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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (15 October 2024) | Viewed by 30807

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Prof. Dr. Dorota Raczkiewicz

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1. Department of Medical Statistics, School of Public Health, Center of Postgraduate Medical Education, 01-826 Warsaw, Poland
2. Department of Demography, Institute of Statistics and Demography, Collegium of Economic Analyses, SGH Warsaw School of Economics, 02-554 Warsaw, Poland
Interests: health promotion; medical statistics; public health
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Dr. Joanna Bartosińska

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Department of Dermatology, Venerology and Paediatric Dermatology, Faculty of Medicine, Medical University of Lublin, 20-059 Lublin, Poland
Interests: medicine; skin; psoriasis

Special Issue Information

Dear Colleagues,

On behalf of the International Journal of Environmental and Public Health, we are happy to announce a new Special Issue called “Epidemiology and Medical Statistics”, providing an opportunity to publish the results of your research and share your viewpoints and opinions on different scientific projects concerning modern and advanced statistical methodologies in epidemiological studies. Statistics is the basic tool used by epidemiology; thus, the crucial role of statistical methods in the epidemiology and public health studies is unquestionable. Apart from many health challenges that contemporary medicine has to tackle, e.g., neoplastic, metabolic, autoimmune, infectious, autoinflammatory, and cardiovascular diseases, the COVID-19 pandemic has drastically changed the approach to the epidemiology and statistics of various disease diagnostics, management, and prognosis.

Therefore, different article types, i.e., original research, review, communication, project report, etc., on epidemiology and statistics in such medical sciences as, e.g., clinical medicine, public health, preventive medicine, health promotion, and others, are very welcome for publication in this Special Issue.

We look forward to receiving your submissions.

Prof. Dr. Dorota Raczkiewicz
Dr. Joanna Bartosińska
Guest Editors

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Keywords

epidemiology
medical statistics
public health
preventive medicine
clinical medicine
health promotion
COVID-19
global health problems

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Published Papers (12 papers)

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11 pages, 307 KiB

Open AccessArticle

The Utility of Data Collected as Part of Australia’s Aboriginal and Torres Strait Islander Health Performance Framework

by Boyd Potts, Christopher M. Doran and Stephen Begg

Int. J. Environ. Res. Public Health 2024, 21(3), 340; https://doi.org/10.3390/ijerph21030340 - 13 Mar 2024

Cited by 2 | Viewed by 2165

Abstract

Since 2006, the Australian Aboriginal and Torres Strait Islander Health Performance Framework (HPF) reports have provided information about Indigenous Australians’ health outcomes. The HPF was designed, in consultation with Indigenous stakeholder groups, to promote accountability and inform policy and research. This paper explores bridging the HPF as a theoretical construct and the publicly available data provided against its measures. A whole-of-framework, whole-of-system monitoring perspective was taken to summarise 289 eligible indicators at the state/territory level, organised by the HPF’s tier and group hierarchy. Data accompanying the 2017 and 2020 reports were used to compute improvement over time. Unit change and confidence indicators were developed to create an abstract but interpretable improvement score suitable for aggregation and visualisation at scale. The result is an exploratory methodology that summarises changes over time. An example dashboard visualisation is presented. The use of secondary data inevitably invites acknowledgments of what analysis cannot say, owing to methods of collection, sampling bias, or unobserved variables and the standard mantra regarding correlation not being causation (though no attempt has been made here to infer relationships between indicators, groups, or tiers). The analysis presented questions the utility of the HPF to inform healthcare reform. Full article

(This article belongs to the Special Issue Epidemiology and Medical Statistics)

23 pages, 2130 KiB

Open AccessArticle

The Inverse Log-Rank Test: A Versatile Procedure for Late Separating Survival Curves

by Jimmy T. Efird

Int. J. Environ. Res. Public Health 2023, 20(24), 7164; https://doi.org/10.3390/ijerph20247164 - 11 Dec 2023

Cited by 2 | Viewed by 2431

Abstract

Often in the planning phase of a clinical trial, a researcher will need to choose between a standard versus weighted log-rank test (LRT) for investigating right-censored survival data. While a standard LRT is optimal for analyzing evenly distributed but distinct survival events (proportional hazards), an appropriately weighted LRT test may be better suited for handling non-proportional, delayed treatment effects. The “a priori” misspecification of this alternative may result in a substantial loss of power when determining the effectiveness of an experimental drug. In this paper, the standard unweighted and inverse log-rank tests (iLRTs) are compared with the multiple weight, default Max-Combo procedure for analyzing differential late survival outcomes. Unlike combination LRTs that depend on the arbitrary selection of weights, the iLRT by definition is a single weight test and does not require implicit multiplicity correction. Empirically, both weighted methods have reasonable flexibility for assessing continuous survival curve differences from the onset of a study. However, the iLRT may be preferable for accommodating delayed separating survival curves, especially when one arm finishes first. Using standard large-sample methods, the power and sample size for the iLRT are easily estimated without resorting to complex and timely simulations. Full article

(This article belongs to the Special Issue Epidemiology and Medical Statistics)

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13 pages, 1190 KiB

Open AccessArticle

Centres of Excellence for Adolescent Health and Development: A Case Study from Uttar Pradesh, India

by Devika Mehra, Rahul Rajak, Sujata Deo, Qazi Najmuddin, Kshetrimayum Surmala Devi, Suresh Kumar Rathi and Sunil Mehra

Int. J. Environ. Res. Public Health 2023, 20(4), 3042; https://doi.org/10.3390/ijerph20043042 - 9 Feb 2023

Cited by 1 | Viewed by 3093

Abstract

Adolescents and young adult comprise a significant proportion of India’s population. Although, this group of the population faces serious challenges to their health and well-being. To promote their health and well-being, Centre of Excellence (CoE) at King George’s Medical University, Lucknow, India, serves as an advanced care facility for 10–24-year-old adolescents and young adult women. This paper reports the socio-demographic characteristics of, and health services availed to adolescents and young adults who are visiting the CoE in Lucknow, India. A total of 6038 beneficiaries received clinical services during June 2018–March 2022. Out of total clinical services, 38.37% counselling and 37.53% referral services were utilised. Menstruation (46.29%), sexual and reproductive (28.19%), nutrition (5.91%), and mental health (1.67%) related problems were highly reported. The age of beneficiaries is classified into three categories, i.e., 10–14, 15–19, and 20–24 years. Prevalence of overweight was highest among adolescents aged 20–24 years compared to other age groups. Other than nutrition, late-adolescent girls (15–19) faced more health problems than their counterparts. The percentage of beneficiaries decreased significantly during and post the COVID-19 period (<0.001). Therefore, age-specific programs are currently needed, and interventions need to be designed accordingly. Full article

(This article belongs to the Special Issue Epidemiology and Medical Statistics)

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11 pages, 994 KiB

Open AccessArticle

Inflammatory Biomarkers Differ among Hospitalized Veterans Infected with Alpha, Delta, and Omicron SARS-CoV-2 Variants

by Catherine Park, Shahriar Tavakoli-Tabasi, Amir Sharafkhaneh, Benjamin J. Seligman, Bret Hicken, Christopher I. Amos, Andrew Chou and Javad Razjouyan

Int. J. Environ. Res. Public Health 2023, 20(4), 2987; https://doi.org/10.3390/ijerph20042987 - 8 Feb 2023

Cited by 10 | Viewed by 2139

Abstract

Mortality due to COVID-19 has been correlated with laboratory markers of inflammation, such as C-reactive protein (CRP). The lower mortality during Omicron variant infections could be explained by variant-specific immune responses or host factors, such as vaccination status. We hypothesized that infections due to Omicron variant cause less inflammation compared to Alpha and Delta, correlating with lower mortality. This was a retrospective cohort study of veterans hospitalized for COVID-19 at the Veterans Health Administration. We compared inflammatory markers among patients hospitalized during Omicron infection with those of Alpha and Delta. We reported the adjusted odds ratio (aOR) of the first laboratory results during hospitalization and in-hospital mortality, stratified by vaccination status. Of 2,075,564 Veterans tested for COVID-19, 29,075 Veterans met the criteria: Alpha (45.1%), Delta (23.9%), Omicron (31.0%). Odds of abnormal CRP in Delta (aOR = 1.85, 95% CI:1.64–2.09) and Alpha (aOR = 1.94, 95% CI:1.75–2.15) were significantly higher compared to Omicron. The same trend was observed for Ferritin, Alanine aminotransferase, Aspartate aminotransferase, Lactate dehydrogenase, and Albumin. The mortality in Delta (aOR = 1.92, 95% CI:1.73–2.12) and Alpha (aOR = 1.68, 95% CI:1.47–1.91) were higher than Omicron. The results remained significant after stratifying the outcomes based on vaccination status. Veterans infected with Omicron showed milder inflammatory responses and lower mortality than other variants. Full article

(This article belongs to the Special Issue Epidemiology and Medical Statistics)

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19 pages, 3190 KiB

Open AccessArticle

Understanding the Influence of Patient Factors on Accuracy and Decision-Making in a Diagnostic Accuracy Study with Multiple Raters—A Case Study from Dentistry

by Kirstin Vach, Nadine Schlueter, Carolina Ganss and Werner Vach

Int. J. Environ. Res. Public Health 2023, 20(3), 1781; https://doi.org/10.3390/ijerph20031781 - 18 Jan 2023

Cited by 1 | Viewed by 1871

Abstract

In diagnostic accuracy studies, the test of interest is typically applied only once in each patient. This paper illustrates some possibilities that arise when diagnoses are carried out by a sufficiently large number of multiple raters. In a dental study, sixty-one examiners were asked to diagnose 49 tooth areas with different grades of tissue loss (minor, moderate, and advanced) to decide whether dentine was exposed (positive status) or not (negative status). The true status was determined by histology (reference). For each tooth, the rate of correct decisions reflecting the difficulty to diagnose this tooth and the positive rate reflecting the perception of the tooth by the raters was computed. Meta-analytical techniques were used to assess the inter-tooth variation and the influence of tooth-specific factors on difficulty or perception, respectively. A huge variation in diagnostic difficulty and perception could be observed. Advanced tissue loss made diagnoses more difficult. The background colour and tissue loss were associated with perception and may hint to cues used by the raters. The use of multiple raters in a diagnostic accuracy study allows detailed investigations which make it possible to obtain further insights into the decision-making process of the raters. Full article

(This article belongs to the Special Issue Epidemiology and Medical Statistics)

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12 pages, 1047 KiB

Open AccessFeature PaperArticle

Association between Pet Ownership and Threatened Abortion in Pregnant Women: The China Birth Cohort Study

by Zheng Zhang, Yunjiang Yu, Boyi Yang, Wenzhong Huang, Yunting Zhang, Yana Luo, Michael S. Bloom, Zhengmin Qian, Lauren D. Arnold, Rienna Boyd, Qingqing Wu, Ruixia Liu, Guanghui Dong, Chenghong Yin and The China Birth Cohort Study (CBCS) Group

Int. J. Environ. Res. Public Health 2022, 19(23), 16374; https://doi.org/10.3390/ijerph192316374 - 6 Dec 2022

Cited by 2 | Viewed by 3426

Abstract

Background: The aim of this study was to assess the association between pet ownership and threatened abortion (TA) in pregnant Chinese women. Materials and Methods: We enrolled pregnant women from 18 provinces and autonomous regions across China between November 2017 and December 2020. Participants were grouped based on the presence or absence of pet ownership. Pet owners were further sub-grouped based on the presence or absence of close contact with their pets. Pet species included cats, dogs, and both. Generalised linear mixed models, with province as a random effect, were used to estimate the associations between pet ownership and TA. Results: Pet ownership, whether or not one had close contact with pets, was associated with greater odds of TA (OR: 1.30, 95% CI: 1.21, 1.40). Keeping pet cats (OR: 1.24, 95% CI: 1.11, 1.40), dogs (OR: 1.29, 95% CI: 1.18, 1.41), or both cats and dogs (OR: 1.36, 95% CI: 1.04, 1.68) during pregnancy were all risk factors for TA. We observed significant group differences (p for difference < 0.05) in pre-pregnancy body mass index, education levels, and annual household income. Conclusions: Cat or dog ownership during pregnancy was associated with an increased risk of TA, especially among overweight, less educated, or lower-income participants. Full article

(This article belongs to the Special Issue Epidemiology and Medical Statistics)

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14 pages, 375 KiB

Open AccessArticle

Characteristics of Households’ Vulnerability to Extreme Heat: An Analytical Cross-Sectional Study from India

by Lipika Nanda, Soham Chakraborty, Saswat Kishore Mishra, Ambarish Dutta and Suresh Kumar Rathi

Int. J. Environ. Res. Public Health 2022, 19(22), 15334; https://doi.org/10.3390/ijerph192215334 - 20 Nov 2022

Cited by 4 | Viewed by 2652

Abstract

High ambient temperature is a key public health problem, as it is linked to high heat-related morbidity and mortality. We intended to recognize the characteristics connected to heat vulnerability and the coping practices among Indian urbanites of Angul and Kolkata. In 2020, a cross-sectional design was applied to 500 households (HHs) each in Angul and Kolkata. Information was gathered on various characteristics including sociodemographics, household, exposure, sensitivity, and coping practices regarding heat and summer heat illness history, and these characteristics led to the computation of a heat vulnerability index (HVI). Bivariate and multivariable logistic regression analyses were used with HVI as the outcome variable to identify the determinants of high vulnerability to heat. The results show that some common and some different factors are responsible for determining the heat vulnerability of a household across different cities. For Angul, the factors that influence vulnerability are a greater number of rooms in houses, the use of cooling methods such as air conditioning, having comorbid conditions, the gender of the household head, and distance from nearby a primary health centre (PHC). For Kolkata, the factors are unemployment, income, the number of rooms, sleeping patterns, avoidance of nonvegetarian food, sources of water, comorbidities, and distance from a PHC. The study shows that every city has a different set of variables that influences vulnerability, and each factor should be considered in design plans to mitigate vulnerability to extreme heat. Full article

(This article belongs to the Special Issue Epidemiology and Medical Statistics)

11 pages, 968 KiB

Open AccessArticle

Impact of COVID-19 Awareness on Protective Behaviors during the Off-Peak Period: Sex Differences among Chinese Undergraduates

by Teng Zhao

Int. J. Environ. Res. Public Health 2022, 19(20), 13483; https://doi.org/10.3390/ijerph192013483 - 18 Oct 2022

Cited by 4 | Viewed by 1943

Abstract

COVID-19 remains an extreme threat in higher education settings, even during the off-peak period. Appropriate protective measures have been suggested to prevent the spread of COVID-19 in a large population context. Undergraduate students represent a highly vulnerable fraction of the population, so their COVID-19 protective behaviors play critical roles in enabling successful pandemic prevention. Hence, this study aims to understand what and how individual factors contribute to undergraduate students’ protective behaviors. After building multigroup structural equation models using data acquired from the survey taken by 991 undergraduates at a large research university in eastern China, I found that students’ COVID-19 awareness was positively associated with their protective behaviors, such as wearing a mask, using hand sanitizer, and maintaining proper social distance, but not with getting vaccinated. In addition, I found students with higher COVID-19 awareness were more likely to have more COVID-19 knowledge than those with less awareness. Furthermore, sex differences were observed in the mediation effects of COVID-19 awareness on wearing a mask and getting vaccinated, via COVID-19 knowledge, respectively. The results of this study have implications in helping higher education stakeholders enact effective measures to prevent the spread of the pandemic. Full article

(This article belongs to the Special Issue Epidemiology and Medical Statistics)

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13 pages, 810 KiB

Open AccessArticle

What Drives Abdominal Obesity in Peru? A Multilevel Analysis Approach Using a Nationally Representative Survey

by Akram Hernández-Vásquez, Kamyla M. Olazo-Cardenas, Fabriccio J. Visconti-Lopez and Antonio Barrenechea-Pulache

Int. J. Environ. Res. Public Health 2022, 19(16), 10333; https://doi.org/10.3390/ijerph191610333 - 19 Aug 2022

Cited by 5 | Viewed by 2337

Abstract

Abdominal obesity (AO) is a serious public health threat due to its increasing prevalence and effect on the development of various non-communicable diseases. A multilevel analysis of the 2019 Demographic and Family Health Survey (ENDES in Spanish) using the Latin American Diabetes Association (ALAD in Spanish) cut-off points was carried out to evaluate the individual and contextual factors associated with AO in Peru. A total of 30,585 individuals 18 years and older were included in the analysis. The prevalence of AO among Peruvians in 2019 was 56.5%. Individuals of older age (aOR 4.64; 95% CI: 3.95–5.45), women (aOR 2.74; 95% CI: 2.33–3.23), individuals with a higher wealth index (aOR 2.81; 95% CI: 2.40–3.30) and having only secondary education (aOR 1.45; 95% CI: 1.21–1.75) showed increased odds of presenting AO compared to their peers. At a contextual level, only the Human Development Index (aOR 1.59; 95% CI: 1.17–2.16) was associated with the development of AO. A high Human Development Index is the contextual factor most associated with AO. It is necessary to formulate and implement new public health policies focused on these associated factors in order to reduce the prevalence of OA and prevent the excessive burden of associated noncommunicable diseases. Full article

(This article belongs to the Special Issue Epidemiology and Medical Statistics)

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12 pages, 933 KiB

Open AccessArticle

Health Needs Assessment: Chronic Kidney Disease Secondary to Type 2 Diabetes Mellitus in a Population without Social Security, Mexico 2016–2032

by Silvia Martínez-Valverde, Rodrigo Zepeda-Tello, Angélica Castro-Ríos, Filiberto Toledano-Toledano, Hortensia Reyes-Morales, Adrián Rodríguez-Matías and Juan Luis Gerardo Durán-Arenas

Int. J. Environ. Res. Public Health 2022, 19(15), 9010; https://doi.org/10.3390/ijerph19159010 - 25 Jul 2022

Cited by 2 | Viewed by 2781 | Correction

Abstract

Health needs assessment is a relevant tracer of planning process of healthcare programs. The objective is to assess the health needs of chronic kidney disease (CKD) secondary to type 2 diabetes mellitus (T2 DM) in a population without social security in Mexico. The study design was a statistical simulation model based on data at the national level of Mexico. A stochastic Markov model was used to simulate the progression from diabetes to CKD. The time horizon was 16 years. The results indicate that in 2022, kidney damage progression and affectation in the diabetic patient cohort will be 34.15% based on the time since T2 DM diagnosis. At the end of the 16-year period, assuming that the model of care remains unchanged, early renal involvement will affect slightly more than twice as many patients (118%) and cases with macroalbuminuria will triple (228%). The need for renal replacement therapy will more than double (169%). Meanwhile, deaths associated with cardiovascular risk will more than triple (284%). We concluded that the clinical manifestations of patients with CKD secondary to T2 DM without social security constitute a double challenge. The first refers to the fact that the greatest health need is early care of CKD, and the second is the urgent need to address cardiovascular risk in order to reduce deaths in the population at risk. Full article

(This article belongs to the Special Issue Epidemiology and Medical Statistics)

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13 pages, 830 KiB

Open AccessArticle

Higher Neutrophil-To-Lymphocyte Ratio Was Associated with Increased Risk of Chronic Kidney Disease in Overweight/Obese but Not Normal-Weight Individuals

by Chia-Ho Lin, Yu-Hsuan Li, Ya-Yu Wang and Wen-Dau Chang

Int. J. Environ. Res. Public Health 2022, 19(13), 8077; https://doi.org/10.3390/ijerph19138077 - 30 Jun 2022

Cited by 8 | Viewed by 2582

Abstract

Background: Inflammation has been proposed to play potential roles in the development and progression of chronic kidney disease (CKD). We evaluated the relationship of neutrophil-to-lymphocyte ratio (NLR), a systemic inflammation marker, with CKD in normal-weight and overweight/obese adults. Methods: This cross-sectional study included 2846 apparently healthy adults who underwent a health examination between August 2000 and April 2002. Normal-weight was defined as a body mass index (BMI, kg/m²) of 18.5–24, while overweight/obesity was defined as a BMI of ≥24. CKD was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m². Logistic and linear regression analysis was performed to explore the NLR–CKD relationship. Results: Of the 2846 participants (1777 men and 1069 women), there were 348 CKD individuals (12.3%), with 262 (14.7%) men and 86 (8%) women. A total of 1011 men (56.9%) and 408 women (38.2%) were overweight or obese. Compared with the normal-weight participants, CKD prevalence was higher in the overweight/obese women (6.1% vs. 11.3%, p = 0.002), but not in the overweight/obese men (14.5% vs. 14.9%, p = 0.793). CKD percentages in the NLR quartile groups were 9.4%, 11.5%, 15.4%, and 22.7% in men (p < 0.0001) and 6.4%, 7.1%, 10.5%, and 8.2% in women (p = 0.2291). After adjustment for confounders, each increment of one unit of NLR was associated with a higher CKD risk in the overweight/obese men (adjusted odds ratio (OR) = 1.37, 95% confidence interval (CI) = 1.03–1.82, p = 0.03) and women (adjusted OR = 1.77, 95% CI = 1.08–2.90, p = 0.023), whereas NLR was not associated with CKD in normal-weight men or women. Further, in the overweight/obese participants with an eGFR of 50–70 mL/min/1.73 m², univariable linear regression analysis revealed a significant negative correlation between NLR and eGFR for men (p = 0.004) and women (p = 0.009). Conclusions: It was found that higher NLR was associated with an increased CKD risk in overweight/obese but not in normal-weight men and women in an adult health examination dataset. Our study suggests a role of NLR for CKD prediction in overweight/obese individuals. Full article

(This article belongs to the Special Issue Epidemiology and Medical Statistics)

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2 pages, 289 KiB

Open AccessCorrection

Correction: Martínez-Valverde et al. Health Needs Assessment: Chronic Kidney Disease Secondary to Type 2 Diabetes Mellitus in a Population without Social Security, Mexico 2016–2032. Int. J. Environ. Res. Public Health 2022, 19, 9010

Int. J. Environ. Res. Public Health 2023, 20(5), 4367; https://doi.org/10.3390/ijerph20054367 - 28 Feb 2023

Cited by 1 | Viewed by 1339

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