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Cavillot L, van Loenhout JAF, Devleesschauwer B, Wyndham-Thomas C, Van Oyen H, Ghattas J, Blot K, Van den Borre L, Billuart M, Speybroeck N, De Pauw R, Stouten V, Catteau L, Hubin P. Sociodemographic and socioeconomic disparities in COVID-19 vaccine uptake in Belgium: a nationwide record linkage study. J Epidemiol Community Health 2023; 78:jech-2023-220751. [PMID: 38148149 PMCID: PMC11045363 DOI: 10.1136/jech-2023-220751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Recent studies have identified important social inequalities in SARS-CoV-2 infections and related COVID-19 outcomes in the Belgian population. The aim of our study was to investigate the sociodemographic and socioeconomic characteristics associated with the uptake of COVID-19 vaccine in Belgium. METHODS We conducted a cross-sectional analysis of the uptake of a first COVID-19 vaccine dose among 5 342 110 adults (≥18 years) in Belgium on 31 August 2021. We integrated data from four national data sources: the Belgian vaccine register (vaccination status), COVID-19 Healthdata (laboratory test results), DEMOBEL (sociodemographic/socioeconomic data) and the Common Base Register for HealthCare Actors (individuals licensed to practice a healthcare profession in Belgium). We used multivariable logistic regression analysis for identifying characteristics associated with not having obtained a first COVID-19 vaccine dose in Belgium and for each of its three regions (Flanders, Brussels and Wallonia). RESULTS During the study period, 10% (536 716/5 342 110) of the Belgian adult population included in our study sample was not vaccinated with a first COVID-19 vaccine dose. A lower COVID-19 vaccine uptake was found among young individuals, men, migrants, single parents, one-person households and disadvantaged socioeconomic groups (with lower levels of income and education, unemployed). Overall, the sociodemographic and socioeconomic disparities were comparable for all regions. CONCLUSIONS The identification of sociodemographic and socioeconomic disparities in COVID-19 vaccination uptake is critical to develop strategies guaranteeing a more equitable vaccination coverage of the Belgian adult population.
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Affiliation(s)
- Lisa Cavillot
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Health and Society Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | | | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | | | - Herman Van Oyen
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Jinane Ghattas
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Health and Society Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Koen Blot
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Laura Van den Borre
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Matthieu Billuart
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Niko Speybroeck
- Health and Society Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Robby De Pauw
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Veerle Stouten
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Lucy Catteau
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Pierre Hubin
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
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Berete F, Demarest S, Charafeddine R, De Ridder K, Van Oyen H, Van Hoof W, Bruyère O, Van der Heyden J. Linking health survey data with health insurance data: methodology, challenges, opportunities and recommendations for public health research. An experience from the HISlink project in Belgium. Arch Public Health 2023; 81:198. [PMID: 37968754 PMCID: PMC10648729 DOI: 10.1186/s13690-023-01213-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023] Open
Abstract
In recent years, the linkage of survey data to health administrative data has increased. This offers new opportunities for research into the use of health services and public health. Building on the HISlink use case, the linkage of Belgian Health Interview Survey (BHIS) data and Belgian Compulsory Health Insurance (BCHI) data, this paper provides an overview of the practical implementation of linking data, the outcomes in terms of a linked dataset and of the studies conducted as well as the lessons learned and recommendations for future links.Individual BHIS 2013 and 2018 data was linked to BCHI data using the national register number. The overall linkage rate was 92.3% and 94.2% for HISlink 2013 and HISlink 2018, respectively. Linked BHIS-BCHI data were used in validation studies (e.g. self-reported breast cancer screening; chronic diseases, polypharmacy), in policy-driven research (e.g., mediation effect of health literacy in the relationship between socioeconomic status and health related outcomes, and in longitudinal study (e.g. identifying predictors of nursing home admission among older BHIS participants). The linkage of both data sources combines their strengths but does not overcome all weaknesses.The availability of a national register number was an asset for HISlink. Policy-makers and researchers must take initiatives to find a better balance between the right to privacy of respondents and society's right to evidence-based information to improve health. Researchers should be aware that the procedures necessary to implement a link may have an impact on the timeliness of their research. Although some aspects of HISlink are specific to the Belgian context, we believe that some lessons learned are useful in an international context, especially for other European Union member states that collect similar data.
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Affiliation(s)
- Finaba Berete
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, Brussels, 1050, Belgium.
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
| | - Stefaan Demarest
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
| | - Rana Charafeddine
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
| | - Karin De Ridder
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
| | - Herman Van Oyen
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Wannes Van Hoof
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
| | - Olivier Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Ageing, Research Unit in Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Johan Van der Heyden
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
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Bogaert P, Verschuuren M, Abboud L, Lyshol H, Schmidt AE, Van Oyen H, van Oers H. Assessing European national health information systems in peer review format: lessons learnt. Eur J Public Health 2023:7188267. [PMID: 37263589 PMCID: PMC10395761 DOI: 10.1093/eurpub/ckad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Systematic assessments of a country's health information system (HIS) help identify strengths and weaknesses and may stimulate actions for improvement. They represent a capacity-building process for the country assessed as well as for the assessor. The joint action on HISs (InfAct) developed a peer-to-peer assessment methodology adapting an established WHO support tool. The aim of this study is to identify lessons learnt and the added value of the InfAct peer assessment for the assessors. METHODS A qualitative evaluation of the peer HIS assessment was performed based on 12 semi-structured interviews: nine interviews were carried out with assessors from nine participating countries, and three with an observer (present during assessments). The interviews were carried out between May 2019 and January 2020. Interviews were analysed using qualitative content analysis. RESULTS The interviews revealed the experiences of the assessors mainly occurred in five areas: assessors strengthened their understanding of what a population-based HIS is; they strengthened their understanding of how a HIS operates in different countries; they learnt how to carry out a HIS assessment; they strengthened their organization, communication, negotiation and reporting skills and they strengthened the networks in health information within and between countries. CONCLUSION Since the assessors are key personnel in their respective national health systems, the impact of the assessment is not limited to the assessor alone but may extend to stakeholders in their country. The deployment of the InfAct HIS peer assessment, anchored in systematic HIS capacity building across European countries, is recommended.
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Affiliation(s)
- Petronille Bogaert
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | | | - Linda Abboud
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Heidi Lyshol
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Herman Van Oyen
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Public Health, Ghent University, Belgium
| | - Hans van Oers
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Braeye T, Catteau L, Brondeel R, van Loenhout JAF, Proesmans K, Cornelissen L, Van Oyen H, Stouten V, Hubin P, Billuart M, Djiena A, Mahieu R, Hammami N, Van Cauteren D, Wyndham-Thomas C. Vaccine effectiveness against transmission of alpha, delta and omicron SARS-COV-2-infection, Belgian contact tracing, 2021-2022. Vaccine 2023; 41:3292-3300. [PMID: 37085456 PMCID: PMC10073587 DOI: 10.1016/j.vaccine.2023.03.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVES Vaccine effectiveness against transmission (VET) of SARS-CoV-2-infection can be estimated from secondary attack rates observed during contact tracing. We estimated VET, the vaccine-effect on infectiousness of the index case and susceptibility of the high-risk exposure contact (HREC). METHODS We fitted RT-PCR-test results from HREC to immunity status (vaccine schedule, prior infection, time since last immunity-conferring event), age, sex, calendar week of sampling, household, background positivity rate and dominant VOC using a multilevel Bayesian regression-model. We included Belgian data collected between January 2021 and January 2022. RESULTS For primary BNT162b2-vaccination we estimated initial VET at 96% (95%CI 95-97) against Alpha, 87% (95%CI 84-88) against Delta and 31% (95%CI 25-37) against Omicron. Initial VET of booster-vaccination (mRNA primary and booster-vaccination) was 87% (95%CI 86-89) against Delta and 68% (95%CI 65-70) against Omicron. The VET-estimate against Delta and Omicron decreased to 71% (95%CI 64-78) and 55% (95%CI 46-62) respectively, 150-200 days after booster-vaccination. Hybrid immunity, defined as vaccination and documented prior infection, was associated with durable and higher or comparable (by number of antigen exposures) protection against transmission. CONCLUSIONS While we observed VOC-specific immune-escape, especially by Omicron, and waning over time since immunization, vaccination remained associated with a reduced risk of SARS-CoV-2-transmission.
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Affiliation(s)
- Toon Braeye
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium.
| | - Lucy Catteau
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
| | - Ruben Brondeel
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
| | - Joris A F van Loenhout
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
| | - Kristiaan Proesmans
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
| | - Laura Cornelissen
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
| | - Herman Van Oyen
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium; Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Gent, Belgium
| | - Veerle Stouten
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
| | - Pierre Hubin
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
| | - Matthieu Billuart
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
| | - Achille Djiena
- Agence pour une Vie de Qualité, Rue de la Rivelaine 11, 6061 Charleroi, Belgium
| | - Romain Mahieu
- Common Community Commission Brussels, Rue Belliard 71/1, 1040 Brussels, Belgium
| | - Naima Hammami
- Agency for Care and Health, Infection Prevention and Control, Flemish Community, Koningin Maria Hendrikaplein 70 bus 55, 9000 Gent, Belgium
| | - Dieter Van Cauteren
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
| | - Chloé Wyndham-Thomas
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
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Meurisse M, Catteau L, van Loenhout JAF, Braeye T, De Mot L, Serrien B, Blot K, Cauët E, Van Oyen H, Cuypers L, Robert A, Van Goethem N. Homologous and Heterologous Prime-Boost Vaccination: Impact on Clinical Severity of SARS-CoV-2 Omicron Infection among Hospitalized COVID-19 Patients in Belgium. Vaccines (Basel) 2023; 11:vaccines11020378. [PMID: 36851257 PMCID: PMC9961733 DOI: 10.3390/vaccines11020378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
We investigated effectiveness of (1) mRNA booster vaccination versus primary vaccination only and (2) heterologous (viral vector-mRNA) versus homologous (mRNA-mRNA) prime-boost vaccination against severe outcomes of BA.1, BA.2, BA.4 or BA.5 Omicron infection (confirmed by whole genome sequencing) among hospitalized COVID-19 patients using observational data from national COVID-19 registries. In addition, it was investigated whether the difference between the heterologous and homologous prime-boost vaccination was homogenous across Omicron sub-lineages. Regression standardization (parametric g-formula) was used to estimate counterfactual risks for severe COVID-19 (combination of severity indicators), intensive care unit (ICU) admission, and in-hospital mortality under exposure to different vaccination schedules. The estimated risk for severe COVID-19 and in-hospital mortality was significantly lower with an mRNA booster vaccination as compared to only a primary vaccination schedule (RR = 0.59 [0.33; 0.85] and RR = 0.47 [0.15; 0.79], respectively). No significance difference was observed in the estimated risk for severe COVID-19, ICU admission and in-hospital mortality with a heterologous compared to a homologous prime-boost vaccination schedule, and this difference was not significantly modified by the Omicron sub-lineage. Our results support evidence that mRNA booster vaccination reduced the risk of severe COVID-19 disease during the Omicron-predominant period.
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Affiliation(s)
- Marjan Meurisse
- Department of Epidemiology and public health, Sciensano, 1070 Brussels, Belgium
- Department of Epidemiology and Biostatistics, Institut de Recherche Expérimentale et Clinique, Faculty of Public Health, Université Catholique de Louvain, 1200 Woluwe-Saint-Lambert, Belgium
- Correspondence:
| | - Lucy Catteau
- Department of Epidemiology and public health, Sciensano, 1070 Brussels, Belgium
| | | | - Toon Braeye
- Department of Epidemiology and public health, Sciensano, 1070 Brussels, Belgium
| | - Laurane De Mot
- Department of Epidemiology and public health, Sciensano, 1070 Brussels, Belgium
| | - Ben Serrien
- Department of Epidemiology and public health, Sciensano, 1070 Brussels, Belgium
| | - Koen Blot
- Department of Epidemiology and public health, Sciensano, 1070 Brussels, Belgium
| | - Emilie Cauët
- Department of Epidemiology and public health, Sciensano, 1070 Brussels, Belgium
| | - Herman Van Oyen
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Lize Cuypers
- Department of Laboratory Medicine, National Reference Center for Respiratory Pathogens, University Hospitals Leuven, 3000 Leuven, Belgium
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
| | | | | | - Annie Robert
- Department of Epidemiology and Biostatistics, Institut de Recherche Expérimentale et Clinique, Faculty of Public Health, Université Catholique de Louvain, 1200 Woluwe-Saint-Lambert, Belgium
| | - Nina Van Goethem
- Department of Epidemiology and public health, Sciensano, 1070 Brussels, Belgium
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Scohy A, Charafeddine R, Van Wilder L, Van Oyen H, De Smedt D, Devleesschauwer B. Changes in quality-adjusted life expectancy in Belgium, 2013 and 2018. Arch Public Health 2022; 80:254. [PMID: 36527095 PMCID: PMC9758921 DOI: 10.1186/s13690-022-01011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION No information is available in Belgium on life expectancy adjusted for health-related quality of life (HRQoL). Quality-adjusted life expectancy (QALE) captures the multidimensionality of health by accounting for losses in mortality and HRQoL linked to physical, mental, and social impairments. The objective of this study is to estimate for Belgium QALE, the changes in QALE between 2013 and 2018 and the contribution of mortality, HRQoL and its dimensions to this trend. METHODS The Belgian Health Interview Survey (BHIS), a representative sample of the general population, included the EQ-5D-5L instrument in 2013 and 2018. The tool assesses HRQoL comprising five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) using a 5-level severity scoring to define a large variety of health states. The Sullivan method was used to compute at different ages QALE by gender using mortality data from the Belgian statistical office and average EQ-5D scores from the BHIS. QALE was calculated for 2013 and 2018, and changes in QALE over time were decomposed into mortality and ill-health effect. RESULTS In 2018, QALE at age 15 years (QALE15) was 56.3 years for women and 55.8 years for men, a decrease from 2013 by 0.7 year for women and a stagnation for men. In men, the decrease in mortality counterbalanced the decline in HRQoL. The decline in QALE in women is driven by a decrease in mortality rates that is too small to compensate for the substantial decline in HRQoL before the age of 50 years. In women at older ages, improvements in HRQoL are observed. In women, QALE15 is decreasing due to an increase in pain/discomfort, anxiety/depression and problems in usual activities. In men at age 15, the pain/discomfort and anxiety/depression domains contributed to the stagnation. QALE65 increased somewhat, due to an improvement in self-care and mobility for both genders, and usual activities and anxiety/depression in men only. CONCLUSION The strength of QALE as member of the family of composite indicators, the health expectancies, is the multidimensional structure of the underlying health component, including both ill-health with different health domains as levels of severity. The ability to decompose differences in the health expectancy not only into a mortality and health component but also into the different health dimensions allows to better inform on general population health trends. Next, compared to other health expectancy indicators, QALE is more sensitive to changes at younger ages.
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Affiliation(s)
- Aline Scohy
- grid.508031.fLifestyle and chronic diseases, Department of Epidemiology and Public Health, Sciensano, Rue J Wytsman 14, 1050 Brussels, Belgium
| | - Rana Charafeddine
- grid.508031.fLifestyle and chronic diseases, Department of Epidemiology and Public Health, Sciensano, Rue J Wytsman 14, 1050 Brussels, Belgium
| | - Lisa Van Wilder
- grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Herman Van Oyen
- grid.508031.fLifestyle and chronic diseases, Department of Epidemiology and Public Health, Sciensano, Rue J Wytsman 14, 1050 Brussels, Belgium ,grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Delphine De Smedt
- grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Brecht Devleesschauwer
- grid.508031.fLifestyle and chronic diseases, Department of Epidemiology and Public Health, Sciensano, Rue J Wytsman 14, 1050 Brussels, Belgium ,grid.5342.00000 0001 2069 7798Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
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Meurisse M, Van Oyen H, Blot K, Catteau L, Serrien B, Klamer S, Cauët E, Robert A, Van Goethem N. Evaluating methodological approaches to assess the severity of infection with SARS-CoV-2 variants: scoping review and applications on Belgian COVID-19 data. BMC Infect Dis 2022; 22:839. [DOI: 10.1186/s12879-022-07777-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Differences in the genetic material of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants may result in altered virulence characteristics. Assessing the disease severity caused by newly emerging variants is essential to estimate their impact on public health. However, causally inferring the intrinsic severity of infection with variants using observational data is a challenging process on which guidance is still limited. We describe potential limitations and biases that researchers are confronted with and evaluate different methodological approaches to study the severity of infection with SARS-CoV-2 variants.
Methods
We reviewed the literature to identify limitations and potential biases in methods used to study the severity of infection with a particular variant. The impact of different methodological choices is illustrated by using real-world data of Belgian hospitalized COVID-19 patients.
Results
We observed different ways of defining coronavirus disease 2019 (COVID-19) disease severity (e.g., admission to the hospital or intensive care unit versus the occurrence of severe complications or death) and exposure to a variant (e.g., linkage of the sequencing or genotyping result with the patient data through a unique identifier versus categorization of patients based on time periods). Different potential selection biases (e.g., overcontrol bias, endogenous selection bias, sample truncation bias) and factors fluctuating over time (e.g., medical expertise and therapeutic strategies, vaccination coverage and natural immunity, pressure on the healthcare system, affected population groups) according to the successive waves of COVID-19, dominated by different variants, were identified. Using data of Belgian hospitalized COVID-19 patients, we were able to document (i) the robustness of the analyses when using different variant exposure ascertainment methods, (ii) indications of the presence of selection bias and (iii) how important confounding variables are fluctuating over time.
Conclusions
When estimating the unbiased marginal effect of SARS-CoV-2 variants on the severity of infection, different strategies can be used and different assumptions can be made, potentially leading to different conclusions. We propose four best practices to identify and reduce potential bias introduced by the study design, the data analysis approach, and the features of the underlying surveillance strategies and data infrastructure.
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Demarest S, Molenberghs G, Berete F, Charafeddine R, Van Oyen H, Van Hal G. Time trends in the use of field-substitution in the Belgian health interview survey. Arch Public Health 2022; 80:229. [PMID: 36348382 PMCID: PMC9644564 DOI: 10.1186/s13690-022-00982-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Matched field-substitution has been applied in the Belgian Health Interview Survey (BHIS) since the first round. During data-collection, non-participating households are replaced by substitute households, if needed up to seven times. In this manuscript, the use of field-substitution in the six rounds of BHIS (1997–2018) is assessed. We investigated to what extent field-substitution contributes to obtaining the requested net-sample size and whether this has evolved throughout the successive BHIS’s. Methods Harmonized para-data gathered throughout de data-collection phases are used to define the final participation status of all households that could be contacted for participation to the survey. The share of the substituted households was calculated and possible trends in the use of field-substitution throughout the successive surveys was assessed using logistic regression. Finally, it was examined whether the application of field-substitution changed in terms of the position of the participating household in the clusters, using the ESTIMATE statement in the SAS procedure NLMIXED. Results Overall, four in ten participating households are substitute households. This proportion remains rather similar over the surveys. The probability of participating according to the position of the household within the cluster is evidently much higher in households at the first position of initial selected clusters. Over the survey-years, the share of participating household derived from substitute clusters in the total number of participating households has slightly increased. Conclusion Field-substitution in BHIS plays a very substantial role in obtaining the requested net sample both in size and composition. Field-substitution, as applied in BHIS might inspire scientists to consider it when developing their surveys. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00982-4.
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Berete F, Demarest S, Charafeddine R, De Ridder K, Vanoverloop J, Van Oyen H, Bruyère O, Van der Heyden J. Predictors of nursing home admission in the older population in Belgium: a longitudinal follow-up of health interview survey participants. BMC Geriatr 2022; 22:807. [PMID: 36266620 PMCID: PMC9585772 DOI: 10.1186/s12877-022-03496-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 09/27/2022] [Indexed: 11/14/2022] Open
Abstract
Background This study examines predictors of nursing home admission (NHA) in Belgium in order to contribute to a better planning of the future demand for nursing home (NH) services and health care resources. Methods Data derived from the Belgian 2013 health interview survey were linked at individual level with health insurance data (2012 tot 2018). Only community dwelling participants, aged ≥65 years at the time of the survey were included in this study (n = 1930). Participants were followed until NHA, death or end of study period, i.e., December 31, 2018. The risk of NHA was calculated using a competing risk analysis. Results Over the follow-up period (median 5.29 years), 226 individuals were admitted to a NH and 268 died without admission to a NH. The overall cumulative risk of NHA was 1.4, 5.7 and 13.1% at respectively 1 year, 3 years and end of follow-up period. After multivariable adjustment, higher age, low educational attainment, living alone and use of home care services were significantly associated with a higher risk of NHA. A number of need factors (e.g., history of falls, suffering from urinary incontinence, depression or Alzheimer’s disease) were also significantly associated with a higher risk of NHA. On the contrary, being female, having multimorbidity and increased contacts with health care providers were significantly associated with a decreased risk of NHA. Perceived health and limitations were both significant determinants of NHA, but perceived health was an effect modifier on limitations and vice versa. Conclusions Our findings pinpoint important predictors of NHA in older adults, and offer possibilities of prevention to avoid or delay NHA for this population. Practical implications include prevention of falls, management of urinary incontinence at home and appropriate and timely management of limitations, depression and Alzheimer’s disease. Focus should also be on people living alone to provide more timely contacts with health care providers. Further investigation of predictors of NHA should include contextual factors such as the availability of nursing-home beds, hospital beds, physicians and waiting lists for NHA. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03496-4.
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Affiliation(s)
- Finaba Berete
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium. .,Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
| | - Stefaan Demarest
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Rana Charafeddine
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Karin De Ridder
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | | | - Herman Van Oyen
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Olivier Bruyère
- WHO Collaborating Centre for Public Health aspects of musculoskeletal health and ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Johan Van der Heyden
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
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10
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Schutte N, Saelaert M, Bogaert P, De Ridder K, Van Oyen H, Van der Heyden J, Devleesschauwer B. Opportunities for a population-based cohort in Belgium. Arch Public Health 2022; 80:188. [PMID: 35953875 PMCID: PMC9366127 DOI: 10.1186/s13690-022-00949-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/27/2022] [Indexed: 11/26/2022] Open
Abstract
Population-based cohorts allow providing answers to a wide range of policy-relevant research questions. In Belgium, existing cohort-like initiatives are limited by their focus on specific population groups or specific topics, or they lack a true longitudinal design. Since 2016, consultations and deliberative processes have been set up to explore the opportunities for a population-based cohort in Belgium. Through these processes, several recommendations emerged to pave the way forward – i.e., to facilitate the establishment of administrative linkages, increase digitalisation, secure long-term financial and organisational efforts, establish a consortium of the willing, and identify and tackle ethical and legal bottlenecks. This comment summarizes these recommendations, as these opportunities should be explored in depth to consolidate the existing collaborations between different stakeholders, and refers to current initiatives that can further facilitate the establishment of a Belgian population-based cohort and, more generally, administrative and health data linkage and reuse for research and policy-making.
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11
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Sarmiento-Suárez R, Padron-Monedero A, Bogaert P, Abboud L, Van Oyen H, Tolonen H, Tijhuis M, Seeling S, Haneef R, Zaletel M, Palmieri L, Gallay A, Lapão LV, Nogueira P, Ziese T, Vukovic J, Beja A, Saso M, Noguer-Zambrano I. The InfAct proposal for a sustainable European health information infrastructure on population health: the Distributed Infrastructure on Population Health (DIPoH). Arch Public Health 2022; 80:139. [PMID: 35581661 PMCID: PMC9113621 DOI: 10.1186/s13690-022-00844-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 03/08/2022] [Indexed: 11/20/2022] Open
Abstract
Background In Europe, data on population health is fragmented, difficult to access, project-based and prone to health information inequalities in terms of availability, accessibility and especially in quality between and within countries. This situation is further exacerbated and exposed by the recent COVID-19 pandemic. The Joint Action on Health Information (InfAct) that builds on previous works of the BRIDGE Health project, carried out collaborative action to set up a sustainable infrastructure for health information in the European Union (EU). The aim of this paper is to present InfAct’s proposal for a sustainable research infrastructure, the Distributed Infrastructure on Population Health (DIPoH), which includes the setup of a Health Information Portal on population health to be maintained beyond InfAct’s time span. Methods The strategy for the proposal was based on three components: scientific initiatives and proposals to improve Health Information Systems (HIS), exploration of technical acceptability and feasibility, and finally obtaining high-level political support.. The technical exploration (Technical Dialogues—TD) was assumed by technical experts proposed by the countries, and political guidance was provided by the Assembly of Members (AoM), which gathered representatives from Ministries of Health and Science of EU/EEA countries. The results from the AoM and the TD were integrated in the sustainability plan compiling all the major outputs of InfAct. Results The InfAct sustainability plan was organized in three main sections: a proposal of a new research infrastructure on population health (the DIPoH), new health information tools and innovative proposals for HIS, and a comprehensive capacity building programme. These activities were carried out in InfAct and are being further developed in the Population Health Information Research Infrastructure (PHIRI). PHIRI is a practical rollout of DIPoH facilitating and generating the best available evidence for research on health and wellbeing of populations as impacted by COVID-19. Conclusions The sustainability plan received wide support from Member States and was recognized to have an added value at EU level. Nevertheless, there were several aspects which still need to be considered for the near future such as: (i) a commitment of stable financial and political support by Member States (MSs), (ii) the availability of resources at regional, national and European level to deal with innovations, and (iii) a more direct involvement from EU and international institutions such as the European Centre for Disease Prevention and Control (ECDC), the World Health Organization (WHO) and the Organisation for Economic Cooperation and Development OECD for providing support and sustainable contributions.
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Affiliation(s)
- Rodrigo Sarmiento-Suárez
- National School of Public Health. Instituto de Salud Carlos III, Avenida Monforte de Lemos 5, 28029, Madrid, Spain. .,Medicine School, University of Applied and Environmental Sciences, Calle 222 #55-37, Bogota, Colombia.
| | - Alicia Padron-Monedero
- National School of Public Health. Instituto de Salud Carlos III, Avenida Monforte de Lemos 5, 28029, Madrid, Spain
| | - Petronille Bogaert
- Scientific Institute of Public Health, SciensanoRue Juliette, Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Linda Abboud
- Scientific Institute of Public Health, SciensanoRue Juliette, Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Herman Van Oyen
- Scientific Institute of Public Health, SciensanoRue Juliette, Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Hanna Tolonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Mannerheimintie 166, 00271, Helsinki, Finland
| | - Mariken Tijhuis
- National Institute for Public Health and the Environment RIVM, 3720 BA, Bilthoven, Netherlands
| | - Stefanie Seeling
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, Berlin, Germany
| | - Romana Haneef
- Santé Publique France, 12 Rue du Val d'Osne, Allée Vacassy, 94410, Saint-Maurice, France
| | - Metka Zaletel
- National Institute of Public Health, Trubarjeva 2, 1000, Ljubljana, Slovenia
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore Di Sanità (ISS), Via Giano della Bella, 34, 00161, Rome, Italy
| | - Anne Gallay
- Santé Publique France, 12 Rue du Val d'Osne, Allée Vacassy, 94410, Saint-Maurice, France
| | - Luís Velez Lapão
- Instituto de Higiene E Medicina Tropical, Universidade NOVA de Lisboa, R. da Junqueira 100, 1349-008, Lisboa, Portugal
| | - Paulo Nogueira
- Instituto de Medicina Preventiva E Saúde Pública, Faculdade de Medicina da Universidade de Lisboa, 1649-028, Lisboa, Portugal
| | - Thomas Ziese
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, Berlin, Germany
| | - Jakov Vukovic
- Croatian Institute of Public Health, Rockefeller str 7, 10000, Zagreb, Croatia
| | - André Beja
- Instituto de Higiene E Medicina Tropical, Universidade NOVA de Lisboa, R. da Junqueira 100, 1349-008, Lisboa, Portugal
| | - Miriam Saso
- Scientific Institute of Public Health, SciensanoRue Juliette, Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Isabel Noguer-Zambrano
- National School of Public Health. Instituto de Salud Carlos III, Avenida Monforte de Lemos 5, 28029, Madrid, Spain
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12
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Meurisse M, Lajot A, Devleesschauwer B, Van Cauteren D, Van Oyen H, Van den Borre L, Brondeel R. Correction to: The association between area deprivation and COVID-19 incidence: a municipality-level spatio-temporal study in Belgium, 2020-2021. Arch Public Health 2022; 80:128. [PMID: 35488294 PMCID: PMC9052175 DOI: 10.1186/s13690-022-00883-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Marjan Meurisse
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.
| | - Adrien Lajot
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | | | - Herman Van Oyen
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Laura Van den Borre
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ruben Brondeel
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
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13
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Stouten V, Hubin P, Haarhuis F, van Loenhout JAF, Billuart M, Brondeel R, Braeye T, Van Oyen H, Wyndham-Thomas C, Catteau L. Incidence and Risk Factors of COVID-19 Vaccine Breakthrough Infections: A Prospective Cohort Study in Belgium. Viruses 2022; 14:802. [PMID: 35458532 PMCID: PMC9029338 DOI: 10.3390/v14040802] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 12/15/2022] Open
Abstract
The objective of this study was to investigate the incidence and risk factors associated with COVID-19 vaccine breakthrough infections. We included all persons ≥18 years that had been fully vaccinated against COVID-19 for ≥14 days, between 1 February 2021 and 5 December 2021, in Belgium. The incidence of breakthrough infections (laboratory confirmed SARS-CoV-2-infections) was determined. Factors associated with breakthrough infections were analyzed using COX proportional hazard models. Among 8,062,600 fully vaccinated adults, we identified 373,070 breakthrough infections with an incidence of 11.2 (95%CI 11.2-11.3)/100 person years. Vaccination with Ad26.COV2.S (HR1.54, 95%CI 1.52-1.56) or ChAdOx1 (HR1.68, 95%CI 1.66-1.69) was associated with a higher risk of a breakthrough infection compared to BNT162b2, while mRNA-1273 was associated with a lower risk (HR0.68, 95%CI 0.67-0.69). A prior COVID-19-infection was protective against a breakthrough infection (HR0.23, 95%CI 0.23-0.24), as was an mRNA booster (HR0.44, 95%CI 0.43-0.45). During a breakthrough infection, those who had a prior COVID-19 infection were less likely to have COVID-19 symptoms of almost all types than naïve persons. We identified risk factors associated with breakthrough infections, such as vaccination with adenoviral-vector vaccines, which could help inform future decisions on booster vaccination strategies. A prior COVID-19 infection lowered the risk of breakthrough infections and of having symptoms, highlighting the protective effect of hybrid immunity.
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Affiliation(s)
- Veerle Stouten
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium; (P.H.); (F.H.); (J.A.F.v.L.); (M.B.); (R.B.); (T.B.); (H.V.O.); (C.W.-T.); (L.C.)
| | - Pierre Hubin
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium; (P.H.); (F.H.); (J.A.F.v.L.); (M.B.); (R.B.); (T.B.); (H.V.O.); (C.W.-T.); (L.C.)
| | - Freek Haarhuis
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium; (P.H.); (F.H.); (J.A.F.v.L.); (M.B.); (R.B.); (T.B.); (H.V.O.); (C.W.-T.); (L.C.)
| | - Joris A. F. van Loenhout
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium; (P.H.); (F.H.); (J.A.F.v.L.); (M.B.); (R.B.); (T.B.); (H.V.O.); (C.W.-T.); (L.C.)
| | - Matthieu Billuart
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium; (P.H.); (F.H.); (J.A.F.v.L.); (M.B.); (R.B.); (T.B.); (H.V.O.); (C.W.-T.); (L.C.)
| | - Ruben Brondeel
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium; (P.H.); (F.H.); (J.A.F.v.L.); (M.B.); (R.B.); (T.B.); (H.V.O.); (C.W.-T.); (L.C.)
| | - Toon Braeye
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium; (P.H.); (F.H.); (J.A.F.v.L.); (M.B.); (R.B.); (T.B.); (H.V.O.); (C.W.-T.); (L.C.)
| | - Herman Van Oyen
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium; (P.H.); (F.H.); (J.A.F.v.L.); (M.B.); (R.B.); (T.B.); (H.V.O.); (C.W.-T.); (L.C.)
- Department of Public Health and Primary Care, Ugent, 9000 Gent, Belgium
| | - Chloé Wyndham-Thomas
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium; (P.H.); (F.H.); (J.A.F.v.L.); (M.B.); (R.B.); (T.B.); (H.V.O.); (C.W.-T.); (L.C.)
| | - Lucy Catteau
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium; (P.H.); (F.H.); (J.A.F.v.L.); (M.B.); (R.B.); (T.B.); (H.V.O.); (C.W.-T.); (L.C.)
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14
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Braeye T, Catteau L, Brondeel R, van Loenhout JAF, Proesmans K, Cornelissen L, Van Oyen H, Stouten V, Hubin P, Billuart M, Djiena A, Mahieu R, Hammami N, Van Cauteren D, Wyndham-Thomas C. Vaccine effectiveness against onward transmission of SARS-CoV2-infection by variant of concern and time since vaccination, Belgian contact tracing, 2021. Vaccine 2022; 40:3027-3037. [PMID: 35459558 PMCID: PMC9001203 DOI: 10.1016/j.vaccine.2022.04.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND During the first half of 2021, we observed high vaccine effectiveness (VE) against SARS-CoV2-infection. The replacement of the alpha-'variant of concern' (VOC) by the delta-VOC and uncertainty about the time course of immunity called for a re-assessment. METHODS We estimated VE against transmission of infection (VET) from Belgian contact tracing data for high-risk exposure contacts between 26/01/2021 and 14/12/2021 by susceptibility (VEs) and infectiousness of breakthrough cases (VEi) for a complete schedule of Ad26.COV2.S, ChAdOx1, BNT162b2, mRNA-1273 as well as infection-acquired and hybrid immunity. We used a multilevel Bayesian model and adjusted for personal characteristics (age, sex, household), background exposure, calendar week, VOC and time since immunity conferring-event. FINDINGS VET-estimates were higher for mRNA-vaccines, over 90%, compared to viral vector vaccines: 66% and 80% for Ad26COV2.S and ChAdOx1 respectively (Alpha, 0-50 days after vaccination). Delta was associated with a 40% increase in odds of transmission and a decrease of VEs (72-64%) and especially of VEi (71-46% for BNT162b2). Infection-acquired and hybrid immunity were less affected by Delta. Waning further reduced VET-estimates: from 81% to 63% for BNT162b2 (Delta, 150-200 days after vaccination). We observed lower initial VEi in the age group 65-84 years (32% vs 46% in the age group 45-64 years for BNT162b2) and faster waning. Hybrid immunity waned slower than vaccine-induced immunity. INTERPRETATION VEi and VEs-estimates, while remaining significant, were reduced by Delta and waned over time. We observed faster waning in the oldest age group. We should seek to improve vaccine-induced protection in older persons and those vaccinated with viral-vector vaccines.
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Affiliation(s)
- Toon Braeye
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium.
| | - Lucy Catteau
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
| | - Ruben Brondeel
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
| | - Joris A F van Loenhout
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
| | - Kristiaan Proesmans
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
| | - Laura Cornelissen
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
| | - Herman Van Oyen
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium; Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Gent, Belgium
| | - Veerle Stouten
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
| | - Pierre Hubin
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
| | - Matthieu Billuart
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
| | - Achille Djiena
- Agence pour une Vie de Qualité, Rue de la Rivelaine 11, 6061 Charleroi, Belgium
| | - Romain Mahieu
- Common Community Commission Brussels, Rue Belliard 71/1, 1040 Brussels, Belgium
| | - Naima Hammami
- Agency for Care and Health, Infection Prevention and Control, Flemish Community, Koningin Maria Hendrikaplein 70 bus 55, 9000 Gent, Belgium
| | - Dieter Van Cauteren
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
| | - Chloé Wyndham-Thomas
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmansstraat 14, 1000 Brussel, Belgium
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15
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Bogaert P, Verschuuren M, Van Oyen H, van Oers H. Capacity building in European health information systems: the InfAct peer assessment methodology. Eur J Public Health 2022; 32:463-467. [PMID: 35325122 PMCID: PMC9159311 DOI: 10.1093/eurpub/ckac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background A Health Information System (HIS) assessment is an evaluation of the functioning of the main elements that compose a national HIS. Assessors from nine countries performed peer assessments of each other’s national HIS in the Joint Action on Health Information (InfAct). The aim of this study is to evaluate the advantages and disadvantages of the InfAct peer assessment methodology as well as the different steps involved in this assessment process. Methods Each peer assessment included a preparatory desk report, a country visit with semi-structured interviews with local stakeholders, a final report and a follow-up stakeholder meeting. A qualitative content analysis of the peer HIS assessment was performed based on 12 semi-structured interviews. Results The main advantage of the assessments is its informal atmosphere, high degree of objectiveness and its networking opportunities. Disadvantages are its informal request format and setting for recommendation uptake. The peer assessment helped the assessors to broaden their understanding of the assessed and their own HISs, to gain knowledge on how to carry out an HIS assessment and to practice their organization, communication, reporting and negotiation skills. All steps of the HIS assessment are essential and each contributes to the enriching experience of the participants. Conclusion The InfAct peer HIS assessment methodology strengthened capacity in national HISs by building up the knowledge and expertise in participating countries and as such addressed health information inequalities. This study confirms the value and relatively easy to implement methodology, and therefore recommends its wide and more systematic application across Europe.
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Affiliation(s)
- Petronille Bogaert
- Department of Epidemiology and Public Health, Sciensano, Belgium.,Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
| | | | - Herman Van Oyen
- Department of Epidemiology and Public Health, Sciensano, Belgium.,Department of Public Health, Ghent University, Belgium
| | - Hans van Oers
- Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
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16
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Molenberghs G, Faes C, Verbeeck J, Deboosere P, Abrams S, Willem L, Aerts J, Theeten H, Devleesschauwer B, Bustos Sierra N, Renard F, Herzog S, Lusyne P, Van der Heyden J, Van Oyen H, Van Damme P, Hens N. COVID-19 mortality, excess mortality, deaths per million and infection fatality ratio, Belgium, 9 March 2020 to 28 June 2020. Euro Surveill 2022; 27. [PMID: 35177167 PMCID: PMC8855510 DOI: 10.2807/1560-7917.es.2022.27.7.2002060] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundCOVID-19 mortality, excess mortality, deaths per million population (DPM), infection fatality ratio (IFR) and case fatality ratio (CFR) are reported and compared for many countries globally. These measures may appear objective, however, they should be interpreted with caution.AimWe examined reported COVID-19-related mortality in Belgium from 9 March 2020 to 28 June 2020, placing it against the background of excess mortality and compared the DPM and IFR between countries and within subgroups.MethodsThe relation between COVID-19-related mortality and excess mortality was evaluated by comparing COVID-19 mortality and the difference between observed and weekly average predictions of all-cause mortality. DPM were evaluated using demographic data of the Belgian population. The number of infections was estimated by a stochastic compartmental model. The IFR was estimated using a delay distribution between infection and death.ResultsIn the study period, 9,621 COVID-19-related deaths were reported, which is close to the excess mortality estimated using weekly averages (8,985 deaths). This translates to 837 DPM and an IFR of 1.5% in the general population. Both DPM and IFR increase with age and are substantially larger in the nursing home population.DiscussionDuring the first pandemic wave, Belgium had no discrepancy between COVID-19-related mortality and excess mortality. In light of this close agreement, it is useful to consider the DPM and IFR, which are both age, sex, and nursing home population-dependent. Comparison of COVID-19 mortality between countries should rather be based on excess mortality than on COVID-19-related mortality.
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Affiliation(s)
- Geert Molenberghs
- I-BioStat, KU Leuven, Leuven, Belgium.,Data Science Institute, I-BioStat, Universiteit Hasselt, Hasselt, Belgium
| | - Christel Faes
- Data Science Institute, I-BioStat, Universiteit Hasselt, Hasselt, Belgium
| | - Johan Verbeeck
- Data Science Institute, I-BioStat, Universiteit Hasselt, Hasselt, Belgium
| | - Patrick Deboosere
- Interface Demography (ID), Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Steven Abrams
- Global Health Institute (GHI), Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.,Data Science Institute, I-BioStat, Universiteit Hasselt, Hasselt, Belgium
| | - Lander Willem
- Centre for Health Economics Research and Modelling of Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Jan Aerts
- Data Science Institute, I-BioStat, Universiteit Hasselt, Hasselt, Belgium
| | - Heidi Theeten
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Brecht Devleesschauwer
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Ghent, Belgium.,Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | | | - Françoise Renard
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Sereina Herzog
- Centre for Health Economics Research and Modelling of Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | | | | | - Herman Van Oyen
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Niel Hens
- Centre for Health Economics Research and Modelling of Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.,Data Science Institute, I-BioStat, Universiteit Hasselt, Hasselt, Belgium
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17
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Unim B, Mattei E, Carle F, Tolonen H, Bernal-Delgado E, Achterberg P, Zaletel M, Seeling S, Haneef R, Lorcy AC, Van Oyen H, Palmieri L. Correction to: Health data collection methods and procedures across EU member states: findings from the InfAct Joint Action on health information. Arch Public Health 2022; 80:51. [PMID: 35164869 PMCID: PMC8842969 DOI: 10.1186/s13690-022-00806-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Brigid Unim
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162, Rome, Italy.
| | - Eugenio Mattei
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162, Rome, Italy
| | - Flavia Carle
- Center of Epidemiology, Biostatistics and Medical Information, Marche Polytechnic University, Ancona, Italy
| | - Hanna Tolonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Enrique Bernal-Delgado
- Data Sciences for Health Services and Policy Research Group, Institute for Health Sciences in Aragon (IACS), Zaragoza, Spain
| | - Peter Achterberg
- Centre for Health Knowledge Integration, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Metka Zaletel
- Health Data Centre, National Institute of Public Health, Ljubljana, Slovenia
| | - Stefanie Seeling
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Romana Haneef
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, 94415, Saint-Maurice, France
| | | | - Herman Van Oyen
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162, Rome, Italy
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Padron-Monedero A, Suárez RS, Bogaert P, Abboud L, Van Oyen H, Tolonen H, Tijhuis MJ, Palmieri L, Haneef R, Gallay A, Lapao L, Nogueira PJ, Ziese T, Seeling S, Vukovic J, Noguer-Zambrano I. Integrating technical and political views for a sustainable European Distributed Infrastructure on Population Health. Arch Public Health 2022; 80:29. [PMID: 35039082 PMCID: PMC8761966 DOI: 10.1186/s13690-022-00790-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background Non-Communicable diseases (NCD) are the main contributors to mortality and burden of disease. There is no infrastructure in Europe that could provide health information (HI) on Public Health monitoring and Health Systems Performance (HSP) for research and evidence-informed decision-making. Moreover, there was no EU and European Economic Area Member States (EU/EEA MSs) general consensus, on developing this initiative and guarantee its sustainability. The aim of this study is to analyze the integration of technical and political views made by the Joint Action on Health Information (InfAct; Information for Action) and the results obtained from those activities, in terms of advice and national and institutional support to develop an integrated and sustainable European Distributed Infrastructure on Population Health (DIPoH) for research and evidence-informed policy-making. Methods InfAct established two main boards, the Technical Dialogues (TDs) and the Assembly of Members (AoM), to provide a platform for discussion with EU/EEA MSs to establish a sustainable infrastructure for HI: 1) The TDs were composed by national technical experts (NTE) with the aim to discuss and provide feedback about scientific aspects, feasibility and EU-added value of the infrastructure proposed by InfAct. 2) The AoM gathered country representatives from Ministries of Health and Research at the highest political level, with the aim of providing policy-oriented advice for the future political acceptance, support, implementation, and development of InfAct’s outcomes including DIPoH. The documentation provided for the meetings consisted in Fact-Sheets, where the main results, new methods and proposals were clearly exposed for discussion and assessment; altogether with more extended information of the DIPoH. The documentation was provided to national representatives within one more before each TD and AoM meeting. The Agenda and methodological approaches for each TD and AoM meeting consisted in the presentations of the InfAct outcomes extending the information provided in the Fact-Sheets; followed by a non-structured interaction, exchange of information, discussion and suggestions by the MSs representatives. The outcomes of the non-structured discussions were collected in Minutes of the TD and AoM meetings, and the final version was obtained with the consensus of all participants. Additionally, structured letters of political support were provided to the AoM representatives, for them to consider providing their MS written support for DIPoH. Results NTE, within the TDs, considered that DIPoH was useful for technical mutual learning and cooperation among and within countries; although they considered that the technical feasibility to uptake InfAct deliverables at the national and EU level was complex. The AoM focused on political support, resources, and expected MSs returns. The AoM representatives agreed in the interest of setting up an integrated and sustainable HI infrastructure and they considered DIPoH to be well-articulated and defined; although, some of them, expressed some barriers for providing DIPoH political support. The AoM representatives stated that the AoM is the most suitable way to inform EU MSs/ACs about future advances of DIPoH. Both boards provided valuable feedback to develop this infrastructure. Eleven countries and sixteen institutions supported the proposal, either by letters of political support or by signing the Memorandum of Understandings (MoU) and three countries, additionally, provided expression of financial commitment, for DIPoH to be added to the ESFRI 2021 roadmap. Conclusions TDs and AoM were key forums to develop, advise, advocate and provide support for a sustainable European research infrastructure for Population Health.
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Affiliation(s)
- Alicia Padron-Monedero
- National School of Public Health, Instituto de Salud Carlos III. Av/ Monforte de Lemos 5, 28029, Madrid, Spain.
| | - Rodrigo Sarmiento Suárez
- National School of Public Health, Instituto de Salud Carlos III. Av/ Monforte de Lemos 5, 28029, Madrid, Spain
| | - Petronille Bogaert
- Department of Epidemiology and Public Health, Scientific Institute of Public Health. Sciensano, Brussels, Belgium
| | - Linda Abboud
- Department of Epidemiology and Public Health, Scientific Institute of Public Health. Sciensano, Brussels, Belgium
| | - Herman Van Oyen
- Department of Epidemiology and Public Health, Scientific Institute of Public Health. Sciensano, Brussels, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Hanna Tolonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Mannerheimintie 166, 00271, Helsinki, Finland
| | - Mariken J Tijhuis
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità (ISS), Via Giano della Bella, 34, 00161, Rome, Italy
| | | | - Anne Gallay
- Santé Publique France, Saint-Maurice, France
| | - Luis Lapao
- Institute of Hygiene and Tropical Medicine, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Paulo Jorge Nogueira
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina da Universidade de Lisboa, 1649-028, Lisbon, Portugal
| | | | | | - Jakov Vukovic
- Croatian Institute of Public Health (CIPH), Zagreb, Croatia
| | - Isabel Noguer-Zambrano
- National School of Public Health, Instituto de Salud Carlos III. Av/ Monforte de Lemos 5, 28029, Madrid, Spain
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Unim B, Mattei E, Carle F, Tolonen H, Bernal-Delgado E, Achterberg P, Zaletel M, Seeling S, Haneef R, Lorcy AC, Van Oyen H, Palmieri L. Health data collection methods and procedures across EU member states: findings from the InfAct Joint Action on health information. Arch Public Health 2022; 80:17. [PMID: 34986889 PMCID: PMC8728985 DOI: 10.1186/s13690-021-00780-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/23/2021] [Indexed: 11/15/2022] Open
Abstract
Background Health-related data are collected from a variety of sources for different purposes, including secondary use for population health monitoring (HM) and health system performance assessment (HSPA). Most of these data sources are not included in databases of international organizations (e.g., WHO, OECD, Eurostat), limiting their use for research activities and policy making. This study aims at identifying and describing collection methods, quality assessment procedures, availability and accessibility of health data across EU Member States (MS) for HM and HSPA. Methods A structured questionnaire was developed and administered through an online platform to partners of the InfAct consortium form EU MS to investigate data collections applied in HM and HSPA projects, as well as their methods and procedures. A descriptive analysis of the questionnaire results was performed. Results Information on 91 projects from 18 EU MS was collected. In these projects, data were mainly collected through administrative sources, population health interview or health examination surveys and from electronic medical records. Tools and methods used for data collection were mostly mandatory reports, self-administered questionnaires, or record linkage of various data sources. One-third of the projects shared data with EU research networks and less than one-third performed quality assessment of their data collection procedures using international standardized criteria. Macrodata were accessible via open access and reusable in 22 projects. Microdata were accessible upon specific request and reusable in 15 projects based on data usage licenses. Metadata was available for the majority of the projects, but followed reporting standards only in 29 projects. Overall, compliance to FAIR Data principles (Findable, Accessible, Interoperable, and Reusable) was not optimal across the EU projects. Conclusions Data collection and exchange procedures differ across EU MS and research data are not always available, accessible, comparable or reusable for further research and evidence-based policy making. There is a need for an EU-level health information infrastructure and governance to promote and facilitate sharing and dissemination of standardized and comparable health data, following FAIR Data principles, across the EU. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00780-4.
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Affiliation(s)
- Brigid Unim
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162, Rome, Italy.
| | - Eugenio Mattei
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162, Rome, Italy
| | - Flavia Carle
- Center of Epidemiology, Biostatistics and Medical Information, Marche Polytechnic University, Ancona, Italy
| | - Hanna Tolonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Enrique Bernal-Delgado
- Data Sciences for Health Services and Policy Research Group, Institute for Health Sciences in Aragon (IACS), Zaragoza, Spain
| | - Peter Achterberg
- Centre for Health Knowledge Integration, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Metka Zaletel
- Health Data Centre, National Institute of Public Health, Ljubljana, Slovenia
| | - Stefanie Seeling
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Romana Haneef
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, 94415, Saint-Maurice, France
| | | | - Herman Van Oyen
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162, Rome, Italy
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Van Goethem N, Danwang C, Bossuyt N, Van Oyen H, Roosens NHC, Robert A. A systematic review and meta-analysis of host genetic factors associated with influenza severity. BMC Genomics 2021; 22:912. [PMID: 34930124 PMCID: PMC8686082 DOI: 10.1186/s12864-021-08240-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/07/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The severity of influenza disease can range from mild symptoms to severe respiratory failure and can partly be explained by host genetic factors that predisposes the host to severe influenza. Here, we aimed to summarize the current state of evidence that host genetic variants play a role in the susceptibility to severe influenza infection by conducting a systematic review and performing a meta-analysis for all markers with at least three or more data entries. RESULTS A total of 34 primary human genetic association studies were identified that investigated a total of 20 different genes. The only significant pooled ORs were retrieved for the rs12252 polymorphism: an overall OR of 1.52 (95% CI [1.06-2.17]) for the rs12252-C allele compared to the rs12252-T allele. A stratified analysis by ethnicity revealed opposite effects in different populations. CONCLUSION With exception for the rs12252 polymorphism, we could not identify specific genetic polymorphisms to be associated with severe influenza infection in a pooled meta-analysis. This advocates for the use of large, hypothesis-free, genome-wide association studies that account for the polygenic nature and the interactions with other host, pathogen and environmental factors.
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Affiliation(s)
- Nina Van Goethem
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium
- Department of Epidemiology and Biostatistics, Institut de Recherche Expérimentale et Clinique, Faculty of Public Health, Université Catholique de Louvain, Clos Chapelle-aux-champs 30, 1200 Brussels, Belgium
| | - Célestin Danwang
- Department of Epidemiology and Biostatistics, Institut de Recherche Expérimentale et Clinique, Faculty of Public Health, Université Catholique de Louvain, Clos Chapelle-aux-champs 30, 1200 Brussels, Belgium
| | - Nathalie Bossuyt
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Herman Van Oyen
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Nancy H. C. Roosens
- Transversal Activities in Applied Genomics, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Annie Robert
- Department of Epidemiology and Biostatistics, Institut de Recherche Expérimentale et Clinique, Faculty of Public Health, Université Catholique de Louvain, Clos Chapelle-aux-champs 30, 1200 Brussels, Belgium
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21
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Van Goethem N, Serrien B, Vandromme M, Wyndham-Thomas C, Catteau L, Brondeel R, Klamer S, Meurisse M, Cuypers L, André E, Blot K, Van Oyen H. Conceptual causal framework to assess the effect of SARS-CoV-2 variants on COVID-19 disease severity among hospitalized patients. Arch Public Health 2021; 79:185. [PMID: 34696806 PMCID: PMC8543112 DOI: 10.1186/s13690-021-00709-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/02/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND SARS-CoV-2 strains evolve continuously and accumulate mutations in their genomes over the course of the pandemic. The severity of a SARS-CoV-2 infection could partly depend on these viral genetic characteristics. Here, we present a general conceptual framework that allows to study the effect of SARS-CoV-2 variants on COVID-19 disease severity among hospitalized patients. METHODS A causal model is defined and visualized using a Directed Acyclic Graph (DAG), in which assumptions on the relationship between (confounding) variables are made explicit. Various DAGs are presented to explore specific study design options and the risk for selection bias. Next, the data infrastructure specific to the COVID-19 surveillance in Belgium is described, along with its strengths and weaknesses for the study of clinical impact of variants. DISCUSSION A well-established framework that provides a complete view on COVID-19 disease severity among hospitalized patients by combining information from different sources on host factors, viral factors, and healthcare-related factors, will enable to assess the clinical impact of emerging SARS-CoV-2 variants and answer questions that will be raised in the future. The framework shows the complexity related to causal research, the corresponding data requirements, and it underlines important limitations, such as unmeasured confounders or selection bias, inherent to repurposing existing routine COVID-19 data registries. TRIAL REGISTRATION Each individual research project within the current conceptual framework will be prospectively registered in Open Science Framework (OSF identifier: https://doi.org/10.17605/OSF.IO/UEF29 ). OSF project created on 18 May 2021.
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Affiliation(s)
- Nina Van Goethem
- Scientific Directorate of Epidemiology and public health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium.
- Department of Epidemiology and Biostatistics, Institut de recherche expérimentale et clinique, Faculty of Public Health, Université catholique de Louvain, Clos Chapelle-aux-champs 30, 1200, Woluwe-Saint-Lambert, Belgium.
| | - Ben Serrien
- Scientific Directorate of Epidemiology and public health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Mathil Vandromme
- Scientific Directorate of Epidemiology and public health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Chloé Wyndham-Thomas
- Scientific Directorate of Epidemiology and public health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Lucy Catteau
- Scientific Directorate of Epidemiology and public health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Ruben Brondeel
- Scientific Directorate of Epidemiology and public health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Sofieke Klamer
- Scientific Directorate of Epidemiology and public health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Marjan Meurisse
- Scientific Directorate of Epidemiology and public health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Lize Cuypers
- Department of Laboratory Medicine, National Reference Centre for Respiratory Pathogens, University Hospitals Leuven, Herestraat 49, BE-3000, Leuven, Belgium
| | - Emmanuel André
- Department of Laboratory Medicine, National Reference Centre for Respiratory Pathogens, University Hospitals Leuven, Herestraat 49, BE-3000, Leuven, Belgium
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory Clinical Bacteriology and Mycology, Herestraat 49, box 1040, BE-3000, Leuven, Belgium
| | - Koen Blot
- Scientific Directorate of Epidemiology and public health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Herman Van Oyen
- Scientific Directorate of Epidemiology and public health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
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Braeye T, Cornelissen L, Catteau L, Haarhuis F, Proesmans K, De Ridder K, Djiena A, Mahieu R, De Leeuw F, Dreuw A, Hammami N, Quoilin S, Van Oyen H, Wyndham-Thomas C, Van Cauteren D. Vaccine effectiveness against infection and onwards transmission of COVID-19: Analysis of Belgian contact tracing data, January-June 2021. Vaccine 2021; 39:5456-5460. [PMID: 34454789 PMCID: PMC8373820 DOI: 10.1016/j.vaccine.2021.08.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 12/20/2022]
Abstract
In Belgium, high-risk contacts of an infected person were offered PCR-testing irrespective of their vaccination status. We estimated vaccine effectiveness (VE) against infection and onwards transmission, controlling for previous infections, household-exposure and temporal trends. We included 301,741 tests from 25 January to 24 June 2021. Full-schedule vaccination was associated with significant protection against infection. In addition, mRNA-vaccines reduced onward transmission: VE-estimates increased to >90% when index and contact were fully vaccinated. The small number of viral-vector vaccines included limited interpretability.
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Affiliation(s)
- Toon Braeye
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Laura Cornelissen
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Lucy Catteau
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Freek Haarhuis
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | | | - Karin De Ridder
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | | | - Romain Mahieu
- Common Community Commission Brussels, Brussels, Belgium
| | | | - Alex Dreuw
- Ministry of the German-speaking Community, Eupen, Belgium
| | - Naima Hammami
- Agency for Care and Health, Infection Prevention and Control, Flemish Community, Ghent, Belgium
| | - Sophie Quoilin
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Herman Van Oyen
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
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23
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Van Goethem N, Robert A, Bossuyt N, Van Poelvoorde LAE, Quoilin S, De Keersmaecker SCJ, Devleesschauwer B, Thomas I, Vanneste K, Roosens NHC, Van Oyen H. Evaluation of the added value of viral genomic information for predicting severity of influenza infection. BMC Infect Dis 2021; 21:785. [PMID: 34376182 PMCID: PMC8353062 DOI: 10.1186/s12879-021-06510-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/18/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The severity of an influenza infection is influenced by both host and viral characteristics. This study aims to assess the relevance of viral genomic data for the prediction of severe influenza A(H3N2) infections among patients hospitalized for severe acute respiratory infection (SARI), in view of risk assessment and patient management. METHODS 160 A(H3N2) influenza positive samples from the 2016-2017 season originating from the Belgian SARI surveillance were selected for whole genome sequencing. Predictor variables for severity were selected using a penalized elastic net logistic regression model from a combined host and genomic dataset, including patient information and nucleotide mutations identified in the viral genome. The goodness-of-fit of the model combining host and genomic data was compared using a likelihood-ratio test with the model including host data only. Internal validation of model discrimination was conducted by calculating the optimism-adjusted area under the Receiver Operating Characteristic curve (AUC) for both models. RESULTS The model including viral mutations in addition to the host characteristics had an improved fit ([Formula: see text]=12.03, df = 3, p = 0.007). The optimism-adjusted AUC increased from 0.671 to 0.732. CONCLUSIONS Adding genomic data (selected season-specific mutations in the viral genome) to the model containing host characteristics improved the prediction of severe influenza infection among hospitalized SARI patients, thereby offering the potential for translation into a prospective strategy to perform early season risk assessment or to guide individual patient management.
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Affiliation(s)
- Nina Van Goethem
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium.
- Department of Epidemiology and Biostatistics, Institut de Recherche Expérimentale et Clinique, Faculty of Public Health, Université Catholique de Louvain, Clos Chapelle-aux-champs 30, 1200, Woluwe-Saint-Lambert, Belgium.
| | - Annie Robert
- Department of Epidemiology and Biostatistics, Institut de Recherche Expérimentale et Clinique, Faculty of Public Health, Université Catholique de Louvain, Clos Chapelle-aux-champs 30, 1200, Woluwe-Saint-Lambert, Belgium
| | - Nathalie Bossuyt
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Laura A E Van Poelvoorde
- Transversal Activities in Applied Genomics, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Sophie Quoilin
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | | | - Brecht Devleesschauwer
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
- Department of Veterinary Public Health and Food Safety, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - Isabelle Thomas
- National Reference Center Influenza, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Kevin Vanneste
- Transversal Activities in Applied Genomics, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Nancy H C Roosens
- Transversal Activities in Applied Genomics, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Herman Van Oyen
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
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Delnord M, Abboud LA, Costa C, Van Oyen H. Developing a tool to monitor knowledge translation in the health system: results from an international Delphi study. Eur J Public Health 2021; 31:695-702. [PMID: 34333628 PMCID: PMC8504997 DOI: 10.1093/eurpub/ckab117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is generally accepted that evidence-informed decision making contributes to better health system performance and health outcomes, yet we are lacking benchmarks to monitor the impact of national health information systems (HIS) in policy and practice. Hence in this study, we have aimed to identify criteria for monitoring Knowledge Translation (KT) capacity within countries. METHODS We conducted a web-based Delphi with over 120 public health professionals from 45 countries to reach agreement on criteria to monitor KT at the level of national HIS. Public health professionals participated in three survey rounds, in which they ranked 85 preselected criteria and could suggest additional criteria. RESULTS Experts working in national (public) health agencies and statistical offices, as well as in health policy and care agreed on 29 criteria which constitute the Health Information (HI)-Impact Index. The criteria cover four essential domains of evaluation: the production of high-quality evidence, broad access and dissemination, stakeholder engagement and knowledge integration across sectors and in civil society. The HI-Impact Index was pretested by officials working in ministries of health and public health agencies in eight countries; they found the tool acceptable and user-friendly. CONCLUSIONS The HI-Impact Index provides benchmarks to monitor KT so that countries can assess whether high-quality evidence can be easily accessed and used by the relevant stakeholders in health policy and practice, by civil society and across sectors. Next steps include further refining the procedure for conducting the assessment in routine, and sharing experiences from HIS evaluations using the HI-Impact Index.
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Affiliation(s)
- Marie Delnord
- Department of Epidemiology and public health, Sciensano, Belgian Institute for Health, Brussels, Belgium
| | - Linda A Abboud
- Department of Epidemiology and public health, Sciensano, Belgian Institute for Health, Brussels, Belgium
| | - Claudia Costa
- Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, Coimbra, Portugal
| | - Herman Van Oyen
- Department of Epidemiology and public health, Sciensano, Belgian Institute for Health, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Haneef R, Schmidt J, Gallay A, Devleesschauwer B, Grant I, Rommel A, Wyper GM, Van Oyen H, Hilderink H, Ziese T, Newton J. Recommendations to plan a national burden of disease study. ACTA ACUST UNITED AC 2021; 79:126. [PMID: 34233754 PMCID: PMC8262070 DOI: 10.1186/s13690-021-00652-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/27/2021] [Indexed: 11/17/2022]
Abstract
Background The InfAct (Information for Action) project is a European Commission Joint Action on Health Information which has promoted the potential role of burden of disease (BoD) approaches to improve the current European Union-Health Information System (EU-HIS). It has done so by raising awareness of the concept, the methods used to calculate estimates and their potential implications and uses in policymaking. The BoD approach is a systematic and scientific effort to quantify and compare the magnitude of health loss due to different diseases, injuries, and risk factors with estimates produced by demographic characteristics and geographies for specific points in time. Not all countries have the resources to undertake such work, and may therefore start with a more restricted objective, e.g., a limited number of diseases, or the use of simple measures of population health such as disease prevalence or life expectancy. The main objective to develop these recommendations was to facilitate those countries planning to start a national burden of disease study. Results These recommendations could be considered as minimum requirements for those countries planning to start a BoD study and includes following elements: (1) Define the objectives of a burden of disease study within the context of your country, (2) Identify, communicate and secure the benefits of performing national burden of disease studies, (3) Secure access to the minimum required data sources, (4) Ensure the minimum required capacity and capability is available to carry out burden of disease study, (5) Establish a clear governance structure for the burden of disease study and stakeholder engagement/involvement, (6) Choose the appropriate methodological approaches and (7) Knowledge translation. These were guided by the results from our survey performed to identify the needs of European countries for BoD studies, a narrative overview from four European countries (Belgium, Germany, The Netherlands and Scotland) and the summary of a comparative study of country health profiles with national health statistics. Conclusions These recommendations as minimum requirements would facilitate efforts by those European countries who intend to perform national BoD studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00652-x.
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Affiliation(s)
- Romana Haneef
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, 12 rue du Val d'Osne, 94415, Saint-Maurice Cedex, France.
| | | | - Anne Gallay
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, 12 rue du Val d'Osne, 94415, Saint-Maurice Cedex, France
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - Ian Grant
- Public Health Scotland, Edinburgh, Scotland, UK
| | - Alexander Rommel
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
| | | | - Herman Van Oyen
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - Henk Hilderink
- Centre for Public Health Forecasting, National Institute for Public Health and the Environment (RIVM), Bilthoven Utrecht, Utrecht, The Netherlands
| | - Thomas Ziese
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
| | - John Newton
- Health Improvement, Public Health England, London, UK
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Dellicour S, Linard C, Van Goethem N, Da Re D, Artois J, Bihin J, Schaus P, Massonnet F, Van Oyen H, Vanwambeke SO, Speybroeck N, Gilbert M. Investigating the drivers of the spatio-temporal heterogeneity in COVID-19 hospital incidence-Belgium as a study case. Int J Health Geogr 2021; 20:29. [PMID: 34127000 PMCID: PMC8200785 DOI: 10.1186/s12942-021-00281-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/01/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic is affecting nations globally, but with an impact exhibiting significant spatial and temporal variation at the sub-national level. Identifying and disentangling the drivers of resulting hospitalisation incidence at the local scale is key to predict, mitigate and manage epidemic surges, but also to develop targeted measures. However, this type of analysis is often not possible because of the lack of spatially-explicit health data and spatial uncertainties associated with infection. METHODS To overcome these limitations, we propose an analytical framework to investigate potential drivers of the spatio-temporal heterogeneity in COVID-19 hospitalisation incidence when data are only available at the hospital level. Specifically, the approach is based on the delimitation of hospital catchment areas, which allows analysing associations between hospitalisation incidence and spatial or temporal covariates. We illustrate and apply our analytical framework to Belgium, a country heavily impacted by two COVID-19 epidemic waves in 2020, both in terms of mortality and hospitalisation incidence. RESULTS Our spatial analyses reveal an association between the hospitalisation incidence and the local density of nursing home residents, which confirms the important impact of COVID-19 in elderly communities of Belgium. Our temporal analyses further indicate a pronounced seasonality in hospitalisation incidence associated with the seasonality of weather variables. Taking advantage of these associations, we discuss the feasibility of predictive models based on machine learning to predict future hospitalisation incidence. CONCLUSION Our reproducible analytical workflow allows performing spatially-explicit analyses of data aggregated at the hospital level and can be used to explore potential drivers and dynamic of COVID-19 hospitalisation incidence at regional or national scales.
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Affiliation(s)
- Simon Dellicour
- Spatial Epidemiology Lab (SpELL), Université Libre de Bruxelles, 50 av. FD Roosevelt, 1050, CP160/12, Bruxelles, Belgium.
- Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical and Epidemiological Virology, Rega Institute, KU Leuven - University of Leuven, Leuven, Belgium.
| | - Catherine Linard
- Institute of Life-Earth-Environment (ILEE), Université de Namur, Rue de Bruxelles 61, 5000, Namur, Belgium
- NAmur Research Institute for LIfe Sciences (NARILIS), Université de Namur, Rue de Bruxelles 61, 5000, Namur, Belgium
| | - Nina Van Goethem
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Daniele Da Re
- Earth & Life Institute, Georges Lemaître Centre for Earth and Climate Research, UCLouvain, Place Louis Pasteur 3, 1348, Louvain-la-Neuve, Belgium
| | - Jean Artois
- Spatial Epidemiology Lab (SpELL), Université Libre de Bruxelles, 50 av. FD Roosevelt, 1050, CP160/12, Bruxelles, Belgium
| | - Jérémie Bihin
- Institute of Life-Earth-Environment (ILEE), Université de Namur, Rue de Bruxelles 61, 5000, Namur, Belgium
| | | | - François Massonnet
- Earth & Life Institute, Georges Lemaître Centre for Earth and Climate Research, UCLouvain, Place Louis Pasteur 3, 1348, Louvain-la-Neuve, Belgium
| | - Herman Van Oyen
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Public Health and Primary Care, Gent University, Gent, Belgium
| | - Sophie O Vanwambeke
- Earth & Life Institute, Georges Lemaître Centre for Earth and Climate Research, UCLouvain, Place Louis Pasteur 3, 1348, Louvain-la-Neuve, Belgium
| | - Niko Speybroeck
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle-aux-champs 30, 1200, Brussels, Belgium
| | - Marius Gilbert
- Spatial Epidemiology Lab (SpELL), Université Libre de Bruxelles, 50 av. FD Roosevelt, 1050, CP160/12, Bruxelles, Belgium
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27
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Taccone FS, Van Goethem N, De Pauw R, Wittebole X, Blot K, Van Oyen H, Lernout T, Montourcy M, Meyfroidt G, Van Beckhoven D. The role of organizational characteristics on the outcome of COVID-19 patients admitted to the ICU in Belgium. The Lancet Regional Health - Europe 2021; 2:100019. [PMID: 35104305 PMCID: PMC7757349 DOI: 10.1016/j.lanepe.2020.100019] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Methods Findings Interpretation Funding
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Berete F, der Heyden JV, Demarest S, Charafeddine R, Tafforeau J, Oyen HV, Bruyère O, Renard F. Validity of self-reported mammography uptake in the Belgian health interview survey: selection and reporting bias. Eur J Public Health 2021; 31:214-220. [PMID: 33226066 PMCID: PMC7851893 DOI: 10.1093/eurpub/ckaa217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The validity of self-reported mammography uptake is often questioned. We assessed the related selection and reporting biases among women aged 50-69 years in the Belgian Health Interview Survey (BHIS) using reimbursement data for mammography stemming from the Belgian Compulsory Health Insurance organizations (BCHI). METHODS Individual BHIS 2013 data (n = 1040) were linked to BCHI data 2010-13 (BHIS-BCHI sample). Being reimbursed for mammography within the last 2-years was used as the gold standard. Selection bias was assessed by comparing BHIS estimates reimbursement rates in BHIS-BCHI with similar estimates from the Echantillon Permanent/Permanente Steekproef (EPS), a random sample of BCHI data, while reporting bias was investigated by comparing self-reported versus reimbursement information in the BHIS-BCHI. Reporting bias was further explored through measures of agreement and logistic regression. RESULTS Mammography uptake rates based on self-reported information and reimbursement from the BHIS-BCHI were 75.5% and 69.8%, respectively. In the EPS, it was 64.1%. The validity is significantly affected by both selection bias {relative size = 8.93% [95% confidence interval (CI): 3.21-14.64]} and reporting bias [relative size = 8.22% (95% CI: 0.76-15.68)]. Sensitivity was excellent (93.7%), while the specificity was fair (66.4%). The agreement was moderate (kappa = 0.63). Women born in non-EU countries (OR = 2.81, 95% CI: 1.54-5.13), with high household income (OR = 1.27, 95% CI: 1.02-1.60) and those reporting poor perceived health (OR = 1.41, 95% CI: 1.14-1.73) were more likely to inaccurately report their mammography uptake. CONCLUSIONS The validity of self-reported mammography uptake in women aged 50-69 years is affected by both selection and reporting bias. Both administrative and survey data are complementary when assessing mammography uptake.
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Affiliation(s)
- Finaba Berete
- Department Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | | | - Stefaan Demarest
- Department Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Rana Charafeddine
- Department Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Jean Tafforeau
- Department Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Herman Van Oyen
- Department Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Ageing, University of Liege, Liège, Belgium
| | - Françoise Renard
- Department Epidemiology and Public Health, Sciensano, Brussels, Belgium
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Bustos Sierra N, Bossuyt N, Braeye T, Leroy M, Moyersoen I, Peeters I, Scohy A, Van der Heyden J, Van Oyen H, Renard F. All-cause mortality supports the COVID-19 mortality in Belgium and comparison with major fatal events of the last century. ACTA ACUST UNITED AC 2020; 78:117. [PMID: 33292536 PMCID: PMC7662738 DOI: 10.1186/s13690-020-00496-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/28/2020] [Indexed: 01/19/2023]
Abstract
Background The COVID-19 mortality rate in Belgium has been ranked among the highest in the world. To assess the appropriateness of the country’s COVID-19 mortality surveillance, that includes long-term care facilities deaths and deaths in possible cases, the number of COVID-19 deaths was compared with the number of deaths from all-cause mortality. Mortality during the COVID-19 pandemic was also compared with historical mortality rates from the last century including those of the Spanish influenza pandemic. Methods Excess mortality predictions and COVID-19 mortality data were analysed for the period March 10th to June 21st 2020. The number of COVID-19 deaths and the COVID-19 mortality rate per million were calculated for hospitals, nursing homes and other places of death, according to diagnostic status (confirmed/possible infection). To evaluate historical mortality, monthly mortality rates were calculated from January 1900 to June 2020. Results Nine thousand five hundred ninety-one COVID-19 deaths and 39,076 deaths from all-causes were recorded, with a correlation of 94% (Spearman’s rho, p < 0,01). During the period with statistically significant excess mortality (March 20th to April 28th; total excess mortality 64.7%), 7917 excess deaths were observed among the 20,159 deaths from all-causes. In the same period, 7576 COVID-19 deaths were notified, indicating that 96% of the excess mortality were likely attributable to COVID-19. The inclusion of deaths in nursing homes doubled the COVID-19 mortality rate, while adding deaths in possible cases increased it by 27%. Deaths in laboratory-confirmed cases accounted for 69% of total COVID-19-related deaths and 43% of in-hospital deaths. Although the number of deaths was historically high, the monthly mortality rate was lower in April 2020 compared to the major fatal events of the last century. Conclusions Trends in all-cause mortality during the first wave of the epidemic was a key indicator to validate the Belgium’s high COVID-19 mortality figures. A COVID-19 mortality surveillance limited to deaths from hospitalised and selected laboratory-confirmed cases would have underestimated the magnitude of the epidemic. Excess mortality, daily and monthly number of deaths in Belgium were historically high classifying undeniably the first wave of the COVID-19 epidemic as a fatal event. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-020-00496-x.
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Affiliation(s)
- Natalia Bustos Sierra
- Scientific Directorate of Epidemiology and public health, Sciensano, J.Wytsmanstraat 14, 1050, Brussels, Belgium.
| | - Nathalie Bossuyt
- Scientific Directorate of Epidemiology and public health, Sciensano, J.Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Toon Braeye
- Scientific Directorate of Epidemiology and public health, Sciensano, J.Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Mathias Leroy
- Scientific Directorate of Epidemiology and public health, Sciensano, J.Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Isabelle Moyersoen
- Scientific Directorate of Epidemiology and public health, Sciensano, J.Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Ilse Peeters
- Scientific Directorate of Epidemiology and public health, Sciensano, J.Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Aline Scohy
- Scientific Directorate of Epidemiology and public health, Sciensano, J.Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Johan Van der Heyden
- Scientific Directorate of Epidemiology and public health, Sciensano, J.Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Herman Van Oyen
- Scientific Directorate of Epidemiology and public health, Sciensano, J.Wytsmanstraat 14, 1050, Brussels, Belgium.,Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Françoise Renard
- Scientific Directorate of Epidemiology and public health, Sciensano, J.Wytsmanstraat 14, 1050, Brussels, Belgium
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Nusselder WJ, Cambois EM, Wapperom D, Meslé F, Looman CWN, Yokota RTC, Van Oyen H, Jagger C, Robine JM. Women's excess unhealthy life years: disentangling the unhealthy life years gap. Eur J Public Health 2020; 29:914-919. [PMID: 31280299 PMCID: PMC6761840 DOI: 10.1093/eurpub/ckz114] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Compared to men, women live longer but have more years with disability. We assessed the contribution of gender differences in mortality and disability, total and by cause, to women’s excess unhealthy life years (ULYs). Methods We used mortality data for France 2008 from Eurostat, causes of death from the CépiDc-INSERM-database; and disability and chronic conditions data from the French Disability Health Survey 2008–09. ULYs were calculated by the Sullivan method. The contributions of mortality and disability differences to gender differences in ULY were based on decomposition analyses. Results Life expectancy of French women aged 50 was 36.3 years of which 19.0 were ULYs; life expectancy of men was 30.4 years of which 14.2 were ULYs. Of the 4.8 excess ULYs in women, 4.0 years were due to lower mortality. Of these 4.0 ULYs, 1.8 ULY originated from women’s lower mortality from cancer, 0.8 ULY from heart disease and 0.3 ULY from accidents. The remaining 0.8 excess ULY in women were from higher disability prevalence, including higher disability from musculoskeletal diseases (+1.8 ULY) and anxiety-depression (+0.6 ULY) partly offset by lower disability from heart diseases (−0.8 ULY) and accidents (−0.3 ULY). Conclusion Lower mortality and higher disability prevalence contributed to women’s longer life expectancy with disability. Women’s higher disability prevalence due to non-fatal disabling conditions was partly offset by lower disability from heart disease and accidents. Conditions differentially impact gender differences in ULY, depending on whether they are mainly life-threatening or disabling. The conclusions confirm the health-survival paradox.
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Affiliation(s)
- Wilma J Nusselder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Emmanuelle M Cambois
- INED (French Institute for Demographic Studies), Mortality, Health, Epidemiology Research Unit, Paris, France
| | - Dagmar Wapperom
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - France Meslé
- INED (French Institute for Demographic Studies), Mortality, Health, Epidemiology Research Unit, Paris, France
| | - Caspar W N Looman
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Renata T C Yokota
- SD Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
| | - Herman Van Oyen
- SD Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Carrol Jagger
- Instiute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Newcastle University Institute for Ageing, Newcastle upon Tyne, UK
| | - Jean Marie Robine
- Inserm (French Institute of Health and Medical Research), CERMES3 Research Unit, Paris, France.,EPHE (École Pratique des Hautes Études), MMDN Research Unit, Univ., Montpellier, France
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31
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Catteau L, Dauby N, Montourcy M, Bottieau E, Hautekiet J, Goetghebeur E, van Ierssel S, Duysburgh E, Van Oyen H, Wyndham-Thomas C, Van Beckhoven D. Low-dose hydroxychloroquine therapy and mortality in hospitalised patients with COVID-19: a nationwide observational study of 8075 participants. Int J Antimicrob Agents 2020; 56:106144. [PMID: 32853673 PMCID: PMC7444610 DOI: 10.1016/j.ijantimicag.2020.106144] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/05/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023]
Abstract
Hydroxychloroquine (HCQ) 2400 mg over 5 days was used in Belgium for COVID-19. Impact of HCQ on mortality among 8075 patients with COVID-19 was assessed. Lower mortality in HCQ-treated patients as compared to supportive care. Lower mortality was irrespective of symptom duration.
Hydroxychloroquine (HCQ) has been largely used and investigated as therapy for COVID-19 across various settings at a total dose usually ranging from 2400 mg to 9600 mg. In Belgium, off-label use of low-dose HCQ (total 2400 mg over 5 days) was recommended for hospitalised patients with COVID-19. We conducted a retrospective analysis of in-hospital mortality in the Belgian national COVID-19 hospital surveillance data. Patients treated either with HCQ monotherapy and supportive care (HCQ group) were compared with patients treated with supportive care only (no-HCQ group) using a competing risks proportional hazards regression with discharge alive as competing risk, adjusted for demographic and clinical features with robust standard errors. Of 8075 patients with complete discharge data on 24 May 2020 and diagnosed before 1 May 2020, 4542 received HCQ in monotherapy and 3533 were in the no-HCQ group. Death was reported in 804/4542 (17.7%) and 957/3533 (27.1%), respectively. In the multivariable analysis, mortality was lower in the HCQ group compared with the no-HCQ group [adjusted hazard ratio (aHR) = 0.684, 95% confidence interval (CI) 0.617–0.758]. Compared with the no-HCQ group, mortality in the HCQ group was reduced both in patients diagnosed ≤5 days (n = 3975) and >5 days (n = 3487) after symptom onset [aHR = 0.701 (95% CI 0.617–0.796) and aHR = 0.647 (95% CI 0.525–0.797), respectively]. Compared with supportive care only, low-dose HCQ monotherapy was independently associated with lower mortality in hospitalised patients with COVID-19 diagnosed and treated early or later after symptom onset.
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Affiliation(s)
- Lucy Catteau
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Nicolas Dauby
- Department of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium; Institute for Medical Immunology, Université Libre de Bruxelles (ULB), Brussels, Belgium; Environmental Health Research Centre, Public Health School, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Marion Montourcy
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joris Hautekiet
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium; Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Els Goetghebeur
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Sabrina van Ierssel
- Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, University Hospital Antwerp (UZA), Edegem, Belgium
| | - Els Duysburgh
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Herman Van Oyen
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium; Public Health and Primary Care, Gent University, Gent, Belgium
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Haneef R, Delnord M, Vernay M, Bauchet E, Gaidelyte R, Van Oyen H, Or Z, Pérez-Gómez B, Palmieri L, Achterberg P, Tijhuis M, Zaletel M, Mathis-Edenhofer S, Májek O, Haaheim H, Tolonen H, Gallay A. Innovative use of data sources: a cross-sectional study of data linkage and artificial intelligence practices across European countries. ACTA ACUST UNITED AC 2020; 78:55. [PMID: 32537143 PMCID: PMC7288525 DOI: 10.1186/s13690-020-00436-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/02/2020] [Indexed: 11/10/2022]
Abstract
Background The availability of data generated from different sources is increasing with the possibility to link these data sources with each other. However, linked administrative data can be complex to use and may require advanced expertise and skills in statistical analysis. The main objectives of this study were to describe the current use of data linkage at the individual level and artificial intelligence (AI) in routine public health activities, to identify the related estimated health indicators (i.e., outcome and intervention indicators) and health determinants of non-communicable diseases and the obstacles to linking different data sources. Method We performed a survey across European countries to explore the current practices applied by national institutes of public health, health information and statistics for innovative use of data sources (i.e., the use of data linkage and/or AI). Results The use of data linkage and AI at national institutes of public health, health information and statistics in Europe varies. The majority of European countries use data linkage in routine by applying a deterministic method or a combination of two types of linkages (i.e., deterministic & probabilistic) for public health surveillance and research purposes. The use of AI to estimate health indicators is not frequent at national institutes of public health, health information and statistics. Using linked data, 46 health outcome indicators, 34 health determinants and 23 health intervention indicators were estimated in routine. The complex data regulation laws, lack of human resources, skills and problems with data governance, were reported by European countries as obstacles to routine data linkage for public health surveillance and research. Conclusions Our results highlight that the majority of European countries have integrated data linkage in their routine public health activities but only a few use AI. A sustainable national health information system and a robust data governance framework allowing to link different data sources are essential to support evidence-informed health policy development. Building analytical capacity and raising awareness of the added value of data linkage in national institutes is necessary for improving the use of linked data in order to improve the quality of public health surveillance and monitoring activities.
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Affiliation(s)
- Romana Haneef
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice, France
| | - Marie Delnord
- Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Michel Vernay
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice, France
| | - Emmanuelle Bauchet
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice, France
| | - Rita Gaidelyte
- Health information centre, Institute of hygiene, Vilnius, Lithuania
| | - Herman Van Oyen
- Epidemiology and public health, Sciensano, Brussels, Belgium.,Department of public health, Ghent University, Ghent, Belgium
| | - Zeynep Or
- Institute of research and information for health economics, Paris, France
| | - Beatriz Pérez-Gómez
- National Centre for Epidemiology & CIBERESP, Carlos III Institute of Health, Madrid, Spain
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, National Institute of Health, Rome, Italy
| | - Peter Achterberg
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Mariken Tijhuis
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Metka Zaletel
- National Institute of Public Health (NIJZ), Ljubljana, Slovenia
| | - Stefan Mathis-Edenhofer
- The Austrian National Public Health Institute (Gesundheit Österreich GmbH, GÖG), Vienna, Austria
| | - Ondřej Májek
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic.,Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Hanna Tolonen
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Anne Gallay
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice, France
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Palazzo C, Yokota RTC, Ferguson J, Tafforeau J, Ravaud JF, Van Oyen H, Nusselder WJ. Methods to assess the contribution of diseases to disability using cross-sectional studies: comparison of different versions of the attributable fraction and the attribution method. Int J Epidemiol 2020; 48:559-570. [PMID: 30376047 DOI: 10.1093/ije/dyy222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study aims to illustrate the differences between approaches proposed for apportioning disability to different diseases in a multicausal situation, i.e. the unadjusted attributable fraction (AF), the adjusted AF, the average AF and the attribution method (AM). This information is useful to better interpret results obtained from cross-sectional data and help policy makers decide on public health strategies. METHODS Data for 29 931 individuals, representative of the French household population, who participated in the 2008-09 cross-sectional Disability-Health Survey, were included. Disability was defined as any limitation reported with the Global Activity Limitation Indicator. Unadjusted AFs were calculated using Levin's formula. Adjusted AFs were estimated for each disease by calculating predicted probabilities of disability for each individual in the dataset, under the assumption that the individual is unexposed to this specific disease (logistic model). Average AFs are based on the same methodology, but have the additional advantage that the average AFs for different diseases sum to the total AF associated with eliminating all diseases. AM accounts for competing risks and partitions total disability prevalence into additive contributions of different diseases and background disability (additive model). RESULTS All methods obtained similar results with respect to the estimates of the disease contribution to disability prevalences and to ranking of the diseases, except unadjusted AFs, as the method ignores multimorbidity. Confounders other than diseases, such as age and gender, should be accurately taken into account. CONCLUSIONS Conceptual differences, strengths and limitations of the different approaches were discussed.
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Affiliation(s)
- Clémence Palazzo
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.,Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Renata T C Yokota
- Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
| | - John Ferguson
- HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - Jean Tafforeau
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Jean-François Ravaud
- INSERM, CNRS, EHESS, Université Paris Descartes, IFRH, CERMES3, Villejuif, France
| | - Herman Van Oyen
- Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Otavova M, Van Oyen H, Yokota RTC, Charafeddine R, Joossens L, Molenberghs G, Nusselder WJ, Boshuizen HC, Devleesschauwer B. Potential impact of reduced tobacco use on life and health expectancies in Belgium. Int J Public Health 2019; 65:129-138. [PMID: 31781804 PMCID: PMC7049546 DOI: 10.1007/s00038-019-01315-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/30/2019] [Accepted: 11/19/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES We investigated the potential impact of reduced tobacco use scenarios on total life expectancy and health expectancies, i.e., healthy life years and unhealthy life years. METHODS Data from the Belgian Health Interview Survey 2013 were used to estimate smoking and disability prevalence. Disability was based on the Global Activity Limitation Indicator. We used DYNAMO-HIA to quantify the impacts of risk factor changes and to compare the "business-as-usual" with alternative scenarios. RESULTS The "business-as-usual" scenario estimated that in 2028 the 15-year-old men/women would live additional 50/52 years without disability and 14/17 years with disability. The "smoking-free population" scenario added 3.4/2.8 healthy life years and reduced unhealthy life years by 0.79/1.9. Scenarios combining the prevention of smoking initiation with smoking cessation programs are the most effective, yielding the largest increase in healthy life years (1.9/1.7) and the largest decrease in unhealthy life years (- 0.80/- 1.47). CONCLUSIONS Health impact assessment tools provide different scenarios for evidence-informed public health actions. New anti-smoking strategies or stricter enforcement of existing policies potentially gain more healthy life years and reduce unhealthy life years in Belgium.
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Affiliation(s)
- Martina Otavova
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark.,Interdisciplinary Center on Population Dynamics, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark
| | - Herman Van Oyen
- Department of Epidemiology and public health, Sciensano, Rue J Wytsman 14, 1050, Brussels, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Renata T C Yokota
- Department of Epidemiology and public health, Sciensano, Rue J Wytsman 14, 1050, Brussels, Belgium
| | - Rana Charafeddine
- Department of Epidemiology and public health, Sciensano, Rue J Wytsman 14, 1050, Brussels, Belgium
| | - Luk Joossens
- Association of European Cancer Leagues, Brussels, Belgium
| | | | - Wilma J Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hendriek C Boshuizen
- Department of Statistics, Informatics and Mathematical Modeling, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Brecht Devleesschauwer
- Department of Epidemiology and public health, Sciensano, Rue J Wytsman 14, 1050, Brussels, Belgium. .,Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
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Moyersoen I, Devleesschauwer B, Dekkers A, Verkaik-Kloosterman J, De Ridder K, Vandevijvere S, Tafforeau J, Van Oyen H, Lachat C, Van Camp J. A Novel Approach to Optimize Vitamin D Intake in Belgium through Fortification Based on Representative Food Consumption Data. J Nutr 2019; 149:1852-1862. [PMID: 31204779 DOI: 10.1093/jn/nxz119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/28/2019] [Accepted: 05/04/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Food fortification is a promising means to improve vitamin D intake of a population. Careful selection of food vehicles is needed to ensure that nearly all individuals within the population benefit from the fortification program. OBJECTIVES The aim of the study was to develop and apply a model that simultaneously selects the optimal combination of food vehicles and defines the optimal fortification level that adequately increases vitamin D intake in the population without compromising safety. METHODS Food consumption data from the Belgian Food Consumption Survey 2014 (n = 3200; age 3-64 y) were used. The optimization model included 63 combinations of 6 potential vehicles for food fortification, namely "bread," "breakfast cereals," "fats and oils," "fruit juices," "milk and milk beverages," and "yogurt and cream cheese." The optimization procedure was designed to minimize inadequate or excessive vitamin D intake in each of the food combinations. This allowed the relative ranking of the different combinations according to their fortification utility. The estimated average requirement and upper intake level were used as thresholds. An age-specific and population-based approach enabled the sensitivity of the population subgroups to adverse health effects to be taken into account. Feasibility, technical aspects, and healthiness of the food vehicles were used to select the optimal combination. RESULTS Multiple combinations of food vehicles significantly reduced the prevalence of inadequate vitamin D intake within the Belgian population (from 92-96% to <2%). Taking other aforementioned criteria into account, the fortification of "milk and milk beverages" and "bread" with 6.9 μg vitamin D/100 kcal was proposed as an optimal fortification scenario. CONCLUSIONS The optimization model allows identification of an effective fortification scenario to improve vitamin D intake within the Belgian population based on acceptable risks of inadequate and excessive intake. The model can be extended to other micronutrients and other populations.
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Affiliation(s)
- Isabelle Moyersoen
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - Arnold Dekkers
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | | | - Karin De Ridder
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | | | - Jean Tafforeau
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Herman Van Oyen
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Public Health and Primary Care
| | - Carl Lachat
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium
| | - John Van Camp
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium
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Yokota RTC, Nusselder WJ, Robine JM, Tafforeau J, Renard F, Deboosere P, Van Oyen H. Contribution of chronic conditions to gender disparities in health expectancies in Belgium, 2001, 2004 and 2008. Eur J Public Health 2019; 29:82-87. [PMID: 29917065 DOI: 10.1093/eurpub/cky105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background We aimed to investigate the contribution of chronic conditions to gender differences in disability-free life expectancy (DFLE) and life expectancy with disability (LED) in Belgium in 2001, 2004 and 2008. Methods Data on disability and chronic conditions from participants of the 2001, 2004 and 2008 Health Interview Surveys in Belgium were used to estimate disability prevalence by cause using the attribution method. Disability prevalence was applied to life tables to estimate DFLE and LED using the Sullivan method. Decomposition techniques were used to assess the contribution of mortality and disability and further of causes of death and disability to gender disparities in DFLE and LED. Results Higher LE, DFLE and LED were observed for women compared with men in all years studied. A decrease in the gender gap in LE (2001: 5.9; 2004: 5.6; 2008: 5.3) was observed in our cross-sectional approach followed by a decrease in gender differences in DFLE (2001: 1.9; 2004: 1.3; 2008: 0.5) and increase in LED (2001: 4.0; 2004: 4.4; 2008: 4.8). The higher LED in women was attributed to their lower mortality due to lung/larynx/trachea cancer, ischaemic heart diseases, and external causes (2001 and 2004) and higher disability prevalence due to musculoskeletal conditions (2008). Higher DFLE was observed in women owing to their lower mortality from lung/larynx/trachea cancer, ischaemic heart diseases, digestive cancer and chronic respiratory diseases. Conclusion To promote healthy ageing of populations, priority should be given to reduce the LED disadvantage in women by targeting non-fatal diseases, such as musculoskeletal conditions.
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Affiliation(s)
- Renata T C Yokota
- Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Jean-Marie Robine
- Mécanismes moléculaires dans les démences neurodégénératives, French Institute of Health and Medical Research (INSERM), Montpellier, France.,Centre de recherche médecine, sciences, santé, santé mentale, société (Cermes3), École Pratique des Hautes Études, Paris, France
| | - Jean Tafforeau
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Françoise Renard
- Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Patrick Deboosere
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Herman Van Oyen
- Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Public Health, Ghent University, Ghent, Belgium
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Van Malderen C, Amouzou A, Barros AJD, Masquelier B, Van Oyen H, Speybroeck N. Socioeconomic factors contributing to under-five mortality in sub-Saharan Africa: a decomposition analysis. BMC Public Health 2019; 19:760. [PMID: 31200681 PMCID: PMC6570834 DOI: 10.1186/s12889-019-7111-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 06/05/2019] [Indexed: 11/10/2022] Open
Abstract
Background In sub-Saharan Africa, socioeconomic factors such as place of residence, mother’s educational level, or household wealth, are strongly associated with risk factors of under-five mortality (U5M) such as health behavior or exposure to diseases and injuries. The aim of the study was to assess the relative contribution of four known socioeconomic factors to the variability in U5M in sub-Saharan countries. Methods The study was based on birth histories from the Demographic and Health Surveys conducted in 32 sub-Saharan countries in 2010–2016. The relative contribution of sex of the child, place of residence, mother’s educational level, and household wealth to the variability in U5M was assessed using a regression-based decomposition of a Gini-type index. Results The Gini index – measuring the variability in U5M related to the four socioeconomic factors – varied from 0.006 (95%CI: 0.001–0.010) in Liberia 2013 to 0.034 (95%CI: 0.029–0.039) in Côte d’Ivoire 2011/12. The main contributors to the Gini index (with a relative contribution higher than 25%) were different across countries: mother’s educational level in 13 countries, sex of the child in 12 countries, household wealth in 11 countries, and place of residence in 8 countries (in some countries, more than one main contributor was identified). Conclusions Factors related to socioeconomic status exert varied effects on the variability in U5M in sub-Saharan African countries. The findings provide evidence in support of prioritizing intersectoral interventions aiming at improving child survival in all subgroups of a population.
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Affiliation(s)
- Carine Van Malderen
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.
| | - Agbessi Amouzou
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | | | - Bruno Masquelier
- Centre de Recherche en Démographie, Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Institut National d'Etudes Démographiques (INED), Paris, France
| | - Herman Van Oyen
- Department of Public Health and Surveillance, Sciensano, Brussels, Belgium.,Department of Public Health, Ghent University, Ghent, Belgium
| | - Niko Speybroeck
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
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Yokota RTC, Nusselder WJ, Robine JM, Tafforeau J, Charafeddine R, Gisle L, Deboosere P, Van Oyen H. Contribution of chronic conditions to smoking differences in life expectancy with and without disability in Belgium. Eur J Public Health 2019; 28:859-863. [PMID: 29901735 DOI: 10.1093/eurpub/cky101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Smoking is the leading cause of premature mortality and morbidity. This study aimed at assessing the impact of smoking on life expectancy (LE) and LE with (LED) and without disability (DFLE). We further estimated the contribution of disability and mortality and their causes to differences in LED and DFLE by smoking. Methods Data on disability, chronic conditions, and smoking from 17 148 participants of the 1997, 2001, 2004 Belgian Health Interview Surveys were used to estimate causes of disability using the attribution method. A 10-year mortality follow-up of survey participants was used. The Sullivan method was applied to estimate LED and DFLE. The contribution of disability and mortality and of causes of disability and death to smoking differences in LED and DFLE was assessed using decomposition methods. Results Never smokers live longer than daily smokers. DFLE advantage at age 15 of +8.5/+4.3 years (y) in men/women never compared with daily smokers was the result of lower mortality (+6.2y/+3y) and lower disability (2.3y/1.3y). The extra 0.3y/1.6y LED in never smokers was due to lower mortality (+2.6y/+2.9y) and lower disability (-2.3y/-1.3y). Lower mortality from lung/larynx/trachea cancer, chronic respiratory, and ischaemic heart diseases was the main contributor to higher LED and DFLE in never smokers. Lower disability from musculoskeletal conditions in men and chronic respiratory diseases in women increased LED and DFLE in never smokers. Conclusions Mortality and disability advantage among never smokers contributed to longer DFLE, while mortality advantage contributed to their longer LED.
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Affiliation(s)
- Renata T C Yokota
- Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Jean-Marie Robine
- Mécanismes moléculaires dans les démences neurodégénératives, French Institute of Health and Medical Research (INSERM), Montpellier, France.,Centre de recherche médecine, sciences, santé, santé mentale, société (Cermes3), École Pratique des Hautes Études, Paris, France
| | - Jean Tafforeau
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | | | - Lydia Gisle
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Patrick Deboosere
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Herman Van Oyen
- Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Public Health, Ghent University, Ghent, Belgium
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Geebelen L, Van Cauteren D, Devleesschauwer B, Moreels S, Tersago K, Van Oyen H, Speybroeck N, Lernout T. Combining primary care surveillance and a meta-analysis to estimate the incidence of the clinical manifestations of Lyme borreliosis in Belgium, 2015–2017. Ticks Tick Borne Dis 2019; 10:598-605. [DOI: 10.1016/j.ttbdis.2018.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/22/2018] [Accepted: 12/23/2018] [Indexed: 02/07/2023]
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Renard F, Devleesschauwer B, Van Oyen H, Gadeyne S, Deboosere P. Evolution of educational inequalities in life and health expectancies at 25 years in Belgium between 2001 and 2011: a census-based study. ACTA ACUST UNITED AC 2019; 77:6. [PMID: 30815257 PMCID: PMC6376710 DOI: 10.1186/s13690-019-0330-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/03/2019] [Indexed: 12/03/2022]
Abstract
Background Reducing socio-economic health inequalities is a public health priority, necessitating careful monitoring that should take into account changes in the population composition. We analyzed the evolution of educational inequalities in life expectancy and disability-free life expectancy at age 25 (LE25 and DFLE25) in Belgium between 2001 and 2011. Methods The 2001 and 2011 census data were linked with the national register data for a five-year mortality follow up. Disability prevalence estimates from the health interview surveys (2001 to 2013) were used to compute DFLE according to Sullivan’s method. LE25 and DFLE25 were computed by educational level (EL). Absolute differentials of LE25 and DFLE25 were calculated for each EL and for each period, as well as composite inequality indices (CII) of population-level impact of inequality. Changes over the 10-year period were then calculated for each inequality index. Results The LE25 increased in all ELs and both genders, except in the lowest EL for women. The increase was larger in the highest EL, leading in 2011 to 6.07 and 4.58 years for the low-versus-high LE25 gaps respectively in men and women, compared to 5.19 and 3.76 in 2001, namely 17 and 22% increases. The upwards shift of the EL distribution led to a limited 7% increase of the CII among men but no change in women. The substantial increase of the DFLE25 in males with high EL (+ 4.5 years) and the decrease of the DFLE25 in women with low EL, results in a substantial increase of all considered DFLE25 inequality measures in both genders. In 2011, DFLE25 gaps were respectively 10.4 and 13.5 years in males and females compared to 6.51 and 9.30 in 2001, representing increases of 61 and 44% for the gaps, and 72 and 20% for the CII. Conclusion The LE25 increased in all ELs, but at a higher pace in highly educated, leading to an increase in the LE25 gaps in both genders. After accounting for the upwards shift of the educational distribution, the population-level inequality index increased only for men. The DFLE25 increased only in highly educated men, and decreased in low educated women, leading to large increases of inequalities in both genders. A general plan to tackle health inequality should be set up, with particular efforts to improve the health of the low educated women. Electronic supplementary material The online version of this article (10.1186/s13690-019-0330-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Françoise Renard
- Department of Epidemiology and public health, Sciensano, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and public health, Sciensano, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.,2Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - Herman Van Oyen
- Department of Epidemiology and public health, Sciensano, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.,3Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sylvie Gadeyne
- 4Interface Demography, Section Social Research, Vrije Universiteit Brussels, Brussels, Belgium
| | - Patrick Deboosere
- 4Interface Demography, Section Social Research, Vrije Universiteit Brussels, Brussels, Belgium
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Palazzo C, Yokota RTC, Tafforeau J, Ravaud JF, Cambois E, Poiraudeau S, Van Oyen H, Nusselder WJ. Contribution of chronic diseases to educational disparity in disability in France: results from the cross-sectional "disability-health" survey. ACTA ACUST UNITED AC 2019; 77:2. [PMID: 30651987 PMCID: PMC6330417 DOI: 10.1186/s13690-018-0326-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022]
Abstract
Background This study aimed 1) to assess whether the contribution of chronic conditions to disability varies according to the educational attainment, 2) to disentangle the contributions of the prevalence and of the disabling impact of chronic conditions to educational disparities. Methods Data of the 2008–09 Disability Health Survey were examined (N = 23,348). The disability indicator was the Global Activity Limitation Indicator (GALI). The attribution method based on an additive hazard model was used to estimate educational differences in disabling impacts and in the contributions of diseases to disability. Counterfactual analyses were used to disentangle the contribution of differences in disease prevalence vs. disabling impact. Results In men, the main contributors to educational difference in disability prevalence were arthritis (contribution to disability prevalence: 5.7% (95% CI 5.4–6.0) for low-educated vs. 3.3% (3.0–3.9) for high-educated men), spine disorders (back/neck pain, deformity) (3.8% (3.6–4.0) vs. 1.9% (1.8–2.1)), chronic obstructive pulmonary diseases (2.4% (2.3–2.6) vs. 0.6% (0.5–0.7)) and ischemic heart /peripheral artery diseases (4.1% (3.9–4.3) vs. 2.4% (2.2–3.0)). In women, arthritis (9.5% (9.1–9.9) vs. 4.5%, (4.1–5.2)), spine disorders (4.5% (4.3–4.7) vs. 2.1% 1.9–2.3) and psychiatric diseases (3.1% (3.0–3.3) vs. 1.1% (1.0–1.3)) contributed most to education gap in disability. The educational differences were equally explained by differences in the disease prevalence and in their disabling impact. Conclusions Public health policies aiming to reduce existing socioeconomic disparities in disability should focus on musculoskeletal, pulmonary, psychiatric and ischemic heart diseases, reducing their prevalence as well as their disabling impact in lower socioeconomic groups. Electronic supplementary material The online version of this article (10.1186/s13690-018-0326-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Clémence Palazzo
- 1Department of Public Health, Erasmus MC, Rotterdam, Netherlands.,Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Renata T C Yokota
- Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.,3Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jean Tafforeau
- Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Jean-François Ravaud
- 4INSERM, CNRS, EHESS, Université Paris Descartes, IFRH, CERMES3, Villejuif, France
| | | | - Serge Poiraudeau
- INSERM, Université Sorbonne Paris Cité, Université Paris Descartes, IFRH, Centre of Research in Epidemiology and Statistics, ECaMO Team, Paris, France
| | - Herman Van Oyen
- Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.,7Department of Public Health, Ghent University, Ghent, Belgium
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Plettinckx E, Antoine J, Gremeaux L, Van Oyen H. Alternatives to prison for drug offenders in Belgium during the past decade. Int J Law Psychiatry 2018; 61:13-21. [PMID: 30454557 DOI: 10.1016/j.ijlp.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/07/2018] [Accepted: 09/19/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Imprisonment has a more pronounced criminogenic effect on drug offenders than on other types of offenders. Additionally, little research has been conducted on the practical application of drug-related alternatives to prison. Therefore, this study describes drug-related alternatives to prison in Belgium over a ten years' period since 2005. METHODS The applied drug-related alternatives to prison ('probation', 'conditional release', 'mediation in criminal cases', 'community service' and 'electronic monitoring') were subject to a secondary data analysis of the database of the Houses of Justice. RESULTS Men, the age group of 16-24 years old and Belgians are most sentenced to alternatives to prison. Nevertheless, 38% of women are guided towards 'probation' while 8% is 'mediated in criminal cases' compared to 30% and 5% of males respectively (p < .001). 26% of non-Belgians are involved in 'conditional release' and 'electronic monitoring' compared to 22% and 16% among Belgians (p < .001) respectively. With regards to age, 21% of the offenders older than 24 years are involved in 'electronic monitoring' compared to 6% among the offenders younger than 25 years (p < .001). CONCLUSIONS The results highlight differences in punishment judgments by age, gender and nationality that continues to be indicative for perceived threat, danger and culpability of the offenders.
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Affiliation(s)
- Els Plettinckx
- Epidemiology and Public Health, Life Style and Chronic Diseases, Sciensano, Juliette Wytsmanstraat 14, Brussels 1050, Belgium.
| | - Jérôme Antoine
- Epidemiology and Public Health, Life Style and Chronic Diseases, Sciensano, Juliette Wytsmanstraat 14, Brussels 1050, Belgium
| | - Lies Gremeaux
- Epidemiology and Public Health, Life Style and Chronic Diseases, Sciensano, Juliette Wytsmanstraat 14, Brussels 1050, Belgium
| | - Herman Van Oyen
- Epidemiology and Public Health, Life Style and Chronic Diseases, Sciensano, Juliette Wytsmanstraat 14, Brussels 1050, Belgium; Department of Public Health, Ghent University, St. Pietersnieuwstraat 33, Ghent 9000, Belgium
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Bogaert P, van Oers H, Van Oyen H. Towards a sustainable EU health information system infrastructure: A consensus driven approach. Health Policy 2018; 122:1340-1347. [PMID: 30360999 DOI: 10.1016/j.healthpol.2018.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/19/2018] [Accepted: 10/09/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Health information in the EU is characterised by diversity and fragmentation of health information infrastructures. A well-defined and sustainable EU health information system infrastructure is lacking. The potential of a European Research Infrastructure Consortium on Health Information for Research and Evidence-based Policy (HIREP-ERIC) to take up this role is investigated. METHODS Two working groups, a BRIDGE Health Steering Committee and the European Commission's Drafting Group of the Expert Group on Health Information, discussed the technical and scientific description of the HIREP-ERIC through a consensus-driven modified Delphi technique. RESULTS Consensus was reached on three aspects of the HIREP-ERIC. First, it was defined as an infrastructure that facilitates interaction of networks and experts in health information by providing central governance and a more permanent collaboration. Second, the infrastructure should be distributed, with a central hub coordinating the operation of distributed networks. Third, it should provide easy access to high quality and comparable data for purposes of research and policy making, and focus its activities around generating, managing, exchanging and translating health information. CONCLUSION A momentum has been created where representatives from 16 European countries agreed on the HIREP-ERIC as a pragmatic bottom-up approach to strengthen the current EU health information landscape. A Member States' commitment is needed at senior political level to make this consensus operational.
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Affiliation(s)
- Petronille Bogaert
- Epidemiology and Public Health, Sciensano, Belgium; Tilburg University, the Netherlands.
| | - Hans van Oers
- Tilburg University, the Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Herman Van Oyen
- Epidemiology and Public Health, Sciensano, Belgium; Department of Public Health, Ghent University, Belgium
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Bogaert P, Van Oyen H, Beluche I, Cambois E, Robine JM. The use of the global activity limitation Indicator and healthy life years by member states and the European Commission. ACTA ACUST UNITED AC 2018; 76:30. [PMID: 29988309 PMCID: PMC6022353 DOI: 10.1186/s13690-018-0279-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 06/07/2018] [Indexed: 11/10/2022]
Abstract
Background In 2005, the European Union (EU) started to use a disability-free life expectancy, known as Healthy Life Years (HLY), to monitor progress in the strategic European policies such as the 2000 Lisbon strategy. HLY are based on the underlying measure: the Global Activity Limitation Indicator (GALI). Twelve years after its implementation, this study aims to assess its current use in EU Member States and the European Commission. Methods In March 2017, a questionnaire was sent to 28 Member states and the European Commission. The questionnaire inquired how the GALI and HLY are used to set policy targets, in which surveys the GALI has been introduced since 2005, how the GALI and HLY are presented, and what the capacity in each country is to investigate the GALI and HLY. Results The survey was answered by 22 Member States and by the Commission. HLY are often used to set targets and develop strategies in health such as national health plans. Analysis of HLY has even led to policy change. In some countries, HLY have become the main indicator for health, gaining more importance than life expectancy. More recently, the GALI and HLY have also been used for policy targets outside the health sector such as in the area of pension and retirement age or in the context of sustainable development. Regarding surveys, the GALI is mostly obtained from the EU-SILC, SHARE and EHIS, but is also increasingly introduced in national surveys. National health reporting systems usually present HLY on their national statistics websites. Most countries have up to three specialists working on the GALI and HLY, which has been consistent through time. Others have increased their capacity over various institutions. Conclusion HLY is an indicator that is systematically used to monitor health developments in most EU countries. The SHARE, EU-SILC and EHIS are commonly used to assess HLY through the GALI. The results are then described in reports and presented on national statistics websites and used in different policy settings. Expertise to analyse the GALI and HLY is available in most countries. Electronic supplementary material The online version of this article (10.1186/s13690-018-0279-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Petronille Bogaert
- Department of Public Health and Surveillance, Epidemiology and public health, Sciensano, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.,2Tilburg University, Tilburg, The Netherlands
| | - Herman Van Oyen
- Department of Public Health and Surveillance, Epidemiology and public health, Sciensano, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.,3Ghent University, Ghent, Belgium
| | - Isabelle Beluche
- 5French Institute of Health and Medical Research (INSERM), Paris, France
| | | | - Jean-Marie Robine
- 5French Institute of Health and Medical Research (INSERM), Paris, France.,6École Pratique des Hautes Études, Paris, France
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Van der Heyden J, De Bacquer D, Gisle L, Demarest S, Charafeddine R, Drieskens S, Tafforeau J, Van Oyen H, Van Herck K. Additional weighting for education affects estimates from a National Health Interview Survey. Eur J Public Health 2018; 27:892-897. [PMID: 28204447 DOI: 10.1093/eurpub/ckx005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background National Health Interview Surveys are used to produce country-wide results for a substantial number of health indicators. However, if some educational groups are underrepresented in the sample, estimates may be biased. This study investigated the impact of the use of post-stratification weights that adjust for the population distribution by education on estimates from the Belgian Health Interview Survey 2013. Methods For 25 health-related indicators that match the European Core Health Indicator shortlist, estimates were computed using two different sets of post-stratification weights: one based on age group, gender and province only and the other one including also education. The Census 2011 was used as auxiliary data source. Statistical differences between the two estimates were assessed with the Delta method. Results If education is not included as post-stratification weighting factor, low educational groups (ISCED 0-2) represent 31.1% of the total study population aged 25 years and older. If education is taken into account this proportion rises to 40.3%. The use of post-stratification weights adjusting for the population distribution by education has an impact on several survey estimates. The most pronounced effect is an increase in the estimated proportion of people with diabetes (+0.73%; 95% CI 0.19-1.27; relative increase +11.6%), asthma (+0.52%; 95% CI, 0.06-0.98; relative increase +12.4%) and difficulties to cover their health expenses (+2.31%; 95% CI, 1.52-3.10; relative increase +9.4%). Conclusions Including education in the calculation of post-stratification weights reduces bias due to educational differences in survey participation. Auxiliary information used to calculate post-stratification weights for national health surveys should include education.
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Affiliation(s)
- Johan Van der Heyden
- Department of Public Health and Surveillance Brussels, Scientific Institute of Public Health, Belgium.,Department of Public Health Ghent, University Ghent, Belgium
| | - Dirk De Bacquer
- Department of Public Health Ghent, University Ghent, Belgium
| | - Lydia Gisle
- Department of Public Health and Surveillance Brussels, Scientific Institute of Public Health, Belgium
| | - Stefaan Demarest
- Department of Public Health and Surveillance Brussels, Scientific Institute of Public Health, Belgium
| | - Rana Charafeddine
- Department of Public Health and Surveillance Brussels, Scientific Institute of Public Health, Belgium
| | - Sabine Drieskens
- Department of Public Health and Surveillance Brussels, Scientific Institute of Public Health, Belgium
| | - Jean Tafforeau
- Department of Public Health and Surveillance Brussels, Scientific Institute of Public Health, Belgium
| | - Herman Van Oyen
- Department of Public Health and Surveillance Brussels, Scientific Institute of Public Health, Belgium.,Department of Public Health Ghent, University Ghent, Belgium
| | - Koen Van Herck
- Department of Public Health Ghent, University Ghent, Belgium
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46
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Van Oyen H, Bogaert P, Yokota RTC, Berger N. Measuring disability: a systematic review of the validity and reliability of the Global Activity Limitations Indicator (GALI). ACTA ACUST UNITED AC 2018; 76:25. [PMID: 29881544 PMCID: PMC5985596 DOI: 10.1186/s13690-018-0270-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/09/2018] [Indexed: 12/03/2022]
Abstract
Background GALI or Global Activity Limitation Indicator is a global survey instrument measuring participation restriction. GALI is the measure underlying the European indicator Healthy Life Years (HLY). Gali has a substantial policy use within the EU and its Member States. The objective of current paper is to bring together what is known from published manuscripts on the validity and the reliability of GALI. Methods Following the PRISMA guidelines, two search strategies (PUBMED, Google Scholar) were combined to identify manuscripts published in English with publication date 2000 or beyond. Articles were classified as reliability studies, concurrent or predictive validity studies, in national or international populations. Results Four cross-sectional studies (of which 2 international) studied how GALI relates to other health measures (concurrent validity). A dose-response effect by GALI severity level on the association with the other health status measures was observed in the national studies. The 2 international studies (SHARE, EHIS) concluded that the odds of reporting participation restriction was higher in subjects with self-reported or observed functional limitations. In SHARE, the size of the Odds Ratio’s (ORs) in the different countries was homogeneous, while in EHIS the size of the ORs varied more strongly. For the predictive validity, subjects were followed over time (4 studies of which one international). GALI proved, both in national and international data, to be a consistent predictor of future health outcomes both in terms of mortality and health care expenditure. As predictors of mortality, the two distinct health concepts, self-rated health and GALI, acted independently and complementary of each other. The one reliability study identified reported a sufficient reliability of GALI. Conclusion GALI as inclusive one question instrument fits all conceptual characteristics specified for a global measure on participation restriction. In none of the studies, included in the review, there was evidence of a failing validity. The review shows that GALI has a good and sufficient concurrent and predictive validity, and reliability.
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Affiliation(s)
- Herman Van Oyen
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium.,2Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Petronille Bogaert
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Renata T C Yokota
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium.,3Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Nicolas Berger
- 4Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Moyersoen I, Lachat C, Cuypers K, Ridder KD, Devleesschauwer B, Tafforeau J, Vandevijvere S, Vansteenland M, De Meulenaer B, Van Camp J, Van Oyen H. Do Current Fortification and Supplementation Programs Assure Adequate Intake of Fat-Soluble Vitamins in Belgian Infants, Toddlers, Pregnant Women, and Lactating Women? Nutrients 2018; 10:E223. [PMID: 29462926 PMCID: PMC5852799 DOI: 10.3390/nu10020223] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/04/2018] [Accepted: 02/04/2018] [Indexed: 12/24/2022] Open
Abstract
Abstracts: Adequate intakes of fat-soluble vitamins are essential to support the growth and development of the foetus, the neonate, and the young child. By means of an online self-administered frequency questionnaire, this study aimed to evaluate the intake of vitamins A, D, E, and K in Belgian infants (n = 455), toddlers (n = 265), pregnant women (n = 161), and lactating women (n = 165). The contribution of foods, fortified foods, and supplements on the total intake was quantified. 5% of toddlers, 16% of pregnant women, and 35% of lactating women had an inadequate vitamin A intake. Conversely, excessive vitamin A intakes were associated with consumption of liver (products). Furthermore, 22% of infants were at risk for inadequate vitamin D intake due to the lack of prophylaxis, while consumption of highly dosed supplements posed a risk for excessive intakes in 6%-26% of infants. Vitamin D intake in pregnant women and lactating women was inadequate (median of 51%, respectively, 60% of the adequate intake). In all groups, the risk for inadequate intake of vitamin E and K was low. Contribution of fortified foods to vitamin A, D, E, and K intake was minor, except in toddlers. National fortification strategies should be investigated as an alternative or additional strategy to prevent vitamin D and A deficiency. There is a need to revise and set uniform supplement recommendations. Finally, non-users of vitamin D prophylaxis need to be identified for targeted treatment.
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Affiliation(s)
- Isabelle Moyersoen
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.
- Department of Food Safety and Food Quality, Ghent University, Coupure Links 653, 9000 Ghent, Belgium.
| | - Carl Lachat
- Department of Food Safety and Food Quality, Ghent University, Coupure Links 653, 9000 Ghent, Belgium.
| | - Koenraad Cuypers
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.
| | - Karin De Ridder
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.
| | - Brecht Devleesschauwer
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.
| | - Jean Tafforeau
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.
| | - Stefanie Vandevijvere
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.
| | - Margot Vansteenland
- Department of Food Safety and Food Quality, Ghent University, Coupure Links 653, 9000 Ghent, Belgium.
| | - Bruno De Meulenaer
- Department of Food Safety and Food Quality, Ghent University, Coupure Links 653, 9000 Ghent, Belgium.
| | - John Van Camp
- Department of Food Safety and Food Quality, Ghent University, Coupure Links 653, 9000 Ghent, Belgium.
| | - Herman Van Oyen
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.
- Department of Public Health, Ghent University, De Pintelaan 185, 9000 Gent, Belgium.
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48
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Cambois E, Grobon S, Van Oyen H, Robine JM. Impact of Question Wording on the Measurement of Activity Limitation: Evidence From a Randomized Test in France. J Aging Health 2018; 28:1315-38. [PMID: 27590804 DOI: 10.1177/0898264316656504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The Global Activity Limitation Indicator (GALI), a single question measuring disability, had been introduced in various European surveys since 2004. The complexity of its wording has been questioned. Our study compares alternative variants aiming to simplify the wording. METHOD We used the Health-Related Opinion Survey run in 2014 in France (N = 3,009). Its split sample design allows testing four variants of the questions. We analyzed the prevalence of activity limitation (AL) resulting from the four different constructs of the GALI using multinomial logistic regressions, adjusted for background variables and functional limitations (FLs). RESULTS The alternative GALI variants result in significantly different prevalences compared with the original question, in particular for people with FL. The current variant is more inclusive than the routed variants. DISCUSSION Our study suggests limited benefits of changing the GALI construct which do not outweigh the costs of breaking the established chronological series of the current variant.
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Affiliation(s)
| | - Sébastien Grobon
- Direction de la recherche de l'évaluation, des études et des statistiques, Ministry of health (DREES), France
| | - Herman Van Oyen
- Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Jean-Marie Robine
- Institut National de la Santé et de la Recherche Médicale (INSERM), Ecole Pratique des Hautes Etudes (EPHE) and Institut National d'Etudes Démographiques (INED), France
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49
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Van den Eynden J, Descamps T, Delporte E, Roosens NHC, De Keersmaecker SCJ, De Wit V, Vermeesch JR, Goetghebeur E, Tafforeau J, Demarest S, Van den Bulcke M, Van Oyen H. The genetic structure of the Belgian population. Hum Genomics 2018; 12:6. [PMID: 29394955 PMCID: PMC5796395 DOI: 10.1186/s40246-018-0136-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/23/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND National and international efforts like the 1000 Genomes Project are leading to increasing insights in the genetic structure of populations worldwide. Variation between different populations necessitates access to population-based genetic reference datasets. These data, which are important not only in clinical settings but also to potentiate future transitions towards a more personalized public health approach, are currently not available for the Belgian population. RESULTS To obtain a representative genetic dataset of the Belgian population, participants in the 2013 National Health Interview Survey (NHIS) were invited to donate saliva samples for DNA analysis. DNA was isolated and single nucleotide polymorphisms (SNPs) were determined using a genome-wide SNP array of around 300,000 sites, resulting in a high-quality dataset of 189 samples that was used for further analysis. A principal component analysis demonstrated the typical European genetic constitution of the Belgian population, as compared to other continents. Within Europe, the Belgian population could be clearly distinguished from other European populations. Furthermore, obvious signs from recent migration were found, mainly from Southern Europe and Africa, corresponding with migration trends from the past decades. Within Belgium, a small north-west to south-east gradient in genetic variability was noted, with differences between Flanders and Wallonia. CONCLUSIONS This is the first study on the genetic structure of the Belgian population and its regional variation. The Belgian genetic structure mirrors its geographic location in Europe with regional differences and clear signs of recent migration.
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Affiliation(s)
- Jimmy Van den Eynden
- Scientific Institute of Public Health, Brussels, Belgium.
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Tine Descamps
- Scientific Institute of Public Health, Brussels, Belgium
| | - Els Delporte
- Scientific Institute of Public Health, Brussels, Belgium
| | | | | | - Vanessa De Wit
- Scientific Institute of Public Health, Brussels, Belgium
| | - Joris Robert Vermeesch
- Laboratory of Cytogenetics and Genome Research, Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Els Goetghebeur
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Jean Tafforeau
- Scientific Institute of Public Health, Brussels, Belgium
| | | | | | - Herman Van Oyen
- Scientific Institute of Public Health, Brussels, Belgium.
- Department of Public Health, Ghent University, Ghent, Belgium.
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50
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Ost C, De Ridder KAA, Tafforeau J, Van Oyen H. The added value of food frequency questionnaire (FFQ) information to estimate the usual food intake based on repeated 24-hour recalls. ACTA ACUST UNITED AC 2017; 75:46. [PMID: 29093816 PMCID: PMC5662101 DOI: 10.1186/s13690-017-0214-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 07/03/2017] [Indexed: 12/02/2022]
Abstract
Background Statistical methods to model the usual dietary intake of foods in a population generally ignore the additional information on the never-consumers. The objective of this study is to determine the added value of Food Frequency Questionnaire (FFQ) data allowing distinguishing the never-consumers from the non-consumers while modeling the usual intake distribution. Methods Three food items with a different proportion of never-consumers were selected from the database of the Belgian food consumption survey of 2004 (N = 3200). The usual intake distribution for these food items was modeled with the Statistical Program for Analysis of Dietary Exposure (SPADE) and modeling parameters were extracted. These parameters were used to simulate (a) a new database with two 24-h recalls per respondent and (b) a “true” usual intake distribution. The usual intake distribution from the new database was obtained by modeling the 24-h recalls with SPADE, once without and once with the inclusion of the FFQ data on the never-consumers. Ratios were calculated for the different percentiles of the usual intake distribution: the modeled usual intake (g/day) (for both SPADE with and without the inclusion of FFQ data on never-consumers) was divided by the corresponding percentile of the simulated “true” usual intake (g/day). The closer the ratio is to one, the better the model fits the data. Results Inclusion of the FFQ information to identify the never-consumers did not improve the estimation of the higher percentiles of the usual intake distribution. However, taking into account this FFQ information improved the estimation of the lower percentiles of the usual intake distribution even when the proportion of never-consumers was low. Conclusions The inclusion of FFQ information to identify the never-consumers is beneficial when interested in the whole usual intake distribution or in the lower percentiles only, no matter how low the proportion of never-consumers for that food item may be. However, when interest is only in the higher percentiles of the usual intake distribution, inclusion of FFQ information to identify the never-consumers will have no benefit. Electronic supplementary material The online version of this article (doi:10.1186/s13690-017-0214-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cloë Ost
- Department of Public Health and Surveillance, Unit Surveys, Lifestyle and Chronic Diseases, Scientific Institute of Public Health, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Karin A A De Ridder
- Department of Public Health and Surveillance, Unit Surveys, Lifestyle and Chronic Diseases, Scientific Institute of Public Health, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Jean Tafforeau
- Department of Public Health and Surveillance, Unit Surveys, Lifestyle and Chronic Diseases, Scientific Institute of Public Health, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Herman Van Oyen
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.,Department of Public Health, Ghent University, Ghent, Belgium
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