bluuebunny/crossref_metadata_2025 huggingface dataset:
1194WebGIS in epidemiology: Lessons from LionVu Usability Assessment within Pennsylvania, United States
Authors: Geyer Nathaniel , Kessler Fritz , Lengerich Eugene
Published: September 2021

Focus of Presentation

LionVu, a web-based mapping tool using Leaflet JavaScript, was recently redesigned to better meet the needs of clinical, educational, and epidemiological audiences within Pennsylvania, United States, containing publicly available health-related and demographic data sets. In addition, the LionVu Usability Assessment, a 50-question online survey, was conducted to assess whether LionVu’s functionality and improved interface met the needs of its intended audiences. The aim of this qualitative data analysis was to assess the themes of the open-ended questions of the LionVu Usability Assessment to improve the tool.

Findings

Invitations to the LionVu Usability Assessment were sent in Spring 2020 (n = 123), with 23 who began (55% female), but only 10 completed the survey. The 23 participants were from academia (n = 10), professional settings (n = 10) or missing (n = 3). Six themes emerged as critical to improve LionVu’s functionality: improving documentation and training materials, enhancing map customizability, including tabular displays below the maps, adjusting the colour schema, saving outputs as files, and displaying maps side-by-side.

Conclusions/Implications

LionVu fills a niche in the health community by giving clinical, educational, and epidemiological audiences the ability to visualize and utilize health data at various levels of aggregations and geographical scales (i.e., state, county, zip code, etc.). Novel applications like LionVu can serve data for future purposes such as mapping and graphing in epidemiology.

Key messages

The usability study of LionVu provided important feedback for its future development. Lessons and best practices on developing comparable WebGIS applications, for clinical, educational, and epidemiological audiences, are addressed.
1515Screened blood pressure and its associated factors among adolescents
Authors: Ghammem Rim , Soua Sarrah , Zammit Nawel , Fredj Siheme Ben , Nasrallah Cyrine Ben , Misbah Rania , Maatoug Jihene , Ghannem Hassen
Published: September 2021

Background

Hypertension (HTN) could have its origin in childhood and remain undetected unless a special screening is done during this period. We conducted this study to determine the screened HTN prevalence in adolescents and its associated factors, in order to increase the awareness on this subject and lead the state to make preventive strategies.

Methods

A cross-sectional study was carried among secondary school students in Sousse, Tunisia, during 2017-2018 school year. Blood pressure and anthropometric indices were measured. A structured questionnaire was used to collect information about socio demographic characteristics, lifestyle, addictive behavior and mental health status.

Results

A total of 1399 adolescents participated in the study. The prevalence of screened HTN was 15.6% (95% CI[13.8% -17.5%]). It was significantly higher in boys (23.1%) than in girls (10.7%; p ≤ 10-3).

After binary logistic regression, positively associated factors to screened HTN in total population were: obesity (aOR=3.69; p ≤ 10-3), and overweight (aOR=1.7; p ≤ 10-3). Female gender (aOR=0.4; p ≤ 10-3), School failure (aOR=0.64; p = 0.014) and depression (aOR=0.67;p=0.017) were negatively associated to screened HTN.

Conclusions

Our study showed an alarming prevalence of high blood pressure among secondary school adolescents in our Low Middle Income Country and that it was mainly associated with weight excess. This emphasizes the emergent need of a comprehensive strategy for the prevention and control of hypertension and NCD risk factors among youth.

Key messages

Hypertension is an alarming emerging problem among youth in LMIC

The emergent need of an effective strategy to prevent NCD risk factors in LMIC

Keywords

Hypertension Prevalence - Adolescent lifestyle- behavior, addictive - mental health
980Quantifying inadvertent data-duplication- findings from validation of antenatal-registration and HIV-testing data-sets from an Indian state
Authors: Godbole Sheela , Chidrawar Shweta , Sane Suvarna , Bansal Yashika , Hegde Asha , Bembalkar Shilpa , Kamble Suchit , Mamulwar Megha , Acharya Shrikala , Bawiskar Vijay , Ramakrishnan Laxmi , Raj Yujwal , Gangakhedkar Raman , Kumar Ashok , Reddy D C S , Pandey Arvind , Saidel Tobi , Rani Naina , Seguy Nicole , Sachdeva K S
Published: September 2021

Background

India plans elimination of HIV-Mother-to-Child-Transmission in 2020. Targets include >95% coverage of Antenatal-care (ANC) and HIV-testing. In 2015-16, while 43% of the estimated Indian pregnant-women (PW) received HIV-tests, one state reported >95% testing. Indian public-health-care is a three-tiered system from primary-level sub-centres (population-5000) to tertiary-level hospitals. ANC involves multiple-visits per pregnancy at different care-levels and data are aggregated in the Health-Management-Information-System (HMIS) at all levels. We validated (public and private-sector data from this state, for duplication in ANC registration and HIV-testing using mixed methods.

Methods

In the absence of guidelines for assessing aggregate-data duplication, we used mixed-methods, including surveys among 9845 PW and providers from 240 facilities in 10/36 representative districts; in-depth-interviews; case-studies and analysis of HMIS and HIV-program data (April 2015-Mar 2017). Interviews and case-studies highlighted inadvertent duplicate data-capture. Surveys quantified levels of duplication and adjustment factors (public and private-sector) were developed.

Results

Twenty-four% PW, visited multiple facilities for ANC, while 81% providers reported all the PW coming to their facilities as new ANC registrations (irrespective of lower-tier registration); identifying a minimum duplication of 19% (24%*81%) in ANC coverage. Twenty-nine% and 28% PW from public and private-facilities reported >1 HIV-test; while 75% and 36% reported visiting another public-facility where HIV test was likely to be reported again. Minimum duplication of 22% and 10% in HIV testing was noted in public and private-sectors respectively.

Conclusions

We report methods to quantify repeat HIV-testing and duplicate-reporting, due to inherent processes in ANC in public-healthcare in India. Modification of data-capture was recommended and adopted across India.

Key messages

Assessing duplication in aggregate health data is key to developing robust datasets for disease elimination
427How does childhood maltreatment influence cardiovascular disease? A sequential causal mediation analysis
Authors: Soares Ana Goncalves , Howe Laura D , Hammerton Gemma , Heron Jon , Rich-Edwards Janet , Magnus Maria C , Halligan Sarah L , Fraser Abigail
Published: September 2021

Background

Childhood maltreatment (CM) has been associated with cardiovascular disease (CVD), but the mechanisms of this relationship are not fully understood. We explored the relative contribution of anxiety/depression, smoking, body mass index (BMI) and C-reactive protein (CRP) to the association between CM and CVD in the United Kingdom (UK) and whether this differed by sex and type of maltreatment.

Methods

We used data from 40,596 men and 59,511 women from UK Biobank. To estimate the indirect effects of CM (physical, sexual and emotional abuse, and emotional and physical neglect) on incident CVD, we applied a sequential mediation approach using g-computation.

Results

Together anxiety/depression, smoking, BMI and CRP mediated 26%-90% of the association between CM and CVD, and the contribution of these mediators differed by type of maltreatment and sex. For sexual abuse, emotional abuse and emotional neglect, anxiety/depression was the most important mediator (accounting for 16%-43% of the total effect), especially in women. In men, BMI contributed the most in associations of physical abuse and physical neglect with CVD; in women anxiety/depression and BMI had similar contributions.

Conclusions

These findings add to the understanding of how CM affects CVD and highlight the potential to reduce the burden of CVD in people exposed to CM through targeting modifiable mediating factors.

Key messages

Anxiety/depression, smoking, BMI and inflammation mediated part of the association between CM and CVD, and the contribution of these mediators differed by type of maltreatment and sex.
1173The impact of adverse and positive experiences on inflammatory outcomes in Australian and UK children
Authors: Guo Shuaijun , Gondek Dawid , O’Connor Meredith , Cahill Stephanie , Downes Marnie , Moreno-Betancur Margarita , Burgner David , Slopen Natalie , Goldfeld Sharon , Wake Melissa , Juonala Markus , Kerr Jessica , Lycett Kate , Wang Yichao , Lacey Rebecca , Priest Naomi
Published: September 2021

Background

Inflammation is one of key mechanisms linking childhood experiences to later chronic disease risk. Childhood adversity is associated with inflammation, but little is known about positive experiences. We examine how adverse and positive experiences are associated with inflammatory markers in late childhood, and whether they have an interaction effect.

Methods

Data sources: Longitudinal Study of Australian Children (LSAC; N = 1237) and Avon Longitudinal Study of Parents and Children (ALSPAC; N = 3488). Exposures: Adverse and positive experiences assessed from 0 to 11 (LSAC) and 0-14 years (ALSPAC). Adversity indicators included parent legal problems, family violence, mental illness, substance abuse, harsh parenting, parental divorce, neighbourhood violence, family member death, and bullying victimization. Positive experiences included positive parenting practice, trusting and supportive relationships, supportive neighbourhood and home learning environments, social engagement and enjoyment. Outcomes: Inﬂammation quantiﬁed by high-sensitivity C-reactive protein (hsCRP) and glycoprotein acetyls (GlycA). Analyses: Linear regression was used to estimate relative change in inﬂammatory markers, adjusted for sociodemographics. Outcomes were log-transformed.

Results

Exposure to adversity was associated with higher levels of inﬂammation (e.g., CRP: β = 8.8%, 95% CI= -16.5% to 34.2% in LSAC), whereas exposure to positive experiences was associated with lower levels (e.g., CRP: β=-18.9%, 95% CI= -45.8% to 7.9% in LSAC), after adjusting for sociodemographics. There was no interaction effect of adverse and positive experiences on inflammation.

Conclusions

Adverse and positive experiences have independent and small effects on children’s inflammation across two cohorts.

Key messages

Positive experiences are critical to inform interventions to improve inflammatory outcomes for children who face adversity.
158Prediction of diabetes and hypertension by opportunistic screening: A facility based study from rural Jodhpur
Authors: Gupta Manoj Kumar , Raghav Pankaja , Bhardwaj Pankaj , Rustagi Neeti , KH Naveen , Goel Akhil D , Thirunavukkarasu Prasanna , Sharma Prem Prakash
Published: September 2021

Background

Nearly half of population with Diabetes and Hypertension is estimated to be undetected in India. The objectives of this study were to conduct opportunistic screening for Diabetes and Hypertension coming to OPD of health centres under Department of Community Medicine and Family Medicine, AIIMS Jodhpur, India and to develop the models for prediction of Diabetes and Hypertension.

Methods

Time bound study was conducted at three rural health centres between 2018-19. A total of 942 patients aged ≥30 years were screened. Data was recorded using Epicollect5. Risk assessment was done by using Indian Diabetes risk score (IDRS), Community based assessment checklist (CBAC), Waist Hip Ratio, & BMI. Random and fasting capillary blood sugar and BP was measured.

Results

The mean age of the participants was 52.4 ± 13.5 years. As much as 446 (47.4%) had IDRS score of ≥ 60 and 276 (29.3%) had CBAC score of ≥ 4. RBS level of ≥ 140mg/dl was found among 223 participants, of these, 42.5% were diagnosed to be diabetic on FBS. One-fourth (25.6%) were estimated to be hypertensive. Physical activity and hypertension were best predicting the diabetes (r2= 90.8), while hypertension was best predicted by age and BMI (r2= 74.3).

Conclusions

Prevalence of diabetes and hypertension was in accordance with the reported prevalence in the country. As compared to existing models, less number of prediction variables were identified for NCDs.

Key messages

The study highlights the need for implementation of hospital based opportunistic screening and point out the necessity to revise the existing prediction models for NCDs.
189Mobilizing for change through UM PEACE (Prevent Elder Abuse and negleCt initiativE) Program
Authors: Hairi Noran Naqiah
Published: September 2021

Focus of Presentation

Elder abuse and neglect (EAN) includes psychological, physical, sexual abuse, neglect, and financial exploitation. Malaysia – projected to become an aged nation by 2030 – is not spared. PEACE focuses on protecting elder rights, empowering the community to be actively engaged in elderly issues, and refining the Malaysian law to address existing gaps.

Findings

Our cohort study revealed that the overall lifetime prevalence of EAN (abuse episodes ever experienced from the age 60) was 8.1% with 4.8%, 3.4%, 1.2%, 0.3% and 1.1% for financial abuse, psychological abuse, physical abuse, sexual abuse and neglect respectively. Perpetrators tend to be family members (adult children) and abuse usually occurs at home. Premature mortality are shown higher among victims. From the legal perspective, the only existing act addressing family violence is the Domestic Violence Act (DVA 1994) and Penal Code. The DVA is neither adequate nor specific to EAN and dynamics of elder abuse. Our findings were presented to the relevant stakeholders including the Deputy Prime Minister of Malaysia. Using four main approaches - making findings understandable to policymakers, increasing opportunities for interaction, addressing barriers and ensuring research is relevant allows better communication between researchers and policy makers and ensuring evidence are translated to policy. PEACE are working on drafting the new Elder Act which will be ready by 2021.

Conclusions/Implications

The PEACE program is an example of how a complex health problem should be addressed. Better communication strategies and multiple interactions between policy makers and PEACE researchers is key to our impactful research.

Key messages

Dissemination approaches should be timely and consistent with culture to translate research evidence to policy.

Protecting the well-being and dignity of our elders is not only a question of conscience or morality, but also a matter of upholding human rights and justice.
697Change of smoking habits by introducing and spreading heated tobacco products in Japan
Authors: Harada Sei , Sata Mizuki , Matsumoto Minako , Takeuchi Ayano , Iida Miho , Kato Suzuka , Hirata Aya , Kuwabara Kazuyo , Sugiyama Daisuke , Okamura Tomonori , Takebayashi Toru
Published: September 2021

Background

Heated tobacco product (HTP) users are rapidly increasing in Japan since 2014. Controlling HTPs is now one of the most urgent issues. We aimed to clarify the change of smoking habits by introducing and spreading HTPs.

Methods

We conducted the survey of HTP use in the participants of the Tsuruoka Metabolomics Cohort Study, a prospective cohort including 11,002 participants aged 40-74 in Japan. All data were obtained in the follow-up (2018-2019) and baseline (2012-2013) survey. Smoking habits were categorized to five groups according to follow-up survey; never smokers (NS), past smokers (PS), cigarette only smokers (CS), HTP only smokers (HS) and dual smokers (DS). Linear regression analysis was performed to examine the association between smoking habits and change of number of smoking tobacco products during follow-up.

Results

Prevalence of HTP user was 12.4% in 40-59 years of age and 1.8% in 60-79 for male, and 1.7% in 40-59 and 0% in 60-79 for female. Dual smokers accounted for 34.9% of all HTP users. Change of smoking number during follow-up (5.7±0.8 years) was +3.11 (95%CI: 1.17, 5.07) in DS and -1.09 (-2.70, 0.53) in HS compared with CS, after adjusted for age, sex and smoking number at baseline.

Conclusions

HTPs smoking including dual smoking was getting popular in Japan. Shift to HTPs was unlikely to affect the number of smoking tobacco, but dual smokers tended to smoke more than at baseline.

Key messages

Dual smokers of cigarettes and HTPs tended to smoke more than before introducing and spreading HTPs.
1245Culturally-appropriate research supporting a co-designed childhood obesity prevention program tailored for Māori & Pacific Islanders
Authors: Hardt Jessica , Matautia Brent , Tanuvasa Elkan , Peu Tevita , Kira Kirstine , Santos Daphne , Brignano Sebastien
Published: September 2021

Background

Children of Māori & Pacific Islander descent living in Australia experience higher rates of obesity, increasing their risk of developing life diminishing chronic diseases. However, community-based, childhood obesity prevention programs, tailored to the Māori & Pacific Islander population are lacking, further escalating the rates of health inequity.

Methods

Program co-design involved a three-phase, iterative, participatory and experienced-based process, guided by the Te Ara Tika: Guidelines for Māori Research Ethics, promoting respect and equity. Following traditional oratory customs of Māori & Pacific Islander cultures, “talanoa” facilitated the collaborative program design with consumers, cultural advisors and health professionals.

Results

Co-design developed an 8-week community-based childhood overweight/obesity prevention program, providing culturally-tailored education across nutrition, physical activity and parenting practices. Maximum engagement demonstrated life-changing improvements across the life course; 72% of children and 67% of parents reduced their sugar sweetened beverage consumption and 60% of children and 47% of adults increased their vegetable consumption. Resultingly, BMI z-score decreased among 59% of children and BMI decreased among 47% of parents.

Conclusions

Endorsing a bottom-up approach, via a co-design methodology, significantly improves culturally-tailored health care delivery. An evidence-based framework developed holds significant potential to be scaled to additional cultural groups. A consumer-led approach is pivotal to sustaining engagement and improving health outcomes, addressing health inequity among Australia’s priority populations.

Key messages

Co-design empowered consumers to formulate program objectives, session plans, resources and evaluation tools. Co-designed quality improvement practices ensure relevance of the program to sustainably address community needs, tackling the complexities of obesity over generations.
1258Development of a valid evaluation tool assessing health behaviours among Māori & Pasifika young people
Authors: Hardt Jessica , Cooper Ellen , MacMillan Freya , Brignano Sebastien , Kira Kirstine , Santos Daphne , Thompson Rhonda , Simmons Distinguished David , McBride Kate
Published: September 2021

Background

The Māori & Pasifika population experience high rates of health inequity, with a greater prevalence of obesity and the associated, life diminishing comorbidities. This is in part attributable to higher socioeconomic disadvantage, low health literacy and a lack of culturally tailored health services. Currently no validated tool exists to assess health behaviour change among Māori & Pasifika populations or success of tailored health interventions to tackle chronic disease.

Methods

The project incorporates a comprehensive validation and pilot testing process, including 1) cognitive interviewing and 2) test-retest reproducibility. Participants will include a representative sample of Māori & Pasifika young people and their parents/guardians. All research methodology is guided by cultural experts, specific to the Māori & Pasifika population.

Results

Qualitative data collected via cognitive interviewing will provide feedback regarding the readability, comprehension and content validity of the questionnaire items. Thematic analysis will inform improvements, optimising participant understandability. Cronbach’s alpha will be used to assess internal consistency and Pearson’s r will determine questionnaire test-retest reproducibility.

Conclusions

A validated questionnaire articulating with cultural values will provide meaningful data to researchers, health practitioners and government bodies regarding the lifestyle decisions of Māori & Pasifika peoples. Enhanced monitoring will determine the success of health initiatives to improve health outcomes of a priority population, across Australia and internationally.

Key messages

Lifestyle programs aiming to improve health outcomes are increasingly adapted to incorporate and acknowledge cultural values. Reliable measurement tools, including questionnaires, are fundamental to advancing future health research and tackling health inequity among priority populations.
1302Potential exposure-response relationships between vitamin D and cognitive performance in middle to older-aged adults
Authors: Harse Janis , Zhu Kun , Bucks Romola , Hunter Michael , Lim Ee Mun , Cooke Brian , Walsh John , Murray Kevin
Published: September 2021

Background

Low vitamin D status is consistently associated with poorer global cognition in older adults, particularly women, but findings in relation to higher status are unclear. A better understanding of the relationship across the range is required.

Methods

We investigated patterns of association between serum levels of 25-hydroxyvitamin D (25OHD), the standard measure of vitamin D status, and cognitive performance in 4872 middle to older-aged adults from the Busselton Healthy Ageing Study. Global cognition and performance in domains of attention, memory, and executive function were modelled using linear regression and restricted cubic splines, while controlling for demographic, lifestyle, and health factors.

Results

Mean (SD) serum 25OHD levels were 78 (24) nM/L for women and 87 (25) nM/L for men. Positive, linear patterns for global cognition in women (p = 0.023) and attention accuracy in men (p = 0.022) suggested cognitive performance improved throughout the range. A non-linear pattern for attention accuracy in women suggested performance improved up to 25OHD levels of approximately 80 nM/L and then plateaued (p = 0.035). In men, negative patterns for semantic verbal fluency (linear, p = 0.025) and global cognition (non-linear, p = 0.015) suggested performance declined as 25OHD levels increased.

Conclusions

Effects were small and patterns of association were inconsistent for men and women and across domains. However, the positive patterns identified for women, particularly in relation to attention accuracy, have biological plausibility as early, exposure-response relationships.
751Investigation of the obesity paradox in kidney cancer: mystifying association or myth?
Authors: Heath Alicia , Clasen Joanna , Riboli Elio , Scelo Ghislaine , Muller David
Published: September 2021

Background

An “obesity paradox” has been reported in kidney cancer, whereby obesity is a risk factor, yet appears to be associated with better survival.

To evaluate this paradox, we investigated the association between pre-diagnostic adiposity and renal cell carcinoma (RCC) incidence and mortality.

Methods

Using data from 363,521 men and women in the European Prospective Investigation into Cancer and Nutrition (EPIC), Cox regression models yielded confounder-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for RCC incidence and mortality in relation to BMI modelled continuously and using restricted cubic splines. RCC-specific and all-cause mortality were evaluated among cases.

Results

During a mean follow-up of 14.9 years, 936 incident RCC cases were identified, 383 of whom died (278 due to RCC). Each 5 kg/m2 increment in BMI was associated with 27% and 46% higher RCC incidence and mortality (HRs=1.27, 95% CI 1.18-1.37 and 1.46, 95% CI 1.28-1.66, respectively). Comparing a BMI of 35 with 22 kg/m2, HRs for RCC incidence and mortality were 1.88 (95% CI 1.54-2.30) and 2.37 (95% CI 1.68-3.35), respectively. Among RCC cases, HRs per 5 kg/m2 increment in BMI were 1.22 (95% CI 1.07-1.41) for RCC-specific mortality and 1.18 (95% CI 1.04-1.34) for all-cause mortality. Similar, positive linear associations were evident for waist circumference and waist-to-hip ratio.

Conclusions

Obesity was associated with increased RCC incidence and mortality, and worse prognosis among cases.

Key messages

The kidney cancer-obesity paradox does not appear to be real. Higher adiposity is associated with an increased risk of incident and fatal RCC.
231The West Australian Burden of Disease Study 2015: mental health in Aboriginal West Australians
Authors: Hobday Michelle , Chapman Ann-Marie , Dixon Tracy , Fathima Parveen , Garcia Julianne , Serafino Stella , Stace-Winkles Nancy , Sun Wendy , Kirkland Laura
Published: September 2021

Background

Mental disorders represent a growing health problem: an estimated 45% of Australians experience a mental disorder in their lifetime. The Western Australian (WA) Burden of Disease study 2015 produced detailed data for sub-populations within the state to inform policy and planning. Using this, we describe the burden of mental, substance use disorders and self-inflicted injuries in the WA Aboriginal population.

Methods

The study generated estimates for over 200 diseases to create ranked disease-level estimates of burden in the WA Aboriginal population for the first time. Eleven individual conditions in the mental disorders disease group, and suicide and self-inflicted injuries were analysed.

Results

Mental disorders contributed 18% of Aboriginal male and 16% of Aboriginal female DALYs in WA. Among Aboriginal males, alcohol use disorders ranked 3rd among all diseases (ASR: 33.6 DALYs per 1,000 males). Among Aboriginal females, anxiety disorders ranked 3rd (ASR: 17.3 per 1,000 females). Suicide and self-inflicted injuries ranked 2nd among all diseases among Aboriginal males (ASR: 39.8 DALYs per 1,000 males) and 5th among Aboriginal females (ASR: 10.8 per 1,000 females).

Conclusions

The study highlighted the high burden of disease from mental disorders and self-inflicted injuries among Aboriginal West Australians: self-inflicted injuries, alcohol use disorders and anxiety disorders ranked in the top 10 of all diseases.

Key messages

Mental disorders contribute substantially to the disease burden in WA among the Aboriginal residents. The findings can inform health policy and planning around mental health in the Aboriginal population, as well as informing social and liquor licensing policy.
521Performance of doubly-robust, machine learning effect estimators in realistic epidemiologic data settings and practical recommendations
Authors: Huang Jonathan , Meng Xiang
Published: September 2021

Background

Flexible, data-adaptive algorithms (machine learning; ML) for nuisance parameter estimation in epidemiologic causal inference have promising asymptotic properties for complex, high-dimensional data. However, recently proposed applications (e.g. targeted maximum likelihood estimation; TMLE) may produce biases parameter and standard error estimates in common real-world cohort settings. The relative performance of these novel estimators over simpler approaches in such settings is unclear.

Methods

We apply double-crossfit TMLE, augmented inverse probability weighting (AIPW), and standard IPW to simple simulations (5 covariates) and “real-world” data using covariate-structure-preserving (“plasmode”) simulations of 1,178 subjects and 331 covariates from a longitudinal birth cohort. We evaluate various data generating and estimation scenarios including: under- and over- (e.g. excess orthogonal covariates) identification, poor data support, near-instruments, and mis-specified biological interactions. We also track representative computation times.

Results

We replicate optimal performance of cross-fit, doubly robust estimators in simple data generating processes. However, in nearly every real world-based scenario, estimators fit with parametric learners outperform those that include non-parametric learners in terms of mean bias and confidence interval coverage. Even when correctly specified, estimators fit with non-parametric algorithms (xgboost, random forest) performed poorly (e.g. 24% bias, 57% coverage vs. 10% bias, 79% coverage for parametric fit), at times underperforming simple IPW.

Conclusions

In typical epidemiologic data sets, double-crossfit estimators fit with simple smooth, parametric learners may be the optimal solution, taking 2-5 times less computation time than flexible non-parametric models, while having equal or better performance. No approaches are optimal, and estimators should be compared on simulations close to the source data.

Key messages

In epidemiologic studies, use of flexible non-parametric algorithms for effect estimation should be strongly justified (i.e. high-dimensional covariates) and performed with care. Parametric learners may be a safer option with few drawbacks.
1455Leveraging multi-omic negative controls for effect estimation in molecular epidemiologic studies: A simulation study
Authors: Huang Jonathan
Published: September 2021

Background

Exploratory null-hypothesis significance testing (e.g. GWAS, EWAS) form the backbone of molecular epidemiology, however methods to identify true causal signals are underdeveloped. Via plasmode simulation, I evaluate two approaches to quantitatively control for shared unmeasured confounding and recover unbiased effects using complementary epigenomes and biologically-informed structural assumptions.

Methods

I adapt proposed negative control-based estimators, the control outcome calibration approach (COCA) and proximal g-computation (PG) to case studies in perinatal molecular epidemiology. COCA may be employed when maternal epigenome has no direct effects on phenotype and proxy shared unmeasured confounders and PG further with suitable genetic instruments (e.g. mQTLs). Baseline covariates were extracted from 777 mother-child pairs in a birth cohort with maternal blood and fetal cord DNA methylation array data. Treatment and outcome values were simulated in 2000 bootstraps. Bootstrapped, ordinary (COCA) and 2-stage (PG) least squares were fitted to estimate treatment effects and standard errors under various common settings of missing confounders (e.g. paternal data). Doubly-robust, machine learning estimators were explored.

Results

COCA and PG performed well in simplistic data generating processes. However, in real-world cohort simulations, COCA performed acceptably only in settings with strong proxy confounders, but otherwise poorly (median bias 610%; coverage 29%). PG performed slightly better. Alternatively, simple covariate adjustment for maternal methylation outperformed (median bias 22%; 71% coverage) COCA, PG, and machine learning estimators.

Discussion

Molecular epidemiology provides key opportunity to leverage biological knowledge against unmeasured confounding. Negative control calibration or adjustments may help under limited scenarios where assumptions are fulfilled, but should be tested with suitable simulations.

Key messages

Quantitative approaches for unmeasured confounding in molecular epidemiology are a critical gap. Negative control calibration or adjustment may help under limiting scenarios. Proposed estimators should be tested in simulation settings that closely mimic target data.
496Higher predicted 10-year risk for cardiovascular disease in primary care consulters for osteoarthritis
Authors: Huang Miss Xiaoyang , Yu Dahai , Wilkie Ross , Mamas Mamas
Published: September 2021

Background

Osteoarthritis (OA) has a major impact on the global burden of disease and is associated with poorer cardiovascular disease (CVD) outcomes. However it’s unclear whether people with OA have higher long-term (10-year) CVD risk compared to people without OA. This study uses electronic health record (EHR) data from a national representative database to calculate the Framingham-score (a gender-specific risk algorithm) to test the hypothesis that OA consulters have higher long-term CVD risk than non-OA consulters.

Methods

205,368 incident OA consulters with 1:1 age, gender, and practice-matched non-OA controls extracted from Clinical Practice Research Datalink (CPRD) were included. All predictors extracted from EHRs within three years prior to the index consultation were used to fit the Framingham-score. Absolute difference (AR) and relative rate ratio (RR) in the proportion of high-risk (predicted-risk ≥20%) individuals between OA and controls were estimated using Poisson regression.

Results

The proportion of high-risk individuals was higher in consulters for OA (5.69 (95% confidence interval (CI): 5.59-5.79)%) cf. 4.37 (4.28-4.46)%). The adjusted AR and RR was (1.94 (95%CI: 1.78-2.10) %) and (1.30 (1.27-1.34)), respectively.

Conclusions

This study confirms the expected higher predicted 10-year CVD risk in OA consulters compared to controls. This suggests that OA consulters could be a target group for more proactive interventions to prevent CVD events.

Key messages

OA consulters have a higher CVD risk predicted by Framingham-score calculated using EHRs than controls; OA consulters are a high risk group that can be considered as a target group for proactive prevention interventions for CVD.
910Maternal adversity and cardiovascular health of the offspring
Authors: Hyde Natalie , Scovelle Anna , Dowty James , Olive Lisa , O'Neil Adrienne
Published: September 2021

Background

We investigated the respective and cumulative impact of mothers’ exposure(s) to adversity over time on cardiovascular (CV) outcomes of her offspring.

Methods

Participants were part of the Avon Longitudinal Study of Parents and Children. Offspring CV measures were collected at seven and 17 years of age. Maternal adversity was self-reported from the onset of pregnancy to 8-weeks postnatal. Linear mixed models were used to analyse associations between adversity and log-transformed longitudinal CV outcomes.

Results

There was no association between cumulative or perceived impact of maternal adversity with CV outcomes in either sex. Specific adversities were associated with CV outcomes. For example, at age seven in girls, “Argued with partner” (β:0.9764 95%CI:0.9608-0.9922) was associated with decreased heart rate, and at age 17 “Partner rejected pregnancy” (β:1.0716 95% CI:1.0191-1.1269) with increased heart rate. In boys, at age seven “Partner was ill” (β:0.9713 95%CI:0.9511-0.9920) was associated with decreased systolic blood pressure, and at age 17 “Very ill” (β:1.0323 95%CI:1.0091-1.0561) with increased systolic blood pressure.

Conclusions

There were no associations evident with the primary exposure measure of maternal adversity and offspring CV outcomes. Specific adversities were associated with favourable changes in offspring CV outcomes at age seven, however the association reversed at age 17. This could be due to a protective adaptive response to maternal adversity present in childhood that may reverse trajectory by age 17.

Key messages

There was no association between cumulative maternal adversity and offspring cardiovascular outcomes, however specific events may be associated with cardiovascular outcomes in an age-dependent manner.
618Is mode of first birth a risk factor for subsequent preterm birth?
Authors: Gugusheff Jessica , Patterson Jillian , Torvaldsen Siranda , Ibiebele Ibinabo , Nippita Tanya
Published: September 2021

Background

Previous preterm birth is a strong predictor of subsequent preterm birth but less is known about the causes of preterm birth following a full-term pregnancy. Recent research highlighted previous caesarean as a potential risk factor and we aimed to further explore this risk.

Methods

This population-based record linkage study included all women in NSW, Australia who had a live singleton first birth at ≥ 37 weeks gestation, followed by a singleton second birth between 2005–2017. Relative risk (RR) and 95%CI of having a subsequent preterm birth, spontaneous preterm birth or preterm pre-labour caesarean was calculated using individual modified Poisson regression models, with mode of first birth as the exposure.

Results

Women who had an intrapartum (RR:1.26, 95%CI 1.19–1.32) or prelabour caesarean (RR:1.26,95%CI 1.18–1.35) first birth had a higher risk of subsequent preterm birth, than those who birthed vaginally. Those who had a pre-labour caesarean (RR:0.74, 95%CI 0.67–0.82) had a lower risk of subsequent spontaneous preterm birth. However, prior pre-labour caesarean also greatly increased the risk of subsequent preterm prelabour caesarean (RR:5.25, 95%CI 4.65–5.93).

Conclusions

Pre-labour and intrapartum caesareans have differing effects on the risk of subsequent spontaneous preterm birth and preterm pre-labour caesarean.

Key messages

The risk of subsequent preterm birth following a first birth caesarean depends on whether the caesarean occurred before or after the onset of labour and whether the subsequent preterm birth is spontaneous or a pre-labour caesarean.
1332Endometriosis, assisted reproductive technology and adverse pregnancy outcomes: a population based data linkage study
Authors: Ibiebele Ibinabo , Nippita Tanya , Baber Rodney , Torvaldsen Siranda
Published: September 2021

Background

Endometriosis is a chronic inflammatory disease characterised by endometrial tissue outside the uterus – pain and infertility are common symptoms. There is a paucity of data on the association between endometriosis and adverse pregnancy outcomes where the contribution of assisted reproductive technology (ART) use is also considered. This study will examine the association between endometriosis, with and without ART use, on adverse pregnancy outcomes.

Methods

Population data linkage study of all female NSW residents aged 15-45 years with a singleton birth in 2006-2015. Pregnancies were classified into 4 groups based on endometriosis diagnosis (yes/no) and ART use (yes/no). Multinomial logistic regression was used to estimate the odds of adverse pregnancy outcomes with 99% confidence intervals, adjusting for maternal and pregnancy factors. Outcomes assessed included placenta praevia, antepartum haemorrhage, planned birth (induction of labour or caesarean section) and preterm birth.

Results

Of 889,101 eligible pregnancies, women with endometriosis were more likely to be older while women who used ART were more likely to be nulliparous, birth in a private hospital and less likely to smoke. Adjusted odds ratios for selected study outcomes are outlined below.

Conclusions

Endometriosis is associated with increased odds of preterm birth, placenta praevia, antepartum haemorrhage and planned birth. In general, the odds of adverse pregnancy outcomes associated with endometriosis were further increased with ART use.

Key messages

These findings suggest that women with endometriosis, especially those who achieved pregnancy via ART use, represent a high risk obstetric population requiring appropriate surveillance and management.
552The lung function and airway inflammation markers associated with short-term pollen exposure- A systematic review
Authors: Idrose N. Sabrina , Lodge Caroline , Koplin Jennifer , Vicendese Don , Douglass Jo , Dharmage Shyamali
Published: September 2021

Background

Experimental challenge studies have shown that pollen can affect the lungs and airways. Here, we systematically reviewed community-based studies investigating outdoor pollen exposure, lung function and/or airway inflammation.

Methods

Four online databases were searched. The search strategy included terms relating to both exposure and outcomes. Inclusion criteria were studies published in English that were representative of the community. We only considered cross-sectional or short-term longitudinal studies which investigated pollen exposure by levels or season. Study quality assessment was performed using the Newcastle-Ottawa scale. Meta-analysis was conducted using random-effects models.

Results

We included 27 of 6,551 studies identified from the search. Qualitative synthesis indicated associations between pollen exposure and predominantly type-2 inflammation in both the upper and lower airways, but little evidence for lung function changes. People with ever asthma and/or seasonal allergic rhinitis (SAR) were at higher risk of such airway inflammation. Meta-analysis confirmed a positive relationship between pollen season and eosinophilic airway inflammation in people with ever SAR but the results between studies were highly variable. Heterogeneity was reduced after further subgrouping by age and the forest plots indicated that eosinophilic airway inflammation to outdoor pollen exposure increased with age.

Conclusion

Among people with ever asthma and ever SAR, exposure to increased ambient pollen triggers type-2 airway inflammation rather than a non-specific or innate inflammation.

Key messages

This review indicates pollen exposure influences predominantly type-2 airway inflammation, but little evidence on lung function.
213Traditional Japanese Diet Score and healthy life expectancy - a longitudinal global study
Authors: Imai Tomoko , Sezaki Ayako , Miyamoto Keiko , Abe Chisato , Kawase Fumiya , Shirai Yoshiro , Inden Ayaka , Kato Takumi , Sanada Masako , Shimokata Hiroshi
Published: September 2021

Background

Traditional Japanese diets are considered to be health and longevity. We created a Traditional Japanese Diet Score (TJDS) and investigated the relationship between the TJDS and healthy life expectancy (HALE) longitudinally using global database.

Methods

Average food (g/day/capita) and energy supply (kcal/day/capita) by countries were identified by the Food and Agriculture Organization of the United Nations Statistics Division database. The sum of characterizing traditional Japanese foods supply (beneficial food components in Japanese diet; rice, fish, soybeans, vegetables, eggs, seaweeds, food components not use so much in Japanese diet; wheat, milk, and red meat) were divided as tertile (beneficial food components;-1, 0, 1, not use so much food components; 1, 0, -1). HALE values by country were derived from the Global Burden of Disease 2017 database. The longitudinal effects of TJDS on the rate of change in HALE from 1990 to 2013 were evaluated using a generalized mixed-effect model (GLMM), which takes into account the dependence of repeated observations within countries. The interaction between TJDS and survey year was applied to access the effects on HALE. This study covered 137 countries with populations of 1 million or greater.

Results

Longitudinal analysis controlled for covariates showed that smooth term of the interaction between TJDS and survey year was significant (p < 0.001). The TJDS was negative associated with HALE in 1990, and in 1991, but positive associated after 2002.

Conclusions

The relationship between the TJDS as a healthy eating style and HALE is getting stronger since the 21st century.

Key messages

Well-balanced eating habits of traditional Japanese diets is supports healthy life expectancy.
1299Association between environmental cadmium exposure and plasma and urinary metabolite profiles in Japanese cohort study
Authors: Ishibashi Yoshiki , Harada Sei , Eitaki Yoko , Iida Miho , Kurihara Ayako , Hirata Aya , Shibuki Takuma , Okamura Tomonori , Hirayama Akiyoshi , Sugimoto Masahiro , Soga Tomoyoshi , Tomita Masaru , Takebayashi Toru
Published: September 2021

Background

The purpose of this study was to identify plasma and urinary metabolites that can be used to better identify the effects of cadmium exposure than N-acetyl-β-D-glucosaminidase (NAG) using capillary electrophoresis - mass spectrometry (CE-MS).

Methods

Urinary cadmium (U-Cd) was measured as an indicator of cadmium exposure. Fasting plasma and urine samples were collected from 1,412 men and 2,022 women in Tsuruoka Metabolomics Cohort Study. Charged 94 plasma and 123 urinary metabolites were detected and determined. Regression analysis was performed for urinary NAG, plasma, and urinary metabolites as dependent variables and U-Cd in quartiles as an independent variable. Multivariate regression model included age, SBP, smoke, rice intake, BMI, HbA1c, LDLc, alcohol consumption, physical activity, educational history, dietary energy intake, urinary Na/K ratio, and uric acid.

Results

The mean U-Cd of the population was 2.65 μg/g creatinine (SD: 1.63). NAG was positively associated with U-Cd, but the association was not significant with lower U-Cd quartiles. In the plasma metabolites, 10 metabolites had significantly negative association with U-Cd in all models and Cd quartiles. Among urinary metabolites, 27 metabolites had significantly positive association with U-Cd. Alanine was negatively associated with U-Cd in urinary metabolites. The trend test also showed significant dose-response trends for 9 plasma and all 28 urinary metabolites (p < 0.05).

Conclusions

We found that the levels of Cd exposure, which did not cause an increase in NAG, caused changes in plasma and urinary metabolites.

Key messages

This study indicated that metabolomics might be promising and useful as markers of Cd exposure.
258Change in population mean BMI accounts for the majority of change in underweight and obesity
Authors: Iurilli Maria Laura Caminia
Published: September 2021

Background

Prevalence of underweight has decreased and that of obesity increased in most countries. A shift of the whole BMI distribution in the population would simultaneously change the mean BMI and the prevalence of underweight and obesity, whereas a change only at the tails would have limited impact on the mean.

Methods

Generalised linear regression of prevalence of underweight and obesity with mean BMI using worldwide data from 2,765 surveys with objectively measured height and weight on 143.5 million men and women aged 20 to 79 years from 1985 to 2016.

Results

Trends in the prevalence of underweight and obesity are largely driven by shifts in the distribution of mean BMI, with smaller contributions from changes in the shape of the distribution. There was a smaller than expected change in the decline of underweight in east and southeast Asia and sub-Saharan Africa and in the rise of obesity in Oceania.

Conclusions

The worldwide rise in obesity and decline in underweight are largely population phenomena. There is also evidence of excess obesity and persistent underweight beyond the distributional shift in some regions, which may be related to growing social inequalities that restrict access to healthy foods for those at highest risk of poor nutrition.

Key messages

Rise in obesity and decline of underweight are largely driven by increase in mean BMI. Effective response must include restrictions on unhealthy foods while making healthy options more accessible.