A doubly robust method to handle missing multilevel outcome data with application to the China Health and Nutrition Survey

2021 ◽  
Author(s):  
Nicole M. Butera ◽  
Donglin Zeng ◽  
Annie Green Howard ◽  
Penny Gordon‐Larsen ◽  
Jianwen Cai
Keyword(s):  
Outcome Data ◽  
Robust Method ◽  
Nutrition Survey ◽  
Health And Nutrition ◽  
Doubly Robust

scholarly journals Unwanted or mistimed pregnancy and developmental issues in Ecuadorian children aged 3 to 5: a doubly robust estimate using data from the National Health and Nutrition Survey 2018

2021 ◽  
Author(s):  
J. Andres Delgado-Ron
Keyword(s):  
Early Childhood ◽  
National Health ◽  
Early Childhood Development ◽  
Childhood Development ◽  
Nutrition Survey ◽  
Safe Abortion ◽  
Robust Estimate ◽  
Health And Nutrition ◽  
Mistimed Pregnancy ◽  
Doubly Robust

Aim: To estimate the effect of unwanted or mistimed pregnancy on early childhood development in Ecuadorian children aged 3 to 5, participating in the National Health and Nutrition Survey 2018.Methods: We used a design-based doubly robust estimate. First, we used propensity score matching to identify a subsample of children aged 3 to 5 equally likely to come from a desired vs. unwanted/mistimed pregnancy. Then, we used a regression model to explore the relation of maternal pregnancy intentions with early childhood development. Results: Among 1,694 observations representing 162,285 Ecuadorian children, mistimed/unwanted pregnancy associated with lagging in development (odds ratio: 1.56; 95% confidence interval: 1.06; 2.29), after adjusting for the household’s geographic area and income, the father’s perception of the pregnancy, the mother’s marital status, age, ethnicity, educational level, and depressive symptoms, and the child’s age, gender, and daycare/class attendance. Unwanted/mistimed was also negatively associated with all four early childhood development index domains, socio-emotional development being the most affected. Discussion: Our doubly robust design found evidence of the relation between the maternal perception of her pregnancy and early child development. Addressing this relation to achieve reproductive justice entails considering a wide spectrum of population health and legal interventions to allow adequate access to education, contraception, and safe abortion. Moreover, pre- and postnatal check-ups could screen for unwanted/mistimed pregnancy and provide support accordingly.

scholarly journals Association between risk of type 2 diabetes and changes in energy intake at breakfast and dinner over 14 years: a latent class trajectory analysis from the China health and nutrition Survey, 1997–2011

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046183
Author(s):  
Xiyun Ren ◽  
Jian Gao ◽  
Tianshu Han ◽  
Changhao Sun
Keyword(s):  
Type 2 Diabetes ◽  
Energy Consumption ◽  
Energy Intake ◽  
Latent Class ◽  
Early Stage ◽  
Harmful Effect ◽  
Nutrition Survey ◽  
Health And Nutrition ◽  
Diabetes Status

ObjectiveThis study aimed to investigate the association between the trajectories of energy consumption at dinner versus breakfast and the risk of type 2 diabetes (T2D).DesignCohort study.SettingThe study was conducted in China.ParticipantsA total of 10 727 adults, including 5239 men and 5488 women, with a mean age of 42.7±11.2 years and a mean follow-up time of 9.1 years, met the study criteria and completed a questionnaire about energy intake and diabetes status from the China Health and Nutrition Survey in 1997–2011.Primary outcome measuresParticipants were divided into subgroups based on the trajectories of the ratio of energy consumption at dinner versus breakfast. Cox multivariate regression models were used to explore the associations between different trajectories and the risk of T2D after adjustment for confounders and their risk factors. Mediation analysis was performed to explore the intermediary effect of triacylglycerol (TG), total cholesterol (TC), uric acid (UA) and apolipoprotein B (ApoB) between the trajectories and the risk of T2D.ResultsFor energy consumption at dinner versus breakfast, compared with a low-stable trajectory, the adjusted HR of T2D in low-increasing from early-stage trajectory was 1.29 (95% CI 1.04 to 1.60). TG, TC, UA and ApoB were significantly higher in low-increasing from early-stage trajectory than other trajectories and play partial regulation roles between trajectories and T2D.ConclusionsThis study emphasised the harmful effect of a gradual increase in the ratio of energy consumption at dinner versus breakfast from early stage on the development of T2D and partially mediated by TG, TC, UA and ApoB, highlighting that it is necessary to intake more energy at breakfast compared with dinner to prevent T2D in adults.

scholarly journals Fruit and Vegetable Intake and All-Cause Mortality in a Chinese Population: The China Health and Nutrition Survey

2021 ◽  
Vol 18 (1) ◽  
pp. 342
Author(s):  
Yuxuan Gu ◽  
Yansu He ◽  
Shahmir H. Ali ◽  
Kaitlyn Harper ◽  
Hengjin Dong ◽  
...  
Keyword(s):  
Vegetable Intake ◽  
Total Mortality ◽  
Negative Association ◽  
Mortality Data ◽  
Sample Population ◽  
Fruit And Vegetable ◽  
Nutrition Survey ◽  
Related Factors ◽  
Health And Nutrition ◽  
All Cause Mortality

This study was to investigate the association of long-term fruit and vegetable (FV) intake with all-cause mortality. We utilized data from the China Health and Nutrition Survey (CHNS), a prospective cohort study conducted in China. The sample population included 19,542 adult respondents with complete mortality data up to 31 December 2011. Cumulative FV intake was assessed by 3 day 24 h dietary recalls. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality. Covariates included sociodemographic characteristics, lifestyle factors, health-related factors, and urban index. A total of 1409 deaths were observed during follow-up (median: 14 years). In the fully adjusted model, vegetable intake of the fourth quintile (327~408 g/day) had the greatest negative association with death compared to the lowest quintile (HR = 0.63, 95% CI: 0.53–0.76). Fruit intake of the fifth quintile (more than 126 g/day) had the highest negative association (HR = 0.24, 95% CI: 0.15–0.40) and increasing general FV intake were also negatively associated with all-cause mortality which demonstrated the greatest negative association in the amount of fourth quintile (HR = 0.59, 95% CI: 0.49–0.70) compared to the lowest quintile. To conclude, greater FV intake is associated with a reduced risk of total mortality for Chinese adults. High intake of fruit has a stronger negative association with mortality than differences in intake of vegetables. Our findings support recommendations to increase the intake of FV to promote overall longevity.

scholarly journals Growth and Weight Status in Chinese Children and Their Association with Family Environments

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 397
Author(s):  
Xu Tian ◽  
Hui Wang
Keyword(s):  
Weight Status ◽  
Family Income ◽  
Decomposition Analysis ◽  
Overweight And Obesity ◽  
Chinese Children ◽  
Nutrition Survey ◽  
Growth Status ◽  
Health And Nutrition ◽  
The Impact ◽  
Over Time

The growth status and weight status of Chinese children have experienced remarkable changes in the past decades. Using China Health and Nutrition Survey (CHNS) data, this paper examines the secular trends and disparity of the growth status and weight status in Chinese children and further investigates the impact of various family environments on children’s growth from 1991 to 2011. We found an increasing trend in standardized growth indicators (height, weight, and BMI), overweight, and obesity from 1991 to 2011. We also observed an increasing disparity in overweight and obesity over time. Family environments had a significant impact on children’s growth status and weight status. In particular, children that live in families with a small size, higher family income, better sanitary conditions, and with well-educated parents or overweight parents tended to be taller and heavier and have a higher BMI, lower risk of being underweight, and higher risk of exhibiting overweight and obesity. Further decomposition analysis showed that more than 70% of the disparity in standardized height, weight, and overweight and around 50% of the disparity in standardized BMI, underweight, and obesity could be attributed to heterogeneity in family environments. Moreover, the disparity associated with family environments tended to increase over time.

Gender Norms and Household Labor: Time Use in the Context of Social Class Differentiation in Transitional China

2021 ◽  
pp. 048661342199044
Author(s):  
Wei Zhang ◽  
Zhun Xu
Keyword(s):  
Social Class ◽  
Time Allocation ◽  
Rural Women ◽  
Jel Classification ◽  
Market Process ◽  
Nutrition Survey ◽  
Policy Makers ◽  
Health And Nutrition ◽  
The Social ◽  
Transitional China

This paper studies the historical evolution of China’s gender relations through the lens of housework time allocation. In particular, we highlight the role played by social class and income. Drawing upon data from the Chinese Health and Nutrition Survey, we find that during the period 1991–2011, being a peasant or earning less than the spouse was increasingly associated with a higher share of housework. The market process appears to have indirectly improved the social status of women (most likely rural women) married to peasant husbands as measured by the former’s declining housework share. Such changes, however, have not challenged traditional patriarchal norms in the countryside and have even facilitated the rise of a new market-based patriarchy. Policy makers should empower women by tackling the different faces of patriarchy as a whole. JEL Classification: B51, J16, P16

scholarly journals Trajectories of mid-life to elderly adulthood BMI and incident hypertension: the China Health and Nutrition Survey

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047920
Author(s):  
Qi Zeng ◽  
Lin Sun ◽  
Qing Zeng
Keyword(s):  
Latent Class ◽  
Mixed Model ◽  
Longitudinal Design ◽  
Nutrition Survey ◽  
Incident Hypertension ◽  
Health And Nutrition ◽  
Stable Class ◽  
Bmi Trajectories ◽  
Distinct Individual ◽  
Prevention Of Hypertension

ObjectivesThis study is designed to identify different body mass index (BMI) trajectories of individuals aged 40–70 years and test the effect of distinct BMI trajectories on incident hypertension.DesignThe accelerated longitudinal design was used for this study.MethodsThe study drew data from the third to ninth China Health and Nutrition Surveys (CHNS), and 4697 participants were included between 1991 and 2015. As analysed, three distinct individual BMI trajectories were identified by the latent class growth mixed model (LCGMM). Then, BMI values and BMI slopes were worked out through calculation with LCGMM trajectory parameters and their primary derivatives, respectively. Later, Cox proportional hazard models were applied to examine BMI values and slopes, and find out the relationship between the said predicted data and incident hypertension for different classes.ResultsThree different trajectory classes were identified, that is, low-stable class (n=3711), sharp-increasing class (n=282) and high-stable class (n=704). Compared with the low-stable class, the adjusted HRs (95% CI) were 1.321 (1.119 to 1.559) and 1.504 (1.322 to 1.711) for the sharp-increasing class and the high-stable class, respectively. The HR (95% CI) for BMI values rose from 1.081 (1.030 to 1.135) to 1.221 (1.171 to 1.273) while the HR (95% CI) for BMI slopes dropped from 1.154 (1.100 to 1.211) to 0.983 (0.943 to 1.025). That is, the HR for BMI slopes were higher than that for BMI values for the class aged 40–47 years.ConclusionThese findings suggest that the calibrated BMI trajectories for the period from mid-life to elderly adulthood have a significant effect on the risk of incident hypertension. The period from age 40 to 47 years is critical and has positive implications for the early prevention of hypertension.

scholarly journals Diabetic Retinopathy and Hearing Loss: Results from the Fifth Korean National Health and Nutrition Survey

2021 ◽  
Vol 10 (11) ◽  
pp. 2398
Author(s):  
Yong Un Shin ◽  
Seung Hun Park ◽  
Jae Ho Chung ◽  
Seung Hwan Lee ◽  
Heeyoon Cho
Keyword(s):  
Hearing Loss ◽  
Logistic Regression ◽  
Diabetic Retinopathy ◽  
Old Age ◽  
National Health ◽  
Noise Exposure ◽  
Middle Aged ◽  
Nutrition Survey ◽  
Aged Group ◽  
Health And Nutrition

We investigated the association between the severity of diabetic retinopathy (DR) and hearing loss based on vascular etiology. We used data from the Korean National Health and Nutrition Survey 2010–2012. Adults aged >40 years with diabetes were enrolled. Demographic, socioeconomic, general medical, noise exposure and biochemical data were used. Participants were classified into three groups: diabetes without DR, non-proliferative DR (NPDR), and proliferative DR (PDR); participants were also divided into two groups (middle age (40 ≤ age < 65 years) vs. old age (age ≥ 65 years)). The association between hearing loss and DR was determined using logistic regression analysis. A total of 1045 participants (n = 411, middle-aged group; n = 634, old-age group) were enrolled. Overall, the prevalence of hearing loss was 58.1%, 61.4%, and 85.0% in the no DR, NPDR, and PDR groups, respectively. After adjusting for confounding factors, the logistic regression model showed that there was no significant association between the prevalence of DR and hearing loss in the overall sample. However, the presence of PDR (OR 7.74, 95% CI 2.08–28.82) was significantly associated with hearing loss in the middle-aged group. Middle-aged people with diabetes may have an association between DR severity and hearing loss. The potential role of microvascular diseases in the development of hearing loss, especially in middle-aged patients, could be considered.

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