Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 11 3 2025 09 15 255 267 EN Rajesh Karki Yeti Health Science Academy, Kathmandu, Nepal Mausam Adhikari Department of Public Health, Yeti Health Science Academy, Purbanchal University, Maharajgunj, Kathmandu, Nepal Roshani Poudel Central Department of Public Health, Institute of Medicine (IOM), Tribhuvan University Maheshor Kaphle Department of Public Health, Peoples Dental College and Hospital, Tribhuvan University 2025 01 13 2025 10 20 Introduction: The unmet need for family planning remains a hurdle to reproductive health equity despite, global efforts to improve access, including in Nepal. This study aimed to assess the prevalence of unmet needs for family planning and associated factors among rural women in Nepal. Methods: In 2023, a cross-sectional study was conducted among married women of reproductive age in a rural municipality in Gandaki Province, Nepal. We recruited 310 participants using consecutive sampling. Data were collected through face-to- face interviews using a structured questionnaire developed from previous literature, validated by experts, and pretested. Descriptive analysis was conducted for categorical variables, and multivariate logistic regression analysis was performed to identify factors associated with unmet needs. Results: The mean age of the respondents was 28.5 ± 5.75 years (range: 17–45 years), and the mean age at marriage was 21.07 ± 3.32 years (range: 14–34 years). More than 80% of the respondents reported having good family planning knowledge, with healthcare workers being the primary source of information (74.8%). The unmet need for family planning was 18.1% (spacing: 16.5%; limiting: 1.6%). The odds of unmet need were higher in Dalit women (AOR 6.66, 95% CI: 1.98–22.40) and women without children (AOR 2.78, 95% CI 1.09–7.13). Conversely, women with a basic education or below (AOR 0.14, 95% CI: 0.03–0.71) and those with husbands who are engaged in business (AOR 0.32, 95% CI 0.12–0.83) had lower odds. Conclusion: This study highlights the significant unmet need for family planning among rural women in Nepal, particularly among adolescents, Dalit women, and those without children. Therefore, targeted interventions are required to address these disparities. Continued efforts should focus on improving family planning access in the study area and similar rural settings, although the findings may not be generalizable to the entire country. https://jbe.tums.ac.ir/index.php/jbe/article/view/1570

Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 11 3 0202 05 06 268 281 EN Maryam Shakiba Guilan University of medical sciences Arsalan Salari Cardiovascular Diseases Research Center, Guilan University of medical sciences Sima Masudi Urmia University of Medical sciences Salman Nikfarjam Cardiovascular Diseases Research Center, Guilan University of medical sciences marjan mahdavi Roshan Cardiovascular Diseases Research Center, Guilan University of medical sciences elnaz abhari Cardiovascular Diseases Research Center, Guilan University of medical sciences yasaman borgheie Cardiovascular Diseases Research Center, Guilan University of medical sciences 2025 02 10 2025 05 18 Introduction: The aim of this study was to explore latent classes of risk factors among patients with acute coronary syndrome. Methods: A cross-sectional study was performed on patients with symptoms of chest pain, unstable angina, or myocardial infarction who had at least one coronary vascular involvement confirmed by angiography. A latent class analysis (LCA) using five categorical risk factors, including metabolic syndrome, physical activity, tobacco use, alcohol, and opium consumption, was conducted on 380 eligible patients. A logistic regression model was used to explore the associations of demographic and clinical variables with latent classes. Results: The mean age of the patients was 59.05 years (SD= 9.82). A two-class model showed the best fit; Class I (45.1%) was characterized by a high probability of smoking, alcohol, and opium consumption, and Class II was characterized by a high probability of metabolic syndrome (54.9%). There was a significant difference between the two classes in terms of age, sex, job, and educational status. The multiple logistic regression model revealed that age and sex were independent predictors of latent class membership. Conclusion: This study revealed two distinct latent risk factor patterns among ACS patients emphasizing the need for personalized prevention approaches. Behavioral interventions should be prioritized in younger patients. While, sex-specific metabolic syndrome management strategies should be underscored in older patients. https://jbe.tums.ac.ir/index.php/jbe/article/view/1601

Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 11 3 2026 05 06 282 289 Azadeh Naderi Department of biostatistics and epidemiology, Tehran University of medical sciences, Tehran, Iran Abbas Rahimi Foroushani Department of biostatistics and epidemiology, Tehran university of medical sciences, Tehran, Iran Ali Moghadas Jafari Farhikhtegan hospital, Azad university of medical sciences, Tehran, Iran Mohammed Ibrahim Mohialdeen Gubari Community medicine, College of medicine, University of Sulaimani, Sulaimani, Iraq Mostafa Hosseini Department of biostatistics and epidemiology, Tehran university of medical sciences, Tehran, Iran 2024 08 16 2025 10 20 Introduction: Childbirth plays a crucial role in population growth and maternal health. In recent decades, many nations, including Iran, have experienced declining birth rates. Since childbirth is a recurrent event in a parent's life, it is useful to analyze it through the lens of recurrent event analysis. This methodological framework, commonly employed in biomedicine, allows for a nuanced examination of the relationship between multiple childbirth experiences and the potential for cured subjects. This study explores childbirth rates in Hamadan province. Methods: A total of 633 mothers who gave birth to their first child in 2012 at Fatemiyeh Hospital in Hamadan participated in this retrospective cohort study. Both mixture cure frailty models and simple frailty models were fitted. The analyses were conducted using the RSTAN package in RStudio version 26.2.4. Results: In this study, we analyzed the childbearing patterns of couples and found that the majority (60.6%) had two children. Additionally, we discovered that 49% of mothers and 55.9% of fathers had education levels below a diploma. The Kaplan-Meier (KM) curves indicated a cure pattern for families with three or more children, revealing that only 10.6% of individuals had three children, and a mere 0.8% had four. Furthermore, results from a mixture cure frailty model demonstrated that maternal education plays a crucial role in influencing childbirth probabilities. Conclusion: Based on the findings of this study, we recommend utilizing mixture cure frailty models rather than simple frailty models when the dataset contains individuals who are cured. https://jbe.tums.ac.ir/index.php/jbe/article/view/1484

Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 11 3 2026 05 06 290 307 Ronald Pratama Adiwinoto Department of Public Health, School of Medicine, Universitas Hang Tuah Saptono Putro School of Medicine, Universitas Hang Tuah Tamam Jauhar Department of Pharmacology, School of Medicine, Universitas Hang Tuah Kellyn Tricia Zenjaya Undergraduate Study Program, School of Medicine, Universitas Hang Tuah Dinnara Nelya Rindayu Undergraduate Study Program, School of Medicine, Universitas Hang Tuah Lidya Prillyarista Herlambang Undergraduate Study Program, School of Medicine, Universitas Hang Tuah I Made Dwi Mertha Adnyana Department of Indonesian Traditional Medicine, School of Health, Universitas Hindu Indonesia; Indonesian Society of Epidemiologists; Royal Society of Tropical Medicine and Hygiene 2025 01 26 2025 10 14 Introduction: Adherence to hypertension medication remains a critical challenge in healthcare management, particularly in resource-limited settings. This study investigated the determinants of medication adherence among patients with hypertension in Indonesian primary healthcare settings. Methods: A cross-sectional study involving 96 hypertensive patients selected through systematic random sampling was conducted at the Public Health Center of Tenggilis, Surabaya. Data were collected via validated questionnaires, including the Morisky Medication Adherence Scale-8 (MMAS-8), and analyzed via multivariate logistic regression. Results: Among the 96 hypertensive patients included in this study, the majority were aged 40–49 years (30.2%), with a male predominance (67.7%). Most participants had a senior high school education (57.3%) and were employed as civil servants (30.2%). Only 52.1% of patients reported consistent medication adherence, with financial barriers and knowledge gaps identified as the primary challenges. Multivariate logistic regression analysis revealed that regular medical control (odds ratio [OR] = 1.963, 95% CI 1.214-3.181; p = 0.006) and alternative diagnostic methods (OR = 2.326, 95% CI 1.532- 3.538, p<0.001) were significantly associated with better medication adherence. Adherence to doctors' advice (OR = 1.699, 95% CI 1.128–2.559, p = 0.012), the ability to manage medication costs (OR = 1.518, 95% CI 1.012–2.278, p = 0.044), and routine treatment management (OR = 1.825, 95% CI 1.219–2.736, p = 0.004) were identified as key predictors of positive medication adherence. Conclusion: Medication adherence in patients with hypertension is influenced by multiple factors, including diagnostic approach, healthcare access, cost management, and routine treatment compliance. These findings emphasize the need for comprehensive interventions that address both clinical and socioeconomic barriers to improve hypertension management in primary healthcare settings. https://jbe.tums.ac.ir/index.php/jbe/article/view/1585

Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 11 3 2026 05 06 308 324 Sahana S Madras Christian College Kumarapandiyan G Madras Christian College 2025 02 12 2025 05 13 Introduction: Clinical diagnosis highlights the essential need to assess biomarker performance for effective disease screening and diagnosis. The Receiver Operating Characteristic (ROC) curve serves as a fundamental tool for assessing and interpreting biomarker effectiveness. Numerous models and techniques have been developed to analyze biomarkers in binary classification settings (Non-Diseased vs. Diseased). This research article seeks to expand the binary classification framework to a three-class scenario, incorporating Diseased, Suspicious, and Non-Diseased categories under a Log-Normal distribution. Methods: It introduces a three-class Log-Normal ROC model based on a Parametric approach, deriving metrics such as Volume Under the ROC Surface (VUS) and Asymptotic Variance, as well as an alternative Non-Parametric approach. The model was validated using simulated data generated for the underlying distribution, and a real-life dataset was used to fit the VUS and ROC curves. Results: The simulation study was conducted using four sets with varying parameters. In the fourth set, the Non-Parametric VUS (0.9966) exceeded the Parametric VUS (0.8058), though the difference was smaller compared to the other sets. The low Standard Error (SE) (0.0472) across all sets indicates high precision in the estimates. Additionally, for the real-life (The multiple sclerosis (ms) disease) dataset the VUS value is 0.6782 which gives moderate fit of the model. Conclusion: In this study, we derived the asymptotic variance and VUS for the Log-Normal distribution using simulated data with varying parameters. The analysis compares diagnostic performance across parameter sets, highlighting the superiority of Non-Parametric VUS over Parametric VUS. Set 4 demonstrated the highest reliability with the lowest standard error (SE = 0.0472). The real-life MS dataset provided a moderate fit to the proposed model. https://jbe.tums.ac.ir/index.php/jbe/article/view/1607

Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 11 3 2026 05 06 325 334 Yousef Alimohamadi Mojtaba Sepandi Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran Esmaeil Samadipour Health Research Center, Life style institute, Baqiyatallah University of Medical Sciences, Tehran, Iran Sima Afrashteh Department of Epidemiology and Biostatistics, School of Public health, Bushehr University of Medical Sciences, Bushehr, Iran 2025 02 16 2025 09 23 Introduction: The incidence and prevalence of cardiovascular disease (CVD) have increased in Iran, considering the importance of documenting and generating information about the risk of CVD in the military community, the current study aimed to measure the prevalence of risk CVD factors as well as predict the 10-year risk of CVD among the Iranian military personnel. The FRS items include age, gender, total cholesterol, high density lipoprotein cholesterol (HDL-C), systolic blood pressure, status of diabetes and smoking. Methods: This cross-sectional study was conducted on 1025 male military personnel in 2022. For comparative analysis, ANOVA or t-test, as well as the Chi-square (or Fisher's exact) test was used. All statistical analyses were conducted using SPSS 22 software. The statistical significance level was set at 0.05. Results: The prevalence of hypertension was 2.3 % and increased with age. The prevalence of overweight and obesity increased with age and was 54.7% as well as 14.1%, respectively, in those 40- 45 years of age. Diabetes affected 6.2% of the oldest group and 8.2% of participants aged 40–45 years. TC was increased in one-third of understudied cases. The percentage of abnormal LDL-C was 57.5%. These results were accompanied by increased TG in 34.6%, low HDL-C in 36.4%, and FPG >100 mg/dl in 13.2% of subjects. Out of a total of 608 participants over 30 years of old, a low FRS (<10%) was calculated for 571 (93.9%), the others, were classified as moderate (5.6%) and high (0.5%) risk. The prevalence of hypertension among the high and moderate FRS risk group was higher than low-risk group older persons have a higher 10- year CVD risk level (p < 0.001). The level of, blood pressure, FPG, LDL, TC, and TG, in the high-risk group, was significantly higher than in the two other groups (P=0.001). Conclusion: Although a high proportion of military personnel had a low risk of CVD in the next 10 years, the high prevalence of overweight and other risk factors such as LDL level needs special attention. https://jbe.tums.ac.ir/index.php/jbe/article/view/1614

Tehran University of Medical Sciences Journal of Biostatistics and Epits with a New Generalized Exponentiated Expo- nential Distribution 484 499 Ibrahim Sule Ahmadu Bello University, Zaria Kolawole Ismail 1Department of Mathematics and Statistics, School of Applied Sciences, Kaduna Polytechnic, Kaduna, Nigeria Olalekan Bello Department of Statistics, Faculty of Physical Sciences, Ahmadu Bello University, Zaria, Nigeria 2024 01 17 2024 04 28 Many experts in the field of distribution theory have focused on extending probability distributions utilizing extended families of continuous distributions to improve the modeling adaptability of the conventional probability distributions. This study introduced a brand-new, five-parameter generalized exponentiated exponential distribution, which is a continuous probability distribution. With the aid of the quantile function, moments, moment generating function, survival function, hazard function, mean, and median, among other mathematical and statistical aspects, the new distribution's shape was deduced and researched. It was also possible to derive the probability density function for the minimum and maximum order statistics for this distribution. The method of maximum likelihood estimate was used to produce a conventional estimation of the unknown parameters. A simulation study was carried out to assess the efficiency and consistency of the estimation method used. To evaluate the fit and adaptability of the new model, it was applied to four real-world datasets in the field of medicine. The analysis's findings demonstrated that the new model performs better than its counterparts and offers a better fit than the Topp-Leone exponentiated exponential (TLEtEx), Topp-Leone Kumaraswamy exponential (TLKEx), exponentiated exponential (EtEx), and exponential (Ex) distributions. https://jbe.tums.ac.ir/index.php/jbe/article/view/1372

Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 9 4 2023 12 15 500 515 EN Faezeh Ramezanzadeh Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Saharnaz Nedjat Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Kamal Azam Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Mehdi Yaseri Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2024 07 21 2024 07 30 Introduction: Determining socio-economic status (SES) can greatly help decision makers in the field of social health. Because SES can play an important role in accessing medical services or welfare amenities. We aimed to determine SES using Principal Component Analysis (PCA), Multiple Correspondence Analysis (MCA) and Factor Analysis of Mixed Data (FAMD) methods. Methods & Materials: In this cross-sectional study (2023), 4448 employees aged 19 to 75 years were included to the study from Tehran University of Medical Sciences employees` cohort (TEC). Demographic variables and socio-economic factors were considered. Considering the weaknesses of PCA and MCA methods, we calculated the SES score using PCA, MCA and FAMD methods, and the percentile of people was determined. These weaknesses include normality assumption and considering only linear relationship for PCA, inability to interpret the relationships between variables and considering each level of classification variables as a new variable for MCA Results: We studied 4448 people (39.3% men) with a mean age of 42.3 and a standard deviation of 8.7. The correlation between the percentiles obtained through PCA, MCA and FAMD methods was very high, and the highest correlation was related to the percentiles obtained through PCA and FAMD methods with a value of 0.994. The intraclass correlation coefficient value was 0.996. Also, this value was 0.996 and 0.994 in the random samples of 250 and 100 individuals from the original data, respectively. Conclusion: All of the three methods worked similarly on determining the SES and calculating the percentile of people. PCA and FAMD methods had better agreement than others. Therefore