Epidemiology and Health

Original Articles

The associations of tobacco use, sexually transmitted infections, HPV vaccination, and screening with the global incidence of cervical cancer: an ecological time series modeling study: Luyan Zheng, Yushi Lin, Jie Wu, Min Zheng; Epidemiol Health. 2023;45:e2023005. Published online December 13, 2022; DOI: https://doi.org/10.4178/epih.e2023005

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
We aimed to quantify the temporal associations between cervical cancer incidence and cervical cancer-related factors and to predict the number of new cervical cancer cases averted under counterfactual scenarios compared to the status quo scenario.
METHODS
We described temporal trends in cervical cancer and associated factors globally from 1990 to 2019. We then used generalized linear mixed models to explore the impact of tobacco use, sexually transmitted infections (STIs), human papillomavirus (HPV) vaccination, and cervical screening on cervical cancer incidence. A counterfactual analysis was performed to simulate the most effective scenario for reducing cervical cancer incidence.
RESULTS
The worldwide incidence of cervical cancer showed a downward trend over the past 3 decades (estimated annual percentage change, -0.72%), although the incidence remained high (>30 cases per 100,000 persons) in sub-Saharan Africa, Latin America, and the Caribbean. Higher smoking and STI prevalence showed significant direct associations with the incidence of cervical cancer, whereas HPV vaccination and screening coverage showed significant inverse associations. If the strategic goals for accelerating the elimination of cervical cancer and tobacco control programs had been achieved in 2019, the largest decrease in the number of new cervical cancer cases would have been observed, with 54,169 fewer new cases of cervical cancer in 2019.
CONCLUSIONS
Our counterfactual analysis found that a comprehensive intervention program emphasizing scaled-up cervical screening coverage (70%), HPV vaccination coverage (90%), and tobacco control (30% relative reduction) would be the most effective program for reducing cervical cancer incidence.; Summary

Key Message
A comprehensive intervention program emphasizing scaled-up cervical screening coverage (70%), HPV vaccination coverage (90%), and tobacco control (30% relative reduction) would be the most effective program for reducing cervical cancer incidence in our counterfactual analysis.

Estimation of the size of the iatrogenic Creutzfeldt-Jakob disease outbreak associated with cadaveric dura mater grafts in Korea: Byoung-Hak Jeon, Jinseob Kim, Ganghyun Kim, Soochul Park, SangYun Kim, Hae-Kwan Cheong; Epidemiol Health. 2016;38:e2016059. Published online December 19, 2016; DOI: https://doi.org/10.4178/epih.e2016059

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Abstract

OBJECTIVES
This study estimated the overall incidence of iatrogenic Creutzfeldt-Jakob disease (iCJD) based on dura graft cases in Korea using a mathematical model.

METHODS

We estimated the number of annual dura grafts performed between 1980 and 1995 by applying the proportion of dura grafts recorded by the Health Insurance Review Agency claim dataset in Korea to the number of nationwide neurosurgery cases. The distribution of the incubation period was assumed to fall under a Weibull distribution with density function or a log-logistic distribution with density function.

RESULTS

The total number of neurosurgery procedures performed from 1980 to 1995 was estimated to be 263,945, and among those operations, 37% used dura graft products. Between the years of 1980 and 2020, our model predicted that the total number of iCJD cases would be between 14.9 and 33.2 (95% confidence interval [CI], 13.4 to 50.9). Notably, we estimated that the cumulative number of iCJD cases caused by dura grafts between 1980 and 2011 was approximately 13.3 to 27.3 (95% CI, 12.2 to 40.6).

CONCLUSIONS

Based on our model, we postulate that the incidence of iCJD will sharply decline from 2012 to 2020. However, additional new cases are still expected, which necessitates a strong national surveillance system.

Summary

Korean summary
국내 경막유래 의인성 크로이츠펠트-증후군 환자의 발생규모 추정 본 연구는 국내 가용한 모든 자료원을 활용하여 국내 의인성 CJD 위험인구를 추산하고 이를기반으로 발생 가능한 의인성 CJD 환자의 규모를 수학적 모형을 통해 추산하는 것을 목적으로 시행하였으며, 예측모형 결과 2020년까지 가파르게 감소할것으로 보이나, 추가 발생에 대비한 국가감시체계의 강화가 필요할것으로 사료된다.

Citations

Citations to this article as recorded by

Interventions to reduce the risk of surgically transmitted Creutzfeldt–Jakob disease: a cost-effective modelling review
Matt Stevenson, Lesley Uttley, Jeremy E Oakley, Christopher Carroll, Stephen E Chick, Ruth Wong
Health Technology Assessment.2020; 24(11): 1. CrossRef

Modeling and Simulations for Infectious Diseases.: Mo ran Ki; Korean J Epidemiol. 2006;28(1):64-68.

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Modeling and simulations of infectious diseases are useful tools to estimate epidemic size and determine effective intervention methods. Models are idealized, simplified representations of reality. Therefore, a simple model should be the first design, with complex models always able to be added later to better represent reality. The following recommendations are made to ensure accurate simulations: (1) minimal feasible complexity, (2) mathematically well-defined, models should be constructed with well characterized stochastic processes rather than 'ad-hoc'behavioral models, (3) if predictions are being made, unknown parameters need to be robustly estimated using the model from epidemiological data, (4) where data is unavailable, a detailed sensitivity analysis needs to be undertaken, and (5) even if models are only being used to explore dynamics, sensitivity analysis is important to understand mechanisms. For the effective control of infectious diseases with models and simulations, we need effective information systems (laboratory and clinical data) for communicable disease control as a permanent infrastructure, closer collaboration between academic and service providers on new developments in communicable disease control, and enhanced monitoring of veterinary infections and 'minor' zoonoses, particularly in resources poor settings.; Summary

Epidemic modeling and Table-top Exercise for Emerging Infectious Diseases in Korea.: Byung Chul Chun; Korean J Epidemiol. 2006;28(1):47-63.

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Abstract PDF: Abstract
Understanding the spread of infections is of vital importance in the control of epidemics and the development of proper policies toprevent infectious diseases. Theory and techniques have been developed for the study of both the evolution of diseases with individual people and the transmission of infections through populations. From broad theoretical issues to specific practical problems, the mathematical modeling studies of infectious diseases have provided great insight to solve the mechanisms of disease spread and to predict the course of epidemics. Emerging and reemerging infectious diseases have attracted widespread concern in Korea. While preparing the influenza pandemic plan in 2004, we developed a model of the new influenza pandemic to estimate the number of cases and deaths, the shortage of medical resources, and the effect of interventions such as isolation and vaccination. Based on this model, we constructed a possible pandemic scenario of the emerging virus, and designed a table-top exercise for public health officials and related administration staff. On March 30th, 2005, the exercise was performed and the results were evaluated as successful. In the case of bioterrorism, a model of small pox epidemic was developed in 2005 to examine the speed of the disease spread in the population and to evaluate the intervention effects in a Korean city. The simulation results were also helpful to form a guideline to prepare for a small pox epidemic. These two experiments confirmed the usefulness of epidemic modeling in Korea.; Summary

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