurred during 10:00-10:59 AM (11.9%). The top three major places where falls might occur were home (56.4%), the road (17.2%) and public residence (14.4%). Leisure activities (37.6%), housework (24.2%) and walk (15.1%) were top three activities when falls occurred. The most common body parts of falls involved were low limbs (31.4%), head (22.5) and truncus (20.7%). Bruise/ scrape (42.2%), fracture (31.8%) and sprain/ strain (14.6%) were the major nature of injury. Moderate and severe injuries accounted for 37.2% of all cases.

Conclusions

The number of falls among people □ 60 years of age from NISS has increased from 2015 to 2018. Further scientific research on the epidemiological characteristics, risk factors and falls prevention should be conducted.

Key messages

This data is from Chinese National Injury Surveillance System and results can provide basis for the formulation of corresponding policies.
442A scoping review to identify physical activity cohort studies for the Physical Activity Cohort Repository (PACe)
Authors: Lynch Brigid
Published: September 2021

Background

The Physical Activity Cohort Repository (PACe) project was initiated by the Epidemiology Council of the International Society of Physical Activity (ISPAH). The project will create a central database of cohort studies with at least 1,000 participants that have collected data on physical activity (self-reported and/or accelerometer measures) at three or more timepoints, to facilitate physical activity epidemiology research worldwide.

Methods

A scoping review commenced in January 2020 to identify relevant cohort studies in PubMed and Web of Science. All titles and abstracts identified in the search were screened, and data are to be extracted by two authors. Data to be extracted include: cohort size; location; years of baseline recruitment; broad demographics of the cohort; how and when physical activity was measured; clinical measures; biological samples; cohort profile publication; and information on how to request access to the data (if applicable).

Results

Our scoping search identified 8,992 articles. From the 851 papers from studies meeting the eligibility criteria, we have identified 409 unique cohort studies. We anticipate having the PACe online database completed and accessible by the end of 2021.

Conclusions

The PACe will help to maximize the investments made into cohort studies, by encouraging researchers to return to mature cohorts and apply contemporary methods to physical activity-related research questions. The PACe will also facilitate international collaborations and help build capacity in low- and middle-income countries.

Key messages

The PACe will be a searchable catalogue of cohort studies that have included self-reported and/or accelerometer measures of physical activity.
272Transdiagnostic Risk and Protective Factors for Psychopathology in Young People: A systematic review
Authors: Lynch Miss Samantha , Sunderland Matthew , Newton Nicola C , Chapman Cath
Published: September 2021

Focus of Presentation

Mental health and substance use disorders are among the leading causes of burden of disease worldwide. These disorders often emerge during adolescence, with risk of onset peaking between the ages 13 and 24. Despite decades of research, the underlying causes of mental health disorders remain unclear. This in part may be due to limitations of existing, categorical diagnostic systems, such as low specificity demonstrated by the high rates of co-occurring mental health disorders. A growing body of research supports a move towards dimensional, empirically derived models of psychopathology, such as the Hierarchical Taxonomy of Psychopathology (Hi-TOP) model. The present systematic review seeks to identify risk and protective factors for psychopathology in young people that occur across traditional diagnostic categories by synthesising and evaluating findings from research investigating empirically based models of psychopathology.

Findings

Findings will be summarised in a narrative synthesis and grouped by broad research domain, such as genetic, neurobiological, cognitive social and environmental.

Conclusions/Implications

The implications of these findings for the development of prevention and early intervention programs will be discussed.

Key messages

Empirically based models of psychopathology provide a vital opportunity to advance our knowledge of the risk and protective factors for mental health and substance use disorders, and in turn lead to the development or enhancement of prevention programs.
1500Determinants of dietary behaviour and physical activity in Australian adolescents
Authors: Marjanovic Sandra , Munasinghe Sithum , Sperandei Sandro , Jani Hir , Conroy Elizabeth , Freebairn Louise , Page Andrew
Published: September 2021

Background

The increased prevalence of obesity, unhealthy diet and sedentary lifestyles among Australian adolescents has become a public health concern. This study investigated the associations between socio-economic status, screen-time, social networks, sleep, and wellbeing and subsequent health behaviours.

Methods

A cohort of 582 adolescents aged 13-19 years from Sydney were prospectively followed for 22-weeks (8 November 2019 – 19 April 2020). Study factors were collected via mobile phone app using weekly ecological momentary assessments (EMAs). Multi-level mixed effects logistic regression model assessed associations between baseline characteristics of participants, socio-economic status, screen-time, sleep, and wellbeing and subsequent dietary behaviour and physical activity.

Results

TV watching (odds ratio [OR]=1.22, 95% CI: 0.98-1.5), social media and internet use (OR = 1.22, 95% CI: 0.97-1.53) were associated with fast food consumption. Participants who spent more than four hours a day on social media were also less likely to be physically active for ³60 minutes (OR = 0.75, 95% CI: 0.6-0.94). Fast food consumption was associated with lower vegetable (OR = 0.61, 95% CI: 0.43-0.85) and fruit intake (OR = 0.78, 95% CI: 0.61-1.01), and was also more prevalent in participants with a job (OR = 1.42, 95% CI: 1.09-1.86). There was no substantial effect of psychological distress, positive emotions, social relationships and sleep on any health behaviour.

Conclusions

The present study has shown that lifestyle behaviours had a stronger effect on dietary behaviour and physical activity than some of the socio-demographic factors.

Key messages

Future studies with a balanced sample in terms of sex, age and cultural background are needed.
670Lifestyle risk factors for hepatocellular carcinoma in treated chronic hepatitis C patients
Authors: Matsuura Tomoka , Ohfuji Satoko , Enomoto Masaru , Tamori Akihiro , Kubo Shoji , Kioka Kiyohide , Fukushima Wakaba
Published: September 2021

Background

The purpose of this study was to identify lifestyle risk factors, such as cigarette smoking and alcohol consumption, associated with the development of hepatocellular carcinoma (HCC) among chronic hepatitis C patients who have achieved a sustained virological response (SVR).

Methods

This cross-sectional study was conducted between 2014 and 2017 using self-administered questionnaires and medical information at two tertiary hospitals in Osaka, Japan. Study subjects were chronic hepatitis C patients who had achieved SVR following antiviral treatment that was completed more than 1 year earlier. A logistic regression model was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for post-SVR HCC.

Results

Of 202 participants, 18 had been diagnosed with post-SVR HCC. After considering potential confounders, former drinkers at the time of SVR (OR, 9.51; 95%CI, 1.08 to 83.90), and patients with a history of gastric or duodenal ulcer (OR, 4.14; 95%CI, 1.37 to 12.46) were significantly associated with HCC. Among patients with severe fibrosis, current smokers at the time of SVR had an increased OR for HCC compared with non-smokers, with marginal significance (OR, 5.61; 95%CI, 0.97 to 32.63).

Conclusions

In chronic hepatitis C patients with severe fibrosis, continued smoking could be a risk factor for post-SVR HCC. The relationship between gastric or duodenal ulcer history and post-SVR HCC should be investigated further.

Key messages

Smoking cessation may be preferred for chronic hepatitis C patients with severe fibrosis to prevent post-SVR HCC.
875Association between dietary inflammatory index and sleep duration
Authors: Melaku Yohannes Adama , Appleton Sarah , Reynolds Amy , Gill Tiffany , Adams Robert
Published: September 2021

Background

Diet and sleep are strongly and bidirectionally linked. This study aims to assess the association between dietary inflammatory index (DII) and sleep duration using the National Health and Nutrition Survey (NHANS) of the United States.

Methods

A total of 27,999 (median age 47 years, 48.6% male) participants were included. Dietary data were collected using 24-hour recall method and DII was calculated using 27 nutrients. Quantiles of DII were constructed (quantile 1, least inflammatory; quantile 5, most inflammatory). Self-reported habitual sleep duration was categorized as ≤ 6 hr (short sleep), ≥7 hr (normal/long sleep). We used log-binomial and multinomial logistic regression, adjusted for potential confounders, to examine the association between DII and short sleep duration. Sensitivity analysis was performed by excluding common chronic diseases. The analyses were adjusted using NHANES sampling weights.

Results

In the fully adjusted model, higher DII score was associated with shorter sleep duration [odds ratio (OR)quartile2vs1=1.04; 95% confidence interval (CI): 0.84-1.29; ORquartile3vs1=1.27; 95% CI: 1.06, 1.52; ORquartile4vs1=95% CI: 1.47; 95 CI: 1.25, 1.74; ORquartile5vs1=1.62; 95% CI: 1.33, 1.97; P for trend<0.0001]. A similar trend of association was observed with long sleep duration and in both male and female participants. Participants in the fifth quantile, compared to those in the first, on average had 6 minutes (95% CI: 1, 11) less sleep.

Conclusions

Pro-inflammatory diet was positively associated with increased odds of short sleep duration.

Key messages

Patients with short sleep duration may benefit from avoiding pro-inflammatory foods. The association between DII and sleep duration could be bidirectional.
66Adverse birth outcomes associated with ambient air pollution at levels below air quality guidelines
Authors: Melody Shannon , Wills Karen , Knibbs Luke , Ford Jane , Venn Alison , Johnston Fay
Published: September 2021

Background

Gaps exist concerning the relationship between maternal exposure to air pollution and birth outcomes, including the importance of low-level exposure. We aimed to explore the association between maternal exposure to ambient nitrogen dioxide (NO2) and fine particulate matter (PM2.5) and selected birth outcomes in Victoria, Australia.

Methods

We included all births occurring in Victoria, Australia from 1st March 2012 to 31st December 2015 using routinely collected government data. Outcomes included birthweight, small for gestational age (SGA), term low birth weight (tLBW), large for gestational age, and spontaneous preterm birth. Annual ambient NO2 and PM2.5 was assigned to maternal residence at birth. Maternal, meteorological and temporal variables were included in final log-binomial models.

Results

There were 285,594 births. Average annual ambient NO2 exposure was 6.0 parts per billion (ppb, IQR 3.9 ppb) and PM2.5 was 6.9 µg/m3 (IQR 1.3). IQR increases in ambient NO2 and PM2.5 were associated with fetal growth restriction, including decrements in birth weight, increased risk of SGA and tLBW. Women with gestational diabetes and hypertensive disorders of pregnancy had greater decrements in birth weight associated with exposure.

Conclusions

Maternal exposure to low-level ambient air pollution at levels below national and international air quality guidelines was associated with fetal growth restriction.

Key messages

Exposure to low-level ambient air pollution was associated with fetal growth restriction and women with obstetric complications were more susceptible.

These findings may inform iterative revisions of air quality guidelines.
111“Place standard” depicts the social gradient in the neighbourhood environment in Cyprus
Authors: Middleton Nicos , Kleopa Daphne , Panayiotou Andrie , Kaifa Chrystalla , Nicolaou Christiana , Kouta Christiana
Published: September 2021

Background

Census data, GIS, surveys and audits are used to profile “place”, each with shortcomings. There are several “neighbourhood environment” tools, including the “Place Standard” a policy and advocacy tool developed in Scotland. “Place” is not a strong feature in the public health agenda in Cyprus.

Methods

In an internet survey, participants rated 14 features of their neighborhood environment. Exploratory factor, cluster and regression analysis were used to explore the dimensionality of the concept, neighborhood profiles and differences according to individual and area-level characteristics.

Results

With the exception of safety (M = 4.4, SD = 1.7 on a 1: large to 7: little improvement), 492 participants (mean age 42, 50% residents for >10 years) from 266 postcodes (33% islandwide) did not rate other features favourably. A clear dimensionality of Built, Physical, Social and Service environment supports the construct validity of the tool. People who rated their neighbourhood lower on a social position ladder were consistently more likely to rate all contextual neighrbourhood features less favourably. The social gradient was evident according to individual and area measures of socio-economic disadvantage and appeared stronger in terms of the built than the social environment.

Conclusions

The “place standard” shows good metric properties and captures the variability ad inequity in the neighbourhood environment.

Key messages

The “Place Standard” can be used to profile the context of health inequalities.

Evidence of a social gradient across all features with larger differences in terms of the built environment.
217Using excess heat factor to measure effect of heatwave severity on foodborne disease incidence
Authors: Milazzo Adriana
Published: September 2021

Background

This study aims to analyse the distribution characteristics of ideal cardiovascular health (ICH) metrics status of the oldest-old and centenarians, and also to explore the relationships with disability and quality of life.

Methods

1002 centenarians and 798 oldest-old were included in the analysis. ICH, disability and quality of life were assessed according to standard methods.

Results

The median number of ICH metrics among centenarians and oldest-old were 4 (4-5) and 3(3-5) respectively. The highest proportion of ICH metrics at ideal levels were glucose (90.2%), BMI (89.8%), and smoking (89.4%), the lowest proportion of ICH metrics at ideal level was blood pressure (8.3%). The disability rates of BADL and IADL decreased with the number of ICH metrics. BADL disability changed from 100.0% to 73.2%, and the IADL disability rate dropped from 100% to 80.0%. BADL disability rate decreased from 45.0% to 25.3% and IADL disability decreased from 100.0% to 57.1% among the oldest-old. The EQ-5D vas, EQ-5D score showed increasing trend along with the number of ICH metrics (p < 0.05). Compared with centenarians who had only 0-2 ICH metrics, the ORs for BADL disability were 0.82, 0.66, 0.52, 0.44, and the ORs for IADL disability were 0.74, 0.65, 0.58, 0.41 for those with 3, 4, 5, ≥6 ICH metrics.

Conclusions

ICH metrics of centenarians and oldest-old were at a relatively good level, and there was a strong and independent inverse relationship between ICH metrics with both disability and lower quality of life.

Key messages

This was the first survey about the distribution of ICH metrics and association with both disability and quality of life based on elderly aged over 80 years old. The results highlighted the importance of cardiovascular prevention even at 80 years and over, which made up for the evidence gap based on this age group.
1127Uncontrolled hypertension among patients with comorbidities in sub-Saharan Africa; pooled analysis using individual participant data
Authors: Mohamed Shukri
Published: September 2021

Background

Despite the numerous studies on hypertension, the current literature reveals little about the relationship between patient comorbidities and uncontrolled hypertension in sub-Saharan Africa (SSA). We aimed to assess the associations between body size, dyslipidemia, diabetes and uncontrolled hypertension.

Methods

We harmonised and pooled individual-level data from 25 cross-sectional studies. We did a meta-analysis of individual participant data to assess the association between uncontrolled hypertension with body size, diabetes and dyslipidemia using a logistic regression while adjusting for potential confounders.

Results

The pooled dataset included 107,339 participants, of whom 64,811 were women and 42,528 were men. The pooled prevalence of uncontrolled hypertension (UHTN) among those on treatment was (3,449) 59.89%. The UHTN estimate ranged from 47.0% in Malawi to 80.0% in Guinea. Significant association were noted between UHTN and diabetes for all countries. The overall pooled estimate for UHTN among patients with diabetes was OR = 1.49 (95% CI 1.30 to 1.67). All countries had significant associations between UHTN and central obesity except for Gambia, Kenya and Tanzania. Study participants from Uganda with central obesity had the highest likelihood of UHTN OR = 1.14 (95% CI 0.38 to 1.89). All countries had significant associations between UHTN and general obesity except for Kenya, Tanzania and Uganda.

Conclusions

The prevalence of uncontrolled hypertension among patients with comorbidities is high in SSA.

Key messages

Effective strategies to improve blood pressure control among patients with chronic comorbidities are needed.
439Reproducibility and relative validity of dietary patterns in older New Zealand adults
Authors: Mumme Karen , Conlon Cath , Hurst Pamela von , Jones Beatrix , Seymour Jamie de , Stonehouse Welma , Heath Anne-Louise , Coad Jane , Haskell-Ramsey Crystal , Beck Kathryn
Published: September 2021

Background

Valid and reproducible dietary patterns (DP) are necessary to assess relationships between diet and disease. This study, Researching Eating, Activity, and Cognitive Health (REACH), assessed the reproducibility and relative validity of DPs derived from a food frequency questionnaire (FFQ) in older New Zealand adults.

Methods

Participants (n = 294, 70±3yrs, 37% male), completed two identical 109-item FFQs to assess reproducibility. A 4-day food record (4DFR) was used to assess relative validity. After collapsing data into 57 food groups, DPs were derived using principal component analysis. Agreement of DP loadings were assessed using Tucker’s congruence coefficient. Agreement between derived DP scores from the FFQs and 4-DFR were assessed using Spearman correlation coefficients, weighted kappa statistic, and Bland-Altman analysis.

Results

Three similar DPs (‘Mediterranean style’, ‘Western’ and ‘prudent’) were identified from each dietary assessment tool. Congruence coefficients between DP loadings ranged from 0.66-0.80 (reproducibility) and 0.54-0.75 (validity). Correlations of DP scores ranged from 0.47-0.59 (reproducibility) and 0.33-0.43 (validity) (all P<0.001); weighted kappa scores ranged from 0.40-0.48 (reproducibility) and 0.27-0.37 (validity); limits of agreement from ±1.79 to ± 2.09 (reproducibility) and ±2.09 to ± 2.27 (validity); a negative slope of bias was seen in the ‘prudent’ pattern for reproducibility and validity (P<0.001).

Conclusions

The FFQ derived DPs demonstrated acceptable reproducibility and relative validity and can be used to examine associations between DPs and health outcomes in older New Zealand adults.

Key Message

Valid DPs improve evidence for assessing DP and health outcome associations.
1159Inequities in on-time childhood vaccination: Evidence from sub-Saharan Africa
Authors: Mutua Martin
Published: September 2021

Introduction

Vaccination coverage has improved over the past decade but inequalities persist; the poorest, least educated, and rural communities are left behind. Programming has focused on increasing coverage and reaching the hardest to reach children but vaccination timeliness is equally important as delays leave children vulnerable to infections. This study examines the levels and inequities of on-time vaccination in the sub-Saharan African (SSA) region.

Methods: The most recent Demographic and Health Surveys or Multiple Indicator Clusters Surveys since 2000 from SSA were used to assess on-time vaccination and inequalities by household wealth, maternal education, and place of residence. Inequalities were quantified using slope index of inequality and concentration index.

Results

The analysis included 153,632 children aged 12-36 months from 40 SSA countries. Median on-time vaccination coverage was below 50% in all four sub-regions. Differences in on-time vaccination were observed by place of residence in Southern (20.8 pp, 95%CI (0.8; 40.8)), West (17.5 pp, 95%CI (5.1; 29.9)), and Eastern (20.9 pp, 95%CI (6.5; 35.2)) regions. Wealth-related inequities were observed in Southern (22.6 pp, 95%CI (4.0; 41.2)), West (30.6 pp, 95%CI (19.1; 42.1)), and Eastern (26.1 pp, 95%CI (8.2; 44.0)) regions. Significant education-related differences in on-time vaccination were observed in West (20.7 pp, 95%CI (10.9; 30.5)), and Eastern (21.2 pp, 95%CI (7.0; 35.4)) regions.

Conclusions

On-time vaccination coverage was low in all sub-regions and nearly all countries. Inequalities in on-time immunization by household wealth, place of residence, and education existed in most countries. Concrete strategies to improve levels of timeliness are needed
647Use of menopausal hormone therapy before and after ovarian cancer diagnosis and ovarian cancer survival
Authors: Na Nina Renhua , Jordan Susan J , Obermair Andreas , Webb Penelope M ,   for the OPAL Study Group
Published: September 2021

Background

Menopausal hormone therapy (MHT) use before ovarian cancer (OvCa) diagnosis has been suggested to improve survival but data on type, duration and use after treatment for OvCa are scarce.

Methods

We investigated MHT use and OvCa survival among participants with newly diagnosed OvCA in the Ovarian cancer Prognosis And Lifestyle (OPAL) Study. Analysis of pre-diagnosis use was restricted to 661 post-menopausal women and analysis of post-diagnosis use included 254 women aged ≤55-years. We used multivariable Cox proportional hazards regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between MHT and OvCa-specific survival. We used propensity score-based approaches to account for potential bias due to confounding by indication.

Results

Approximately 14% of post-menopausal women were current/recent users of oestrogen-only (7%) or oestrogen-progestin/unknown MHT (E-P=7%) at the time of diagnosis. In the pre-diagnosis analysis, E-P use was associated with better survival (HR = 0.60, 95%CI=0.37-0.98; HR = 0.93, 95%CI=0.79-1.09 per 5-years/use). The association between oestrogen-only MHT and survival was weaker and non-significant (HR = 0.74, 95%CI=0.47-1.16). Among women ≤55-years at diagnosis, the HR was 0.91 (95%CI=0.50-1.67) for new use after diagnosis regardless of type; and 0.89 (95%CI 0.51-1.54) for any use post-diagnosis compared to never users. Propensity-score-based methods showed similar estimates.

Conclusions

Pre-diagnosis MHT use is associated with better ovarian cancer survival. Post-diagnosis MHT use might also improve survival for women younger than 55-years, even after accounting for bias due to confounding by indication.

Key messages

Menopausal hormone therapy may be considered to manage menopausal symptoms in women with ovarian cancer.
1255Associations between select lifestyle behaviours and quality of life based on MS phenotype
Authors: Nag Nupur , Yu Maggie , Simpson-Yap Steve , Neate Sandra , Schmidt Hollie
Published: September 2021

Background

Multiple sclerosis (MS) comprises progressive and non-progressive phenotypes, both presenting with symptoms that may reduce quality of life (QoL). Lifestyle behaviours, including diet, exercise, and wellness activities, are associated with higher QoL, however little is known about differences by MS phenotype. We assessed associations between lifestyle behaviours and QoL, between progressive vs non-progressive MS.

Methods

Self-reported cross-sectional data from the iConquerMS study (n = 1,109) were analysed. Lifestyle behaviours were queried via tick-box options for diet-type, supplement use, and wellness activities; and physical activity via Godin-Shephard Leisure-Time Physical Activity Questionnaire. QoL was queried via Neuro-QoL. Linear regression, adjusted for age, sex, BMI, education, disability, and MS duration, was used to assess associations and moderation analyses to assess differences between MS phenotypes.

Results

Diet-type, physical activity, and wellness activities were associated with specific QoL subdomains. Only associations between diet and physical activity, with QoL subdomains, differed between phenotypes. Anti-inflammatory diets were associated with a 1.5-point increase in mobility in progressive MS. In non-progressive MS, high physical activity was associated with a 3.6-point decrease in depression, and a 4.2-, 2.3- and 3.0-point increase in positive affect, fine motor skills, and social participation, respectively.

Conclusions

Specific lifestyle behaviours were associated with QoL subdomains. Associations between diet and physical activity with QoL differed between MS phenotype.

Key messages

Specific lifestyle behaviours are associated with higher QoL. Lifestyle interventions for MS management should consider disease course.
74Relationship of higher-level functional capacity on long-term mortality in Japanese population: NIPPON DATA90
Authors: Nagata Hideki , Miura Katsuyuki , Tanaka Sachiko , Kadota Aya , Hayakawa Takehito , Takashima Naoyuki , Kita Yoshikuni , Kondo Keiko , Okayama Akira , Okamura Tomonori , Ueshima Hirotsugu
Published: September 2021

Background

Little is known about the relationships between higher-level functional capacity (HLFC) and mortality, and its gender difference.

Methods

NIPPON DATA90 is the cohort study of the National Cardiovascular Survey of Japan in 1990. We followed up 1824 Japanese adults over 65 years who were independent in basic activities of daily living in 1995 until 2010. HLFC was measured in 1995 using the total score and 3 subscales (instrumental activities of daily living [IADL], intellectual activity, social role) by the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC). The association of HLFC to mortality was evaluated by adjusted hazard ratio (HR) and 95% confidence interval (CI) using the Cox proportional hazard model.

Results

During average 12.2-year follow-up, 836 participants (45.8%) died. Participants with impaired total TMIG-IC score showed significantly higher risk of mortality (adjusted HR 1.37; 95%CI 1.14-1.66) compared with normal participants, even after adjusting for other variables. The corresponding HR was significant only in women (HR 1.42; 95% CI 1.10-1.83). Among the 3 subscales, only impaired social role showed significantly higher risk of mortality (HR 1.37; 95%CI 1.12-1.67) in men. In contrast, IADL and intellectual activity showed significantly higher risk in women (HR 1.51; 95%CI 1.16-1.96) (HR 1.46; 95%CI 1.19-1.80).

Conclusions

Impaired HLFC was related to higher risk of long-term mortality in Japanese elderly at baseline. Especially among women, IADL and intellectual activity were important predictors, whereas social role was important in men.

Key messages

Impaired HLFC was related to long-term mortality in Japanese elderly.
1371Ambient air pollution and adverse birth outcomes: a systematic synthesis of meta-analyses of epidemiological studies
Authors: Nyadanu Sylvester Dodzi , Dunne Jennifer , Tessema Gizachew Assefa , Mullins Ben , Duko Bereket , Pereira Gavin
Published: September 2021

Background

We conducted the first umbrella review of meta-analyses on the association between in utero exposure to ambient air pollution and adverse birth outcomes.

Methods

We systematically searched for meta-analyses on criteria air pollutants (NO2, CO, O3, SO2, and PM2.5 and PM10) and adverse birth outcomes (preterm birth, stillbirth, reduced birth weight, low birth weight, and small-for-gestational age) from PubMed, CINAHL, Scopus, MEDLINE/Ovid, EMBASE/Ovid, Web of Science, systematic reviews repositories, electronic grey literature, and references on 21st September 2020 with weekly alerts thereafter. We graded the overall direction and confidence of cause-and-effect as per our pre-specified protocol (Doi:10.3390/ijerph17228658).

Results

Sixteen (16) meta-analyses, pooling 192 unique primary studies with moderate (9.0%) overlap qualified for the final synthesis. Consistent positive associations were reported between whole pregnancy exposure to PM2.5/PM10 and birth weight reduction and between CO/SO2 and low birth weight and were graded as strong ( ++). There were less consistent associations between whole pregnancy PM2.5/NO2 exposures with PTB, and for all criteria pollutants with stillbirth, hence graded moderate (+). Evidence for associations with trimester specific exposures were also moderate (+). However, meta-analyses observed high heterogeneity, high imprecision, and lacked experimental studies. Consequently, taken together, the current observations indicate ‘probable evidence’ of causation.

Conclusions

Current observations indicate ‘probable evidence’ of causation. Further studies with standardised designs would help elucidate reasons for heterogeneity of associations.

Key messages

In the absence of randomised controlled trials, the strong observational evidence for associations between ambient air pollution and adverse birth outcomes warrants adoption of the precautionary principle.
622Low birthweight prediction is not improved by repeated measures of gestational weight: the BOSHI study
Authors: Oba Mari S , Murakami Yoshitaka , Sato Michihiro , Murakami Takahisa , Iwama Noriyuki , Ishikuro Mami , Obara Taku , Imai Yutaka , Hoshi Kazuhiko , Ohkubo Takayoshi , Metoki Hiroto
Published: September 2021

Background

Both pre-pregnancy body mass index and total weight gain during pregnancy are known risk factors for perinatal outcomes. However, little is known if repeated measurements of gestational weight gain can be utilized in the prediction of perinatal outcomes. We examined whether repeated measures of gestational weight improve the prediction of low infant birthweight.

Methods

Using data from the BOSHI study, we developed prediction models with low infant birthweight (<2500 g) as the outcome and gestational weight gain as the exposure of interest. A prediction model (Model 1) using only baseline values (pre-pregnancy body mass index) as the exposure was compared with a model using baseline and the last weight measurement (Model 2) and a model using baseline and trimester-specific measurements (Model 3). Model performance was assessed using c-statistics, Brier scores, and calibration plots.

Results

Among women who experienced full-term deliveries and had measured weights, the proportion of low infant birthweights was 5%. The c-statistics of Model 1, Model 2, and Model 3 were 0.78, 0.81, and 0.83, respectively. Other assessments were relatively unchanged. The extent of predictive performance improvement depends not only on the exposure-outcome associations but correlations among exposure measurements.

Conclusions

The inclusion of repeated gestational weight measurements in a model for predicting low infant birthweight only produced a marginal improvement in predictive performance.

Key messages

The prediction of low infant birthweight is not substantially improved by using repeated measurements of gestational weight.
428Prevalence and forms of Intimate Partner Violence in WLWHA and HIV negative women in Umuahia
Authors: Odini Franklin , Emma-Ukaegbu Uloaku , Nwamoh Uche
Published: September 2021

Background

Intimate Partner Violence (IPV) is the range of sexually, psychologically and physically coercive acts used against adult and adolescent women by a current or former male partner. IPV is the commonest form of violence against women and one of the most pervasive human rights abuses against women. The UN reported that 1 in 3 women had experienced physical/sexual violence at some point in their lives and 2 in 3 victims of intimate partner homicide are women.

This study is aimed at determining the prevalence and forms of IPV affecting WLWHA and HIV negative women in Umuahia, Nigeria.

Methods

A comparative cross-sectional study involving 200 WLWHA and 200 HIV negative women in Umuahia using systematic random sampling method. An interviewer-administered questionnaire was deployed for data collection. Data analysis was done using IBM SPSS.

Results

A total of 115 (57.5%) WLWHA compared to 73 (36.5%) of the HIV negative women had suffered from any form of IPV. Furthermore, a higher proportion of WLWHA suffered emotional (50.0%), physical (39.0%) and sexual (28.5%) IPV, compared to 31.5%, 17.5% and 12.0% respectively for HIV negative women.

Conclusion

IPV occurs in both groups of women but much higher in WLWHA. Primary prevention interventions aimed at prevention and reduction should be instituted especially amongst WLWHA. Health care settings should be equipped to ensure a comprehensive response whenever IPV is detected.

Keywords

Intimate Partner Violence, Prevalence, Forms.