Tag: statistics

Arch Osteoporos. 2025 Feb 16;20(1):25. doi: 10.1007/s11657-025-01510-x.

ABSTRACT

Injectable antiresorptive drugs may reduce refracture risk in older adults with previous fractures, though further research is needed to explore related factors, including the crucial role of consistent adherence.

PURPOSE: Osteoporosis increases fracture risk, particularly in older adults. Spinal and hip fractures are common and costly complications. To examine the effectiveness of parenteral antiresorptive medications-denosumab and zoledronate-in reducing refracture rates among older adults with prior spinal or hip fractures.

METHODS: A nationwide retrospective cohort study was conducted using data from Taiwan’s National Health Insurance Research Database (2011-2020). Patients aged 50 and older with spinal or hip fractures were divided into a treatment group (received zoledronate or denosumab) and a control group (no osteoporosis treatment). A 1:1 matching based on age, sex, and Charlson Comorbidity Index was performed. Kaplan-Meier method and Cox proportional hazards regression were used for analysis.

RESULTS: Out of 23,331 eligible patients, 582 were in the treatment group and 17,281 in the control group. After matching, 211 patients received zoledronate and 367 received denosumab. The treatment group showed a trend toward lower refracture risk compared to the control group, though not statistically significant. Hazard ratios were 0.63 for zoledronate and 0.80 for denosumab, indicating potential benefits. There was no substantial difference between the two medications.

CONCLUSION: This is the first real-world study to assess the effectiveness of complete adherence to parenteral antiresorptive medications in reducing the risk of refractures among older adults with prior spinal or hip fractures. However, further research is needed to confirm these findings and investigate long-term effects.

PMID:39955693 | DOI:10.1007/s11657-025-01510-x

Osteoporos Int. 2025 Feb 16. doi: 10.1007/s00198-025-07397-1. Online ahead of print.

ABSTRACT

The relationship between rheumatoid arthritis (RA) and fracture risk was estimated in an international meta-analysis of individual-level data from 29 prospective cohorts. RA was associated with an increased fracture risk in men and women, and these data will be used to update FRAX®.

INTRODUCTION: RA is a well-documented risk factor for subsequent fracture that is incorporated into the FRAX algorithm. The aim of this study was to evaluate, in an international meta-analysis, the association between rheumatoid arthritis and subsequent fracture risk and its relation to sex, age, duration of follow-up, and bone mineral density (BMD) with a view to updating FRAX.

METHODS: The resource comprised 1,909,896 men and women, aged 20-116 years, from 29 prospective cohorts in which the prevalence of RA was 3% or less (primary analysis) and an additional 17 cohorts with a prevalence greater than 3% (supplementary analysis). The association between RA and fracture risk (any clinical fracture, osteoporotic fracture, major osteoporotic fracture (MOF), and hip fracture) was examined using an extension of the Poisson regression model in each cohort and each sex, followed by random-effects meta-analyses of the weighted beta coefficients.

RESULTS: In the primary analysis, RA was reported in 1.3% of individuals. During 15,683,133 person-years of follow-up, 139,002 fractures occurred, of which 27,518 were hip fractures. RA was associated with an increased risk of any clinical fracture (hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.35-1.65). The HRs were of similar magnitude for osteoporotic fracture and MOF but higher for hip fracture (HR = 2.23; 95% CI 1.85-2.69). For hip fracture, there was a significant interaction with age with higher HRs at younger ages. HRs did not differ between men and women and were independent of exposure to glucocorticoids and femoral neck BMD. Lower HRs were observed in the supplementary analysis cohorts, particularly in those with a high apparent prevalence of RA, possibly from conflation of RA with osteoarthritis.

CONCLUSIONS: A diagnosis of RA confers an increased risk of fracture that is largely independent of BMD, sex, and corticosteroids. RA should be retained as a risk factor in future iterations of FRAX with updated risk functions to improve fracture risk prediction.

PMID:39955689 | DOI:10.1007/s00198-025-07397-1

Orv Hetil. 2025 Feb 16;166(7):263-271. doi: 10.1556/650.2025.33233. Print 2025 Feb 16.

ABSTRACT

Bevezetés: A humán papillomavírus kimutatásán alapuló hatékonyabb méhnyakszűrés hazai bevezetésének tervezésekor a szakorvoshoz nem vagy ritkán eljutó nők közvetlen megszólítása, elérése is fontos. A védőnők képzése közel egy évtizede kiegészült a népegészségügyi célú méhnyakszűrés kompetenciájával. Célkitűzés: Egy korábbi hazai reprezentatív humán papillomavírus prevalencia felmérés adatai alapján elemeztük a védőnők által elért populáció jellemzőit és az általuk levett minták (n = 905) eredményeit, összehasonlítva a szakorvosok által szűrt populációval és eredményekkel (n = 3826). Módszer: Anonim kérdőíves felmérést és méhnyaki mintavételt végeztünk megyénként véletlenszerűen kiválasztott, összesen 169 szülész-nőgyógyász szakorvos és 40 védőnő segítségével ThinPrep edényzetbe Rovers Cervex-Brush Combi eszközzel. A laboratóriumi feldolgozás Neumann Confidence és Roche Linear Array klinikailag validált genotipizáló tesztekkel történt. Eredmények: A védőnői szűrésen részt vettek körében a páciensek átlagéletkora, az érettségivel nem rendelkezők és azok aránya, akiknél 3 évnél régebben vagy soha nem történt kenetcitológiai méhnyakszűrés, szignifikánsan magasabb volt, mint a szakorvosi szűrésen részt vevők körében. Az 55 év feletti korcsoportokban a védőnők mintája lényegesen közelebb állt a célcsoport populációs részarányához, mint a szakorvosoknál megjelenteké. Az eredménytelen minták aránya nem tért el szignifikánsan attól függően, hogy védőnő vagy szakorvos vette a mintát. A szakorvosok pácienseinél a pozitivitási arány szignifikánsan nagyobb volt, bár nagyobb arányban kaptak korábban humán papillomavírus elleni védőoltást. Megbeszélés: A községi mintákban az életkori hatás statisztikai kiküszöbölése után is látott alacsonyabb vírusprevalenciának mediátora lehetett a mintavételt végző szakember is, hiszen kóros előzményekkel rendelkező páciens nagyobb eséllyel fordulhat szakorvoshoz, mintsem hogy megvárja a védőnői megkeresést. Következtetés: Az iskolai oltási program elindulását, valamint a méhnyakrák előfordulásának korosztályi eloszlását figyelembe véve a szűrés szerepe sikeres oltási program mellett is legalább 20–30 évig jelentős marad. Az 50 év feletti, községben élő, alacsonyabb iskolázottságú célcsoport bevonása védőnőkön keresztül hatékonyabbnak bizonyult, mint szakorvosi rendelésen. Az erre képzett védőnők bizonyítottan eredményes mintavétellel, a nők egyéni felkeresésével, a szűréssel kapcsolatos kétségeik megválaszolásával egyedülálló szerepet játszhatnak a prevenciós célok megvalósulásában. Orv Hetil. 2025; 166(7): 263–271.

PMID:39955680 | DOI:10.1556/650.2025.33233

Arch Osteoporos. 2025 Feb 16;20(1):26. doi: 10.1007/s11657-024-01483-3.

ABSTRACT

This study employs a time-series analysis to investigate how sunshine duration associates hip fractures in China and found both short and long durations of sunshine increased the risk of hip fractures. The findings can guide strategies for reducing hip fractures and enhance health education on fracture prevention.

BACKGROUND: Studies on the associations between sunshine duration and emergency visits for hip fractures (HF) are limited. This study aimed to assess the short-term effect of sunshine duration on the risk of emergency visits for HF.

METHODS: Daily emergency visits for HF at Beijing Jishuitan Hospital from 2015 to 2019 and contemporaneous meteorological and air pollutant data were collected. A Poisson generalized linear regression model combined with a distributed lag non-linear model was applied to analyze the lag-exposure-response relationship between sunshine duration and HF. Stratified analysis was performed by gender and age.

RESULTS: A total of 10,874 cases were identified. The overall cumulative exposure-response curve showed a U-shaped relationship between sunshine duration and HF. With 7.2 h as the reference (lowest HF emergency visit risk), significant single-day effects of short sunshine duration (0 h, 2.5th percentile) were observed from the 11th to the 13th day, peaking on lag day 13 (RR = 1.033, 95% CI: 1.003-1.065), while its cumulative effects lasted from lag days 0-11 to 0-14, with the highest RR of 1.327 (95% CI: 1.088-1.619) at lag day 0-14. Significant single-day effects of long sunshine duration (12.7 h, 97.5th percentile) occurred from the 10th to the 12th day, peaking on the 12th day (RR = 1.030, 95% CI: 1.000-1.061), but no cumulative lag effects were found. This U-shaped pattern was consistent across subgroups, especially among female patients and those aged 66-79 years; conversely, the risk of HF-related emergency visits decreased with increasing sunshine duration in patients aged 40-65 years with a relatively high uncertainty.

CONCLUSIONS: Both short and long durations of sunshine are associated with an increased risk of HFs emergency visits. Females and patients aged 66-79 years might be more vulnerable to short sunshine duration.

PMID:39955678 | DOI:10.1007/s11657-024-01483-3

Arch Osteoporos. 2025 Feb 16;20(1):24. doi: 10.1007/s11657-025-01505-8.

ABSTRACT

The purpose of this study is to scientifically and systematically investigate the clinical effectiveness of a fracture liaison service (FLS) for patients with femoral fractures.

METHODS: The international databases Ovid-MEDLINE, EMBASE, and The Cochrane Library and the Korean databases KISS, RISS, KoreaScience, Koreamed, and Kmbase were used. Risk of bias assessment was conducted at the study design level, and meta-analysis utilized both random-effects and fixed-effects models, along with subgroup analysis.

RESULTS: From the 32 selected articles, 14 articles related to subsequent fracture and 18 articles related to mortality were included in the meta-analysis. As a result of the meta-analysis, the risk of subsequent fracture in the group that participated in the fracture liaison service was 46% lower than that in the non-participated group, and this difference was statistically significant (RR = 0.54, 95% CI = 0.50-0.59). The risk of death in the group that participated in the FLS was 17% lower than that in the non-participating group, and this difference was not statistically significant as well (RR = 0.83, 95% CI = 0.67-1.03). As a result of subgroup analysis, there was a statistically significant difference in the reduction of subsequent fracture in the clinical outcomes, and there was a significant difference in mortality in the intervention follow-up period and clinical outcomes.

CONCLUSION: The global implementation of FLS has played a crucial role in enhancing the clinical management and treatment of patients with femoral fractures, contributing to a decrease in subsequent fracture and mortality. This indicates the significant role of FLS in minimizing the disease burden associated with femoral fractures worldwide.

PMID:39955675 | DOI:10.1007/s11657-025-01505-8

Asian Pac J Allergy Immunol. 2025 Feb 16. doi: 10.12932/AP-100724-1889. Online ahead of print.

ABSTRACT

BACKGROUND: Despite concerns on the major neuropsychiatric side effects for long-term use of H1-receptor antagonist (anti-histamine, AH), one of the major therapeutic tools for allergic diseases, their association has not been investigated well.

OBJECTIVE: This study aimed to assess the association between AH usage and neuropsychiatric disorder (NPD) incidence using the National Health Insurance Service Database.

METHODS: This study was conducted using data from the National Health Insurance Service Database from January 1st 2002 through December 31th 2017. To enroll the participants who may have history of long-term use of AH, participants having common allergic diseases were enrolled. We defined NPD as diagnosed by a psychiatrist occurring during and after antihistamine use to 6 months thereafter.

RESULTS: A total of 1,488,075 participants were enrolled. No significant association was found between increased AH usage and NPD incidence after adjusting for potential confounding factors in the health screening data. Notably, the 30-89 day AH usage group showed a significantly lower NPD risk in the subgroup analysis in participants aged over 60 years. No other groups within this age category showed a significant increase in risk.

CONCLUSIONS: This study suggests that long-term AH use does not significantly increase NPD risk. While this study lacked evaluation of mild neuropsychiatric side effects not requiring psychiatric visits, this study may contribute real-world evidence to the understanding of AHs’ long-term neuropsychiatric side effects.

PMID:39955641 | DOI:10.12932/AP-100724-1889

Asian Pac J Allergy Immunol. 2025 Feb 16. doi: 10.12932/AP-280524-1865. Online ahead of print.

ABSTRACT

BACKGROUND: Premorbid allergic diseases are linked with the development of age-related macular degeneration (AMD), however, the risk of allergic diseases among patients with AMD is largely unknown.

OBJECTIVE: To evaluate the association between AMD with or without visual disability (VD) and the risk of allergic diseases.

METHODS: A total of 2,744,372 Individuals 50 years or older participated in the Korean National Health Screening Program in 2009 were categorized by presence of AMD and VD. Patients were followed until December 2019, and the prospective association of AMD and related VD with incident allergic diseases cases identified during the study period was investigated using the multivariable-adjusted Cox proportional hazard model.

RESULTS: During an average follow-up period of 5.87 years, 1,783,370 individuals were diagnosed with allergic diseases. Moreover, an increased risk of allergic diseases was observed in the group of individuals with AMD as compared to the control group (adjusted HR [aHR], 1.13; 95%CI, 1.11-1.14). The risk of atopic dermatitis or allergic rhinitis was more profound than that of asthma (aHR 1.12 [95%CI 1.07-1.18], aHR 1.13 [95%CI 1.11-1.14], and aHR 1.06 [95%CI 1.04-1.09], respectively). Furthermore, patients affected by AMD with VD were at an increased risk of atopic dermatitis (aHR 1.32, 95%CI 1.12-1.56) than those without VD (aHR 1.11, 95%CI 1.05-1.16) when compared with those in the control group.

CONCLUSIONS: AMD is associated with an increased risk of developing allergic diseases. Further investigations are required to elucidate the underlying mechanisms.

PMID:39955640 | DOI:10.12932/AP-280524-1865

Asian Pac J Allergy Immunol. 2025 Feb 16. doi: 10.12932/AP-131223-1749. Online ahead of print.

ABSTRACT

BACKGROUND: Atopic dermatitis (AD) and food allergy (FA) often originate early in life. Gut microbiota interactions with the host immune system influence allergy development, yet the distinct gut microbiome and functional profiles in individuals with AD, FA, or both AD+FA remain underexplored.

OBJECTIVE: We investigated microbial colonization and proteomic profiles in infants with AD, FA, and AD+FA compared to age- and sex-matched controls from the Allergy Development in Early Life and Associated Factors in the Thai Birth Cohort (ALICE).

METHODS: Gut microbiomes from stool samples were analyzed using 16S sequencing, and proteomic analysis was conducted by liquid chromatography-tandem mass spectrometry.

RESULTS: The study included 16 AD, 5 FA, 5 AD+FA subjects, and 26 controls. AD+FA group exhibited the most severe dysbiosis. Enrichment of proteins involved in methionine biosynthesis in Bifidobacterium scardovii and high Erysipelotrichaceae colonization suggest a link to high-fat diets, known to reduce intestinal short-chain fatty acid and serotonin levels, contributing to allergies. Erysipelotrichaceae in AD+FA groups also expressed proteins related to histidine degradation. Low Bifidobacteriaceae levels were noted in FA and AD+FA, with more pathogenic strains colonized. Increased Bacteroidaceae in FA and AD+FA and Enterobacteriaceae in FA were detected. Pathways involving vitamin B1, a ligand for proliferator-activated receptor-γ (PPAR-γ) from Enterobacteriaceae could promote TH2 cells, type 2 innate lymphoid cells, and M2 macrophages, likely contribute to allergic inflammation.

CONCLUSIONS: AD+FA phenotype exhibited the most distinctive gut microbiome alterations, highlighting unique dysbiosis patterns. Microbiome biosynthesis pathways involving metabolism of methionine, histidine, serotonin, and vitamin B1 point to new targets for modifying or treating AD and FA.

PMID:39955638 | DOI:10.12932/AP-131223-1749

J Ethn Subst Abuse. 2025 Feb 16:1-21. doi: 10.1080/15332640.2025.2465390. Online ahead of print.

ABSTRACT

Immigrant young adults from predominantly people of color countries (IYPOC) encounter structural stressors that potentially exacerbate health outcomes such as substance use amidst ongoing societal challenges. The association may be further compounded by cultural isolation and the dual task of identity negotiation. The current study explored cultural isolation as a mediator of the association between racial discrimination and substance use among IYPOC. A cross-sectional online survey was conducted to collect data from IYPOC residing in the United States. The analytic sample was composed of 262 individuals aged 18 to 29, and the largest racial group was Black or African American. The current study performed regressions and PROCESS Macro Model 4 with bootstrapping. Racial discrimination and cultural isolation were statistically significantly associated with substance use. The indirect effect of racial discrimination on substance use through cultural isolation was statistically significant. The results underscore the need for tailored support and interventions that address the complex interplay of racial discrimination, cultural isolation, and health outcomes among IYPOC.

PMID:39955637 | DOI:10.1080/15332640.2025.2465390

Med J Aust. 2025 Feb 17;222(3):135-143. doi: 10.5694/mja2.52594.

ABSTRACT

OBJECTIVES: To assess differences in eligibility rates and use of the National Disability Insurance Scheme (NDIS).

STUDY DESIGN: Analysis of NDIS unit-record administrative data.

SETTING, PARTICIPANTS: Applicants for NDIS support aged 7 years or older, 1 July 2016 – 31 August 2022 (eligibility analysis); active NDIS participants aged 7 years or older on 31 August 2022 (plan size and spending analyses).

MAIN OUTCOME MEASURES: Differences in NDIS eligibility rates by broad age group (under 55 years v 55 years or older), gender (girls and women v other applicants), and residential socio-economic status (three lowest deciles of the Index of Relative Socioeconomic Disadvantage v other areas); differences in NDIS personal plan size (allocation) and spending (use) by gender and residential socio-economic status.

RESULTS: During 2016-22, 705 594 people aged 7 years or older had applied for NDIS support; 485 676 applicants with recorded decisions were included in our analysis (393 152 eligible, 92 524 ineligible). Eligibility rates were highest for applicants with brain injury or stroke, intellectual disability, or autism (900 or more per 1000 applicants), and only minor inequalities by socio-demographic group were evident. Eligibility rates were lower for applicants with physical disability, psychosocial disability, or unclassified (other) disability (60-75%). Eligibility inequalities were most marked for people with physical disability, with fewer approvals for women and girls than men and boys (145 [95% confidence interval {CI}, 138 – 152] fewer approvals per 1000 applicants), for people aged 55 years or older than for younger applicants (235 [95% CI, 227-242] fewer approvals per 1000 applicants), and for people from lower socio-economic status areas than for those from other areas (86 [95% CI, 78-93] fewer approvals per 1000 applicants). The eligibility rate for applicants with psychosocial disability was lower for women and girls than men and boys (83 [95% CI, 77-89] fewer approvals per 1000 applicants). Inequalities in plan sizes and spending by socio-economic group and gender for the 312 268 active participants at 31 August 2022 were smaller.

CONCLUSIONS: Women and girls and applicants over 55 years of age or living in socio-economically disadvantaged areas with certain disability types are less likely to be deemed eligible for NDIS support than other applicants. Inequalities in plan allocation and use of personal NDIS budgets are less marked. Changes to NDIS eligibility processes could reduce these inequalities.

PMID:39955631 | DOI:10.5694/mja2.52594