Annals of Epidemiology

ImportancePersistent racial and ethnic disparities in breast and prostate cancer mortality are well documented. Most prior studies emphasize between-group differences and rely on population averages or single composite measures of social disadvantage, which can obscure high-need communities within groups. How socio-behavioral determinants of health vary within groups across local gradients of cancer mortality remains incompletely characterized. A framework that combines race- and cancer-specific...

BackgroundHypertension guidelines recommend the use of automated BP devices over manual devices to reduce observer bias, such as terminal digit preference. We aimed to evaluate systematic differences in BP readings and the association with incident stroke according to type of measurement. MethodsUsing de-identified electronic health record data from Optum Labs Data Warehouse from primary care visits in 2024, we classified providers BP measurement method using proportion of odd terminal digit pr...

IntroductionMusculoskeletal injuries (MSKIs) are ubiquitous in the U.S. military, especially among high-performing service members such as Marines. Given that female service members only started to be assigned to ground combat roles since December 2015, evaluation of sex on MSKI risk in ground combat occupations has not been possible until there was an ample population to study. The purpose of this population-level epidemiological study was to assess (1) if female sex was a salient risk factor f...

BackgroundPacked lunches are a common feature of early childhood food provision, yet evidence describing their nutritional composition in early years settings remains limited. Understanding the foods provided during this developmental period is important, given the potential influence of early dietary exposures on later health. AimTo characterise the composition, nutritional quality, cost, and dietary patterns of packed lunches brought from home in Early Childhood Education and Care settings, a...

BackgroundHelmet use is a proven safety measure that reduces the risk of head injury among cyclists and e-scooter riders. Despite legal requirements for pedal bikes and e-bikes in Australia, compliance varies, particularly among users of electric vehicles. The growing popularity of e-bikes and e-scooters in urban areas presents new public health challenges, yet observational data on helmet use, behavioural determinants, and the effectiveness of safety interventions remain limited. AimPhase 3 of...

BackgroundFood systems--particularly livestock production--account for substantial greenhouse gas (GHG) emissions, while unhealthy diets, characterized by excessive animal-based and insufficient plant-based food consumption, are a major risk factor for all-cause mortality in Europe. Implementing climate mitigation policies related to the GHG emissions of the food system could therefore bring important health co-benefits. MethodsWe developed a health impact assessment model based on a life table...

BackgroundHelmet use is a proven safety measure that reduces the risk of head injury among cyclists and e-scooter riders. Despite legal requirements for pedal bikes and e-bikes in Australia, compliance varies, particularly among users of electric vehicles. The growing popularity of e-bikes and e-scooters in urban areas presents new public health challenges, yet observational data on helmet use, behavioural determinants, and the effectiveness of safety interventions remain limited. AimPhase 4 of...

BackgroundHelmet use is a proven safety measure that reduces the risk of head injury among cyclists and e-scooter riders. Despite legal requirements for pedal bikes and e-bikes in Australia, compliance varies, particularly among users of electric vehicles. The growing popularity of e-bikes and e-scooters in urban areas presents new public health challenges, yet observational data on helmet use, behavioural determinants, and the effectiveness of safety interventions remain limited. AimPhases 1 a...

IntroductionPregnancy is a critical test of womens cardiovascular risk. Structural factors may influence long-term cardiovascular health beyond individual, social experiences. We examined associations of neighborhood-level deprivation and individual-level social vulnerability (SV) during pregnancy with postpartum blood pressure (BP). MethodsThis secondary analysis of a prospective cohort study used data from 3,728 nulliparous women in the nuMoM2b-HHS cohort followed from early pregnancy to 2-7 ...

ObjectiveTo characterize associations between tattooing and health status. MethodsWe used data from [~]27,000 respondents to the 2020-2022 Utah Behavioral Risk Factor Surveillance System (BRFSS). Multivariable Poisson regression was used to calculate prevalence ratios (PR) and 95% confidence intervals (CI) associating ever receiving a tattoo with physical/mental health status. ResultsIn this cross-sectional study, ever receiving a tattoo was associated with self-reported "poorer" vs. "excellen...

Objective: Minimum unit pricing (MUP) aims to reduce use of cheap, high strength alcoholic beverages that drive harm, yet concerns remain about inequitable effects for structurally vulnerable groups. As part of the Costs, Harms, Expenditures and Alcohol Prices (CHEAP) study, we linked individual-level, product-specific alcohol consumption data from a customized survey with provincial retail price data to estimate prices per standard drink (PPSD) and examine their association with alcohol-related...

Suicide is one of the worlds leading public health problems, with more than 720,000 deaths annually. Suicide has traditionally been studied from an individual perspective. However, research has increasingly highlighted the influence of community-level factors on suicide risk. This study aimed to (1) analyse the spatial distribution of suicide mortality at the provincial level in Spain (2018-2022); (2) perform stratified analyses by sex and age group; and (3) compare suicide risk across differen...

BackgroundPeople with HIV (PWH) experience higher cancer-specific mortality and may have worse surgical outcomes than people without HIV (PWoH), though the limited prior evidence largely predates the treat-all antiretroviral therapy (ART) era. We examined postoperative outcomes among PWH and PWoH enrolled in Medicaid in 26 states and Washington, D.C. from 2001-2021. MethodsWe identified the first inpatient/outpatient surgery for anal, bladder, breast, colorectal, female genitourinary, gastroeso...

BackgroundConcern about long-term health effects of repetitive head impacts in football has increased, but it remains unclear whether position-specific exposure patterns were associated with differential long-term all-cause mortality among elite players across the 20th century. MethodsWe conducted two retrospective cohort studies of elite male professional football players. The World Cup cohort included all players on the team rosters from FIFA World Cup tournaments (1930-1990), and the UEFA Eu...

BackgroundObstructive sleep apnea (OSA), as measured by the Apnea Hypopnea Index (AHI), is associated with adverse outcomes. Measures that characterize the temporal variability in events may provide information over and beyond a simple summary of event frequency as measured by the AHI. Research QuestionTo assess whether temporal variability in the occurrence of obstructive apnea/hypopneas during the night is associated with all-cause mortality or incident cardiovascular disease (CVD). Study De...

BackgroundCannabis use is highly prevalent among people who use unregulated drugs. While daily cannabis use has been hypothesized to provide protective effects through substitution or tolerance mechanisms, the relationship between cannabis use frequency and overdose risk remains poorly understood, particularly for infrequent users. MethodsWe conducted a secondary analysis of cross-sectional interview data from people who use unregulated drugs in Vancouver, British Columbia, collected during the...

ObjectiveTo evaluate risk of early-onset dementia (EOD) after diagnosis of cancer among Medicaid beneficiaries. DesignLongitudinal observational study of Medicaid enrollment, inpatient, and outpatient claims data from 26 states and Washington, DC, 2001-2019. MethodsBeneficiaries aged 18-64 with [≥]6 months of enrollment were matched 1:1 on cancer status (lung, colon, breast, prostate) by age, sex, race, year and state. We estimated the weighted cumulative incidence functions of EOD at 1, 2,...

Students who frequently miss school are at greater risk for academic difficulty. High levels of absenteeism as early as kindergarten have been associated with long-term consequences, such as low reading proficiency in Grade 3 and low academic achievement in Grade 5, both of which have been associated with lower rates of high school graduation and enrollment in post-secondary education. The prevalence of school absenteeism has increased significantly since the COVID-19 pandemic and there have bee...

BackgroundSecondhand smoke (SHS) exposure remains a major public health concern among adolescents, particularly in low- and middle-income countries. Evidence from Zambia is limited, despite increasing tobacco use and existing tobacco control policies. This study examined the prevalence and correlates of SHS exposure among adolescents in Zambia. MethodsWe analyzed data from the 2021 Zambia Global Youth Tobacco Survey (GYTS), a nationally representative, school-based survey. The sample included 6...

BackgroundHeart failure (HF), atrial fibrillation (AF)/atrial flutter (AFL) and sepsis commonly co-occur in hospitalized patients. This study determines temporal mortality trends associated with concurrent HF, AF/AFL, and sepsis among adults across demographic and geographic groups in the United States. MethodsThe CDC Wonder database was utilized to extract age-adjusted mortality rates (AAMR) per 100,000 for deaths listing HF, AF/AFL, and sepsis. Trends were analyzed by age, race/ethnicity, reg...