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International Journal of Epidemiology
Journal Prestige (SJR): 3.969
Citation Impact (citeScore): 5
Number of Followers: 265  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0300-5771 - ISSN (Online) 1464-3685
Published by Oxford University Press Homepage  [406 journals]
  • Network multipliers and public health
    • Authors: VanderWeele T; Christakis N.
      Pages: 1032 - 1037
      PubDate: Thu, 21 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz010
      Issue No: Vol. 48, No. 4 (2019)
       
  • Data Resource Profile: The ALSPAC birth cohort as a platform to study the
           relationship of environment and health and social factors
    • Authors: Boyd A; Thomas R, Hansell A, et al.
      Pages: 1038 - 1039k
      PubDate: Sun, 21 Apr 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz063
      Issue No: Vol. 48, No. 4 (2019)
       
  • Data resource profile: Household Influenza Vaccine Evaluation (HIVE) Study
    • Authors: Monto A; Malosh R, Evans R, et al.
      Pages: 1040 - 1040g
      PubDate: Tue, 30 Apr 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz086
      Issue No: Vol. 48, No. 4 (2019)
       
  • Cohort Profile: The LoewenKIDS Study – life-course perspective on
           infections, the microbiome and the development of the immune system in
           early childhood
    • Authors: Gottschick C; Raupach-Rosin H, Langer S, et al.
      Pages: 1042 - 1043h
      PubDate: Wed, 27 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz001
      Issue No: Vol. 48, No. 4 (2019)
       
  • Cohort Profile: The National Health and Aging Trends Study (NHATS)
    • Authors: Freedman V; Kasper J.
      Pages: 1044 - 1045g
      PubDate: Tue, 25 Jun 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz109
      Issue No: Vol. 48, No. 4 (2019)
       
  • Cohort Profile: The ASPREE Longitudinal Study of Older Persons (ALSOP)
    • Authors: McNeil J; , Woods R, et al.
      Pages: 1048 - 1049h
      PubDate: Tue, 08 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyy279
      Issue No: Vol. 48, No. 4 (2019)
       
  • Cohort Profile: The Danish Longitudinal Study of Ageing (DLSA)
    • Authors: Kjær A; Siren A, Seestedt M, et al.
      Pages: 1050 - 1050g
      PubDate: Thu, 14 Mar 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz026
      Issue No: Vol. 48, No. 4 (2019)
       
  • Cohort Profile: The DynaHEALTH consortium – a European consortium for a
           life-course bio-psychosocial model of healthy ageing of glucose
           homeostasis
    • Authors: Sebert S; Lowry E, Aumüller N, et al.
      Pages: 1051 - 1051k
      PubDate: Wed, 10 Apr 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz056
      Issue No: Vol. 48, No. 4 (2019)
       
  • Cohort Profile: The Ageing Trajectories of Health – Longitudinal
           Opportunities and Synergies (ATHLOS) project
    • Authors: Sanchez-Niubo A; Egea-Cortés L, Olaya B, et al.
      Pages: 1052 - 1053i
      PubDate: Wed, 24 Apr 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz077
      Issue No: Vol. 48, No. 4 (2019)
       
  • Are cities good for health' A study of the impacts of planned
           urbanization in China
    • Authors: Hou B; Nazroo J, Banks J, et al.
      Pages: 1083 - 1090
      Abstract: BackgroundUrbanization in developing countries is usually accompanied by migration to cities, making it a challenge to unpack the independent relationships between migration, urbanization and health, particularly in the presence of health-selective migration. Since 1978, unprecedented planned urbanization has taken place in China and further increases to the urban population are expected. This paper explored the impacts of urbanization in China through a comparative study of in situ urbanized population.MethodsUsing the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative dataset for people aged 45 years or older, we compared self-assessed general health, depressive symptoms and waist circumference among three groups: (i) in situ urbanized-rural residents; (ii) rural residents; and (iii) urban residents. Using a model informed by the literature on the social determinants of health in later life, we investigated the patterning and drivers of differences in health outcomes between these three groups, in order to explore the impact of urbanization independent of the impact of migration.ResultsThere are consistent advantages in health and less depression among urbanized-rural residents compared with the rural group; and this group has even better health outcomes than the urban group after adjusting for early life differences. However, this relationship is reversed for waist circumference. Socioeconomic circumstances and factors related to a planned urbanization partly explain these effects.ConclusionsUrbanization in China has, on average, had an independent and positive effect on health and well-being. Planned urbanization could benefit people’s health in developing countries. It is likely that improved infrastructure is a key driver.
      PubDate: Mon, 18 Mar 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz031
      Issue No: Vol. 48, No. 4 (2019)
       
  • Heatwaves and diabetes in Brisbane, Australia: a population-based
           retrospective cohort study
    • Authors: Xu Z; Tong S, Cheng J, et al.
      Pages: 1091 - 1100
      Abstract: BackgroundAvailable data on the effects of heatwaves on hospitalizations for diabetes and the post-discharge status of diabetics are scarce. This study aimed to assess the effects of heatwaves on hospitalizations and post-discharge deaths for diabetes, and to identify the individual- and community-level characteristics [i.e. age, gender, Socio-economic Indexes for Areas (SEIFA), and normalized difference vegetation index (NDVI)] that modified heatwave effects.MethodsHealth data were extracted from a cohort study which included patients in Brisbane, Australia, who were hospitalized due to diabetes from 1st January 2005 to 31st December 2013, and died within 2 months after they were discharged. Data on community-level modifiers, including SEIFA and NDVI (i.e. urban vegetation), were obtained from Australian Bureau of Statistics and Australian Bureau of Meteorology, respectively. Case-crossover design was used to quantify the effects of heatwaves on hospitalizations and post-discharge deaths due to diabetes. Four heatwave definitions incorporating both intensity (i.e. 90th, 95th, 97th and 99th percentiles of mean temperature distribution) and duration (2 days), as well as excess heat factor (EHF), were used. A case-only design was adopted to identify the modifiers of heatwave effects.ResultsThere were 10 542 hospitalizations for diabetes, and 513 patients died due to diabetes within 2 months after discharge. During low-intensity heatwave days (i.e. 90th percentile & 2 days), we did not observe a significant increase in hospitalizations for diabetes [9% at lag 0; 95% confidence interval (CI): –3%, 23%; P = 0.146], but we observed a significant increase in post-discharge deaths (46% at lag 2; 95% CI: 3%, 107%; P = 0.036). During middle-intensity heatwave days (i.e. 95th percentile & 2 days), hospitalizations for diabetes increased by 19% at lag 0 (95% CI: 2%, 39%; P = 0.026), and post-discharge deaths increased by 64% at lag 0 (95% CI: 6%, 154%; P = 0.027). During high-intensity heatwave days (i.e. 97th percentile & 2 days), hospitalizations for diabetes increased by 37% at lag 1 (95% CI: 11%, 69%; P = 0.004) and post-discharge deaths increased by 137% at lag 1 (95% CI: 39%, 303%; P = 0.002). When heatwave intensity increased to 99th percentile, we did not observe a significant increase in hospitalizations (–1% at lag 0; 95% CI: –38%, 59%; P = 0.870) or post-discharge deaths (79% at lag 0; 95% CI: –39%, 431%; P = 0.301). When we used EHF to define heatwaves, we observed significant increases of hospitalizations (7%; 95% CI: 1%, 15%; P = 0.039) and post-discharge deaths (68%, 95% CI: 10%, 158%; P = 0.017) during heatwave days, compared with non-heatwave days. Children and male diabetics were particularly vulnerable to heatwave effects, but we did not find any significant modification effect of SEIFA or NDVI on the associations of heatwaves with hospitalizations and post-discharge deaths due to diabetes.ConclusionHeatwaves may lead to hospitalizations of diabetics and their premature deaths. Heat-related diabetes burden in children may increase as climate warms and with increasing obesity rates in adolescents.
      PubDate: Fri, 29 Mar 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz048
      Issue No: Vol. 48, No. 4 (2019)
       
  • How urban characteristics affect vulnerability to heat and cold: a
           multi-country analysis
    • Authors: Sera F; Armstrong B, Tobias A, et al.
      Pages: 1101 - 1112
      Abstract: BackgroundThe health burden associated with temperature is expected to increase due to a warming climate. Populations living in cities are likely to be particularly at risk, but the role of urban characteristics in modifying the direct effects of temperature on health is still unclear. In this contribution, we used a multi-country dataset to study effect modification of temperature–mortality relationships by a range of city-specific indicators.MethodsWe collected ambient temperature and mortality daily time-series data for 340 cities in 22 countries, in periods between 1985 and 2014. Standardized measures of demographic, socio-economic, infrastructural and environmental indicators were derived from the Organisation for Economic Co-operation and Development (OECD) Regional and Metropolitan Database. We used distributed lag non-linear and multivariate meta-regression models to estimate fractions of mortality attributable to heat and cold (AF%) in each city, and to evaluate the effect modification of each indicator across cities.ResultsHeat- and cold-related deaths amounted to 0.54% (95% confidence interval: 0.49 to 0.58%) and 6.05% (5.59 to 6.36%) of total deaths, respectively. Several city indicators modify the effect of heat, with a higher mortality impact associated with increases in population density, fine particles (PM2.5), gross domestic product (GDP) and Gini index (a measure of income inequality), whereas higher levels of green spaces were linked with a decreased effect of heat.ConclusionsThis represents the largest study to date assessing the effect modification of temperature–mortality relationships. Evidence from this study can inform public-health interventions and urban planning under various climate-change and urban-development scenarios.
      PubDate: Wed, 27 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz008
      Issue No: Vol. 48, No. 4 (2019)
       
  • Risk of acute respiratory infection from crop burning in India: estimating
           disease burden and economic welfare from satellite and national health
           survey data for 250 000 persons
    • Authors: Chakrabarti S; Khan M, Kishore A, et al.
      Pages: 1113 - 1124
      Abstract: BackgroundRespiratory infections are among the leading causes of death and disability globally. Respirable aerosol particles released by agricultural crop-residue burning (ACRB), practised by farmers in all global regions, are potentially harmful to human health. Our objective was to estimate the health and economic costs of ACRB in northern India.MethodsThe primary outcome was acute respiratory infection (ARI) from India’s fourth District Level Health Survey (DLHS-4). DLHS-4 data were merged with Moderate-Resolution Imaging Spectroradiometer satellite data on fire occurrence. Mutually adjusted generalized linear models were used to generate risk ratios for risk factors of ARI. Overall disease burden due to ACRB was estimated in terms of disability-adjusted life years.ResultsSeeking medical treatment for ARI in the previous 2 weeks was reported by 5050 (2%) of 252 539 persons. Living in a district with intense ACRB—the top quintile of fires per day—was associated with a 3-fold higher risk of ARI (mutually adjusted risk ratio 2.99, 95% confidence interval 2.77 to 3.23) after adjustment for socio-demographic and household factors. Children under 5 years of age were particularly susceptible (3.65, 3.06 to 4.34 in this subgroup). Additional ARI risk factors included motor-vehicle congestion (1.96, 1.72 to 2.23), open drainage (1.91, 1.73 to 2.11), cooking with biomass (1.73, 1.58 to 1.90) and living in urban areas (1.35, 1.26 to 1.44). Eliminating ACRB would avert 14.9 million disability-adjusted life years lost per year, valued at US$152.9 billion over 5 years.ConclusionsInvestments to stop crop burning and offer farmers alternative crop-residue disposal solutions are likely to improve population-level respiratory health and yield major economic returns.
      PubDate: Thu, 28 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz022
      Issue No: Vol. 48, No. 4 (2019)
       
  • Early-life exposure to ambient fine particulate air pollution and infant
           mortality: pooled evidence from 43 low- and middle-income countries
    • Authors: Goyal N; Karra M, Canning D.
      Pages: 1125 - 1141
      Abstract: BackgroundMany low- and middle-income countries are experiencing high and increasing exposure to ambient fine particulate air pollution (PM2.5). The effect of PM2.5 on infant and child mortality is usually modelled using concentration response curves extrapolated from studies conducted in settings with low ambient air pollution, which may not capture its full effect.MethodsWe pool data on more than half a million births from 69 nationally representative Demographic and Health Surveys that were conducted in 43 low- and middle-income countries between 1998 and 2014, and we calculate early-life exposure (exposure in utero and post partum) to ambient PM2.5 using high-resolution calibrated satellite data matched to the child’s place of residence. We estimate the association between the log of early-life PM2.5 exposure, both overall and separated by type, and the odds of neonatal and infant mortality, adjusting for child-level, parent-level and household-level characteristics.ResultsWe find little evidence that early-life exposure to overall PM2.5 is associated with higher odds of mortality relative to low exposure to PM2.5. However, about half of PM2.5 is naturally occurring dust and sea-salt whereas half is from other sources, comprising mainly carbon-based compounds, which are mostly due to human activity. We find a very strong association between exposure to carbonaceous PM2.5 and infant mortality, particularly neonatal mortality, i.e. mortality in the first 28 days after birth. We estimate that, at the mean level of exposure in the sample to carbonaceous PM2.5—10.9 µg/m3—the odds of neonatal mortality are over 50% higher than in the absence of pollution.ConclusionOur results suggest that the current World Health Organization guideline of limiting the overall ambient PM2.5 level to less than 10 µg/m³ should be augmented with a lower limit for harmful carbonaceous PM2.5.
      PubDate: Fri, 10 May 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz090
      Issue No: Vol. 48, No. 4 (2019)
       
  • Fine particulate air pollution and adult hospital admissions in 200
           Chinese cities: a time-series analysis
    • Authors: Tian Y; Liu H, Liang T, et al.
      Pages: 1142 - 1151
      Abstract: BackgroundThe association between short-term exposure to ambient fine particulate matter (PM2.5) and morbidity risk in developing countries is not fully understood. We conducted a nationwide time-series study to estimate the short-term effect of PM2.5 on hospital admissions in Chinese adults.MethodsDaily counts of hospital admissions for 2014–16 were obtained from the National Urban Employee Basic Medical Insurance database. We identified more than 58 million hospitalizations from 0.28 billion insured persons in 200 Chinese cities for subjects aged 18 years or older. Generalized additive models with quasi-Poisson regression were applied to examine city-specific associations of PM2.5 concentrations with hospital admissions. National-average estimates of the association were obtained from a random-effects meta-analysis. We also investigated potential effect modifiers, such as age, sex, temperature and relative humidity.ResultsAn increase of 10 μg/m3 in same-day PM2.5 concentrations was positively associated with a 0.19% (95% confidence interval: 0.07–0.30) increase in the daily number of hospital admissions at the national level. PM2.5 exposure remained positively associated with hospital admissions on days when the daily concentrations met the current Chinese Ambient Air Quality Standards (75 μg/m3). Estimates of admission varied across cities and increased in cities with lower PM2.5 concentrations (p = 0.044) or higher temperatures (p = 0.002) and relative humidity (p = 0.003). The elderly were more sensitive to PM2.5 exposure (p < 0.001).ConclusionsShort-term exposure to PM2.5 was positively associated with adult hospital admissions in China, even at levels below current Chinese Ambient Air Quality Standards.
      PubDate: Mon, 03 Jun 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz106
      Issue No: Vol. 48, No. 4 (2019)
       
  • Physical activity of UK adults with chronic disease: cross-sectional
           analysis of accelerometer-measured physical activity in 96 706 UK Biobank
           participants
    • Authors: Barker J; Smith Byrne K, Doherty A, et al.
      Pages: 1167 - 1174
      Abstract: BackgroundPhysical inactivity is associated with an increased risk of major chronic diseases, although uncertainty exists about which chronic diseases, themselves, might contribute to physical inactivity. The objective of this study was to compare the physical activity of those with chronic diseases to healthy individuals using an objective measure of physical activity.MethodsWe conducted a cross-sectional analysis of data from 96 706 participants aged 40 years or older from the UK Biobank prospective cohort study (2006–10). Diagnoses were identified through ICD 9 and 10 coding within hospital admission records and a cancer registry linked to UK Biobank participants. We extracted summary physical activity information from participants who wore a wrist-worn triaxial accelerometer for 7 days. Statistical analyses included computation of adjusted geometric means and means using general linear models.ResultsParticipants with chronic disease undertook 9% or 61 minutes (95% confidence interval: 57.8–64.8) less moderate activity and 11% or 3 minutes (95% confidence interval: 2.7–3.3) less vigorous activity per week than individuals without chronic disease. Participants in every chronic-disease subgroup undertook less physical activity than those without chronic disease. Sixty-seven diagnoses within these subgroups were associated with lower moderate activity.ConclusionsThe cross-sectional association of physical activity with chronic disease is broad. Given the substantial health benefits of being physically active, clinicians and policymakers should be aware that their patients with any chronic disease are at greater health risk from other diseases than anticipated because of their physical inactivity.
      PubDate: Tue, 05 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyy294
      Issue No: Vol. 48, No. 4 (2019)
       
  • Driving status, travel modes and accelerometer-assessed physical activity
           in younger, middle-aged and older adults: a prospective study of 90 810
           UK Biobank participants
    • Authors: Hajna S; White T, Panter J, et al.
      Pages: 1175 - 1186
      Abstract: BackgroundAssociations between driving and physical-activity (PA) intensities are unclear, particularly among older adults. We estimated prospective associations of travel modes with total PA, sedentary time (ST), light-intensity PA (LPA), and moderate-to-vigorous intensity PA (MVPA) among adults aged 39–70 years.MethodsWe studied 90 810 UK Biobank participants (56.1 ± 7.8 years). Driving status, specific travel modes (non-work travel; commuting to/from work) and covariates were assessed by questionnaire (2006–10). PA was assessed over 7 days by wrist-worn accelerometers (2013–15). We estimated associations using overall and age-stratified multivariable linear-regression models.ResultsDrivers accumulated 1.4% more total PA (95% confidence interval: 0.9, 1.9), 11.2 min/day less ST (–12.9, –9.5), 12.2 min/day more LPA (11.0, 13.3) and 0.9 min/day less MVPA (–1.6, –0.2) than non-drivers. Compared with car/motor-vehicle users, cyclists and walkers had the most optimal activity profiles followed by mixed-mode users (e.g. for non-work travel, cyclists: 10.7% more total PA, 9.0, 12.4; 20.5 min/day less ST, –26.0, –15.0; 14.5 min/day more MVPA, 12.0, 17.2; walkers: 4.2% more total PA, 3.5, 5.0; 7.5 min/day less ST –10.2, –4.9; 10.1 min/day more MVPA, 8.9, 11.3; mixed-mode users: 2.3% more total PA, 1.9, 2.7; 3.4 min/day less ST –4.8, –2.1; 4.9 min/day more MVPA, 4.3, 5.5). Some associations varied by age (p interaction < 0.05), but these differences appeared small.ConclusionsAssessing specific travel modes rather than driving status alone may better capture variations in activity. Walking, cycling and, to a lesser degree, mixed-mode use are associated with more optimal activity profiles in adults of all ages.
      PubDate: Fri, 19 Apr 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz065
      Issue No: Vol. 48, No. 4 (2019)
       
  • Prevalence of behavioural risk factors for road-traffic injuries among the
           Iranian population: findings from STEPs 2016
    • Authors: Fathollahi S; Saeedi Moghaddam S, Rezaei N, et al.
      Pages: 1187 - 1196
      Abstract: BackgroundTo achieve Sustainable Development Goal 3.6 in Iran, we need to have a comprehensive understanding of the distribution of risky behaviours regarding road-traffic injuries at national and sub-national levels. Little is known about the road-use vulnerability patterns of road-traffic injuries in Iran. The aim of this study is to describe the prevalence of self-reported human risk factors in road-traffic injuries using the findings from a large-scale cross-sectional study based on the World Health Organization’s stepwise approach to surveillance of non-communicable diseases (STEPs).MethodsA cross-sectional survey study in 2016 assessed the road-use pattern and prevalence of risky behaviours of people more than 18 years old. In this study, we planned to recruit 31 050 individuals as a representative sample at national and provincial levels. In practice, 30 541 individuals (3105 clusters) from urban and rural areas of Iran were selected. Basic socio-demographic data, major behavioural risk factors such as seatbelt and helmet non-compliance, drunk driving and occupant in a car with a drunk driver were assessed through baseline interviews gathered through an Android tablet-based questionnaire.ResultsThe overall prevalence of seatbelt and helmet compliance was 75.2% (95% confidence interval: 74.7–75.7) and 13.9% (13.4–14.5), respectively, at the national level. The prevalence of risk-taking behaviours such as drink driving was 0.5% (0.4–0.6) and for being an occupant in a car with a drunk driver was 3.5% (3.2–3.8). At the provincial level, the highest age-standardized prevalence of seatbelt compliance (89.6%) was almost 1.5 times higher than the lowest provincial prevalence (58.5%). In 63% of provinces, the lowest prevalence of seatbelt compliance was observed among people aged 18–24 years old.ConclusionsIn Iran, existing disease-prevention and health-promotion programmes should be expanded to target vulnerable subgroups that have more prevalent human risk factors for road-traffic injuries. Further research is required to investigate the context-specific proximal human risk factors and vulnerability patterns in Iran.
      PubDate: Wed, 06 Mar 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz021
      Issue No: Vol. 48, No. 4 (2019)
       
  • The impact of bicycle helmet legislation on cycling fatalities in
           Australia
    • Authors: Olivier J; Boufous S, Grzebieta R.
      Pages: 1197 - 1203
      Abstract: BackgroundAustralian bicycle helmet laws were first introduced in Victoria in July 1990 and the remaining Australian states, Australian Capital Territory and Northern Territory by July 1992. Previous research on helmet legislation has focused on changes in helmet wearing and bicycle-related head injury. Although it is generally accepted that bicycle helmets can reduce the risk of fatality due to head injury, there has been little research assessing the impact of helmet legislation on cycling fatalities.MethodsAn interrupted time series approach was used to assess the impact of bicycle helmet legislation on yearly-aggregated rates of bicycle-related fatalities per population from 1971 to 2016.ResultsImmediately following bicycle helmet legislation, the rate of bicycle fatalities per 1 000 000 population reduced by 46% relative to the pre-legislation trend [95% confidence interval (CI): 31, 58]. For the period 1990–2016, we estimate 1332 fewer cycling fatalities (95% CI: 1201, 1463) or an average of 49.4 per year (95% CI: 44.5, 54.2). Reductions were also observed for pedestrian fatalities; however, bicycle fatalities declined by 36% relative to pedestrian fatalities (95% CI: 12, 54).ConclusionsIn the absence of robust evidence showing a decline in cycling exposure following helmet legislation or other confounding factors, the reduction in Australian bicycle-related fatality appears to be primarily due to increased helmet use and not other factors.
      PubDate: Tue, 05 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz003
      Issue No: Vol. 48, No. 4 (2019)
       
  • Using healthcare-seeking behaviour to estimate the number of Nipah
           outbreaks missed by hospital-based surveillance in Bangladesh
    • Authors: Hegde S; Salje H, Sazzad H, et al.
      Pages: 1219 - 1227
      Abstract: BackgroundUnderstanding the true burden of emergent diseases is critical for assessing public-health impact. However, surveillance often relies on hospital systems that only capture a minority of cases. We use the example of Nipah-virus infection in Bangladesh, which has a high case-fatality ratio and frequent person-to-person transmission, to demonstrate how healthcare-seeking data can estimate true burden.MethodsWe fit logistic-regression models to data from a population-based, healthcare-seeking study of encephalitis cases to characterize the impact of distance and mortality on attending one of three surveillance hospital sites. The resulting estimates of detection probabilities, as a function of distance and outcome, are applied to all observed Nipah outbreaks between 2007 and 2014 to estimate the true burden.ResultsThe probability of attending a surveillance hospital fell from 82% for people with fatal encephalitis living 10 km away from a surveillance hospital to 54% at 50 km away. The odds of attending a surveillance hospital are 3.2 (95% confidence interval: 1.6, 6.6) times greater for patients who eventually died (i.e. who were more severely ill) compared with those who survived. Using these probabilities, we estimated that 119 Nipah outbreaks (95% confidence interval: 103, 140)—an average of 15 outbreaks per Nipah season—occurred during 2007–14; 62 (52%) were detected.ConclusionsOur findings suggest hospital-based surveillance missed nearly half of all Nipah outbreaks. This analytical method allowed us to estimate the underlying burden of disease, which is important for emerging diseases where healthcare access may be limited.
      PubDate: Thu, 11 Apr 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz057
      Issue No: Vol. 48, No. 4 (2019)
       
  • Comparison of 1-week and 2-week recall periods for caregiver-reported
           diarrhoeal illness in children, using nationally representative household
           surveys
    • Authors: Overbey K; Schwab K, Exum N.
      Pages: 1228 - 1239
      Abstract: BackgroundDiarrhoeal outcomes in children are often ascertained using caregiver-reported symptoms, which are subject to a variety of biases and methodological challenges. One source of bias is the time window used for reporting diarrhoeal illness and the ability of caregivers to accurately recall episodes in children.MethodsDiarrhoea period prevalence in children under five was determined using two similarly administered, nationally representative household surveys: Performance Monitoring and Accountability 2020 (PMA2020) (1-week recall, N = 14 603) and Demographic and Health Surveys (DHS) (2-week recall, N = 66 717). Countries included in the analysis were the Democratic Republic of the Congo, Ethiopia, Ghana, Kenya and Uganda. Diarrhoea period prevalence estimates were compared and water, sanitation and hygiene risk factors were analysed.ResultsChildhood diarrhoea prevalence using 1-week recall (PMA2020) pooled across countries was 21.4% [95% confidence interval (CI): 19.9%, 22.9%] versus 16.0% using 2-week recall (DHS) (95% CI: 15.4%, 16.5%). In stratified analyses for all five countries, the number of diarrhoea cases detected was consistently higher using 1-week recall versus 2-week recall. The key risk factors identified in the PMA2020 data that were not associated with diarrhoeal episodes or were attenuated in the DHS data included: the main sanitation classifications for households, disposal method used for child faeces, number of household members and wealth quintiles.ConclusionsFor nationally representative household surveys assessing childhood diarrhoea period prevalence, a 2-week recall period may underestimate diarrhoea prevalence compared with a 1-week period. The household sanitation facility and practices remain key risk factors for diarrhoeal disease in children under five.
      PubDate: Mon, 25 Mar 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz043
      Issue No: Vol. 48, No. 4 (2019)
       
  • Evaluating vaccination policies to accelerate measles elimination in
           China: a meta-population modelling study
    • Authors: Hao L; Glasser J, Su Q, et al.
      Pages: 1240 - 1251
      Abstract: BackgroundMeasles is among the most highly infectious human diseases. By virtue of increasingly effective childhood vaccination, together with targeted supplemental immunization activities (SIAs), health authorities in the People’s Republic of China have reduced measles’ reproduction number from about 18 to 2.3. Despite substantial residual susceptibility among young adults, more in some locales than others, sustained routine childhood immunization likely would eliminate measles eventually. To support global eradication efforts, as well as expedite morbidity and mortality reductions in China, we evaluated alternative SIAs via mechanistic mathematical modelling.MethodsOur model Chinese population is stratified by immune status (susceptible to measles infection; infected, but not yet infectious; infectious; and recovered or immunized), age (0, 1–4, 5–9, …, 65+ years) and location (31 provinces). Contacts between sub-populations are either empirical or a mixture of preferential and proportionate with respect to age and decline exponentially with distance between locations at age-dependent rates. We estimated initial conditions and most parameters from recent cross-sectional serological surveys, disease surveillance and demographic observations. Then we calculated the reproduction numbers and gradient of the effective number with respect to age- and location-specific immunization rates. We corroborated these analytical results by simulating adolescent and young adult SIAs using a version of our model in which the age-specific contact rates vary seasonally.ResultsWhereas the gradient indicates that vaccinating young adults generally is the optimal strategy, simulations indicate that a catch-up campaign among susceptible adolescent schoolchildren would accelerate elimination, with timing dependent on uptake.ConclusionsThese results are largely due to indirect effects (i.e. fewer infections than immunized people might otherwise cause), which meta-population models with realistic mixing are uniquely capable of reproducing accurately.
      PubDate: Thu, 11 Apr 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz058
      Issue No: Vol. 48, No. 4 (2019)
       
  • Unmasking herd protection by an oral cholera vaccine in a
           cluster-randomized trial
    • Authors: Ali M; Qadri F, Kim D, et al.
      Pages: 1252 - 1261
      Abstract: BackgroundSeveral studies have shown that inactivated, whole-cell oral cholera vaccines (OCVs) confer both direct protection on vaccinees and herd protection on populations. Because our earlier cluster-randomized effectiveness trial (CRT) in urban Bangladesh failed to detect OCV herd protection, we reanalysed the trial to assess whether herd effects were masked in our original analysis.MethodsA total of 267 270 persons were randomized to 90 approximately equal-sized clusters. In 60 clusters persons aged 1 year and older were eligible to receive OCV and in 30 clusters persons received no intervention and served as controls. We analysed OCV protection against severely dehydrating cholera for the entire clusters, as in our original analysis, and for subclusters consisting of residents of innermost households. We hypothesized that if OCV herd protection was attenuated by cholera transmission into the clusters from the outside in this densely populated setting, herd protection would be most evident in the innermost households.ResultsDuring 2 years of follow-up of all residents of the clusters, total protection (protection of OCV recipients relative to control residents) was 58% [95% confidence interval (CI): 43%, 70%; P<0.0001], indirect protection (protection of non-OCV recipients in OCV clusters relative to control participants) was 16% (95% CI: –20%, 41%; P=0.35) and overall OCV protection (protection of all residents in the OCV clusters relative to control residents) was 46% (95% CI: 30%, 59%; P<0.0001). Analyses of the inner 75% and 50% households of the clusters showed similar findings. However, total protection was 75% (95% CI: 50%, 87%, P<0.0001), indirect protection 52% (95% CI: –9%, 79%; P=0.08) and overall protection 72% (95% CI: 49%, 84%; P<0.0001) for the innermost 25% households.ConclusionConsistent with past studies, substantial OCV herd protective effects were identified, but were unmasked only by analysing innermost households of the clusters. Caution is needed in defining clusters for analysis of vaccine herd effects in CRTs of vaccines.
      PubDate: Tue, 09 Apr 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz060
      Issue No: Vol. 48, No. 4 (2019)
       
  • Association of menopausal characteristics and risk of coronary heart
           disease: a pan-European case–cohort analysis
    • Authors: Dam V; van der Schouw Y, Onland-Moret N, et al.
      Pages: 1275 - 1285
      Abstract: BackgroundEarlier age at menopause has been associated with increased risk of coronary heart disease (CHD), but the shape of association and role of established cardiovascular risk factors remain unclear. Therefore, we examined the associations between menopausal characteristics and CHD risk; the shape of the association between age at menopause and CHD risk; and the extent to which these associations are explained by established cardiovascular risk factors.MethodsWe used data from EPIC-CVD, a case–cohort study, which includes data from 23 centres from 10 European countries. We included only women, of whom 10 880 comprise the randomly selected sub-cohort, supplemented with 4522 cases outside the sub-cohort. We conducted Prentice-weighted Cox proportional hazards regressions with age as the underlying time scale, stratified by country and adjusted for relevant confounders.ResultsAfter confounder and intermediate adjustment, post-menopausal women were not at higher CHD risk compared with pre-menopausal women. Among post-menopausal women, earlier menopause was linearly associated with higher CHD risk [HRconfounder and intermediate adjusted per-year decrease = 1.02, 95% confidence interval (CI) = 1.01–1.03, p = 0.001]. Women with a surgical menopause were at higher risk of CHD compared with those with natural menopause (HRconfounder-adjusted = 1.25, 95% CI = 1.10–1.42, p < 0.001), but this attenuated after additional adjustment for age at menopause and intermediates (HR = 1.12, 95% CI = 0.96–1.29, p = 0.15). A proportion of the association was explained by cardiovascular risk factors.ConclusionsEarlier and surgical menopause were associated with higher CHD risk. These associations could partially be explained by differences in conventional cardiovascular risk factors. These women might benefit from close monitoring of cardiovascular risk factors and disease.
      PubDate: Fri, 22 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz016
      Issue No: Vol. 48, No. 4 (2019)
       
  • Accounting for missing data in statistical analyses: multiple imputation
           is not always the answer
    • Authors: Hughes R; Heron J, Sterne J, et al.
      Pages: 1294 - 1304
      Abstract: BackgroundMissing data are unavoidable in epidemiological research, potentially leading to bias and loss of precision. Multiple imputation (MI) is widely advocated as an improvement over complete case analysis (CCA). However, contrary to widespread belief, CCA is preferable to MI in some situations.MethodsWe provide guidance on choice of analysis when data are incomplete. Using causal diagrams to depict missingness mechanisms, we describe when CCA will not be biased by missing data and compare MI and CCA, with respect to bias and efficiency, in a range of missing data situations. We illustrate selection of an appropriate method in practice.ResultsFor most regression models, CCA gives unbiased results when the chance of being a complete case does not depend on the outcome after taking the covariates into consideration, which includes situations where data are missing not at random. Consequently, there are situations in which CCA analyses are unbiased while MI analyses, assuming missing at random (MAR), are biased. By contrast MI, unlike CCA, is valid for all MAR situations and has the potential to use information contained in the incomplete cases and auxiliary variables to reduce bias and/or improve precision. For this reason, MI was preferred over CCA in our real data example.ConclusionsChoice of method for dealing with missing data is crucial for validity of conclusions, and should be based on careful consideration of the reasons for the missing data, missing data patterns and the availability of auxiliary information.
      PubDate: Sat, 16 Mar 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz032
      Issue No: Vol. 48, No. 4 (2019)
       
  • Outlier detection for questionnaire data in biobanks
    • Authors: Sakurai R; Ueki M, Makino S, et al.
      Pages: 1305 - 1315
      Abstract: BackgroundBiobanks increasingly collect, process and store omics with more conventional epidemiologic information necessitating considerable effort in data cleaning. An efficient outlier detection method that reduces manual labour is highly desirable.MethodWe develop an unsupervised machine-learning method for outlier detection, namely kurPCA, that uses principal component analysis combined with kurtosis to ascertain the existence of outliers. In addition, we propose a novel regression adjustment approach to improve detection, namely the regression adjustment for data by systematic missing patterns (RAMP).ResultApplication to epidemiological record data in a large-scale biobank (Tohoku Medical Megabank Organization, Japan) shows that a combination of kurPCA and RAMP effectively detects known errors or inconsistent patterns.ConclusionsWe confirm through the results of the simulation and the application that our methods showed good performance. The proposed methods are useful for many practical analysis scenarios.
      PubDate: Fri, 08 Mar 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz012
      Issue No: Vol. 48, No. 4 (2019)
       
  • Update on the global epidemiology of intussusception: a systematic review
           of incidence rates, age distributions and case-fatality ratios among
           children aged <5 years, before the introduction of rotavirus
           vaccination
    • Authors: Clark A; Hasso-Agopsowicz M, Kraus M, et al.
      Pages: 1316 - 1326
      Abstract: BackgroundIn some countries that have introduced oral rotavirus vaccines, a small but elevated risk of intussusception—a rare bowel disorder—has been reported. Updated estimates on the global epidemiology of intussusception are needed to help predict the potential number of intussusception cases that could be caused by the vaccine in different settings.MethodsWe estimated incidence rates, age distributions and case-fatality ratios (CFRs) for intussusception hospital admissions among children aged <5 years, before the introduction of rotavirus vaccines. We included all articles identified in a systematic review between January 2002 and January 2018, and contacted authors for more granular unpublished data on age distributions.ResultsWe identified 128 articles containing 227 country datasets (61 age distributions, 71 incidence rates and 95 CFRs). The median age of intussusception ranged from 29 weeks in Africa (83% of cases in the first year of life) to 70 weeks in the Western Pacific region (35% of cases in the first year of life). The median (range) annual incidence of intussusception hospital admissions per 100 000 aged <1 year ranged from 34 (13–56) in Africa to 90 (9–380) in the Western Pacific region. We found extreme differences between the CFRs in Africa (1 death in every 10 hospital admissions) and the rest of the world (fewer than 1 death in every 100–2000 hospital admissions).ConclusionIntussusception epidemiology varies by country and region. Understanding and recognizing these differences will be important when assessing the potential number of intussusception cases associated with rotavirus vaccines.
      PubDate: Sat, 16 Mar 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz028
      Issue No: Vol. 48, No. 4 (2019)
       
  • Integrated approach for triple elimination of mother-to-child transmission
           of HIV, hepatitis B and syphilis is highly effective and cost-effective:
           an economic evaluation
    • Authors: Zhang L; Tao Y, Woodring J, et al.
      Pages: 1327 - 1339
      Abstract: BackgroundThe Regional Framework for Triple Elimination of Mother-to-Child Transmission (EMTCT) of HIV, Hepatitis B (HBV) and Syphilis in Asia and the Pacific 2018-30 was endorsed by the Regional Committee of WHO Western Pacific in October 2017, proposing an integrated and coordinated approach to achieve elimination in an efficient, coordinated and sustainable manner. This study aims to assess the population impacts and cost-effectiveness of this integrated approach in the Cambodian context.MethodsBased on existing frameworks for the EMTCT for each individual infection, an integrated framework that combines infection prevention procedures with routine antenatal care was constructed. Using decision tree analyses, population impacts, cost-effectiveness and the potential reduction in required resources of the integrated approach as a result of resource pooling and improvements in service coverage and coordination, were evaluated. The tool was assessed using simulated epidemiological data from Cambodia.ResultsThe current prevention programme for 370,000 Cambodian pregnant women was estimated at USD$2.3 ($2.0–$2.5) million per year, including the duration of pregnancy and up to 18 months after delivery. A model estimate of current MTCT rates in Cambodia was 6.6% (6.2–7.1%) for HIV, 14.1% (13.1–15.2%) for HBV and 9.4% (9.0–9.8%) for syphilis. Integrating HIV and syphilis prevention into the existing antenatal care framework will reduce the total time required to provide this integrated care by 19% for health care workers and by 32% for pregnant women, resulting in a net saving of $380,000 per year for the EMTCT programme. This integrated approach reduces HIV and HBV MTCT to 6.1% (5.7–6.5%) and 13.0% (12.1–14.0%), respectively, and substantially reduces syphilis MCTC to 4.6% (4.3–5.0%). Further introduction of either antiviral treatment for pregnant women with high viral load of HBV, or hepatitis B immunoglobulin (HBIG) to exposed newborns, will increase the total cost of EMTCT to $4.4 ($3.6–$5.2) million and $3.3 ($2.7–$4.0) million per year, respectively, but substantially reduce HBV MTCT to 3.5% (3.2–3.8%) and 5.0% (4.6–5.5%), respectively. Combining both antiviral and HBIG treatments will further reduce HBV MTCT to 3.4% (3.1–3.7%) at an increased total cost of EMTCT of $4.5 ($3.7–$5.4) million per year. All these HBV intervention scenarios are highly cost–effective ($64–$114 per disability-adjusted life years averted) when the life benefits of these prevention measures are considered.ConclusionsThe integrated approach, using antenatal, perinatal and postnatal care as a platform in Cambodia for triple EMTCT of HIV, HBV and syphilis, is highly cost-effective and efficient.
      PubDate: Sat, 16 Mar 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz037
      Issue No: Vol. 48, No. 4 (2019)
       
  • Socio-economic inequalities in life expectancy of older adults with and
           without multimorbidity: a record linkage study of 1.1 million people in
           England
    • Authors: Chan M; van den Hout A, Pujades-Rodriguez M, et al.
      Pages: 1340 - 1351
      Abstract: BackgroundAge of onset of multimorbidity and its prevalence are well documented. However, its contribution to inequalities in life expectancy has yet to be quantified.MethodsA cohort of 1.1 million English people aged 45 and older were followed up from 2001 to 2010. Multimorbidity was defined as having 2 or more of 30 major chronic diseases. Multi-state models were used to estimate years spent healthy and with multimorbidity, stratified by sex, smoking status and quintiles of small-area deprivation.ResultsUnequal rates of multimorbidity onset and subsequent survival contributed to higher life expectancy at age 65 for the least (Q1) compared with most (Q5) deprived: there was a 2-year gap in healthy life expectancy for men [Q1: 7.7 years (95% confidence interval: 6.4–8.5) vs Q5: 5.4 (4.4–6.0)] and a 3-year gap for women [Q1: 8.6 (7.5–9.4) vs Q5: 5.9 (4.8–6.4)]; a 1-year gap in life expectancy with multimorbidity for men [Q1: 10.4 (9.9–11.2) vs Q5: 9.1 (8.7–9.6)] but none for women [Q1: 11.6 (11.1–12.4) vs Q5: 11.5 (11.1–12.2)]. Inequalities were attenuated but not fully attributable to socio-economic differences in smoking prevalence: multimorbidity onset was latest for never smokers and subsequent survival was longer for never and ex smokers.ConclusionsThe association between social disadvantage and multimorbidity is complex. By quantifying socio-demographic and smoking-related contributions to multimorbidity onset and subsequent survival, we provide evidence for more equitable allocation of prevention and health-care resources to meet local needs.
      PubDate: Wed, 03 Apr 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz052
      Issue No: Vol. 48, No. 4 (2019)
       
  • Welfare regimes modify the association of disadvantaged adult-life
           socioeconomic circumstances with self-rated health in old age
    • Authors: Sieber S; Cheval B, Orsholits D, et al.
      Pages: 1352 - 1366
      Abstract: BackgroundWelfare regimes in Europe modify individuals’ socioeconomic trajectories over their life-course, and, ultimately, the link between socioeconomic circumstances (SECs) and health. This paper aimed to assess whether the associations between life-course SECs (early-life, young adult-life, middle-age and old-age) and risk of poor self-rated health (SRH) trajectories in old age are modified by welfare regimes (Scandinavian [SC], Bismarckian [BM], Southern European [SE], Eastern European [EE]).MethodsWe used data from the longitudinal SHARE survey. Early-life SECs consisted of four indicators of living conditions at age 10. Young adult-life, middle-age, and old-age SECs indicators were education, main occupation and satisfaction with household income, respectively. The association of life-course SECs with poor SRH trajectories was analysed by confounder-adjusted multilevel logistic regression models stratified by welfare regime. We included 24 011 participants (3626 in SC, 10 256 in BM, 6891 in SE, 3238 in EE) aged 50 to 96 years from 13 European countries.ResultsThe risk of poor SRH increased gradually with early-life SECs from most advantaged to most disadvantaged. The addition of adult-life SECs differentially attenuated the association of early-life SECs and SRH at older age across regimes: education attenuated the association only in SC and SE regimes and occupation only in SC and BM regimes; satisfaction with household income attenuated the association across regimes.ConclusionsEarly-life SECs have a long-lasting effect on SRH in all welfare regimes. Adult-life SECs attenuated this influence differently across welfare regimes.
      PubDate: Thu, 03 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyy283
      Issue No: Vol. 48, No. 4 (2019)
       
  • Reflection on modern methods: years of life lost due to premature
           mortality—a versatile and comprehensive measure for monitoring
           non-communicable disease mortality
    • Authors: Martinez R; Soliz P, Caixeta R, et al.
      Pages: 1367 - 1376
      Abstract: The analysis of causes impacting on premature mortality is an essential function of public health surveillance. Diverse methods have been used for accurately assessing and reporting the level and trends of premature mortality; however, many have important limitations, particularly in capturing actual early deaths. We argue that the framework of years of life lost (YLL), as conceptualized in disability-adjusted life-years (DALYs), is a robust and comprehensive measure of premature mortality. Global Burden of Disease study is systematically providing estimates of YLL; however, it is not widely adopted at country level, among other reasons because its conceptual and methodological bases seem to be not sufficiently known and understood. In this paper, we provide the concepts and the methodology of the YLL framework, including the selection of the loss of function that defines the time lost due to premature deaths, and detailed methods for calculating YLL metrics. We also illustrate how to use YLL to quantify the level and trends of premature non-communicable disease (NCD) mortality in the Americas. The tutorial style of the illustrative example is intended to educate the public health community and stimulate the use of YLL in disease prevention and control programmes at different levels.
      PubDate: Wed, 09 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyy254
      Issue No: Vol. 48, No. 4 (2019)
       
  • Prenatal smoke exposure, DNA methylation and a link between DRD1 and lung
           cancer
    • Authors: Ryan B; Robles A.
      Pages: 1377 - 1378
      Abstract: We read with interest the recent work by Richmond et al.1 where they describe changes in DNA methylation that persist into adulthood among individuals exposed to second-hand smoke in utero. Among the genes affected was DRD1, also known as dopamine receptor, D1. We were struck by this finding as we previously published work describing a gene–environment interaction between a single nucleotide polymorphism (SNP) in DRD1 with risk of lung cancer, specifically among individuals exposed to second-hand smoke during childhood, but not adulthood.2 We detected this gene–environment interaction in both ever and never smokers, which is also consistent with the findings of Richmond et al. The SNP of focus in our study was a 3′UTR SNP, rs686. While the methylation probe detected in the study by Richmond et al. lies downstream of DRD1, it is interesting to hypothesize that rs686 could be a tag SNP for a functional locus or methylation expression quantitative trait locus (meQTL) in this gene neighbourhood.
      PubDate: Fri, 15 Mar 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz035
      Issue No: Vol. 48, No. 4 (2019)
       
  • Response to: Prenatal smoke exposure, DNA methylation and a link between
           DRD1 and lung cancer
    • Authors: Richmond R; Suderman M, Langdon R, et al.
      Pages: 1378 - 1379
      Abstract: We thank Ryan and Robles for their interesting comment on our finding that prenatal smoke exposure was associated with DNA methylation levels in adulthood at a CpG site annotated to DRD1.1 In their previous study,2 Ryan and Robles found evidence for a gene–environment interaction between a single nucleotide polymorphism (SNP) in DRD1 and second-hand smoke exposure in relation to lung cancer. They speculate that their observed interaction could be mediated by DNA methylation at DRD1. The SNP they mention (rs686) is located 245 766 base pairs downstream of the identified CpG site (cg22807681) in DRD1.
      PubDate: Thu, 21 Mar 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz036
      Issue No: Vol. 48, No. 4 (2019)
       
  • One size does not fit all— application of accelerometer thresholds
           in chronic disease
    • Authors: Dibben G; Taylor R, Dalal H, et al.
      Pages: 1380 - 1380
      Abstract: We would like to congratulate Barker et al.1 on their recent publication comparing physical activity (PA) of those with and without chronic disease among the UK Biobank participants. The authors conclude that those with chronic disease have lower PA levels than their healthy peers. However, we would like to draw attention to what we believe is a key limitation of this study.
      PubDate: Fri, 02 Aug 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz164
      Issue No: Vol. 48, No. 4 (2019)
       
  • Response to: One size does not fit all—application of accelerometer
           thresholds in chronic disease
    • Authors: Barker J; Smith Byrne K, Doherty A, et al.
      Pages: 1381 - 1381
      Abstract: We thank Dibben et al. for their comments on our paper.1 A concern was raised that our analysis might introduce differential bias between those with vs those without chronic disease, through the use of a fixed y-axis threshold (100 mg) to determine whether an individual is likely to be moderately active at any given time. In an ideal scenario, we would have access to validation datasets in a large sample of healthy and diseased individuals. Unfortunately, such datasets simply do not exist at present. The heart failure validation data shared by Dibben and colleagues is potentially relevant but currently unpublished. At present, published validation data is only available on healthy individuals,2 which we acknowledge as a potential limitation in our paper.
      PubDate: Fri, 02 Aug 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz165
      Issue No: Vol. 48, No. 4 (2019)
       
  • Cohort profile: The LoewenKIDS Study – life-course perspective on
           infections, the microbiome and the development of the immune system in
           early childhood
    • Authors: Gottschick C; Raupach-Rosin H, Langer S, et al.
      Pages: 1382 - 1383
      Abstract: First published online: 27 February 2019, Int J Epidemiol 2019, doi: https://doi.org/10.1093/ije/dyz001
      PubDate: Mon, 01 Apr 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz069
      Issue No: Vol. 48, No. 4 (2019)
       
  • Are cities good for health' A study of the impacts of planned
           urbanization in China
    • Authors: Hou B; Nazroo J, Banks J, et al.
      Pages: 1384 - 1384
      Abstract: First published online: 18 March 2019, Int J Epidemiol 2019, doi: https://doi.org/10.1093/ije/dyz031
      PubDate: Tue, 23 Apr 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz088
      Issue No: Vol. 48, No. 4 (2019)
       
  • Evaluating vaccination policies to accelerate measles elimination in
           China: a meta-population modelling study
    • Authors: Hao L; Glasser J, Su Q, et al.
      Pages: 1385 - 1385
      Abstract: First published online: 11 April 2019, Int J Epidemiol 2019, doi: https://doi.org/10.1093/ije/dyz058
      PubDate: Sun, 05 May 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz103
      Issue No: Vol. 48, No. 4 (2019)
       
  • Physical activity of UK adults with chronic disease: cross sectional
           analysis of accelerometer measured physical activity in 96 706 UK
           Biobank participants
    • Authors: Barker J; Smith Byrne K, Doherty A, et al.
      Pages: 1386 - 1386
      Abstract: First published online: 5 February 2019, Int J Epidemiol, doi: https://doi.org/10.1093/ije/dyy294
      PubDate: Fri, 05 Jul 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz148
      Issue No: Vol. 48, No. 4 (2019)
       
  • Spillover effects on health outcomes in low- and middle-income countries:
           a systematic review
    • Authors: Benjamin-Chung J; Abedin J, Berger D, et al.
      Pages: 1387 - 1387
      Abstract: Int J Epidemiol, 2017; 46: 1251–76. doi: https://doi.org/10.1093/ije/dyx039.
      PubDate: Mon, 03 Jun 2019 00:00:00 GMT
      DOI: 10.1093/ije/dyz111
      Issue No: Vol. 48, No. 4 (2019)
       
 
 
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