Semiparametric mixture of binomial regression with a degenerate component

IntroductionThe COVID-19 pandemic has disproportionately impacted care homes and vulnerable populations, exacerbating existing health inequalities. However, the role of area deprivation in shaping the impacts of COVID-19 in care homes is poorly understood. We examine whether area deprivation is linked to higher rates of COVID-19 outbreaks and deaths among care home residents across upper tier local authorities in England (n=149).MethodsWe constructed a novel dataset from publicly available data. Using negative binomial regression models, we analysed the associations between area deprivation (Income Deprivation Affecting Older People Index (IDAOPI) and Index of Multiple Deprivation (IMD) extent) as the exposure and COVID-19 outbreaks, COVID-19-related deaths and all-cause deaths among care home residents as three separate outcomes—adjusting for population characteristics (size, age composition, ethnicity).ResultsCOVID-19 outbreaks in care homes did not vary by area deprivation. However, COVID-19-related deaths were more common in the most deprived quartiles of IDAOPI (incidence rate ratio (IRR): 1.23, 95% CI 1.04 to 1.47) and IMD extent (IRR: 1.16, 95% CI 1.00 to 1.34), compared with the least deprived quartiles.DiscussionThese findings suggest that area deprivation is a key risk factor in COVID-19 deaths among care home residents. Future research should look to replicate these results when more complete data become available.

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Clinical prediction of bacteremia and early antibiotics therapy in patients with solid tumors

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.314 ◽

2021 ◽

pp. 1-7

Author(s):

Jonathan M. Hyak ◽

Mayar Al Mohajer ◽

Daniel M. Musher ◽

Benjamin L. Musher

Keyword(s):

Solid Tumors ◽

Solid Tumor ◽

Cardiopulmonary Arrest ◽

Tertiary Care ◽

Organ Transplant ◽

Antibiotic Use ◽

Care Hospital ◽

Tumor Patients ◽

Binomial Regression ◽

Sirs Criteria

Abstract Objective: To investigate the relationship between the systemic inflammatory response syndrome (SIRS), early antibiotic use, and bacteremia in solid-tumor patients. Design, setting, and participants: We conducted a retrospective observational study of adults with solid tumors admitted to a tertiary-care hospital through the emergency department over a 2-year period. Patients with neutropenic fever, organ transplant, trauma, or cardiopulmonary arrest were excluded. Methods: Rates of SIRS, bacteremia, and early antibiotics (initiation within 8 hours of presentation) were compared using the χ2 and Student t tests. Binomial regression and receiver operator curves were analyzed to assess predictors of bacteremia and early antibiotics. Results: Early antibiotics were administered in 507 (37%) of 1,344 SIRS-positive cases and 492 (22%) of 2,236 SIRS-negative cases (P < .0001). Of SIRS-positive cases, 70% had blood cultures drawn within 48 hours and 19% were positive; among SIRS negative cases, 35% had cultures and 13% were positive (19% vs 13%; P = .003). Bacteremic cases were more often SIRS positive than nonbacteremic cases (60% vs 50%; P =.003), but they received early antibiotics at similar rates (50% vs 49%, P = .72). Three SIRS components predicted early antibiotics: temperature (OR, 1.7; 95% CI, 1.31–2.29; P = .0001), tachycardia (OR, 1.4; 95% CI, 1.10–1.69; P < .0001), and white blood-cell count (OR, 1.8; 95% CI, 1.56–2.14; P < .0001). Only temperature (OR, 1.6; 95% CI, 1.09–2.41; P = .01) and tachycardia (OR, 1.5; 95% CI, 1.09–2.06; P = .01) predicted bacteremia. SIRS criteria as a composite were poorly predictive of bacteremia (AUC, 0.57). Conclusions: SIRS criteria are frequently used to determine the need for early antibiotics, but they are poor predictors of bacteremia in solid-tumor patients. More reliable models are needed to guide judicious use of antibiotics in this population.

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Association between fatality rate of COVID-19 and selenium deficiency in China

BMC Infectious Diseases ◽

10.1186/s12879-021-06167-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hai-Yang Zhang ◽

An-Ran Zhang ◽

Qing-Bin Lu ◽

Xiao-Ai Zhang ◽

Zhi-Jie Zhang ◽

...

Keyword(s):

Negative Binomial ◽

Viral Infections ◽

Case Fatality ◽

Selenium Deficiency ◽

Negative Binomial Regression ◽

Negative Binomial Regression Model ◽

Fatality Rate ◽

Selenium Content ◽

Individual Level ◽

Binomial Regression

Abstract Background COVID-19 has impacted populations around the world, with the fatality rate varying dramatically across countries. Selenium, as one of the important micronutrients implicated in viral infections, was suggested to play roles. Methods An ecological study was performed to assess the association between the COVID-19 related fatality and the selenium content both from crops and topsoil, in China. Results Totally, 14,045 COVID-19 cases were reported from 147 cities during 8 December 2019–13 December 2020 were included. Based on selenium content in crops, the case fatality rates (CFRs) gradually increased from 1.17% in non-selenium-deficient areas, to 1.28% in moderate-selenium-deficient areas, and further to 3.16% in severe-selenium-deficient areas (P = 0.002). Based on selenium content in topsoil, the CFRs gradually increased from 0.76% in non-selenium-deficient areas, to 1.70% in moderate-selenium-deficient areas, and further to 1.85% in severe-selenium-deficient areas (P < 0.001). The zero-inflated negative binomial regression model showed a significantly higher fatality risk in cities with severe-selenium-deficient selenium content in crops than non-selenium-deficient cities, with incidence rate ratio (IRR) of 3.88 (95% CIs: 1.21–12.52), which was further confirmed by regression fitting the association between CFR of COVID-19 and selenium content in topsoil, with the IRR of 2.38 (95% CIs: 1.14–4.98) for moderate-selenium-deficient cities and 3.06 (1.49–6.27) for severe-selenium-deficient cities. Conclusions Regional selenium deficiency might be related to an increased CFR of COVID-19. Future studies are needed to explore the associations between selenium status and disease outcome at individual-level.

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Nicotine dependence of cigarette and heated tobacco users in Japan, 2019: a cross-sectional analysis of the JASTIS Study

Tobacco Control ◽

10.1136/tobaccocontrol-2020-056237 ◽

2021 ◽

pp. tobaccocontrol-2020-056237

Author(s):

Yan Kwan Lau ◽

Sumiyo Okawa ◽

Rafael Meza ◽

Kota Katanoda ◽

Takahiro Tabuchi

Keyword(s):

Nicotine Dependence ◽

Tobacco Use ◽

Cross Sectional ◽

The Public ◽

The Past ◽

Cross Sectional Analysis ◽

Binomial Regression ◽

Sectional Analysis ◽

Prevalence Ratios ◽

Min Cut

ObjectivesJapan is currently the biggest market of heated tobacco products (HTPs) in the world. Little is known about nicotine dependence among HTP users. Thus, the objective was to assess the association of type of tobacco use and time-to-first-use, a marker of nicotine dependence.MethodsA cross-sectional analysis of the 2019 data from an internet cohort study was conducted. The analytical sample consisted of 2147 current (≥1 day use in the past 30 days) HTP and/or conventional cigarette users, aged 25+ years. Marginal structural binomial regression was used to estimate nicotine dependence prevalence ratios (PRs) for each category of tobacco use (exclusive daily cigarette, exclusive HTP (≥1 day), dual HTP+daily cigarette, dual HTP+non-daily cigarette), relative to exclusive, non-daily cigarette smoking.ResultsUsing a 5 min cut-off for time-to-first-use, the prevalence of nicotine dependence was higher among dual users of HTP and daily cigarettes (PR=1.38; 95% CI: 1.05 to 1.82) and exclusive, daily cigarette users (PR=1.48; 95% CI: 1.15 to 1.91), relative to exclusive, non-daily cigarette users. However, nicotine dependence among exclusive HTP users, and dual HTP+non-daily cigarette users, did not differ from that of exclusive, non-daily cigarette users. When using 15 and 30 min cut-offs, all types of users, including exclusive HTP, had higher levels of nicotine dependence relative to exclusive, non-daily cigarette users.ConclusionsRegardless of HTP use, daily cigarette users had higher prevalence of nicotine dependence compared with non-daily cigarette users. Exclusive HTP users had similar (or potentially higher) dependence compared with exclusive, non-daily cigarette users. Longitudinal studies are needed to interrogate the public health implications of growing HTP use worldwide.

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Statistical models for analyzing count data: predictors of length of stay among HIV patients in Portugal using a multilevel model

BMC Health Services Research ◽

10.1186/s12913-021-06389-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ahmed Nabil Shaaban ◽

Bárbara Peleteiro ◽

Maria Rosario O. Martins

Keyword(s):

Length Of Stay ◽

Regression Model ◽

Random Effects ◽

Count Data ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Comprehensive Approach ◽

Negative Binomial Regression Model ◽

Hiv Patients ◽

Binomial Regression

Abstract Background This study offers a comprehensive approach to precisely analyze the complexly distributed length of stay among HIV admissions in Portugal. Objective To provide an illustration of statistical techniques for analysing count data using longitudinal predictors of length of stay among HIV hospitalizations in Portugal. Method Registered discharges in the Portuguese National Health Service (NHS) facilities Between January 2009 and December 2017, a total of 26,505 classified under Major Diagnostic Category (MDC) created for patients with HIV infection, with HIV/AIDS as a main or secondary cause of admission, were used to predict length of stay among HIV hospitalizations in Portugal. Several strategies were applied to select the best count fit model that includes the Poisson regression model, zero-inflated Poisson, the negative binomial regression model, and zero-inflated negative binomial regression model. A random hospital effects term has been incorporated into the negative binomial model to examine the dependence between observations within the same hospital. A multivariable analysis has been performed to assess the effect of covariates on length of stay. Results The median length of stay in our study was 11 days (interquartile range: 6–22). Statistical comparisons among the count models revealed that the random-effects negative binomial models provided the best fit with observed data. Admissions among males or admissions associated with TB infection, pneumocystis, cytomegalovirus, candidiasis, toxoplasmosis, or mycobacterium disease exhibit a highly significant increase in length of stay. Perfect trends were observed in which a higher number of diagnoses or procedures lead to significantly higher length of stay. The random-effects term included in our model and refers to unexplained factors specific to each hospital revealed obvious differences in quality among the hospitals included in our study. Conclusions This study provides a comprehensive approach to address unique problems associated with the prediction of length of stay among HIV patients in Portugal.

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Association between breakfast skipping and metabolic outcomes by sex, age, and work status stratification

Nutrition & Metabolism ◽

10.1186/s12986-020-00526-z ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Jun Heo ◽

Won-Jun Choi ◽

Seunghon Ham ◽

Seong-Kyu Kang ◽

Wanhyung Lee

Keyword(s):

Regression Analysis ◽

Negative Binomial ◽

Metabolic Diseases ◽

Young Male ◽

Negative Binomial Regression ◽

Final Analysis ◽

Work Status ◽

Breakfast Skipping ◽

Metabolic Outcomes ◽

Binomial Regression

Abstract Background The association between breakfast skipping and abnormal metabolic outcomes remains controversial. A comprehensive study with various stratified data is required. Objective The aim of this study was to investigate the relationship between abnormal metabolic outcomes and breakfast skipping by sex, age, and work status stratification. Methods We used data from the Korea National Health and Nutrition Examination Surveys from 2013 to 2018. A total of 21,193 (9022 men and 12,171 women) participants were included in the final analysis. The risk of metabolic outcomes linked to breakfast skipping was estimated using the negative binomial regression analysis by sex, work status, and age stratification. Results A total of 11,952 (56.4%) participants consumed breakfast regularly. The prevalence of abnormal metabolic outcomes was higher among those with irregular breakfast consumption habits. Among young male workers, negative binomial regression analysis showed that irregular breakfast eaters had a higher risk of abnormal metabolic outcomes, after adjusting for covariates (odds ratio, 1.15; 95% confidence interval, 1.03–1.27). Conclusions The risk of abnormal metabolic outcomes was significant in young men in the working population. Further studies are required to understand the association of specific working conditions (working hours or shift work) with breakfast intake status and the risk of metabolic diseases.

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Coronary deaths during Midsummer festival in Finland: miseries of long, light nights

European Journal of Epidemiology ◽

10.1007/s10654-021-00744-6 ◽

2021 ◽

Author(s):

Simo Näyhä

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Alcohol Consumption ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Adverse Consequence ◽

Heavy Alcohol ◽

Summer Peak ◽

Binomial Regression ◽

Heavy Alcohol Consumption

AbstractThis paper examines whether the anomalous summer peak in deaths from coronary heart disease (CHD) in Finland could be attributed to adverse effects of the Midsummer festival and alcohol consumption during the festival. Daily deaths from CHD and alcohol poisoning in Finland, 1961–2014, that occurred during the 7 days centering on Midsummer Day were analysed in relation to deaths during 14 to 4 days before and 4 to 14 after Midsummer Day. Daily counts of deaths from CHD among persons aged 35–64 years were regressed on days around the Midsummer period by negative binomial regression. Mortality from CHD was highest on Midsummer Day (RR 1.25 (95% confidence interval 1.12–1.31), one day after the peak in deaths from alcohol poisonings. RR for CHD on Midsummer Day was particulary high (RR = 1.43; 1.09–1.86) in the 2000s, 30% of deaths being attributable to that day. In conclusion, the anomalous and prominent summer peak in deaths from CHD in Finland is an adverse consequence of the Midsummer festival. The most likely underlying reason is heavy alcohol consumption during the festival period, especially on Midsummer Eve. In the 2000s, one third of deaths from CHD on Midsummer Day are preventable.

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Mobility and social deprivation on primary care utilisation among paediatric patients with asthma

Family Medicine and Community Health ◽

10.1136/fmch-2021-001085 ◽

2021 ◽

Vol 9 (3) ◽

pp. e001085

Author(s):

Jennifer A Lucas ◽

Miguel Marino ◽

Sophia Giebultowicz ◽

Katie Fankhauser ◽

Shakira F Suglia ◽

...

Keyword(s):

Primary Care ◽

Influenza Vaccination ◽

Negative Binomial ◽

Social Deprivation ◽

Pneumococcal Vaccination ◽

Negative Binomial Regression ◽

High Deprivation ◽

Care Utilisation ◽

Binomial Regression ◽

Children With Asthma

ObjectiveAsthma care is negatively impacted by neighbourhood social and environmental factors, and moving is associated with undesirable asthma outcomes. However, little is known about how movement into and living in areas of high deprivation relate to primary care use. We examined associations between neighbourhood characteristics, mobility and primary care utilisation of children with asthma to explore the relevance of these social factors in a primary care setting.DesignIn this cohort study, we conducted negative binomial regression to examine the rates of primary care visits and annual influenza vaccination and logistic regression to study receipt of pneumococcal vaccination. All models were adjusted for patient-level covariates.SettingWe used data from community health centres in 15 OCHIN states.ParticipantsThe sample included 23 773 children with asthma aged 3–17 across neighbourhoods with different levels of social deprivation from 2012 to 2017. We conducted negative binomial regression to examine the rates of primary care visits and annual influenza vaccination and logistic regression to study receipt of pneumococcal vaccination. All models were adjusted for patient-level covariates.ResultsClinic visit rates were higher among children living in or moving to areas with higher deprivation than those living in areas with low deprivation (rate ratio (RR) 1.09, 95% CI 1.02 to 1.17; RR 1.05, 95% CI 1.00 to 1.11). Children moving across neighbourhoods with similarly high levels of deprivation had increased RRs of influenza vaccination (RR 1.13, 95% CI 1.03 to 1.23) than those who moved but stayed in neighbourhoods of low deprivation.ConclusionsMovement into and living within areas of high deprivation is associated with more primary care use, and presumably greater opportunity to reduce undesirable asthma outcomes. These results highlight the need to attend to patient movement in primary care visits, and increase neighbourhood-targeted population management to improve equity and care for children with asthma.

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