Tag: statistics

J Med Internet Res. 2025 Jan 15;27:e62645. doi: 10.2196/62645.

ABSTRACT

BACKGROUND: Health inequalities among older adults become increasingly pronounced as aging progresses. In the digital era, some researchers argue that access to and use of digital technologies may contribute to or exacerbate these existing health inequalities. Conversely, other researchers believe that digital technologies can help mitigate these disparities.

OBJECTIVE: This study aimed to investigate the relationship between the digital divide and health inequality among older adults and to offer recommendations for promoting health equity.

METHODS: Data were obtained from the 2018 and 2020 waves of the China Health and Retirement Longitudinal Study. Physical, mental, and subjective health were assessed using the Activities of Daily Living (ADL) scale, the Instrumental Activities of Daily Living scale, the Mini-Mental State Examination scale, and a 5-point self-rated health scale, respectively. The chi-square and rank sum tests were used to explore whether internet use and access were associated with health inequality status. After controlling for confounders, multiple linear regression models were used to further determine this association. Sensitivity analysis was conducted using propensity score matching, and heterogeneity was analyzed for different influencing factors.

RESULTS: The 2018 analysis highlighted widening health disparities among older adults due to internet access and use, with statistically significant increases in inequalities in self-rated health (3.9%), ADL score (5.8%), and cognition (7.5%). Similarly, internet use widened gaps in self-rated health (7.5%) and cognition (7.6%). Conversely, the 2020 analysis demonstrated that internet access improved health disparities among older adults, reducing gaps in self-rated health (3.8%), ADL score (2.1%), instrumental ADL score (3.5%), and cognition (7.5%), with significant results, except for ADL. Internet use also narrowed disparities, with significant effects on self-rated health (4.8%) and cognition (12.8%). The robustness of the results was confirmed through propensity score-matching paired tests. In addition, the study found heterogeneity in the effects of internet access and use on health inequalities among older adults, depending on sex, age, education, and region.

CONCLUSIONS: The impact of internet access and use on health inequalities among older adults showed different trends in 2018 and 2020. These findings underscore the importance of addressing the challenges and barriers to internet use among older adults, particularly during the early stages of digital adoption. It is recommended to promote equitable access to the health benefits of the internet through policy interventions, social support, and technological advancements.

PMID:39813666 | DOI:10.2196/62645

Neurology. 2025 Feb 11;104(3):e210286. doi: 10.1212/WNL.0000000000210286. Epub 2025 Jan 15.

ABSTRACT

BACKGROUND AND OBJECTIVES: Previous studies have shown inconsistent associations between red meat intake and cognitive health. Our objective was to examine the association between red meat intake and multiple cognitive outcomes.

METHODS: In this prospective cohort study, we included participants free of dementia at baseline from 2 nationwide cohort studies in the United States: the Nurses’ Health Study (NHS) and the Health Professionals Follow-Up Study (HPFS). Diets were assessed using a validated semiquantitative food frequency questionnaire. We ascertained incident dementia cases from both NHS participants (1980-2023) and HPFS participants (1986-2023). Objective cognitive function was assessed using the Telephone Interview for Cognitive Status (1995-2008) among a subset of NHS participants. Subjective cognitive decline (SCD) was self-reported by NHS participants (2012, 2014) and HPFS participants (2012, 2016). Cox proportional hazards models, general linear regression, and Poisson regression models were applied to assess the associations between red meat intake and different cognitive outcomes.

RESULTS: The dementia analysis included 133,771 participants (65.4% female) with a mean baseline age of 48.9 years, the objective cognitive function analysis included 17,458 female participants with a mean baseline age of 74.3 years, and SCD analysis included 43,966 participants (77.1% female) with a mean baseline age of 77.9 years. Participants with processed red meat intake ≥0.25 serving per day, compared with <0.10 serving per day, had a 13% higher risk of dementia (hazard ratio [HR] 1.13; 95% CI 1.08-1.19; p_linearity < 0.001) and a 14% higher risk of SCD (relative risk [RR] 1.14; 95% CI 1.04-1.25; p_linearity = 0.004). Higher processed red meat intake was associated with accelerated aging in global cognition (1.61 years per 1 serving per day increment [95% CI 0.20-3.03]) and in verbal memory (1.69 years per 1 serving per day increment [95% CI 0.13-3.25], both p_linearity = 0.03). Unprocessed red meat intake of ≥1.00 serving per day, compared with <0.50 serving per day, was associated with a 16% higher risk of SCD (RR 1.16; 95% CI 1.03-1.30; p_linearity = 0.04). Replacing 1 serving per day of nuts and legumes for processed red meat was associated with a 19% lower risk of dementia (HR 0.81, 95% CI 0.75-0.86), 1.37 fewer years of cognitive aging (95% CI -2.49 to -0.25), and a 21% lower risk of SCD (RR 0.79, 95% CI 0.68-0.92).

DISCUSSION: Higher intake of red meat, particularly processed red meat, was associated with a higher risk of developing dementia and worse cognition. Reducing red meat consumption could be included in dietary guidelines to promote cognitive health. Further research is needed to assess the generalizability of these findings to populations with diverse ethnic backgrounds.

PMID:39813632 | DOI:10.1212/WNL.0000000000210286

Neurology. 2025 Feb 11;104(3):e213348. doi: 10.1212/WNL.0000000000213348. Epub 2025 Jan 15.

ABSTRACT

BACKGROUND AND OBJECTIVES: Although around one-third of survivors of aneurysmal subarachnoid hemorrhage (aSAH) suffer from anxiety and depression, studies focusing on suicide risk after aSAH are lacking. Thus, we aimed to investigate whether survivors of aSAH have an elevated risk of suicide death in comparison with the general population.

METHODS: Using 2 externally validated nationwide registers (Care Register for Health Care and Cause of Death Register), we identified all ≥15-year-old survivors of aSAH (alive 30 days after hospital admission) in Finland during 1998-2017 and followed these patients until death or the end of 2018. By calculating standardized mortality ratios (SMRs) with 95% CIs using the Mid-P exact test, we compared the observed suicide rates of survivors of aSAH with the expected rates based on the age-matched, sex-matched, and year-matched general Finnish population.

RESULTS: We identified 5,708 survivors of aSAH (59% female, median age 55 years) of whom 19 (5 female patients and 14 male patients) died by suicide during a total of 53,060 person-years (median 8.9 years) of follow-up. Of all deaths by suicide, 7 were caused by self-poisoning, 6 by hanging/strangulation, 3 by a firearm, 2 by jumping, and 1 by a sharp object. The observed rate of suicide was 35.8 per 100,000 person-years compared with the expected rate of 20.4 per 100,000 person-years resulting in an overall SMR of 1.75 (95% CI 1.09-2.69). The risk of suicide was especially high among 15-39-year-old female and male patients (72.5 per 100,000 person-years; SMR = 3.57 [1.31-7.92]) and during the first year after aSAH (81.2 per 100,000 person-years; SMR = 3.64 [1.16-8.77]), after which the risk attenuated.

DISCUSSION: Survivors of aSAH are at excessive risk of suicide death in comparison with the general population. Given that this risk seems to be the highest among young individuals and during the first year after aSAH, early assessment and management of psychological distress, especially in young survivors of aSAH may be warranted. Future studies should include detailed individual-level data on psychiatric comorbidities and aSAH-specific factors, as well as record both nonfatal and fatal suicide attempts.

PMID:39813630 | DOI:10.1212/WNL.0000000000213348

Hepatol Commun. 2025 Jan 16;9(2):e0620. doi: 10.1097/HC9.0000000000000620. eCollection 2025 Feb 1.

ABSTRACT

BACKGROUND: Refractory ascites (RA) remains a serious complication in patients with cirrhosis. Currently, the insertion of a TIPS is considered the standard of care in these patients. To achieve symptom control in those with TIPS contraindications, tunneled peritoneal catheters (PeCa) or ascites pumps were introduced. However, data comparing the available treatment options are scarce. This study aims to compare outcomes among patients with RA treated either with TIPS, PeCa, or ascites pump.

METHODS: All patients with RA and cirrhosis treated at Hannover Medical School between 2009 and 2023 were evaluated. Endpoints included mortality, acute kidney injury (AKI), hyponatremia, peritonitis, and rehospitalization rate. Propensity score matching was conducted to adjust for group differences.

RESULTS: First, 31 patients with ascites pump were compared to 62 patients with a PeCa after propensity score matching. There were no differences regarding mortality nor incidences of AKI, hyponatremia, or rehospitalization. However, incidences of peritonitis and explantation were lower in those with ascites pump (HR 0.32, 95% CI: 0.15-0.70, and HR 0.32, 95% CI: 0.14-0.71, respectively). Second, 35 ascites pump patients were matched with 70 individuals with TIPS. No differences regarding mortality or peritonitis incidence were observed. Ascites pump patients showed higher incidences of AKI (HR 4.55, 95% CI: 2.53-8.18) and hyponatremia (HR 4.13, 95% CI: 2.08-8.22). Last, 129 patients with TIPS were compared to 129 with PeCa. Mortality was comparable, while incidences of AKI (HR 5.01, 95% CI: 3.36-7.47), hyponatremia (HR 4.64, 95% CI: 3.03-7.12), and peritonitis (HR 2.19, 95% CI: 1.41-3.41) were higher in those with PeCa.

CONCLUSIONS: While ascites pump was associated with lower incidences of device infections and explantations, TIPS was associated with the lowest incidence of clinical complications in patients with RA.

PMID:39813591 | DOI:10.1097/HC9.0000000000000620

Epidemiol Serv Saude. 2025 Jan 13;33(spe1):e2024515. doi: 10.1590/S2237-96222024v33e2024515.especial.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To describe the sociodemographic profile and access to social assistance and health services among trans people and travestis experiencing homelessness in Salvador, the capital city of Bahia state.

METHODS: This was a cross-sectional study involving 24 (4.5%) participants who identified as trans people or travestis out of a total of 529 people, aged 18 or older, living in public spaces or institutional shelters included in the survey. Data were collected between 2021 and 2022, using structured questionnaires.

RESULTS: The sample was predominantly comprised of trans women and travestis (n=18), young individuals (n=13), of Black race/skin color (n=22), single individuals (n=18) and those engaged in informal occupations (n=23), many of whom reported experiencing violence (n=17). Frequent barriers to accessing healthcare and social assistance services were found (n=15), including lack of documentation, delay in service provision and social/racial discrimination.

CONCLUSION: The findings highlight the heightened vulnerability of transgender people and travestis experiencing homelessness, who are subjected to multiple forms of discrimination and social exclusion.

PMID:39813583 | DOI:10.1590/S2237-96222024v33e2024515.especial.en

Epidemiol Serv Saude. 2025 Jan 13;33(spe1):e2024341. doi: 10.1590/S2237-96222024v33e2024341.especial.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To assess adherence to and completeness of vaccination schedules against human papillomavirus (HPV) and hepatitis A and B among transgender women and travestis in São Paulo, capital city of São Paulo state.

METHODS: This was a secondary data analysis of the multicenter TransOdara study. Data were collected from 403 transgender women and travestis aged 18 years or older, recruited through respondent-driven sampling between December 2019 and October 2020.

RESULTS: High adherence to vaccines was observed (88.8%), but completeness of the analyzed vaccination schedules was low: 12% (95%CI 8.0; 17.3) for hepatitis A, 7.2% (95%CI 3.5; 12.8) for hepatitis B and 8.1% (95%CI 3.0; 16.6) for HPV, with no statistically significant differences between them.

CONCLUSION: Despite high adherence, the low completion of vaccination schedules highlighted the need for diversified strategies to improve vaccination coverage and reduce the prevalence of vaccine-preventable sexually transmitted infections in this population.

PMID:39813582 | DOI:10.1590/S2237-96222024v33e2024341.especial.en

Cad Saude Publica. 2025 Jan 13;40(12):e00035624. doi: 10.1590/0102-311XEN035624. eCollection 2025.

ABSTRACT

This study aimed to identify latent (unobservable) dimensions representing specific physical activity-related behaviors and explore their potential effects on obesity burden and spatial distribution in Colombia. A cross-sectional study (n = 9,658) was conducted based on the Colombian National Survey of Nutritional Status. A generalized structural equations model was proposed, combining exposure and measurement models to define a disease model. Modeling identified latent dimensions of physical activity focused on screen time and means of transportation and estimated their direct and indirect effects on obesity occurrence. Mapping techniques were used to illustrate adherence to these dimensions. The latent dimensions identified were named “Screens use” and “Active transportation”; the latter was inversely associated with obesity occurrence (p = 0.004), with the use of bicycles being the dominant variable, contrasting with the use of motor vehicles. The mapping showed that departments with the highest adherence to the “Active transportation” construct have a lower prevalence of obesity. Bicycle use, as opposed to non-active transportation, represented a dimension of physical activity-related behaviors with a protective effect against obesity. This suggests that active transportation may be a crucial factor in the designing preventive interventions. Moreover, social inequalities may be contributing to the obesity epidemic and physical activity behaviors in Colombia, requiring equitable and multisectoral responses.

PMID:39813567 | DOI:10.1590/0102-311XEN035624

Cad Saude Publica. 2025 Jan 13;40(11):e00217323. doi: 10.1590/0102-311XPT217323. eCollection 2025.

ABSTRACT

This study aimed to evaluate the overall excess mortality and COVID-19 mortality in the regions of Brazil, in 2020, by sex and age group. An ecological study was carried out to calculate the overall excess mortality, by sex and age group, using the expected number of deaths in a non-pandemic context and the deaths observed in 2020. Data on deaths were extracted from the Brazilian Mortality Information System, in addition to population data from the Brazilian Institute of Geography and Statistics. Excess mortality was calculated considering: the difference between the mortality rates observed in 2020 and the average of the rates from 2015 to 2019, standardized by age; and the difference between observed deaths obtained via a quasi-Poisson model and the deaths expected for 2020. In Brazil, the standardized overall mortality rate in 2020 was 590 deaths per 100,000 inhabitants, with excess mortality of 44 deaths per 100,000 inhabitants, while the mortality rate from COVID-19 was 79 deaths per 100,000 inhabitants. The highest overall mortality rates were observed in the North and Northeast regions. The excess deaths estimated by the ratio between observed and expected deaths nationwide in 2020 was 16%; of which 17% were males, 16% were females, 7% were individuals from 0 to 59 years old, and 20% were individuals aged 60 years or older. These outcomes enabled a better understanding on the impact of the COVID-19 pandemic on the mortality in Brazil in 2020, indicating a more pronounced excess mortality in the North, Northeast and Central-West regions and among men older than 60 years.

PMID:39813565 | DOI:10.1590/0102-311XPT217323

Cad Saude Publica. 2025 Jan 13;40(11):e00052624. doi: 10.1590/0102-311XPT052624. eCollection 2025.

ABSTRACT

This study aimed to identify the existence of therapeutic itineraries shared by users of specialized mental health services in a medium-sized municipality. This is a cross-sectional study, carried out from August to November 2019 including 341 users of specialized mental health services in the municipality of Itatiba, São Paulo State, Brazil. To identify the itineraries, based on a set of variables, the users were grouped with clustering. The best measure of silhouette of cohesion and separation (> 0.3) for the clusters was achieved based on four variables: situation in which the mental health problem was identified, place of first care, origin of referral to the current service, and bond maintenance with primary health care (PHC). The clusters identified in the study demonstrated: (1) low participation of PHC in welcoming new cases, with most of the care taking place in specialized services; (2) high proportion of cases identified in crisis situations; (3) low participation of PHC in the referral of cases, with high access to specialized services by spontaneous demand; (4) lack of continuity in PHC services after entering the specialized service. The study highlighted significant weaknesses in the studied healthcare network, evincing the need to develop strategies that foster the services integration, especially regarding PHC, both to favor access to specialized care in a timely manner and to enable the continuity of care between different healthcare facilities.

PMID:39813561 | DOI:10.1590/0102-311XPT052624

Epidemiol Serv Saude. 2025 Jan 10;33(spe2):e2024432. doi: 10.1590/S2237-96222024v33e2024432.especial2.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To evaluate opportunity for vaccination in children born alive in Londrina, up to 6 months old and the relationship between socioeconomic stratum and vaccination regularity.

METHOD: Population survey study based on a retrospective cohort of children born in 2017 and 2018 that identified vaccines not administered in a given session. Vaccination regularity was compared between socioeconomic strata using Pearson’s chi-square test.

RESULTS: Out of 456 vaccination cards, the proportion of vaccination opportunities not recovered for doses to be administered at birth and at two, four and six months was 5.0% (95%CI 3.1;7.5), 4. 5% (95%CI 2.8;6.9), 7.2% (95%CI 5.0;10.2) and 2.1% (95%CI 1.0;4.0), respectively. There was no statistical difference in vaccination regularity between the strata.

CONCLUSION: Missed opportunities for vaccination were found at all ages. Socioeconomic stratum did not influence vaccination regularity.

PMID:39813547 | DOI:10.1590/S2237-96222024v33e2024432.especial2.en