population attributable fractions
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Author(s):  
Lorentz Erland Linde ◽  
Cathrine Ebbing ◽  
Dag Moster ◽  
Jörg Kessler ◽  
Elham Baghestan ◽  
...  

Abstract Purpose This study examines individual aggregation of postpartum hemorrhage (PPH), paternal contribution and how offspring birthweight and sex influence recurrence of PPH. Further, we wanted to estimate the proportion of PPH cases attributable to a history of PPH or current birthweight. Methods We studied all singleton births in Norway from 1967 to 2017 using data from Norwegian medical and administrational registries. Subsequent births in the parents were linked. Multilevel logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CI) for PPH defined as blood loss > 500 ml, blood loss > 1500 ml, or the need for blood transfusion in parous women. Main exposures were previous PPH, high birthweight, and fetal sex. We calculated adjusted population attributable fractions for previous PPH and current high birthweight. Results Mothers with a history of PPH had three- and sixfold higher risks of PPH in their second and third deliveries, respectively (adjusted OR 2.9; 95% CI 2.9–3.0 and 6.0; 5.5–6.6). Severe PPH (> 1500 ml) had the highest risk of recurrence. The paternal contribution to recurrence of PPH in deliveries with two different mothers was weak, but significant. If the neonate was male, the risk of PPH was reduced. A history of PPH or birthweight ≥ 4000 g each accounted for 15% of the total number of PPH cases. Conclusion A history of PPH and current birthweight exerted strong effects at both the individual and population levels. Recurrence risk was highest for severe PPH. Occurrence and recurrence were lower in male fetuses, and the paternal influence was weak.


2021 ◽  
Author(s):  
Anurag Bhargava ◽  
Madhavi Bhargava ◽  
Andrea Beneditti ◽  
Anura Kurpad

AbstractIntroductionThe Global TB Report 2020 estimated the population attributable fractions (PAF) for the major risk factors of TB. Undernourishment emerged as the leading risk factor accounting for 19% of the cases. The WHO however used the terms undernourishment and undernutrition interchangeably in its computation of PAF. Undernourishment is an indirect model derived estimate of decreased per capita energy availability, while undernutrition is defined by direct anthropometric measurements of nutritional status.MethodsWe re-estimated the PAF of undernutrition (instead of undernourishment) in 30 high TB burden countries, using the prevalence of undernutrition (age standardized estimate of BMI < 18.5 kg/m2 in adults for both sexes), and the relative risk (RR) of 3.2. Further, we revised PAF estimates of undernutrition with an RR of 4.49, in light of recent evidence.FindingsTwenty four percent of TB in high burden countries is attributable to undernutrition. The PAF of undernutrition was highest in Asian countries, unlike the PAF of undernourishment that was highest in Africa. The corrected estimate led up to 65% increase in number of cases attributable to undernutrition in Asian countries. More than one-third to nearly half of TB cases in India could be attributable to undernutrition.InterpretationEstimation of the PAF of TB related to undernutrition is methodologically valid and operationally relevant, rather than PAF related to undernourishment. Addressing undernutrition, the leading driver of TB in high TB burden countries (especially Asia) could enable achievement of END TB milestones of TB incidence for 2025.


2021 ◽  
Author(s):  
Karen Schliep ◽  
Lily Gu ◽  
Kristine Lynch ◽  
Michelle Sorweid ◽  
Michael Varner ◽  
...  

Abstract Background Prior research indicates that at least 35% of Alzheimer’s disease and related dementia risk may be amenable to prevention. Subjective cognitive decline is often the first indication of preclinical dementia, with the risk of subsequent Alzheimer’s disease in such individuals being greater in women than men. We wished to understand how modifiable factors are associated with subjective cognitive decline, and whether differences exist by sex. Methods Data were collected from men and women (45 years and older) who completed the U.S. Behavioral Risk Factor Surveillance System Cognitive Decline Module (2015–2018), n=216,838. We calculated population attributable fractions for subjective cognitive decline, stratified by sex, of the following factors: limited education, deafness, social isolation, depression, smoking, physical inactivity, obesity, hypertension, and diabetes. Our models were adjusted for age, race, income, employment, marital and Veteran status, and accounted for communality among risk factors. Results The final study sample included more women (53.7%) than men, but both had a similar prevalence of subjective cognitive decline (10.6% of women versus 11.2% of men). Women and men had nearly equivalent overall population attributable fractions to explain subjective cognitive decline (39.7% for women versus 41.3% for men). The top three contributing risk factors were social isolation, depression, and hypertension, which explained three-quarters of the overall population attributable fraction. Conclusions While we did not identify any differences in modifiable factors between men and women contributing to subjective cognitive decline, other factors including reproductive or endocrinological health history or biological factors that interact with sex to modify risk warrant further research.


2021 ◽  
pp. sextrans-2021-055242
Author(s):  
Louise Causer ◽  
Bette Liu ◽  
Caroline Watts ◽  
Hamish McManus ◽  
Basil Donovan ◽  
...  

ObjectiveAboriginal women living in remote Australia experience a high burden of both chlamydia and gonorrhoea infections and disproportionately high rates of pelvic inflammatory disease (PID). We estimated for the first time the fraction of PID attributable to these infections in young Aboriginal women living in these settings.MethodsUsing published data from two large Australian studies (2002–2013; 2010–2014), we calculated the fraction of emergency department presentations and hospitalisations for PID attributable to chlamydia and/or gonorrhoea infection in Aboriginal women aged 16–29 years living in remote Australia. We used a Monte Carlo simulation to estimate the mean and 95% CIs for the assumed prevalence and population attributable fractions for PID for infection stratifications (chlamydia only, gonorrhoea only and dual infection) as well as for any infection (chlamydia and/or gonorrhoea). Additional outputs were calculated for chlamydia infection with/without gonorrhoea coinfection, and vice versa.ResultsThe prevalence of chlamydia only was 12.9% (95% CI: 11.6% to 14.2%), gonorrhoea only was 7.8% (95% CI: 6.6% to 8.9%) and dual infection was 6.5% (95% CI: 5.8% to 7.2%); rate ratios of PID were 1.9 (95% CI: 1.5 to 2.3), 5.2 (95% CI: 4.3 to 6.4) and 4.6 (95% CI: 3.8 to 5.5), respectively. The overall fraction of PID attributable to chlamydia and/or gonorrhoea was 40.2% (95% CI: 36.0% to 44.4%); any gonorrhoea was 33.4% (95% CI: 29.2% to 37.8%) and any chlamydia was 20.6% (95% CI: 16.9% to 24.6%).ConclusionOur study demonstrates the importance of calculating the fraction of PID related to chlamydia and gonorrhoea in the local context, demonstrating the major contribution gonorrhoea makes to PID hospitalisations among Australian Aboriginal women living in remote settings. To significantly and sustainably reduce the unacceptable rate of PID in this population, strategies are urgently needed to improve timely testing and treatment and recognition and management of PID in primary care.


2021 ◽  
Vol 17 (S10) ◽  
Author(s):  
Sandra Wezeman ◽  
Jeroen F Uleman ◽  
Geeske Peeters ◽  
Eleni Margioti ◽  
Nikolaos Scarmeas ◽  
...  

Author(s):  
Hiroyasu Iso ◽  
Renzhe Cui ◽  
Iseki Takamoto ◽  
Masahiko Kiyama ◽  
Isao Saito ◽  
...  

Background It is uncertain whether risk classification under the nationwide program on screening and lifestyle modification for metabolic syndrome captures well high‐risk individuals who could benefit from lifestyle interventions. We examined the validity of risk classification by linking the incidence of cardiovascular disease (CVD). Methods and Results Individual‐level data of 29 288 Japanese individuals aged 40 to 74 years without a history of CVD from 10 prospective cohort studies were used. Metabolic syndrome was defined as the presence of high abdominal obesity and/or overweight plus risk factors such as high blood pressure, high triglyceride or low high‐density lipoprotein cholesterol levels, and high blood glucose levels. The risk categories for lifestyle intervention were information supply only, motivation‐support intervention, and intensive support intervention. Sex‐ and age‐specific hazard ratios and population attributable fractions of CVD, which were also further adjusted to consider non–high density lipoprotein cholesterol levels, were estimated with reference to nonobese/overweight individuals, using Cox proportional hazard regression. Since the reference category included those with risk factors, we set a supernormal group (nonobese/overweight with no risk factor) as another reference. We documented 1023 incident CVD cases (565 men and 458 women). The adjusted CVD risk was 60% to 70% higher in men and women aged 40 to 64 years receiving an intensive support intervention, and 30% higher in women aged 65 to 74 years receiving a motivation‐support intervention, compared with nonobese/overweight individuals. The population attributable fractions in men and women aged 40 to 64 years receiving an intensive support intervention were 17.7% and 6.6%, respectively, while that in women aged 65 to 74 years receiving a motivation‐support intervention was 9.4%. Compared with the supernormal group, nonobese/overweight individuals with risk factors had similar hazard ratios and population attributable fractions as individuals with metabolic syndrome. Conclusions Similar CVD excess and attributable risks among individuals with metabolic syndrome components in the absence and presence of obesity/overweight imply the need for lifestyle modification in both high‐risk groups.


2021 ◽  
Author(s):  
Shahrzad Nematollahi ◽  
Mohammad Ali Mansournia ◽  
Abbas Rahimi-Foroushani ◽  
Ali Mouseli ◽  
Hossein Shabkhiz ◽  
...  

Abstract Background: Low Birth Weight (LBW) poses a major health challenge in low-resource suburban communities. Despite relatively commonality, there is little evidence on the effects of water pipe and dietary caffeine on reproductive outcomes in the Middle-East region. The Bandar Abbas Pregnancy Cohort (BAPC), as a population-based prospective study, has been investigating the effects of lifestyle and environmental factors on maternal wellbeing and child growth and development in suburban communities in the south of Iran. This study used the BAPC data to estimate the attribution of LBW incidence to fully or partially removal of dietary caffeine intake and water pipe smoking during pregnancy.Methods: ‎The present study used data on 861 live singleton pregnancies in the first two BAPC visits (response rate= 95.42%). Water pipe smoking (yes/no) was measured during pregnancy using a structured checklist recommended by the World Health Organization (WHO). Dietary caffeine intake was measured during pregnancy using a structured checklist and categorized into low for 0-99 mg/day, and high for>100 mg/day. LBW (yes/no) was determined using recorded birth weight in infant`s vaccination card. Exposure relative risks were calculated using Modified Poisson regression models. Population Attributable Fractions (PAFs) and Generalized Impact Fractions (GIFs) were calculated on relative risk scale. The prevalence of counter fact was set as 3% for water pipe smokers and 14.9% for intake of >100 mg/day caffeine.Results: The cumulative incidence of LBW was 16.1%. An estimated 19% (95%CI: 6, 30%) and 11% (95%CI: 8, 14%) of LBW were attributed to high intake of dietary caffeine and water pipe smoking, respectively. Reducing the intake of caffeine to less than 100 mg/day or prevalence of water pipe to 3% would prevent 10.7% (95%CI: 6.6, 25.3%) and 5.7% ‎‎(95%CI: ‎5.0, 6.8%) of LBW incidence, respectively. ‎Conclusions: Our findings have provided evidence on quantitative contributions of caffeine and water pipe on LBW using real-world data. Integration of this information into practical action plans to prevent LBW is the next step in our cohort project. Furthermore, to get an overarching picture and in-depth understanding of reproductive effects of caffeine and water pipe, exercising this study`s analytic approach in other contexts is encouraged. ‎


2021 ◽  
Vol 9 ◽  
Author(s):  
Fang Gu ◽  
Siliang Zhou ◽  
Ke Lou ◽  
Rui Deng ◽  
Xingxiu Li ◽  
...  

Objectives: To assess the relationship between modifiable lifestyle factors and risk of overweight/obesity in Chinese students, and to evaluate the predicting prevalence of overweight if the lifestyle risk factors were removed.Methods: A cross-sectional survey was conducted among 40,141 students in grade three and above (8–24yrs) in 2019 in Zhejiang Province, China. Physical examination was performed, and a self-administered questionnaire was used to collect lifestyle information, including dietary behavior, physical activity, TV watching, sleeping, smoking, drinking, and tooth-brushing habits. Logistic regression models were performed to assess the relationship between overweight/obesity and a series of lifestyle factors. Population attributable fractions (PAFs) were used to calculate the predicting prevalence of overweight/obesity if lifestyle risk factors were removed.Results: The prevalence of overweight/obesity of participants was 25.5% (male 32.3%, female 18.1%). Overweight/obesity were associated with adverse lifestyle factors, such as watch TV ≥1 h/day (OR = 1.14, 95% CI: 1.11–1.22), insufficient sleep (OR = 1.14, 95% CI: 1.11–1.22), and irregular toothbrushing habits (OR = 1.19, 95% CI: 1.01–1.39). Based on the calculated PAFs, the predicted prevalence of overweight/obesity would decline moderately if lifestyle factors were modified, with the magnitudes of decrease vary by sex, age and residence. Generally, a larger reduction was estimated if the sleeping time was increased and TV time was reduced, with the prevalence of overweight/obesity decreased by 1.1% (95% CI: 0.7, 1.5%) and 0.9% (95% CI: 0.6, 1.2%), respectively.Conclusions: Predicted prevalence of overweight/ obesity in Chinese students may decrease if modifiable lifestyle risk factors were removed. The attributable risk for obesity of lifestyle behaviors varied in age, sex and residence groups. The findings of this study may provide insights for planning and optimizing future obesity intervention endeavors.


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