A comparison of two methods for estimating odds ratios: results from the National Health Survey

Sexual Minority Stress, Adverse Childhood Experiences, and Obesity Among Gay Men in Taiwan: Findings from a Panel Study

Purpose: Obesity is linked to personal behaviors and external stressors. Despite emerging evidence that sexual minority stress (SMS) and adverse childhood experiences (ACEs) are associated with the risk of obesity, little is known about their independent and interactive effects on sexual minority men. This study investigated these relationships using panel data. Methods: Self-identified gay and bisexual adult men in Taiwan were recruited through Facebook advertisements to complete an online questionnaire. This study reports only on data from the gay subsample (n = 731, mean age = 28.05 years, standard deviation = 5.75 years) as the bisexual subsample (n = 132) was insufficient for comparative statistical analysis. Over two time points, respondents reported their body weight and height, experiences with SMS, and ACEs on an online survey platform. Data analysis was conducted using multiple logistic regression to determine the individual and interactive effects of the ACE score, ACE components, and SMS on the odds for obesity. Results: Almost 16% of the respondents met the criterion for obesity (body-mass index ≥27). In the adjusted models, neither SMS nor ACEs had significant associations with the likelihood of obesity. Only the interaction term of SMS and childhood sexual abuse was significant, indicating that victims of sexual abuse have an increased likelihood of obesity that SMS may intensify. Conclusions: This study shows that gay men who experience childhood sexual abuse and SMS accumulatively faced an increased risk of obesity. Healthy weight promotion for these men should address these stressors.

Application of the Marginal Beta-Binomial Model in Estimation the Overall Odds of Obesity Among Iranian Adults: Meta-Analysis Method

CONTEXT

To obtain accurate and reliable estimation of overall obesity odds ratio (OR) a statistical method is needed to be designed to account for heterogeneity among studies. The marginal beta-binomial model is a new method with attractive features that make it robust for meta-analysis.

OBJECTIVES

The aim of this study is the estimation of overall obesity OR among Iranian adults with particularly attention to age, sex, place of residence, and smoking status.

DATA SOURCES

We systematically reviewed all studies regarding obesity in Iranian adults in national and international journals that are published between 1990 and 2017, including PubMed, Scopus, SID, Google Scholar, Magiran, and IranMedex. The R software was used for data analysis and obtaining overall obesity OR using the marginal beta-binomial model.

RESULTS

A total of 18 studies, with a sample size of 258283, were included in our analysis. Results showed that increasing age, female sex, and residence in urban areas increases the odds of obesity. Using the age group 20 - 30 years as the reference, the overall obesity ORs for 30 - 40, 40 - 50, 50 - 60, and 60+ years were 2.13, 3.33, 3.15, and 2.33, respectively. The overall obesity OR for women was 2.35, compared with men. The estimated odds of obesity were 53% higher for urban adults. Smoking has a negative effect on obesity; the OR of obesity for smokers was 0.48 compared with non-smokers.

CONCLUSION

Consistent results in our research can be used as a basis to reinforce health programs for prevention and treatment of obesity in Iran.

Assessing factors related to waist circumference and obesity: application of a latent variable model

Background. Because the use of BMI (Body Mass Index) alone as a measure of adiposity has been criticized, in the present study our aim was to fit a latent variable model to simultaneously examine the factors that affect waist circumference (continuous outcome) and obesity (binary outcome) among Iranian adults. Methods. Data included 18,990 Iranian individuals aged 20–65 years that are derived from the third National Survey of Noncommunicable Diseases Risk Factors in Iran. Using latent variable model, we estimated the relation of two correlated responses (waist circumference and obesity) with independent variables including age, gender, PR (Place of Residence), PA (physical activity), smoking status, SBP (Systolic Blood Pressure), DBP (Diastolic Blood Pressure), CHOL (cholesterol), FBG (Fasting Blood Glucose), diabetes, and FHD (family history of diabetes). Results. All variables were related to both obesity and waist circumference (WC). Older age, female sex, being an urban resident, physical inactivity, nonsmoking, hypertension, hypercholesterolemia, hyperglycemia, diabetes, and having family history of diabetes were significant risk factors that increased WC and obesity. Conclusions. Findings from this study of Iranian adult settings offer more insights into factors associated with high WC and high prevalence of obesity in this population.

Obesity and Related Factors in Iran: The STEPS Survey, 2011

Background:

To date, no study has addressed the association between race/ethnicity and obesity considering other sociodemographic and lifestyle factors in Iran.

Objectives:

The current study aimed to study lifestyle and the environmental factors affecting obesity in the Iranian subjects of the STEPS Survey, 2011.

Patients and Methods:

The study was conducted on 8639 subjects (aged ≥ 20 years) in the STEPS Survey 2011 in Iran under supervision of the World Health Organization (WHO). Height and body weight were measured following the standardized procedures. Generalized Estimating Equations (GEE) method was used to examine factors associated with obesity. The examined variables were age, gender, race/ethnicity, place of residence, employment status, physical activity, smoking status, and educational level.

Results:

Overall, 22.3% of the subjects were obese. In a GEE model, a healthy weight status among adults was associated with being younger, male, in a rural residence, employees, spending more time engaged in physical activity, being a smoker and having a moderate or high level of education. These associations were statistically significant after adjusting for other variables.

Conclusions:

The study results suggest a need for targeted interventions and continued surveillance for the Iranian adults.

Financial hardship and the intensity of medical care received near death

BACKGROUND

Although end-of-life (EOL) care can present a substantial financial burden for the household, the influence of this burden on the intensity of care received at the EOL remains unknown. The goal of this study was to determine the association between financial hardship and intensive care in the last week of life.

METHODS

The Coping with Cancer (CwC) Study is a longitudinal, multisite cohort study of terminally ill cancer patients and their informal caregivers, September 2002-February 2008. Patients (N = 281) were followed from baseline to death, a median of 4.4 months after baseline assessment. Intensive care was defined as the use of resuscitation and/or ventilation in the patient's last week of life. Financial hardship was measured at study baseline as a positive response to whether the household had to use all or most of their savings because of the family member's illness.

RESULTS

Twenty-nine percent reported financial hardship, and 9% received intensive EOL care. Patients reporting financial hardship had a 3.22 (95% CI: 1.38, 7.53) higher likelihood of receiving intensive EOL care compared with patients not reporting financial hardship. After adjusting for sociodemographic characteristics and patient preferences, patients reporting financial hardship had a 3.05 (95% CI: 1.22, 7.62) higher likelihood of receiving intensive EOL care.

CONCLUSION

The depletion of a family's financial resources is a significant predictor of intensive EOL care, over and above the influence of sociodemographic characteristics and patient preferences.

Let continuous outcome variables remain continuous

The complementary log-log is an alternative to logistic model. In many areas of research, the outcome data are continuous. We aim to provide a procedure that allows the researcher to estimate the coefficients of the complementary log-log model without dichotomizing and without loss of information. We show that the sample size required for a specific power of the proposed approach is substantially smaller than the dichotomizing method. We find that estimators derived from proposed method are consistently more efficient than dichotomizing method. To illustrate the use of proposed method, we employ the data arising from the NHSI.

Factors associated with obesity in Iranian elderly people: results from the national health survey

Background

No studies have been carried out so far to cover the association between factors related to obesity, in a representative sample of the Iranian elderly population.

Methods

The data in this investigation were taken from the National Health Survey in Iran, which included 4380 people aged 60 and older. The logistic regression was applied to model the relationship between the odds of obesity and age, sex, education level, place of residence, smoking and marital status.

Results

Obesity odds ratios were 1.96 (95% CI: 1.53--2.52) for women, 2.16 (95% CI: 1.71--2.72) for the subjects living in urban areas and 0.68 (95% CI: 0.47--0.97) for smokers. Regarding the people aged 60-64 years as the reference group, the obesity odds ratios were 0.86 (95% CI: 0.66--1.10) for ages 65-69 years, 0.75 (95% CI: 0.57--0.97) for ages 70-74 years, 0.43 (95% CI: 0.30--0.60) for ages 75-79 years and 0.36 (95% CI: 0.20--0.63) for ages 80+ years. Using the basic education level as the reference group, obesity odds ratios were 1.38 (95% CI: 1.08-1.76) for the moderate level and 0.92 (95% CI: 0.56- 1.52) for the high level group.

Conclusions

As the result of findings, we are optimistic that we would be able to contribute to the aged community of the society, which could be achieved by means of better treatments and reductions in the rate of obesity.

Factors related to obesity among Iranian men: results from the National Health Survey

OBJECTIVE

To our knowledge, only a few Iranian studies have investigated factors associated with obesity among men. The aims of the present study were to explore the associations between sociodemographic factors, smoking and obesity in Iranian men and compare these associations between Iranian men and women.

DESIGN

We used data from the National Health Survey in Iran. A generalised estimating equations model included 11,697 men and 14,854 women aged 20-69 years (12,850 households). Body weight and height were objectively measured. BMI was calculated as kg/m2, and subjects were classified into obese (BMI >or= 30 kg/m2) and non-obese (BMI < 30 kg/m2).

RESULTS

Among men, adjusted obesity OR were 0.62 (95 % CI 0.52, 0.74), 1.09 (95 % CI 0.90, 1.32), 1.003 (95 % CI 1.00, 1.007) and 0.57 (95 % CI 0.40, 0.81) for smokers, married, economic index and active workforce groups, respectively. Using low education as the reference group, the obesity OR for men were 1.06 (95 % CI 0.89, 1.26) and 0.75 (95 % CI 0.57, 0.99) for the moderate and high education groups, respectively. Using rural as the reference group, the obesity OR was 1.87 (95 % CI 1.56, 2.26) for urban men.

CONCLUSIONS

Our findings may point towards a better understanding of the social and cultural mechanisms of obesity in Iranian men. The above sociodemographic factors are large contributors to obesity and provide the greatest opportunity for actions and interventions designed for prevention and treatment.