Category: Statistics

BMC Public Health. 2025 Oct 1;25(1):3257. doi: 10.1186/s12889-025-24530-1.

ABSTRACT

BACKGROUND: The COVID-19 pandemic disproportionately affected various demographics and regions in the United States. Understanding disparities in COVID-19 mortality is essential for promoting health equity and guiding future responses.

OBJECTIVE: To examine demographic and regional disparities in age-adjusted and proportionate COVID-19 mortality in the US from 2020 to 2023.

DESIGN, SETTING, AND PARTICIPANTS: In this repeated cross-sectional study, data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) multiple causes of death database were used to analyze death certificates from 2020 to 2023 for COVID-19-related mortality among persons aged ≥ 15 years in the U.S.

MAIN OUTCOME MEASURES: Age-adjusted mortality rate (AAMR) per 100,000 persons, Rate ratio (with 95% CI), and proportionate mortality of COVID-19, calculated using descriptive statistics.

RESULTS: From 2020 to 2023, 1,167,362 (8.91%) of 13,098,787 total deaths in the U.S. were attributed to COVID-19. The AAMR peaked in 2021 at 147.0 (95% CI: 146.6-147.5) per 100,000, with 13.45% of all deaths related to COVID-19, decreasing to 23.1 (2.49%) by 2023. Males exhibited a 1.56-fold higher AAMR than females. Non-Hispanic (NH) American Indian/Alaska Native experienced the highest cumulative AAMR (154), followed by NH Native Hawaiian/Pacific Islander (124.2) and NH African American (123.9) populations. Hispanics had the highest proportionate mortality, with COVID-19 contributing to 23.55% of all deaths in 2021. The oldest age group (≥ 75 years) had the highest cumulative AAMR, 71.6 times higher compared to the youngest group (15-44 years), whereas the highest proportionate mortality was seen in middle-aged adults (45-74 years). Regionally, the Southern U.S. census region recorded the highest cumulative and annual AAMR, except for the Northeast, in 2020.

CONCLUSION: From 2020 to 2023, males, older adults, and racial/ethnic minority groups, notably NH AI/AN, NH NH/PI, NH African American, and Hispanic populations, experienced higher COVID-19 mortality. Regionally, the Southern U.S. Census region had the highest COVID-19 mortality, except for the Northeast, in 2020. These disparities underscore the importance of implementing equitable public health strategies and ensuring preparedness for future health crises.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41034766 | DOI:10.1186/s12889-025-24530-1

BMC Pregnancy Childbirth. 2025 Oct 1;25(1):997. doi: 10.1186/s12884-025-08134-6.

ABSTRACT

BACKGROUND: Geographic access to healthcare continues to pose a significant challenge for pregnant women in rural areas of sub-Saharan Africa, resulting in consistently high rates of maternal mortality. Geographic barriers can persist even in settings where financial barriers have been reduced and health system strengthening (HSS) efforts are in place. The aim of this study is to gain a precise understanding of spatiotemporal changes in access to and utilization of maternal care services in a rural district of Madagascar benefiting from HSS support.

METHODS: We collected geolocated monthly information at the village level on antenatal care visits, deliveries and postnatal visits from the registries of 18 public primary health centers in Ifanadiana District, from 2016 to 2018. Similar data were collected from a district-representative cohort via surveys on over 1500 households done in 2016 and 2018. We estimated precise travel time from each village to the nearest health center to understand spatio-temporal variations in maternal care access, and to assess the impact of geographic barriers via statistical analyses while controlling for health system factors.

RESULTS: Women who lived within a one-hour walk from a health facility in the HSS catchment area had rates of per capita utilization of most maternal health services were roughly twice that those who lived 1-2 h away and three times higher than those who lived over 2 h away (e.g. relative change for delivery at a health center was 0.60 [0.53-0.67] and 0.40 [0.36-0.45] for women living 1-2 h and over 2 h from a facility, respectively). The exception was the first antenatal care visit (ANC1), for which travel time had more modest effect (e.g. relative change of 0.72 [0.67-0.77] over 2 h). Improvements to primary care services due to HSS in this setting were only observed among women living within two hours from health centers. Statistical models revealed that women’s travel time from a health facility was the strongest determinant of maternal care service utilization.

CONCLUSION: This study shows how a combination of geo-located health system information and population-representative data can help assess the impact of geographical barriers to maternal care in rural areas of sub-Saharan Africa. It highlights that women who live more than 2 h from a health facility had virtually no access to maternal health services despite efforts in place to reduce financial barriers to care and strengthen the health system.

PMID:41034758 | DOI:10.1186/s12884-025-08134-6

BMC Ophthalmol. 2025 Oct 1;25(1):530. doi: 10.1186/s12886-025-04379-z.

ABSTRACT

BACKGROUND: To investigate the factors related to the change in axial length after repeated low-level red-light(RLRL) therapy.

METHODS: A retrospective case study. A total of 323 children and adolescents who underwent RLRL therapy concurrently with their eye examinations at Wuhan Children’s Hospital from 2022 to 2023 were included. The biological eye parameters, including the axial length (AL), spherical equivalent refractive (SER), the subfoveal choroidal thickness (SFCT), intraocular pressure (IOP), corneal curvature and corneal thickness, were recorded at baseline, 3-month, 6-month, 12-month, 12-month, 18-month and 24-month. The factors related to the degree of change in axial length were analyzed.

RESULTS: There was a statistical difference in the amount of AL changes during the follow-up (F = 16.12, P < 0.001), and the amount of AL changes was significant at the 6-month follow-up (△AL=-0.16 ± 0.18), and then gradually decreased with the extension of follow-up time. There was a statistically positive correlation between baseline AL and baseline SER and changes in AL (P < 0.05). The axial regression in high myopia group was significantly greater than that in mild and moderate myopia group (P < 0.05). There was also a statistically positive correlation between age and changes in AL (P < 0.05). At the follow-up of 6 months, 12 months, 18 months, combined with other myopia prevention and control was correlated with the change of AL (P < 0.05). Baseline corneal thickness, baseline corneal curvature and baseline IOP were not correlated with changes in AL (all P > 0.05).

CONCLUSION: The longer the baseline AL, the higher SER, the thinner SFCT, the older the age and the combination of other myopia prevention and control measures, the more obvious the change of AL. However, the changes of AL were not affected by IOP, corneal curvature and corneal thickness.

PMID:41034752 | DOI:10.1186/s12886-025-04379-z

BMC Public Health. 2025 Oct 1;25(1):3275. doi: 10.1186/s12889-025-24490-6.

ABSTRACT

BACKGROUND: Physical inactivity among adults in the United Arab Emirates (UAE) is a growing public health concern, contributing to chronic diseases and increased healthcare burdens. Understanding physical activity literacy (PAL) and behaviour, along with associated sociodemographic factors, is essential for designing effective interventions.

METHODS: A cross-sectional study was conducted among 630 adults in UAE, using a validated self-administered questionnaire. The tool assessed knowledge of physical activity and its health benefits, engagement in physical activity, and sociodemographic characteristics. Knowledge scores were categorized as ‘good’ (≥ 6) and ‘poor’ (≤ 5). Data were analysed using SPSS version 28, for associations between literacy, behavior, and demographic factors were analyzed using chi-square tests, with Bonferroni correction for multiple comparisons. Effect sizes and 95% confidence intervals (CI) were reported.

RESULTS: Most participants (95.2%) demonstrated good knowledge of physical activity benefits, though misconceptions persisted regarding its effects on HIV/AIDS (32.4% incorrect) and blood pressure (28.9% incorrect). A high proportion (97.3%) reported engaging in physical activity, with 61% moderately active (3-5 times/week) and 19% highly active (6-7 times/week). There was no statistically significant association between knowledge level and physical activity performance (p = 0.192; odds ratio = 0.359, 95% CI: 0.078-1.647). Significant associations were observed between literacy level and gender (p = 0.001) as well as employment status (p = 0.002), with females and unemployed individuals more likely to have higher literacy. Physical activity engagement was not significantly associated with any sociodemographic variable.

CONCLUSIONS: Although both knowledge and participation levels are high among adults in UAE, targeted educational interventions are needed to address persistent misconceptions, especially regarding specific health outcomes. Tailoring these interventions based on gender and employment status may improve their effectiveness and promote sustained physical activity engagement across different population groups in the UAE.

PMID:41034750 | DOI:10.1186/s12889-025-24490-6

BMC Cancer. 2025 Oct 1;25(1):1491. doi: 10.1186/s12885-025-14883-6.

ABSTRACT

INTRODUCTION: Brain tumor symptoms may affect the patients’ caregivers. This study aimed to explore the mediation roles of hope and social support in the relationship between fatigue and burden in brain tumor caregivers.

METHODS: This is a cross-sectional study on 280 caregivers of brain tumor patients. Adult Hope Scale, Zarit Burden Interview, Personal Resources questionnaire 85, and Multidimensional Fatigue Inventory were used. The mediator model by the SPSS Macro PROCESS (Model 4, and 6) was used.

RESULTS: Over half of caregivers reported moderate fatigue and social support, with half experiencing moderate to severe caregiving burden. Moreover, 60.4% were moderately to highly hopeful. Significant relationships were found between fatigue and hope (r=-0.57, p < 0.001), social support (r=-0.65, p < 0.001), and burden (r = 0.63, p < 0.001), as well as between hope and social support (r = 0.57, p < 0.001). Fatigue, social support, and hope predicted the caregivers’ burden. The indirect effect of fatigue on burden by hope was significant (Effect = 0.16, 95% CI 0.02 to 0.30). The indirect effect of fatigue on burden by social support was also significant (Effect = 0.38, 95% CI 0.21 to 0.57). The indirect effect of fatigue on burden by hope and social support was significant (Effect = 0.12, 95% CI 0.04 to 0.21).

CONCLUSION: The results of this study showed that hope and social support should be improved in the caregivers of brain tumor patients. By conducting interventions in this field, it is possible that the burden of caregivers is decreased in situations with high fatigue.

PMID:41034745 | DOI:10.1186/s12885-025-14883-6

BMC Bioinformatics. 2025 Oct 1;26(1):237. doi: 10.1186/s12859-025-06155-8.

ABSTRACT

BACKGROUND: Prior results for tRNA and 5S rRNA demonstrated that secondary structure prediction accuracy can be significantly improved by modifying the parameters in the multibranch loop entropic penalty function. However, for reasons not well understood at the time, the scale of improvement possible across both families was well below the level for each family when considered separately.

RESULTS: We resolve this dichotomy here by showing that each family has a characteristic target region geometry, which is distinct from the other and significantly different from their own dinucleotide shuffles. This required a much more efficient approach to computing the necessary information from the branching parameter space, and a new theoretical characterization of the region geometries.

CONCLUSIONS: The insights gained point strongly to considering multiple possible secondary structures generated by varying the multiloop parameters. We provide proof-of-principle results that this significantly improves prediction accuracy across all 8 additional families in the Archive II benchmarking dataset.

PMID:41034743 | DOI:10.1186/s12859-025-06155-8

BMC Pregnancy Childbirth. 2025 Oct 1;25(1):994. doi: 10.1186/s12884-025-08026-9.

ABSTRACT

BACKGROUND: Sleep disorders are common among pregnant women and can adversely affect maternal and infant health. Traditional statistical methods have limitations in predicting these disorders, highlighting the need for advanced machine learning (ML) approaches. This study aimed to develop a reliable ML model for early prediction of pregnancy-related sleep disorders.

METHODS: Data from 1,681 pregnant women in western China were analyzed. Logistic regression and LASSO regression identified key predictors, with 10 variables selected for Model training. Eight ML algorithms were evaluated using 5-fold cross-validation. SHAP analysis interpreted the model’s decisions.

RESULTS: Ten predictors were identified: age, standardized gestational weight gain, gestational weeks, severity of morning sickness, pregnancy intention, pre-pregnancy health, underlying diseases, anxiety, depression, and the combined effect of anxiety and depression. LightGBM achieved the highest AUC (0.718) in the test set, with accuracy of 0.670 and specificity of 0.764. SHAP analysis revealed depression as the strongest predictor (mean |SHAP|=0.26), followed by gestational weeks and Std. GWG.

CONCLUSION: The interpretable and accurate LightGBM model, using clinically feasible variables, is a practical tool for early identification of pregnant women at high risk of sleep disorders. It enables targeted interventions to mitigate sleep – related adverse outcomes, thus improving maternal and infant health.

PMID:41034737 | DOI:10.1186/s12884-025-08026-9

J Hazard Mater. 2025 Sep 27;498:139981. doi: 10.1016/j.jhazmat.2025.139981. Online ahead of print.

ABSTRACT

Microplastics (MPs) are emerging environmental contaminants that pose potential health risks through inhalation, ingestion, and dermal contact. However, data on MP exposure and its impact on the pediatric respiratory system remain limited. This study aimed to assess MP levels in bronchoalveolar lavage fluid (BALF) and evaluate their associations with macrolide resistance in children with Mycoplasma pneumoniae pneumonia (MPP). BALF samples from 195 children aged 1-16 years were analyzed using Laser Direct Infrared (LDIR) spectroscopy and Pyrolysis-Gas Chromatography/Mass Spectrometry (Py-GC/MS). Six types of MPs were identified: Polyamide 66 (PA66) (92.31 %), Polyvinyl Chloride (PVC) (81.54 %), Polystyrene (PS) (78.97 %), Polyethylene (PE) (51.28 %), Polymethyl Methacrylate (PMMA) (21.02 %), and Polypropylene (PP) (11.28 %). MPs were detected in 194 out of 195 samples, with an overall detection rate of 99.48 %. Logistic regression showed that moderate exposure to PE (0.32-1.05 µg/mL) significantly increased the odds of macrolide-resistant MPP compared to low exposure (OR = 1.39; 95 % CI: 1.01-1.92; P < 0.05). Among children aged ≤ 6 years, high PE exposure was strongly associated with odds of macrolide-resistant MPP (OR = 2.62; 95 % CI: 1.37-5.02; P < 0.05), with a significant dose-response trend (P trend = 0.004). These findings provide the first evidence linking lower respiratory tract MP exposure with antibiotic resistance in pediatric MPP, particularly among younger children, and underscore the importance of minimizing environmental MP exposure in vulnerable populations.

PMID:41032928 | DOI:10.1016/j.jhazmat.2025.139981

Neurosurg Focus. 2025 Oct 1;59(4):E12. doi: 10.3171/2025.7.FOCUS25500.

ABSTRACT

OBJECTIVE: To date, there is no consensus on treatment indications for chronic subdural hematoma (CSDH) in patients in their 10th decade of life. The present investigation aims to focus on and carefully evaluate the clinical course of this particularly fragile subgroup of patients.

METHODS: The authors retrospectively analyzed the clinical, radiological, and surgical records from a multicentric prospectively maintained database of patients with CSDH surgically treated between June 2005 and August 2021. Patients included in the study were divided into two subgroups: group A, those whose age was < 90 years; and group B, those whose age was ≥ 90 years. The following variables were recorded for each patient: age, sex, clinical disease onset, history of traumatic brain injury, antiplatelet or anticoagulant use, and pre- and/or postoperative corticosteroid medication intake. The surgical approach and whether a surgical drain had been left in the subdural space were recorded, as was the anesthesia protocol. Clinical results were measured using the Markwalder Grading Scale. Recurrence and mortality were analyzed separately.

RESULTS: The final cohort comprised 1312 patients who had undergone surgery for CSDH, 1240 patients whose age was < 90 years and 72 patients whose age was ≥ 90. Patients in their 10th decade of life experienced similar or even better clinical outcomes than their younger counterparts. In particular, the pre-postoperative variation in Markwalder grades was favorable in elderly patients (p = 0.006). Multivariate analyses confirmed that local anesthesia (p = 0.013), single-sided CSDH (p = 0.010), and no antiplatelet or anticoagulant intake (p = 0.004 and p = 0.037, respectively) are independent predictors of favorable outcomes.

CONCLUSIONS: Patients in their 10th decade can experience clinical and radiological outcomes similar to those in their younger counterparts. Such patients could be eligible for standard minimally invasive treatments.

PMID:41032907 | DOI:10.3171/2025.7.FOCUS25500

Neurosurg Focus. 2025 Oct 1;59(4):E10. doi: 10.3171/2025.7.FOCUS25528.

ABSTRACT

OBJECTIVE: Chronic subdural hematoma (cSDH) is one of the most common diseases treated by neurosurgeons. While surgical evacuation has been the traditional way to address symptomatic lesions, there is expanding evidence of the beneficial use of middle meningeal artery (MMA) embolization as a treatment or as an adjunct for cSDH. With the current strain on healthcare resources, physicians must balance providing the best care for patients and making cost-conscious decisions. Therefore, the aim of this study was to compare the cost of surgery alone versus surgery plus MMA embolization for treatment of cSDH, and to calculate an institutional tipping point for cost benefit.

METHODS: This is a retrospective study of patients with symptomatic cSDH requiring surgical intervention at a single institution from May 2019 to December 2022. The patients were concurrently enrolled in a prospective randomized controlled trial. To compare the cost of surgical treatment alone versus surgical treatment plus MMA embolization, all charges related to cSDH treatment from admission to the last follow-up were categorized (procedure, radiology, pharmacy, intensive care unit bed, laboratory, floor bed, and other) and assessed. The institutional tipping point (point at which it becomes financially beneficial to add MMA embolization to surgical evacuation during the same admission) was calculated to help guide decision-making.

RESULTS: Forty-one patients (28 male, mean age 67.9 years) were included in the analysis, and were previously randomized to surgical intervention only (n = 21) or surgical intervention plus MMA embolization (n = 20). The groups were comparable in terms of demographic and cSDH characteristics. The overall mean cost for the index admission was lower in the surgery only group (US$158,320 vs $235,263; p = 0.037). This was also true for all categories of charges. Throughout the duration of the study there were 27 admissions in the surgery only group and 20 admissions in the surgery plus MMA embolization group (p = 0.0052). When analyzing costs per patient instead of per admission, no differences were observed between treatment groups for any of the categories. Likewise, the overall mean costs related to the care of patients in either treatment group showed no statistical difference ($203,554 vs $235,263; p = 0.25). Consequently, the institutional tipping point for the addition of MMA embolization was 20.8%.

CONCLUSIONS: MMA embolization can be considered as an adjunct to surgery in the treatment of symptomatic cSDH, decreasing the overall cost by lowering rates of readmission and repeat intervention. The tipping point formula used in this study is versatile and adaptable. It can be a useful guide to determine appropriate treatment options for patients with symptomatic cSDH according to institutional or national standards.

PMID:41032896 | DOI:10.3171/2025.7.FOCUS25528