Eur. J. Epidemiol. [JOURNAL]
Sun
200 papers
Separability and identifiability as primary obstacles to substantively useful mediation analysis.
Shpitser I
Eur J Epidemiol · 2026 Jul · PMID 42400738 · Publisher ↗
Abstract loading — click title to view on PubMed.
Intergenerational income mobility and psychotropic drug dispensation in a 1953 Stockholm cohort: a diagonal reference model approach.
Gurzo K, Oksuzyan A, Modin B
Eur J Epidemiol · 2026 Jul · PMID 42400737 · Publisher ↗
The theoretical link between intergenerational social mobility and mental health has long been explored in the social sciences. Declining social mobility in high-income countries alongside rising mental health concerns h...
The theoretical link between intergenerational social mobility and mental health has long been explored in the social sciences. Declining social mobility in high-income countries alongside rising mental health concerns have reignited interest in this research area. Sweden, while experiencing similar trends, remains a country known for its high social mobility. To investigate the relationship between social mobility and mental health, we used psychotropic drug dispensation as a proxy for mental health problems. We analyzed survey and register data of a 1953 Stockholm cohort (n = 11,199), followed up for psychotropic drug dispensation between ages 52-66. We measure social mobility using parental income at ages 10 and 17 and adult income between ages 37-48. Using diagonal reference models, we analyzed the association between income mobility and psychotropic drug use, stratified by gender. Adjustments were made for growing up in a single-parent household, cognitive ability, social skills, marital status, and previous hospitalization. An income gradient in psychotropic drug dispensation for the stable income group was observed, with a more pronounced pattern among men than women. Net of social origin and destination, income mobility was related to psychotropic drug dispensation among men, but not women. Downward mobility increased, while upward mobility decreased the probability of dispensing psychotropic drugs among men (0.046, p = 0.029 vs. - 0.047, p < 0.020). These results remained robust after adjustments (0.048, p = 0.010 vs. - 0.044, p < 0.017). Our findings suggest that income mobility is associated with middle-aged men's use of psychotropic drugs. Further research is needed to confirm these results in different contexts and age groups.
Genetic risk score to enhance glaucoma case detection: a prospective double-blind screening study (EyeLife) in the population-based Lifelines cohort.
Neustaeter A, Nolte IM, Snieder H … +1 more , Jansonius NM
Eur J Epidemiol · 2026 Jul · PMID 42400736 · Publisher ↗
Early detection of glaucoma prevents blindness but its low population-based prevalence impedes cost-effective screening. We investigated whether genetic pre-screening could increase the prior probability. Design, methods...
Early detection of glaucoma prevents blindness but its low population-based prevalence impedes cost-effective screening. We investigated whether genetic pre-screening could increase the prior probability. Design, methods, and primary analysis were pre-specified and published previously. In this prospective study, we invited 1829 participants aged 55 + from the Dutch Lifelines cohort, selecting from either the highest or lowest 20% of a GWAS-based genetic risk score distribution; subgroups had similar age and gender. Researchers were blinded to subgroup allocation; participants to genetic risk selection. Participants underwent perimetry, optical coherence tomography, fundus photography, tonometry, pachymetry, and visual acuity assessment. Abnormalities prompted a full ophthalmic examination. Participants were classified as definite, probable, or possible open-angle glaucoma, or as unaffected. We calculated the relative risk of combined definite and probable glaucoma for high versus low genetic risk, adjusting for age, sex, and genotyping platform. 1022 participants (median [interquartile range] age 64 [59-70] years, 53% female, Northwestern European ancestry) agreed to participate and were included, 487 with high and 535 with low genetic risk. Of these, 59 (age 70 [64-76] years) were classified as definite (29 with high and 2 with low genetic risk) or probable (21 and 7) glaucoma. Relative risk was 7.4 (95% confidence interval 3.7-14.7), indicating that participants with high genetic risk were over seven times more likely to be classified with glaucoma than those with low risk. Stratifying the general population based on genetic risk strongly increases the prior probability of glaucoma and may enable a cost-effective screening approach.
Different risks, same causes: educational attainment influences when, not from what, we die.
Bergeron-Boucher MP, Strozza C
Eur J Epidemiol · 2026 Jun · PMID 42380402 · Publisher ↗
Education is a well-established determinant of lifespan and mortality risk. Individuals with lower education levels experience higher mortality from nearly all causes. Yet since everyone ultimately dies from some conditi...
Education is a well-established determinant of lifespan and mortality risk. Individuals with lower education levels experience higher mortality from nearly all causes. Yet since everyone ultimately dies from some condition, how does education affect the causes of death? We show that the distribution of causes of death is remarkably similar across education levels in both Denmark and the United States. Despite notable differences in age at death between education groups, the underlying and contributing conditions leading to death remain consistent across education levels. These findings indicate that education mainly influences when people die, not what they die from.
Loneliness around the world: patterns, predictors, and well-being implications.
Leblang D, Wesselbaum D
Eur J Epidemiol · 2026 Jun · PMID 42360637 · Publisher ↗
Loneliness is increasingly recognized as a global public health concern, yet cross-national evidence remains limited. Using data from the 2023-2024 Gallup World Poll, this study provides a globally representative descrip...
Loneliness is increasingly recognized as a global public health concern, yet cross-national evidence remains limited. Using data from the 2023-2024 Gallup World Poll, this study provides a globally representative description of loneliness across 148 countries (N = 218,048). Over one in five adults reported feeling lonely, with prevalence highest in low-income countries and Sub-Saharan Africa. Multivariate analyses identified several predictors of lower loneliness, such as better health, higher education, larger household size, and employment, though their associations varied by context. Loneliness was also associated with lower subjective well-being, more frequent negative emotions, and stronger migration intentions. These patterns were most pronounced in high-income and more developed regions, where loneliness appeared more psychologically burdensome despite lower prevalence. Overall, the findings highlight loneliness as a universal but context-sensitive experience, suggesting the need for policies that consider both structural and psychosocial factors to promote social connection and emotional well-being worldwide.
Cohort profile: Swiss personalized health network cohort consortium.
Bochud M, Tiali SEB, Armida J … +26 more , Wissa R, Österle S, Blanco JM, Ghobril JP, Henchoz Y, Pittet V, Benkert P, Kuhle J, Castelao E, Preisig M, Chizzolini C, Günthard HF, Kusejko K, Imboden M, Probst-Hensch N, Koller M, Marques-Vidal P, Vollenweider P, Pruijm M, Rauch A, Ribi C, Scherer A, Tellenbach C, Ponte B, Vaucher J, Fortier I
Eur J Epidemiol · 2026 Jun · PMID 42360636 · Publisher ↗
Swiss cohort studies provide high-quality longitudinal data, but finding and comparing relevant studies across cohorts has historically been challenging. The Swiss Personalized Health Network Cohort Consortium (SPHN-CC)...
Swiss cohort studies provide high-quality longitudinal data, but finding and comparing relevant studies across cohorts has historically been challenging. The Swiss Personalized Health Network Cohort Consortium (SPHN-CC) was established to address these limitations by creating the first coordinated network of Swiss cohort studies within the internationally recognized Maelstrom Research catalogue. Participating cohorts were invited in 2021-2022, including longitudinal and cross-sectional studies with 1010-21,993 participants. Data collected include questionnaires, physical and cognitive assessments, administrative records, and biological samples. Variables were classified into 18 domains and 134 subdomains, and an online metadata catalogue was implemented to document study designs, explore variable content, and assess harmonization potential. The catalogue enables researchers to identify study-specific and harmonized variables for co-analysis. Core variables, such as age, sex/gender, anthropometrics, and medication use, are widely available, while other variables vary across cohorts. Harmonization assessments demonstrate that several key variables can be co-analyzed across multiple studies, supporting collaborative research with over 37,000 participants. A use case illustrates the potential for harmonizing and co-analyzing data across studies. The SPHN-CC strengthens Swiss cohort research by enhancing data discoverability, supporting harmonization, and facilitating cross-cohort and international research, providing a model for more efficient use of high-value longitudinal data.
The SINTER study: a recall-by-genotype design with multidimensional musculoskeletal phenotyping across internal-medicine outpatient clinics.
Huininga K, Koromani F, Li S … +22 more , Trajanoska K, Berk KA, Boon MR, Chaker L, van Daele P, Hofland J, van Hoek MH, Hemmelder MH, Roeters van Lennep JE, Medici M, Olieman JF, Ozcan B, Peeters RP, Mattace-Raso F, Mulugeta E, van Rossum EFC, van Rooij JGJ, Uitterlinden AG, Visser WJ, van Velsen EFS, Zillikens MC, Rivadeneira F
Eur J Epidemiol · 2026 Jun · PMID 42360635 · Publisher ↗
Bone mineral density (BMD) measured by DXA remains the clinical standard for diagnosing osteoporosis, but fails to capture the heterogeneity of skeletal fragility, particularly in patients with chronic diseases. We hereb...
Bone mineral density (BMD) measured by DXA remains the clinical standard for diagnosing osteoporosis, but fails to capture the heterogeneity of skeletal fragility, particularly in patients with chronic diseases. We hereby describe the design of the EraSmus medIcal CeNTer skEletal fRagility (SINTER) Study, which integrates polygenic scores for BMD (PGS) with a multidimensional phenotyping approach in diverse outpatient clinics, as a methodological framework for musculoskeletal research. The study aims at assessing the additional value of combining genetic information with comprehensive musculoskeletal phenotyping to better elucidate the mechanisms of skeletal fragility in chronic conditions. SINTER is an observational, cross-sectional Recall-by-Genotype (RbG) study drawn in two stages: (1) genotyping 5,650 patients from nine internal medicine clinics; (2) recalling 1,500 patients from the extremes of the PGS distribution for multidimensional musculoskeletal phenotyping together with 400 patients with a rare condition (mastocytosis). Phenotyping includes imaging (DXA, EOSEdge, pQCT), macro- and tissue-level skeletal properties (ultrasound, reference point indentation), functional assessments (mechanography, handgrip), lifestyle and systemic exposures (diet, physical activity), and patient perceptions obtained via in-depth interview and questionnaires. The study design is unique in combining a RbG framework with multidimensional phenotyping in outpatient clinics, enabling systematic evaluation of genetic and disease-specific contributors to skeletal fragility. SINTER provides a methodological template for RbG designs with particular emphasis on musculoskeletal clinical research.
SARS-CoV-2 infection as a trigger of type 2 diabetes in adults: a population-based cohort study in Sweden using a double negative control design.
Andreasson J, Bennet L, Björk J … +1 more , Dietler D
Eur J Epidemiol · 2026 Jun · PMID 42360634 · Publisher ↗
Previous studies suggest an increased risk of new-onset type 2 diabetes (T2D) following SARS-CoV-2 infection, which may be subject to detection bias from increased health care contacts among the infected. We aimed to ass...
Previous studies suggest an increased risk of new-onset type 2 diabetes (T2D) following SARS-CoV-2 infection, which may be subject to detection bias from increased health care contacts among the infected. We aimed to assess the causal effect of SARS-CoV-2 infection on new-onset T2D using a test-negative design and negative control outcomes. We included all individuals aged ≥ 18 years registered in Sweden on 1 February 2020 without prior T2D who ordered a SARS-CoV-2 test through the Swedish healthcare service between 1 February 2020 and 28 February 2022 (N = 3,175,958). A test-negative design was applied, matching infected individuals with up to five controls based on birth year, sex, region, vaccination status, and test date. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association between infection and new-onset T2D. The influence of COVID-19 severity was assessed using stratified Cox regression. Negative control outcomes anaemia, chronic kidney disease, and thyroid disorder were used to evaluate detection bias. SARS-CoV-2 infection was associated with a 12% (HR 1.12, 95% CI 1.04-1.20) increase in T2D risk, driven by elevated incidence during weeks 1-4 post-infection. Increased risk was concentrated among individuals hospitalized (HR 3.60, 95% CI 2.71-4.78) or admitted to intensive care (HR 4.85, 95% CI 2.60-9.05). Negative control outcomes showed similar patterns. Our findings do not support a causal effect of SARS-CoV-2 infection on new-onset T2D. Instead, observed increases appear largely attributable to increased detection of early-phase, sub-clinical T2D cases during hospitalization or intensive care.
Cohort profile: transformative research on equity and social determinants to uplift resilience and empower LGBTQ+ health in China (TREASURE).
Zhao P, Yang J, Mu J … +8 more , Liu L, Du P, Wang Y, Xu Y, Deng Q, Wang X, Wu D, Song H
Eur J Epidemiol · 2026 Jun · PMID 42348091 · Publisher ↗
The Transformative Research on Equity And Social determinants to Uplift Resilience and Empower LGBTQ+ Health in China (TREASURE) is the first large-scale cohort study designed to investigate health conditions and social...
The Transformative Research on Equity And Social determinants to Uplift Resilience and Empower LGBTQ+ Health in China (TREASURE) is the first large-scale cohort study designed to investigate health conditions and social determinants of health among the LGBTQ+ population in China. The TREASURE cohort study was developed in close collaboration with community-based organizations, ensuring culturally appropriate study procedures and improved inclusion of hard-to-reach populations. Participants were recruited through co-created, multi-channel strategies, including on-site recruitment, community outreach, WeChat advertising, and social network referrals. Eligible participants were individuals aged 16 years and older, who self-identified as LGBTQ+ and resided in Chengdu or had primary LGBTQ+ social activities in the area. From August 2023 to November 2025, 10,093 participants enrolled in the baseline investigation from Chengdu City and surrounding areas including cisgender gay men (47.9%), cisgender lesbians (19.0%), cisgender bisexual individuals (5.8%), transgender participants (13.3%), and queer or questioning individuals (14.1%). The first round of cohort follow-up was conducted 12 months after the baseline and every two years thereafter. The baseline survey collected comprehensive data on sociodemographic information, sexual orientation and gender identity related experiences, psychosocial factors, health outcomes, and other topics of interest. Follow-ups are designed to obtain repeated measurements of sociopsychological determinants and health outcomes, as well as additional information on health service needs. The TREASURE cohort documents a substantial burden of psychosocial adversity among LGBTQ+ individuals in China, including high levels of trauma exposure, SOGI-related discrimination and violence, depressive symptoms, PTSD symptoms, suicide risk, and other adverse health outcomes.
Adherence to the Mediterranean diet and risk of pancreatic cancer: an analysis of 2.3 million participants in the Pooling Project of Prospective Studies of Diet and Cancer (DCPP).
Shen Q, Mobley C, Wang M … +50 more , Ferrari P, Adami HO, Afshar N, Babic A, van den Brandt PA, Cheng E, Eliassen AH, Fung TT, Giovannucci EL, Hirabayashi M, Hou T, Huang BZ, Huang WY, Joshu CE, Kanehara R, Katzke V, Lacey JV, Landry MJ, Larsson SC, Liao LM, Martinez ME, McCullough ML, Miller AB, Milne RL, Moore SC, Mucci LA, Naudin S, Prizment A, Park SY, Rohan TE, Riboli E, Robien K, Sandin S, Sawada N, Shams-White MM, Sinha R, Smith-Byrne K, Stampfer MJ, Stolzenberg-Solomon RZ, Um CY, Visvanathan K, Wang SS, Weiderpass E, White E, Willett WC, Wolk A, Wolpin BM, Yuan C, Smith-Warner SA, Genkinger JM
Eur J Epidemiol · 2026 Jun · PMID 42348090 · Publisher ↗
Pancreatic cancer incidence is rising, yet few modifiable risk factors have been identified. The Mediterranean diet, which lowers inflammation and improves healthy weight maintenance and insulin control, may lower pancre...
Pancreatic cancer incidence is rising, yet few modifiable risk factors have been identified. The Mediterranean diet, which lowers inflammation and improves healthy weight maintenance and insulin control, may lower pancreatic cancer risk, yet the evidence for this association is inconsistent. To investigate the association, we conducted a pooled analysis of 2,315,406 individuals from 23 prospective cohorts in the Pooling Project of Prospective Studies of Diet and Cancer (DCPP), of whom 10,748 developed incident pancreatic cancer over a mean follow-up duration ranging from 8.1 to 23.3 years across studies. Adherence to the Mediterranean diet was assessed using the alternative Mediterranean diet score (aMED) and a modified score excluding alcohol (maMED). Study- and sex-specific hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models and then pooled using random effect models. No statistically significant association was found between aMED or maMED and pancreatic cancer or pancreatic ductal adenocarcinoma (PDAC) risk. For aMED, the pooled pancreatic cancer HR was 0.96 (95% CI: 0.90-1.02) comparing the fourth to the first quartile, 0.94 (0.88-1.00) comparing high (6-9) versus low (0-3) scores, and 0.98 (0.96-1.00) per 2-unit increment in the score. Overall, there was no evidence of heterogeneity in these associations by sex, attained age, race, BMI, physical activity, or follow-up time; a positive association between maMED and pancreatic cancer risk was observed in past smokers (HR = 1.04, 95% CI 1.00-1.09) but not in never or current smokers (P=0.04). In conclusion, there was little evidence of an association between a Mediterranean diet score and pancreatic cancer risk in this large international pooled analysis.
Wqsreg: a Stata command for weighted quantile sum regression.
Ponzano M, Renzetti S, Gennings C … +1 more , Bellavia A
Eur J Epidemiol · 2026 Jun · PMID 42348089 · Publisher ↗
Weighted Quantile Sum (WQS) regression is a statistical method for quantifying the association between multiple possibly correlated predictors and a health outcome, estimating both the joint effect of the predictors as w...
Weighted Quantile Sum (WQS) regression is a statistical method for quantifying the association between multiple possibly correlated predictors and a health outcome, estimating both the joint effect of the predictors as well as their individual contributions to the total effect. WQS has become one of the most popular and widely used approaches for investigating complex mixtures in environmental epidemiology, yet its implementation has been largely restricted to R users. In this paper we present wqsreg, the first Stata command for WQS regression, implemented for continuous, binary and count outcomes. We describe command's architecture and present an application of the command on exposome data exploring the association between 38 exposures and a continuous outcome. Wqsreg provides a user-friendly command for WQS regression that integrates several flexible components of the framework such as bootstrap, training/validation splitting, and repeated holdout procedures. Wqsreg returns regression estimates as well as graphical displays of the individual weights. It requires Stata version 11 or higher and is freely available on GitHub [ https://github.com/PonzanoMarta/wqsreg ]. Given the increasing importance of appropriately exploring complex multidimensional exposures, this contribution will further promote the use of appropriate statistical methods in epidemiological settings with multiple correlated predictors.
Dynamics of infection, vaccination and excess mortality during the COVID-19 pandemic among older individuals-a nationwide analysis.
Koster EAS, Sluiskes MH, Putter H … +4 more , Rosendaal FR, van Hylckama Vlieg A, de Boer MGJ, de Wreede LC
Eur J Epidemiol · 2026 Jun · PMID 42257779 · Publisher ↗
The Coronavirus Diseases (COVID-19) pandemic led to excess mortality in many countries, i.e., to more deaths than expected. Older individuals generally had higher absolute risks of excess death. The complex dynamics of i...
The Coronavirus Diseases (COVID-19) pandemic led to excess mortality in many countries, i.e., to more deaths than expected. Older individuals generally had higher absolute risks of excess death. The complex dynamics of infection, vaccination and excess mortality have not yet been captured in one comprehensive model. With nationwide and unselected data from Statistics Netherlands, we analyzed the impact of documented infection and vaccination on excess mortality during 2020 and 2021 in the Dutch population aged over 63 on 1 January 2020 (n = 3,826,770) by incorporating relative survival into a multi-state model considering COVID-19 (re)infection, vaccination and death. Background mortality was based on the observed mortality in 2015-2019 per sex, age and month of the year. All analyses were performed for the total cohort as well as stratified per sex and age category. The absolute excess mortality in 2020-2021 was 0.34% (95% confidence interval 0.32-0.37), comprising 4.41% of the observed mortality. It was higher in men (except in the youngest age group) and older individuals. Excess mortality occurred mostly during the first four weeks after a positive COVID-19 test, but also thereafter. If infection occurred after vaccination, excess mortality was still observed, but considerably less than without prior vaccination. These patterns were observed in all groups. In conclusion, these analyses demonstrate the substantial impact of COVID-19 on excess mortality during and after acute SARS-CoV-2 infection in individuals aged over 63 years. Moreover, the results show a reduction of excess mortality after vaccination for all groups in this cohort.
Design and characteristics of the national Danish injury cohort (NDIC).
Rasmussen M, Kruckow S, Mairey IP … +1 more , Christensen AI
Eur J Epidemiol · 2026 Jun · PMID 42257778 · Publisher ↗
The National Danish Injury Cohort (NDIC) is a nationwide, register-based cohort established to examine the incidence of total and specific injuries in Denmark and to provide insights into causes and consequences. Compreh...
The National Danish Injury Cohort (NDIC) is a nationwide, register-based cohort established to examine the incidence of total and specific injuries in Denmark and to provide insights into causes and consequences. Comprehensive individual-level information for this cohort is stored in the NDIC dataset, serving as a foundation for analyses of injury determinants and supporting the planning and evaluation of preventive measures aimed at reducing injury-related harm. Individuals registered in the Danish National Patient Register with an injury from 2010 onwards are included in the dataset. Additionally, it comprises persons in the Cause of Death Register whose deaths was attributed to accidents, violence, or suicide. The cohort is currently updated through 2022 and contains information on more than 7.2 million primary injury contacts and 26 thousand accident-related deaths. Analyses based on NDIC demonstrated substantial demographic and geographical disparities in the incidence rates of injuries. Overall, men exhibited higher rates of both injury incidents and injury‑related mortality compared with women. Marked differences were observed when stratifying by sex and age, as well as by region of residence. NDIC offers a solid data foundation facilitating research into injury trends, causes, and impacts, including disparities across social groups and geographic areas. It presents unique opportunities to explore novel research ideas to boost injury prevention, improve targeting of interventions, and reduce health inequalities. Strengthening this research area will help further reinforce NDIC's role in injury surveillance and evidence‑based policymaking.
Increasing incidence of type 1 diabetes in children and adolescents from 2012 to 2021 in Germany: trends before and during the COVID-19 pandemic.
Lehner CT, Anastasova I, Schauberger G … +5 more , Eberl M, Schederecker F, Tauscher M, Gerlach R, Klug SJ
Eur J Epidemiol · 2026 Jun · PMID 42228226 · Publisher ↗
Type 1 Diabetes (T1D) is a common chronic autoimmune disorder in children and adolescents worldwide. We described the development of T1D incidence from 2012 to 2021 and compared the incidence of the pre-pandemic period (...
Type 1 Diabetes (T1D) is a common chronic autoimmune disorder in children and adolescents worldwide. We described the development of T1D incidence from 2012 to 2021 and compared the incidence of the pre-pandemic period (2012-2019) with the pandemic period (2020-2021) in Bavaria, Germany. Routinely collected health claims from the Bavarian Association of Statutory Health Insurance Physicians (KVB), covering a population of 2 million children and adolescents (aged ≤ 19 years), were used. All cases of newly diagnosed T1D (ICD-10-GM E10) were included. Sex-specific annual and quarterly crude incidence rates (CIR) and age-standardized incidence rates (ASIR) were calculated. Sex-specific CIRs were calculated by 5-year age groups. Interrupted time series analysis was used to analyze trend changes in the pandemic versus the pre-pandemic period. From 2012 to 2021, 5,762 incident cases were identified in Bavaria. Overall, an increasing incidence was observed with an average annual increase of 3.7% in females (from 23.5 in 2012 to 32.5 per 100,000 person-years (py) in 2021) and 5.0% in males (from 25.2 to 38.9 per 100,000 py). The increase was highest in age groups 0-4 (12.4%) in males and 15-19 (8.5%) in females. Regression analysis showed no clear level or slope change in T1D incidence for both sexes during the pandemic period. When accounting for non-linear trends, a statistically significant level change was observed for females during the pandemic period (ß=7.66, 95% CI 0.23, 15.09), suggesting a potential association for females. The increasing T1D incidence in Bavarian youth from 2012 to 2021 highlights the importance of incidence surveillance.
APOE genotype, cardiovascular risk, and incident dementia in the Norwegian HUNT study.
Grøtting N, Wolford BN, Kvaløy K … +3 more , Omland T, Selbæk G, Ernstsen L
Eur J Epidemiol · 2026 Jun · PMID 42223769 · Publisher ↗
Apolipoprotein E (APOE) genotype and cardiovascular risk are both associated with dementia, but their separate and joint contributions remain uncertain. We examined the independent and combined associations of APOE genot...
Apolipoprotein E (APOE) genotype and cardiovascular risk are both associated with dementia, but their separate and joint contributions remain uncertain. We examined the independent and combined associations of APOE genotype and cardiovascular disease (CVD) risk with incident dementia in a Norwegian populationbased cohort. In this prospective cohort study, baseline data were obtained from the second Trøndelag Health Study (HUNT2, 1995-97), with follow-up through linkage to specialist health-care records and the Norwegian Cause of Death Registry through Dec 31, 2023. We included 22,108 participants aged 50 years or older who were free of CVD, diabetes, and dementia at baseline. APOE genetic risk and cardiovascular risk based on SCORE2 were each classified into three categories. Adjusted hazard ratios (HRs) for incident dementia were estimated using Cox models. During a median follow-up of 22.0 years, 3,714 incident dementia events occurred. Compared with low APOE genetic risk, adjusted HRs were 1.25(95% CI1.10-1.41) for intermediate risk and 3.09(2.73-3.49) for high risk. Compared with low-to-moderate CVD risk, adjusted HRs were 1.19(1.07-1.32) for high risk and 1.36(1.19-1.55) for very high risk. In joint analyses, the highest risk was observed in participants with high APOE genetic risk and very high cardiovascular risk (HR 3.78, 2.85-5.01). Higher cardiovascular risk was more clearly associated with dementia in participants without high APOE genetic risk, whereas dementia risk was consistently elevated across cardiovascular risk categories among those with high APOE genetic risk. There was no clear evidence of multiplicative interaction (p=0.059). APOE genotype and cardiovascular risk were independently associated with incident dementia, with highest risk among individuals with both high genetic and cardiovascular risk.
The Aarhus bereavement study (TABstudy).
Marello Havn MM, Möller S, Denckla C … +3 more , Lundorff M, Greve LT, O'Connor M
Eur J Epidemiol · 2026 May · PMID 42217120 · Publisher ↗
The Aarhus Bereavement Study (TABstudy) was established to assess the health and societal impact of bereavement and pathological grief. This is the first register-identified bereavement cohort, linked to a longitudinal s...
The Aarhus Bereavement Study (TABstudy) was established to assess the health and societal impact of bereavement and pathological grief. This is the first register-identified bereavement cohort, linked to a longitudinal survey on grief, with non-bereaved controls. The entire cohort (N = 68,960), followed from Danish register creation until 2030, includes annual data on socio-economic demographics, income, workforce, government financial assistance, education, incidence of somatic health conditions, incidence of psychiatric health conditions, prescription medication sales, and cause of mortality for bereaved spouses, matched controls, and all their children. The longitudinal self-reported survey (N = 1,227, 54% response rate) of recent spousal-loss and parental-loss in Aarhus, Denmark, from 2017 to 2018 collected data on lifestyle factors, substance use, personality, significant life changes, well-being, and psychological measures in 8 waves across 5 years. A final 10-year follow-up survey wave is planned for 2027, while register data will cover until 13 years after loss. The cohort at bereavement was on average 51 years old, 56% women, most attained secondary education or higher, and most were employed. Bereaved and control subsamples were similar on nearly all characteristics. Data are stored at Statistics Denmark. Researchers interested in collaboration should contact the Unit for Bereavement Research, Aarhus, Denmark (maja@psy.au.dk, Dr. Maja O'Connor).
Adiposity and the risk of aortic aneurysm: results from the UK Biobank, Japan-Specific Health Check-ups Study and a systematic review and meta-analysis of cohort studies.
Aune D, Otaki Y, Mahamat-Saleh Y … +18 more , Hibino M, Heath AK, Berlanga-Taylor A, Konta T, Yamagata K, Fujimoto S, Tsuruya K, Narita I, Kasahara M, Shibagaki Y, Iseki K, Moriyama T, Kondo M, Asahi K, Watanabe T, Watanabe T, Watanabe M, Janszky I
Eur J Epidemiol · 2026 May · PMID 42213332 · Publisher ↗
Overweight and obesity has been associated with increased risk of aortic aneurysm in some cohort studies, however, results have been inconsistent. To clarify this association we analysed data from two large cohort studie...
Overweight and obesity has been associated with increased risk of aortic aneurysm in some cohort studies, however, results have been inconsistent. To clarify this association we analysed data from two large cohort studies with a total of > 1.1 million participants, and conducted a systematic review and meta-analysis of published cohort studies. The analytical cohorts included 495,438 participants in UK Biobank and 630,841 participants in the Japan Specific Health Checkups (J-SHC) Study. Multivariable Cox proportional hazards regression models were used to analyse associations between anthropometric factors and risk of aortic aneurysm. PubMed and Embase databases were searched for studies on adiposity and aortic aneurysm up to 18 March 2026, and random effects models were used to estimate summary relative risks (RRs) and 95% confidence intervals (CIs). In the UK Biobank, a total of 3,447 incident cases and 183 deaths from aortic aneurysm occurred during 12.3 years follow-up, and in the J-SHC Study, 51 aortic aneurysm deaths occurred during 4 years follow-up. In UK Biobank, HRs (95% CIs) were 1.18 (1.08-1.29), 1.51 (1.36-1.67), 1.45 (1.23-1.70), and 1.56 (1.20-2.02) for a BMI of 25-<30, 30-<35, 35-<40, and ≥ 40 vs. 18.5-<25.0, respectively. Positive associations were also observed for the highest vs. lowest quintile of waist circumference (1.66, 1.48-1.87), waist-to-hip ratio (1.67, 1.48-1.89), hip circumference (1.37, 1.22-1.53), waist-to-height ratio (1.70, 1.51-1.91), fat mass (1.62, 1.44-1.83) and body fat percentage (1.45, 1.28-1.63). In the J-SHC Study, comparing the highest vs. lowest categories the HRs were 1.79 (0.86-4.00, p=0.15) for BMI, 3.12 (1.10-11.11, p=0.006) for waist circumference, and 3.18 (1.17-8.64, p=0.01) for waist-to-height ratio. In the meta-analysis, the summary RR per 5 kg/m increment in BMI was 1.17 (1.13-1.21, I = 0%, n = 6 studies) for aortic aneurysm, 1.27 (1.04-1.55, I = 33%, n = 3 studies) for thoracic aortic aneurysm, and 1.11 (1.05-1.17, I = 55%, n = 12 studies) for abdominal aortic aneurysm. The respective summary RRs for total, thoracic, and abdominal aortic aneurysm were 1.29 (0.98-1.68, I = 73%, n = 2), 1.29 (0.92-1.82, I = 67%, n = 2), and 1.15 (1.07-1.24, I = 49%, n = 6) per 10 cm increase in waist circumference, and 1.37 (1.05-1.78, I = 45%, n = 2), 1.47 (0.89-2.42, I = 62%, n = 2), and 1.33 (1.25-1.42, I = 0%, n = 2) per 0.1 unit increase in waist-to-height ratio. These results suggest that higher BMI and abdominal fatness are associated with a dose-related increase in risk of aortic aneurysm overall and across subtypes. Any further studies should further investigate the associations between adiposity measures and subtypes of aortic aneurysm.
Evaluating synergistic effects among multiple factors in disease causation: a new approach using a generalized synergy index.
La Torre G, D'Urso P
Eur J Epidemiol · 2026 May · PMID 42213331 · Publisher ↗
The methodological objective of the present study is to extend Rothman's additive interaction framework from two factors to three or more factors considered simultaneously, while preserving its original causal interpreta...
The methodological objective of the present study is to extend Rothman's additive interaction framework from two factors to three or more factors considered simultaneously, while preserving its original causal interpretation and operational simplicity. we propose a generalized Synergy Index (S) that retains the additive logic of Rothman's original formulation while extending it to an arbitrary number of dichotomous factors. For the analysis we used a database of a previous work in which the synergistic factor was calculated for each couples of two factors (alcohol, tobacco smoke and other risk factors) for age-related macular degeneration. The proposed three-factor S is sensitive to the underlying structure of the risk factors considered. When a strong susceptibility component such as family history is included, the combined exposure exhibits clear super-additive behavior (S = 1.783). Conversely, when hypercholesterolemia replaces family history, the joint effect remains substantial but does not exceed additivity (S = 0.756). The generalized multi-factor Synergy Index represents a valuable conceptual and analytical tool for investigating higher-order interactions. It is particularly well suited for the study of complex diseases, where multiple exposures co-occur and interact. It enables the identification of exposure constellations characterized by true superadditivity, with potential implications for etiological research, risk stratification, and targeted prevention strategies.
Multi-city Elderly Health Examination Cohort Study (MEHECS) in China.
Yang L, Zhou Z, Lin L … +16 more , Yan F, Yu L, Hu X, Xu J, Ni W, Wu T, Lei Z, Cao J, Long T, Zhang Y, Wu J, Yan Y, Dai J, Wang L, Zhou M, Yin P
Eur J Epidemiol · 2026 May · PMID 42207416 · Publisher ↗
Multi-city Elderly Health Examination Cohort Study (MEHECS) is an ongoing multicenter multistage prospective cohort study in China with yearly data available between 2012 and 2023, aiming to provide a reliable source of...
Multi-city Elderly Health Examination Cohort Study (MEHECS) is an ongoing multicenter multistage prospective cohort study in China with yearly data available between 2012 and 2023, aiming to provide a reliable source of Chinese elderly health data and detailed multidimensional information. This study correlated elderly health management data from the Basic Public Health Services Project in China with mortality registration data from the China Population Death Information Registration System. Participants were entitled to an annual free health examination which was structured into three components: a face-to-face questionnaire interview, a medical examination, and health assessment summary. The standardized questionnaire was used to obtain information on the elderly's personal information, lifestyles, current health problems, physical symptoms, healthcare utilization, current medications, and history of non-programmatic immunization. The medical examination covered general conditions, anthropometric measurements, physical examination, functional capacities, and auxiliary examinations. Since 2012, baseline data have been collected in 3,716,364 participants with a mean age of 70.9 years. The proportion of participants over 80 years old was 10.0%, and the proportion of men was 46.8%. By the end of 2023, a total of 412,869 death cases were identified during a median follow-up of 4.44 years. Baseline data collection and follow-up are ongoing. Research results are continuously produced, which can provide evidence to help policy-makers develop better policies to promote healthy aging in China.
Multivariate mendelian randomization for joint inferences of correlated outcomes.
Zhang Y, Wang M, Joehanes R … +6 more , Huan T, Weber LM, Yang Q, Lunetta KL, Levy D, Liu C
Eur J Epidemiol · 2026 May · PMID 42207415 · Publisher ↗
Mendelian randomization (MR) typically analyzes causal relationships between exposures and outcomes independently, potentially missing important correlations among related outcomes. Few methods exist to jointly analyze m...
Mendelian randomization (MR) typically analyzes causal relationships between exposures and outcomes independently, potentially missing important correlations among related outcomes. Few methods exist to jointly analyze multiple outcomes in MR studies. We propose two novel multivariate approaches for handling correlated outcomes in MR. Multivariate inverse-variance weighted MR (multivariate MR-IVW) incorporates outcome correlations through multivariate meta-analysis. Multivariate MR pleiotropy residual sum and outlier (multivariate MR-PRESSO) test leverages Mahalanobis distance to detect heterogeneous instruments across correlated outcomes. We evaluated these methods through comprehensive simulation study. Multivariate methods were applied to investigate causal relationships between DNA methylation at cg11294513 and five zinc finger gene expressions using Framingham Heart Study and Genotype-Tissue Expression project data. Simulation study demonstrated that multivariate MR-IVW consistently achieved lower bias and mean squared error compared to univariate method. For global hypothesis testing, multivariate MR-IVW showed substantially higher sensitivity than univariate method (e.g., 95% vs. 52% at r = 0.8 with two outcomes) while maintaining controlled false positive rates. Multivariate MR-PRESSO detected outlying SNPs with substantially higher sensitivity compared to univariate method (e.g., 85-90% vs. 35-40% with four outcomes and balanced pleiotropy). In real data application, MR analysis revealed significant causal effects of DNA methylation at cg11294513 on all five zinc finger genes. Multivariate MR-PRESSO identified additional heterogeneous instruments that were undetected by univariate analysis. Multivariate MR methods provide superior causal effect estimation and pleiotropy detection, as well as more flexible hypothesis testing by leveraging outcome correlations. These approaches enable comprehensive analysis of complex multi-omics data.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe