Epidemiology and Health

Original Articles

Spatial analysis of tuberculosis treatment outcomes in Shanghai: implications for tuberculosis control: Jing Zhang, Xin Shen, Chongguang Yang, Yue Chen, Juntao Guo, Decheng Wang, Jun Zhang, Henry Lynn, Yi Hu, Qichao Pan, Zhijie Zhang; Epidemiol Health. 2022;44:e2022045. Published online May 1, 2022; DOI: https://doi.org/10.4178/epih.e2022045

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Tuberculosis (TB) treatment outcomes are a key indicator in the assessment of TB control programs. We aimed to identify spatial factors associated with TB treatment outcomes, and to provide additional insights into TB control from a geographical perspective.
METHODS
We collected data from the electronic TB surveillance system in Shanghai, China and included pulmonary TB patients registered from January 1, 2009 to December 31, 2016. We examined the associations of physical accessibility to hospitals, an autoregression term, and random hospital effects with treatment outcomes in logistic regression models after adjusting for demographic, clinical, and treatment factors.
RESULTS
Of the 53,475 pulmonary TB patients, 49,002 (91.6%) had successful treatment outcomes. The success rate increased from 89.3% in 2009 to 94.4% in 2016. The successful treatment outcome rate varied among hospitals from 78.6% to 97.8%, and there were 12 spatial clusters of poor treatment outcomes during the 8-year study period. The best-fit model incorporated spatial factors. Both the random hospital effects and autoregression terms had significant impacts on TB treatment outcomes, ranking 6th and 10th, respectively, in terms of statistical importance among 14 factors. The number of bus stations around the home was the least important variable in the model.
CONCLUSIONS
Spatial autocorrelation and hospital effects were associated with TB treatment outcomes in Shanghai. In highly-integrated cities like Shanghai, physical accessibility was not related to treatment outcomes. Governments need to pay more attention to the mobility of patients and different success rates of treatment among hospitals.; Summary

Key Message
Tuberculosis treatment outcomes, a key indicator in the assessment of TB control programs, were associated with spatial autocorrelation and hospital effects in Shanghai; however, they were not associated with physical accessibility to hospitals.

Epidemiology and treatment status of hepatitis C virus infection among people who have ever injected drugs in Korea: a prospective multicenter cohort study from 2007 to 2019 in comparison with non-PWID: Kyung-Ah Kim, Gwang Hyun Choi, Eun Sun Jang, Young Seok Kim, Youn Jae Lee, In Hee Kim, Sung Bum Cho, Moran Ki, Hwa Young Choi, Dahye Paik, Sook-Hyang Jeong; Epidemiol Health. 2021;43:e2021077. Published online October 6, 2021; DOI: https://doi.org/10.4178/epih.e2021077

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Abstract

OBJECTIVES
Injection drug use is a major risk factor for hepatitis C virus (HCV) infection; however, limited data on this topic are available in Korea. Thus, this study aimed to investigate the epidemiological and clinical characteristics, treatment uptake, and outcomes of HCV infection among people who inject drugs (PWID).

METHODS

We used the data from the Korea HCV cohort, which prospectively enrolled patients with HCV infection between 2007 and 2019. Clinical data and results of a questionnaire survey on lifetime risk factors for HCV infection were analyzed according to a self-reported history of injection drug use (PWID vs. non-PWID group).

RESULTS

Among the 2,468 patients, 166 (6.7%) were in the PWID group, which contained younger patients (50.6±8.2 vs. 58.2±13.1 years) and a higher proportion of male (81.9 vs. 48.8%) than the non-PWID group. The distribution of PWID showed significant regional variations. Exposure to other risk factors for HCV infection was different between the groups. The proportion of patients with genotype non-2 infection was higher in the PWID group. Treatment uptake was higher in the PWID group in the interferon era; however, it was comparable between the groups in the direct-acting antiviral era. The rate of sustained virological response did not significantly differ between the groups.

CONCLUSIONS

As of 2019, PWID constituted a minority of HCV-infected people in Korea. The epidemiological characteristics, but not treatment uptake and outcomes, were different between the PWID and non-PWID groups. Therefore, active HCV screening and treatment should be offered to PWID in Korea.

Summary

Korean summary
1. 국내 C형간염 환자 중 정맥주사 사용자의 비율은 6.7%로 서구에 비하면 낮은 편이며, 지역별로 차이가 있다. 2. C형간염 환자 중 정맥주사 사용자는 비사용자에 비하여 연령, 성별 및 C형간염 위험 요인 노출 등에서 상이한 역학적 특성을 보인다. 3. 정맥주사 사용자의 C형간염 치료 수용률이나 치료 성공률은 비사용자와 비슷하다.

Key Message
As of 2019, PWID comprised a minority (6.7%) of all HCV-infected people in South Korea. The epidemiological features of the PWID group were different from those of the non-PWID group in terms of age, sex and exposure to risk factors of HCV infection. However, the treatment uptake and outcomes were not significantly different between these 2 groups in DAA era. Therefore, considering the global and national increase in the number of PWID and the contribution of PWID to new cases of HCV infection, active screening and treatment should be offered to PWID in Korea.

Citations

Citations to this article as recorded by

Prevalence and factors associated with hepatitis C among pregnant women in China: a cross-sectional study
Sun He, Gao Shuang, Wu Yinglan, Wang Lan, Wang Wei, Wang Ailing, Wang Changhe, Wang Xiaoyan, Gao Qun, Lu Zechun, Huang Dongxu, Wang Yu, Mo Phoenix Kit Han, Chen Zhongdan, Polin Chan, Wang Qian
Scientific Reports.2023;[Epub] CrossRef
Hepatitis C Virus Seroprevalence in Persons Who Inject Drugs in Korea, 2012–2022: A Multicenter, Retrospective Study
Jihye Kim, Gwang Hyeon Choi, Og-Jin Jang, Younghoon Chon, Sung Nam Cho, Dohoon Kwon, Sook-Hyang Jeong
Journal of Korean Medical Science.2023;[Epub] CrossRef

Methods

Network meta-analysis: application and practice using R software: Sung Ryul Shim, Seong-Jang Kim, Jonghoo Lee, Gerta Rücker; Epidemiol Health. 2019;41:e2019013. Published online April 8, 2019; DOI: https://doi.org/10.4178/epih.e2019013

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241 Web of Science
196 Crossref

Abstract Summary PDF Supplementary Material

Abstract

The objective of this study is to describe the general approaches to network meta-analysis that are available for quantitative data synthesis using R software. We conducted a network meta-analysis using two approaches: Bayesian and frequentist methods. The corresponding R packages were “gemtc” for the Bayesian approach and “netmeta” for the frequentist approach. In estimating a network meta-analysis model using a Bayesian framework, the “rjags” package is a common tool. “rjags” implements Markov chain Monte Carlo simulation with a graphical output. The estimated overall effect sizes, test for heterogeneity, moderator effects, and publication bias were reported using R software. The authors focus on two flexible models, Bayesian and frequentist, to determine overall effect sizes in network meta-analysis. This study focused on the practical methods of network meta-analysis rather than theoretical concepts, making the material easy to understand for Korean researchers who did not major in statistics. The authors hope that this study will help many Korean researchers to perform network meta-analyses and conduct related research more easily with R software.

Summary

Korean summary
통계프로그램으로서의 R이 대세인 연구환경에서 R을 활용한 체계적인 메타분석 안내서가 요구되어지며 본 연구는 이에 대한 좋은 해답이 될 것이다. 더욱이 본 연구는 네트워크 메타분석 (Network meta-analysis)의 이론과 더불어 R을 활용한 실습위주의 내용으로 구성되어져 있어 누구나 쉽게 실행할 수 있을 것이다. 본 연구를 통하여 많은 연구자들이 보다 쉽게 본인의 연구분야에 적용하여 관련 연구가 활성화되기를 바란다.

Citations

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Network meta-analysis: application and practice using Stata: Sungryul Shim, Byung-Ho Yoon, In-Soo Shin, Jong-Myon Bae; Epidemiol Health. 2017;39:e2017047. Published online October 27, 2017; DOI: https://doi.org/10.4178/epih.e2017047

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Abstract Summary PDF Supplementary Material

Abstract

This review aimed to arrange the concepts of a network meta-analysis (NMA) and to demonstrate the analytical process of NMA using Stata software under frequentist framework. The NMA tries to synthesize evidences for a decision making by evaluating the comparative effectiveness of more than two alternative interventions for the same condition. Before conducting a NMA, 3 major assumptions—similarity, transitivity, and consistency—should be checked. The statistical analysis consists of 5 steps. The first step is to draw a network geometry to provide an overview of the network relationship. The second step checks the assumption of consistency. The third step is to make the network forest plot or interval plot in order to illustrate the summary size of comparative effectiveness among various interventions. The fourth step calculates cumulative rankings for identifying superiority among interventions. The last step evaluates publication bias or effect modifiers for a valid inference from results. The synthesized evidences through five steps would be very useful to evidence-based decision-making in healthcare. Thus, NMA should be activated in order to guarantee the quality of healthcare system.

Summary

Korean summary
같은 치료 목적을 가진 여러 치료법들 간의 효과를 상호 비교한 결과들을 통합하기 위해 개발된 네트워크 메타분석 (NMA) 결과는 의사결정의 우선순위를 정하는데 있어 가장 상위의 과학적 설득력을 갖는다. STATA 통계프로그램에서 제공하는 빈도주의 틀에 기반한 NMA를 수행하는데 점검해야 할 가정들과 실제 적용 과정을 소개한다.

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Editorial

Current status of hepatitis C virus infection and countermeasures in South Korea: Sook-Hyang Jeong, Eun Sun Jang, Hwa Young Choi, Kyung-Ah Kim, Wankyo Chung, Moran Ki; Epidemiol Health. 2017;39:e2017017. Published online April 13, 2017; DOI: https://doi.org/10.4178/epih.e2017017

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Abstract

Hepatitis C virus (HCV) infection is a major cause of liver cirrhosis, hepatocellular carcinoma, and liver-related mortality. The new antiviral drugs against HCV, direct acting antivirals, result in >90% cure rate. This review aimed to summarize the current prevalence, clinical characteristics, outcomes, and treatment response associated with HCV infection, and countermeasures for optimal HCV control in South Korea. Based on a literature review, the current anti-HCV prevalence in the Korean population is 0.6 to 0.8%, with increasing prevalence according to age. The major HCV genotypes in Korean patients were genotype 1b and genotype 2. Successful antiviral treatment leads to significantly reduced liver related complications and mortality. However, only about one third of the individuals with HCV infection seem to be managed under the current national health insurance system, suggesting a remarkable rate of underdiagnoses and subsequent loss of opportunity to cure. A recent study in South Korea showed that targeted population screening for HCV infection is cost-effective. To prevent recently developed clusters of HCV infection in some clinics, mandatory surveillance rather than sentinel surveillance for HCV infection is required and governmental countermeasures to prevent reuse of syringes or other medical devises, and public education should be maintained. Moreover, one-time screening for a targeted population should be considered and a cost-effectiveness study supporting an optimal screening strategy is warranted.

Summary

Korean summary
우리나라 C형간염 유병률은 1% 미만(0.6-0.8%)이며, 수혈에 의한 C형간염은 더 이상 발생하지 않을 것으로 보인다. 그러나 최근 의료기관에서 C형간염 집단감염이 발생하여 국가적 대응이 필요한 공중보건의 문제로 떠올랐다. 2016년 부터는 C형간염을 완치할 수 있는 효과적이고 안전한 약제가 건강보험급여로 인정되어 이미 진단된 환자들에서는 효과적인 치료가 시작되었다. 그러나 진단되지 않은 상태에서 간질환이 진행되고 있는 환자들을 발굴하기 위해 국가 검진체계와 연계하여 선별검사를 시행한다면, 단기적으로는 진단과 치료비용 부담이 커지겠지만 장기적으로 사망률을 감소시키고, 삶의 질을 높이는 비용효과적인 C형간염 퇴치 전략이 될 것이다.

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Original Articles

Visceral leishmaniasis treatment outcome and its determinants in northwest Ethiopia: Getachew Mebrahtu Welay, Kefyalew Addis Alene, Berihun Assefa Dachew; Epidemiol Health. 2017;39:e2017001. Published online December 28, 2016; DOI: https://doi.org/10.4178/epih.e2017001

19,043 View
394 Download
19 Web of Science
20 Crossref

Abstract PDF

Abstract

OBJECTIVES
Poor treatment outcomes of visceral leishmaniasis (VL) are responsible for the high mortality rate of this condition in resource-limited settings such as Ethiopia. This study aimed to identify the proportion of poor VL treatment outcomes in northwest Ethiopia and to evaluate the determinants associated with poor outcomes.

METHODS

A hospital-based retrospective study was conducted among 595 VL patients who were admitted to Kahsay Abera Hospital in northwest Ethiopia from October 2010 to April 2013. Data were entered into Epi Info version 7.0 and exported to SPSS version 20 for analysis. Bivariate and multivariate logistic regression models were fitted to identify the determinants of VL treatment outcomes. Adjusted odds ratio (aORs) with 95% confidence intervals (CIs) were used, and p-values <0.05 were considered to indicate statistical significance.

RESULTS

The proportion of poor treatment outcomes was 23.7%. Late diagnosis (≥29 days) (aOR, 4.34; 95% CI, 2.22 to 8.46), severe illness at admission (inability to walk) (aOR, 1.63; 95% CI, 1.06 to 2.40) and coinfection with VL and human immunodeficiency virus (HIV) (aOR, 2.72; 95% CI, 1.40 to 5.20) were found to be determinants of poor VL treatment outcomes.

CONCLUSIONS

Poor treatment outcomes, such as death, treatment failure, and non-adherence, were found to be common. Special attention must be paid to severely ill and VL/HIV-coinfected patients. To improve VL treatment outcomes, the early diagnosis and treatment of VL patients is recommended.

Summary

Citations

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Survival analysis of adult visceral leishmaniasis patients admitted to Metema Hospital, Metema, Ethiopia: a hospital-based cross-sectional study
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Factors associated with seeking treatment for postpartum morbidities in rural India: Aditya Singh, Abhishek Kumar; Epidemiol Health. 2014;36:e2014026. Published online October 30, 2014; DOI: https://doi.org/10.4178/epih/e2014026

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Abstract PDF

Abstract

OBJECTIVES
To understand the prevalence of postpartum morbidities and factors associated with treatment-seeking behaviour among currently married women aged 15-49 residing in rural India.

METHODS

We used data from the nationally representative District Level Household Survey from 2007-2008. Cross-tabulation was used to understand the differentials for the prevalence of postpartum morbidities and treatment-seeking behaviours across selected background characteristics. Two-level binary logistic regression was applied to understand the factors associated with treatment-seeking behaviour.

RESULTS

Approximately 39.8% of rural women suffered from at least one of the six postpartum morbidities including high fever, lower abdominal pain, foul-smelling vaginal discharge, excessive bleeding, convulsions, and severe headache. Morbidities were more prevalent among poor, illiterate, Muslim, and high-parity women. About 55.1% of these rural women sought treatment/consultation for their problems. The odds of seeking treatment/consultation increased as economic status and years of schooling among both the woman and her husband increased. Poor, uneducated, unemployed, Hindu, and tribal women were less likely to seek treatment/consultation for postpartum morbidities than their counterparts were. The odds of seeking treatment/consultation decreased as the distance to the nearest private health facility increased. Most women visited a private hospital (46.3%) or a friend/family member’s home (20.8%) for treatment/consultation. Only a small percentage visited publicly funded health institutions such as a primary health centre (8.8%), community health centre (6.5%), health sub-centre (2.8%), or district hospital (13.1%). Rural women from the northeast region of India were 50% less likely to seek treatment/consultation than women from the central region were.

CONCLUSIONS

Providing antenatal and delivery care, and ensuring nearby government healthcare facilities are available to serve rural women might increase the likelihood of care-seeking for postpartum morbidities. Targeted interventions for vulnerable groups should be considered in future policies to increase the likelihood women will seek treatment or advice postpartum.

Summary

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Maryam Rouhi, Maryam Vizheh, Leila Rouhi, Hossein Esmaili, Leila Vaziri, Zeynab Fathi Gherekhlou
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A Review Study on Comparing Treatment Effects among Subgroups.: Seonwoo Kim, Minji Kim, Soon Young Lee; Korean J Epidemiol. 1999;21(1):104-110.

5,894 View
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Abstract PDF: Abstract
It is interested in examining treatment effect on a particular category of subjects or in comparing treatment effects among different subgroups as well as overall treatment effect due to heterogeneity of study subjects. Subgroup analyses are exceedingly common, but they are also often misleading. Conclusions based on subgroup analyses can do harm both when a particular category of people is denied effective treatment (a "false-negative" conclusion), and when ineffective or even harmful treatment is given to a subgroup of people (a "false-positive" conclusion). Because of the frequency and the importance of clinical application of subgroup analysis, researchers need to be cautious about doing subgroup analyses. This study presents guidelines to help conducting subgroup analyses correctly.; Summary

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