Nuclear power plants (NPPs) are a major source of electricity in the United States, yet concerns persist regarding potential health effects of chronic low-level radiation exposure among nearby populations. Evidence on population-level mortality impacts remains limited. To evaluate the association between long-term exposure to NPPs and all-cause mortality across U.S. counties from 2000 to 2018. A proximity-based exposure was calculated as the sum of inverse distances from each county’s population centroid to all active nuclear power plants within 200 km for each year and averaged over a 20-year moving window to account for latency. Using aggregated county-level data in an ecological framework across the United States, associations between nuclear power plant proximity and age- and sex-specific all-cause mortality were estimated using Poisson regression models within a generalized estimating equations (GEE) framework, adjusted for county-level covariates. Positive associations between NPP proximity and all-cause mortality were concentrated in middle- and older-age groups. The largest effect estimates were observed among females aged 55–64 (β = 0.834, 95
Cardiovascular diseases (CVD) remain a leading cause of death, with diet as a key modifiable risk factor. While prospective cohort studies using food frequency questionnaires (FFQs) underpin dietary guidelines, FFQs are prone to measurement errors that typically attenuate true associations. Characterizing the degree of error through validation is essential to properly interpret and adjust observed diet-disease relationships. It remains unclear whether FFQ validation evidence adequately supports the specific dietary exposures analyzed in recent CVD research. Therefore, this meta-research study aimed to evaluate this gap by examining discrepancies between validated dietary factors and those used in association analyses. A systematic search of multiple databases identified cohort studies published between 2019 and 2024 using keywords related to cohort studies, CVDs, and FFQs (PROSPERO: CRD42024589050). The proportion of cohorts with discrepancies was examined, defined as cases in which the dietary variables examined in association analyses lacked direct validation in the referenced FFQ validation paper. A total of 298 cohort studies from over 50 countries were included, with 88.3
This study aims to estimate the effects of vitamin D supplementation on cardiovascular diseases in populations with different baseline vitamin D distributions, by emulating the VITAL and D-Health trials within the UK Biobank. We emulated randomized trials using subcohorts of the UK Biobank selected to match the inclusion criteria of the VITAL and D-Health trials (n = 237,502 and 185,809, respectively). Exposures were defined as increases in serum 25-hydroxyvitamin-D concentrations of 30 nmol/L and 38 nmol/L, corresponding to the intervention effects in the trials. Outcomes included cardiovascular mortality, myocardial infarction, ischemic stroke, and major adverse cardiovascular events. Expected hazard ratios over trial median follow-up durations of 5.3 and 5.7 years were estimated using Cox proportional hazards models. Vitamin D insufficiency was more common in the UK Biobank than in the original trials. When participants were weighted to match the trial baseline 25-hydroxyvitamin-D distributions, the expected effects became more similar to the largely null findings reported in the original trials. By contrast, among individuals with vitamin D insufficiency or deficiency, increases in 25-hydroxyvitamin-D concentration as achieved in the trials were associated with significantly lower risks of cardiovascular outcomes, except ischemic stroke. For cardiovascular mortality, hazard ratios ranged from 0.74 (95
Lung cancer is a major global health issue, especially among men. While smoking and occupational or environmental exposures are known risks, the role of benzene remains under investigation. We aimed to conduct a systematic review and meta-analysis to evaluate the association between occupational benzene exposure and lung cancer incidence and mortality. We included cohort and case–control studies mentioned in the 2018 IARC Monograph on benzene and performed a systematic literature review to identify studies published up to 2024 by using PubMed, SCOPUS, and EMBASE databases. We constructed forest plots of relative risk (RR) to visualize and analyze the data. A random-effects model was used to address heterogeneity between studies. Stratified analyses were conducted to explore effect modification. We included 44 independent studies in our meta-analysis. The findings didn’t reveal an association between total occupational benzene exposure and lung cancer overall (RR = 1.00, 95
Although antihypertensive treatment reduces stroke risk, it remains unclear whether advances in hypertension management have translated into equitable stroke prevention at the population level. We quantified realized stroke prevention attributable to antihypertensive treatment in adults aged 30–79 years across 198 countries from 1990 to 2019. In this population-level modelling analysis, we integrated country-, sex-, age-, and year-specific estimates of hypertension prevalence and treatment coverage with stroke incidence data to derive the prevented fraction for the population (PFP), defined as the proportion of strokes averted under observed treatment patterns relative to a no-treatment counterfactual. We compared PFP across sex, age, and World Bank income groups and summarized temporal trends using average annual percentage change and age-period-cohort analyses. From 1990 to 2019, median PFP increased globally from 8.8
Participation in exercise-based cardiac rehabilitation (ExCR) lowers hospitalisation risk in people with coronary heart disease. We investigated whether improvements in health-related quality of life (HRQoL), including physical and mental dimensions, mediated the effect of ExCR on hospitalisation risk in people with coronary heart disease. Individual participant data from five randomised controlled trials were pooled, which randomized participants to ExCR or usual care. All trials had to be published since 2010 to reflect contemporary medicine. A one-stage meta-analysis was performed to assess whether changes in HRQoL, including physical and mental dimensions, mediated the effect of ExCR on all-cause and cardiovascular disease (CVD)-related hospitalisation risk. HRQoL was assessed before and directly following the intervention period, and preceded hospitalisation assessments at 1- and 2-year follow-up. Compared to controls (n = 1,986), ExCR (n = 1,973) did not reduce 1-year, but significantly reduced 2-year all-cause (hazard ratio [HR] 0.72, 95
The global flourishing study is a longitudinal panel study designed to advance research on human flourishing across culturally and geographically diverse contexts. wave 1 included more than 200,000 adults from 21 countries and one territory, recruited to be approximately nationally representative of adult (18 +) populations. The initial cohort profile detailed the wave 1 sampling design and implementation. In this cohort profile update, we describe major developments since the original profile was published, including a mid-year retention survey, completion of wave 2 data collection, and inclusion of mainland China data. We summarize attrition patterns across countries, methodological refinements, and potential research applications. These include high variation in retention rates across countries, ranging from 90
The theoretical link between intergenerational social mobility and mental health has long been explored in the social sciences. Declining social mobility in high-income countries alongside rising mental health concerns have reignited interest in this research area. Sweden, while experiencing similar trends, remains a country known for its high social mobility. To investigate the relationship between social mobility and mental health, we used psychotropic drug dispensation as a proxy for mental health problems. We analyzed survey and register data of a 1953 Stockholm cohort (n = 11,199), followed up for psychotropic drug dispensation between ages 52–66. We measure social mobility using parental income at ages 10 and 17 and adult income between ages 37–48. Using diagonal reference models, we analyzed the association between income mobility and psychotropic drug use, stratified by gender. Adjustments were made for growing up in a single-parent household, cognitive ability, social skills, marital status, and previous hospitalization. An income gradient in psychotropic drug dispensation for the stable income group was observed, with a more pronounced pattern among men than women. Net of social origin and destination, income mobility was related to psychotropic drug dispensation among men, but not women. Downward mobility increased, while upward mobility decreased the probability of dispensing psychotropic drugs among men (0.046, p = 0.029 vs. − 0.047, p < 0.020). These results remained robust after adjustments (0.048, p = 0.010 vs. − 0.044, p < 0.017). Our findings suggest that income mobility is associated with middle-aged men’s use of psychotropic drugs. Further research is needed to confirm these results in different contexts and age groups.
Early detection of glaucoma prevents blindness but its low population-based prevalence impedes cost-effective screening. We investigated whether genetic pre-screening could increase the prior probability. Design, methods, and primary analysis were pre-specified and published previously. In this prospective study, we invited 1829 participants aged 55 + from the Dutch Lifelines cohort, selecting from either the highest or lowest 20
Education is a well-established determinant of lifespan and mortality risk. Individuals with lower education levels experience higher mortality from nearly all causes. Yet since everyone ultimately dies from some condition, how does education affect the causes of death? We show that the distribution of causes of death is remarkably similar across education levels in both Denmark and the United States. Despite notable differences in age at death between education groups, the underlying and contributing conditions leading to death remain consistent across education levels. These findings indicate that education mainly influences when people die, not what they die from.
Loneliness is increasingly recognized as a global public health concern, yet cross-national evidence remains limited. Using data from the 2023–2024 Gallup World Poll, this study provides a globally representative description of loneliness across 148 countries (N = 218,048). Over one in five adults reported feeling lonely, with prevalence highest in low-income countries and Sub-Saharan Africa. Multivariate analyses identified several predictors of lower loneliness, such as better health, higher education, larger household size, and employment, though their associations varied by context. Loneliness was also associated with lower subjective well-being, more frequent negative emotions, and stronger migration intentions. These patterns were most pronounced in high-income and more developed regions, where loneliness appeared more psychologically burdensome despite lower prevalence. Overall, the findings highlight loneliness as a universal but context-sensitive experience, suggesting the need for policies that consider both structural and psychosocial factors to promote social connection and emotional well-being worldwide.
Previous studies suggest an increased risk of new-onset type 2 diabetes (T2D) following SARS-CoV-2 infection, which may be subject to detection bias from increased health care contacts among the infected. We aimed to assess the causal effect of SARS-CoV-2 infection on new-onset T2D using a test-negative design and negative control outcomes. We included all individuals aged ≥ 18 years registered in Sweden on 1 February 2020 without prior T2D who ordered a SARS-CoV-2 test through the Swedish healthcare service between 1 February 2020 and 28 February 2022 (N = 3,175,958). A test-negative design was applied, matching infected individuals with up to five controls based on birth year, sex, region, vaccination status, and test date. Cox proportional hazards models estimated hazard ratios (HR) and 95
Bone mineral density (BMD) measured by DXA remains the clinical standard for diagnosing osteoporosis, but fails to capture the heterogeneity of skeletal fragility, particularly in patients with chronic diseases. We hereby describe the design of the EraSmus medIcal CeNTer skEletal fRagility (SINTER) Study, which integrates polygenic scores for BMD (PGSBMD) with a multidimensional phenotyping approach in diverse outpatient clinics, as a methodological framework for musculoskeletal research. The study aims at assessing the additional value of combining genetic information with comprehensive musculoskeletal phenotyping to better elucidate the mechanisms of skeletal fragility in chronic conditions. SINTER is an observational, cross-sectional Recall-by-Genotype (RbG) study drawn in two stages: (1) genotyping 5,650 patients from nine internal medicine clinics; (2) recalling 1,500 patients from the extremes of the PGSBMD distribution for multidimensional musculoskeletal phenotyping together with 400 patients with a rare condition (mastocytosis). Phenotyping includes imaging (DXA, EOSEdge, pQCT), macro- and tissue-level skeletal properties (ultrasound, reference point indentation), functional assessments (mechanography, handgrip), lifestyle and systemic exposures (diet, physical activity), and patient perceptions obtained via in-depth interview and questionnaires. The study design is unique in combining a RbG framework with multidimensional phenotyping in outpatient clinics, enabling systematic evaluation of genetic and disease-specific contributors to skeletal fragility. SINTER provides a methodological template for RbG designs with particular emphasis on musculoskeletal clinical research.
The Transformative Research on Equity And Social determinants to Uplift Resilience and Empower LGBTQ+ Health in China (TREASURE) is the first large-scale cohort study designed to investigate health conditions and social determinants of health among the LGBTQ+ population in China. The TREASURE cohort study was developed in close collaboration with community-based organizations, ensuring culturally appropriate study procedures and improved inclusion of hard-to-reach populations. Participants were recruited through co-created, multi-channel strategies, including on-site recruitment, community outreach, WeChat advertising, and social network referrals. Eligible participants were individuals aged 16 years and older, who self-identified as LGBTQ+ and resided in Chengdu or had primary LGBTQ+ social activities in the area. From August 2023 to November 2025, 10,093 participants enrolled in the baseline investigation from Chengdu City and surrounding areas including cisgender gay men (47.9
Weighted Quantile Sum (WQS) regression is a statistical method for quantifying the association between multiple possibly correlated predictors and a health outcome, estimating both the joint effect of the predictors as well as their individual contributions to the total effect. WQS has become one of the most popular and widely used approaches for investigating complex mixtures in environmental epidemiology, yet its implementation has been largely restricted to R users. In this paper we present wqsreg, the first Stata command for WQS regression, implemented for continuous, binary and count outcomes. We describe command’s architecture and present an application of the command on exposome data exploring the association between 38 exposures and a continuous outcome. Wqsreg provides a user-friendly command for WQS regression that integrates several flexible components of the framework such as bootstrap, training/validation splitting, and repeated holdout procedures. Wqsreg returns regression estimates as well as graphical displays of the individual weights. It requires Stata version 11 or higher and is freely available on GitHub [ https://github.com/PonzanoMarta/wqsreg ]. Given the increasing importance of appropriately exploring complex multidimensional exposures, this contribution will further promote the use of appropriate statistical methods in epidemiological settings with multiple correlated predictors.
Pancreatic cancer incidence is rising, yet few modifiable risk factors have been identified. The Mediterranean diet, which lowers inflammation and improves healthy weight maintenance and insulin control, may lower pancreatic cancer risk, yet the evidence for this association is inconsistent. To investigate the association, we conducted a pooled analysis of 2,315,406 individuals from 23 prospective cohorts in the Pooling Project of Prospective Studies of Diet and Cancer (DCPP), of whom 10,748 developed incident pancreatic cancer over a mean follow-up duration ranging from 8.1 to 23.3 years across studies. Adherence to the Mediterranean diet was assessed using the alternative Mediterranean diet score (aMED) and a modified score excluding alcohol (maMED). Study- and sex-specific hazard ratios (HRs) and 95
The Coronavirus Diseases (COVID-19) pandemic led to excess mortality in many countries, i.e., to more deaths than expected. Older individuals generally had higher absolute risks of excess death. The complex dynamics of infection, vaccination and excess mortality have not yet been captured in one comprehensive model. With nationwide and unselected data from Statistics Netherlands, we analyzed the impact of documented infection and vaccination on excess mortality during 2020 and 2021 in the Dutch population aged over 63 on 1 January 2020 (n = 3,826,770) by incorporating relative survival into a multi-state model considering COVID-19 (re)infection, vaccination and death. Background mortality was based on the observed mortality in 2015–2019 per sex, age and month of the year. All analyses were performed for the total cohort as well as stratified per sex and age category. The absolute excess mortality in 2020–2021 was 0.34
The National Danish Injury Cohort (NDIC) is a nationwide, register-based cohort established to examine the incidence of total and specific injuries in Denmark and to provide insights into causes and consequences. Comprehensive individual-level information for this cohort is stored in the NDIC dataset, serving as a foundation for analyses of injury determinants and supporting the planning and evaluation of preventive measures aimed at reducing injury-related harm. Individuals registered in the Danish National Patient Register with an injury from 2010 onwards are included in the dataset. Additionally, it comprises persons in the Cause of Death Register whose deaths was attributed to accidents, violence, or suicide. The cohort is currently updated through 2022 and contains information on more than 7.2 million primary injury contacts and 26 thousand accident-related deaths. Analyses based on NDIC demonstrated substantial demographic and geographical disparities in the incidence rates of injuries. Overall, men exhibited higher rates of both injury incidents and injury‑related mortality compared with women. Marked differences were observed when stratifying by sex and age, as well as by region of residence. NDIC offers a solid data foundation facilitating research into injury trends, causes, and impacts, including disparities across social groups and geographic areas. It presents unique opportunities to explore novel research ideas to boost injury prevention, improve targeting of interventions, and reduce health inequalities. Strengthening this research area will help further reinforce NDIC’s role in injury surveillance and evidence‑based policymaking.
