Epidemiology最新文献

Disaggregating health differences and disparities with machine learning and observed-to-expected ratios: Application to major lower limb amputation. 用机器学习和观察到的预期比率分解健康差异和差异：在下肢主要截肢中的应用。

IF 4.7 2区医学

Epidemiology Pub Date : 2025-07-09 DOI: 10.1097/EDE.0000000000001892

Paula D Strassle, Samantha D Minc, Corey A Kalbaugh, Macarius M Donneyong, Jamie S Ko, Katharine L McGinigle

{"title":"Disaggregating health differences and disparities with machine learning and observed-to-expected ratios: Application to major lower limb amputation.","authors":"Paula D Strassle, Samantha D Minc, Corey A Kalbaugh, Macarius M Donneyong, Jamie S Ko, Katharine L McGinigle","doi":"10.1097/EDE.0000000000001892","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001892","url":null,"abstract":"Background: Major lower limb amputation is a devastating but preventable complication of peripheral artery disease. It is unclear whether racial and ethnic and rural differences in amputation rates are due to clinical, hospital, or structural factors.Methods: We included all peripheral artery disease hospitalizations of patients ≥40 years old between 2017-2019 in Florida, Georgia, Maryland, Mississippi, or New York (HCUP State Inpatient Databases). We estimated the expected number of amputations using three models: 1) unadjusted, 2) adjusted for clinical factors, and 3) adjusted for clinical factors, hospital factors, and social determinants of health) using LASSO. We calculated and compared observed-to-expected ratios and quantified the role of these factors in amputation rates.Results: Overall, 1,577,061 hospitalizations (990,152 unique patients) and 21,233 major lower limb amputations (1.4%) were included. After accounting for clinical differences, we observed amputation disparities among rural Black, Hispanic, Native American, and White patients and non-rural Black and Native American patients. After accounting for hospital factors and social determinants of health, disparities were no longer present among rural White adults (0.93, 95% CI 0.77-1.09); however, disparities persisted among rural Black (1.26, 95% CI 1.01-1.51), Hispanic (1.50, 95% CI 0.89-2.12), and Native American patients (1.13, 95% CI 0.68-1.58) and non-rural Black (1.12, 95% CI 1.09-1.15) and Native American (1.15, 95% CI 0.86-1.44) patients.Conclusions: Clinical factors did not fully explain differences in amputation rates, and hospital factors and social determinants did not fully explain disparities. These findings provide additional evidence that implicit bias is associated with amputation disparities.","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Generalizing and Transporting Causal Inferences from Randomized Trials in the Presence of Trial Engagement Effects. 在试验参与效应的存在下，从随机试验中归纳和传递因果推论。

IF 4.7 2区医学

Epidemiology Pub Date : 2025-07-01 Epub Date: 2025-04-23 DOI: 10.1097/EDE.0000000000001863

Lawson Ung, Tyler J VanderWeele, Issa J Dahabreh

{"title":"Generalizing and Transporting Causal Inferences from Randomized Trials in the Presence of Trial Engagement Effects.","authors":"Lawson Ung, Tyler J VanderWeele, Issa J Dahabreh","doi":"10.1097/EDE.0000000000001863","DOIUrl":"10.1097/EDE.0000000000001863","url":null,"abstract":"Trial engagement effects are effects of trial participation on the outcome that are not mediated by treatment assignment. Most work on extending (generalizing or transporting) causal inferences from a randomized trial to a target population has, explicitly or implicitly, assumed that trial engagement effects are absent, allowing evidence about the effects of the treatments examined in trials to be applied to nonexperimental settings. Here, we define novel causal estimands and present identification results for generalizability and transportability analyses in the presence of trial engagement effects. Our approach allows for trial engagement effects under assumptions of no causal interaction between trial participation and treatment assignment on the absolute or relative scales. We show that under these assumptions, even in the presence of trial engagement effects, the trial data can be combined with covariate data from the target population to identify average treatment effects in the context of usual care as implemented in the target population (i.e., outside the experimental setting). The identifying observed data functionals under these no-interaction assumptions are the same as those obtained under the stronger identifiability conditions that have been invoked in prior work. Therefore, our results suggest a new interpretation for previously proposed generalizability and transportability estimators. This interpretation may be useful in analyses under causal structures where background knowledge suggests that trial engagement effects are present but interactions between trial participation and treatment are negligible.","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"500-510"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Liacine Bouaoun, Winner of the 2025 Rothman Prize. Liacine Bouaoun， 2025年罗斯曼奖得主。

IF 4.7 2区医学

Epidemiology Pub Date : 2025-07-01 Epub Date: 2025-05-29 DOI: 10.1097/EDE.0000000000001870

引用次数: 0

Modeling Time-varying Dispersion to Improve Estimation of the Short-term Health Effect of Environmental Exposure in a Time-series Design. 在时间序列设计中建立时变离散度模型以改进对环境暴露的短期健康影响的估计。

IF 4.7 2区医学

Epidemiology Pub Date : 2025-07-01 Epub Date: 2025-03-31 DOI: 10.1097/EDE.0000000000001856

Danlu Zhang, Stefanie T Ebelt, Noah C Scovronick, Howard H Chang

{"title":"Modeling Time-varying Dispersion to Improve Estimation of the Short-term Health Effect of Environmental Exposure in a Time-series Design.","authors":"Danlu Zhang, Stefanie T Ebelt, Noah C Scovronick, Howard H Chang","doi":"10.1097/EDE.0000000000001856","DOIUrl":"10.1097/EDE.0000000000001856","url":null,"abstract":"Background: Time-series models for count outcomes are routinely used to estimate short-term health effects of environmental exposures. The dispersion parameter is universally assumed to be constant over the study period.Objective: The aim is to examine whether dispersion depends on time-varying covariates in a case study of emergency department visits in Atlanta during 1999-2009 and to evaluate approaches for addressing time-varying dispersion.Methods: Using the double generalized linear model framework, we jointly modeled the Poisson log-linear mean and dispersion to estimate associations between emergency department visits for respiratory diseases and daily ozone concentrations. We conducted a simulation study to evaluate the impact of time-varying overdispersion on health effect estimation when constant overdispersion is assumed and developed an analytic code for implementing double generalized linear model using R.Results: We found dispersion to depend on calendar date and meteorology. Assuming constant dispersion, the relative risk (RR) per interquartile range increase in 3-day moving ozone exposure was 1.037 (95% confidence interval: 1.024, 1.050). In the multivariable dispersion model, the RR was reduced to 1.029 (95% confidence interval: 1.020, 1.039), but with a large (26%) reduction in log RR standard error. The positive associations for ozone were robust against different dispersion model specifications. Simulation study results also demonstrated that when time-varying dispersion is present, it can lead to a larger standard error assuming constant dispersion.Conclusion: When the outcome exhibits large dispersion in a time-series analysis, allowing for covariate-dependent time-varying dispersion can improve inference, particularly by increasing estimation precision.","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"450-457"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Abortion Ratios After First-trimester Exposure to Teratogenic Medication in People with Disabilities. 残疾人妊娠早期接触致畸药物后的流产率。

IF 4.7 2区医学

Epidemiology Pub Date : 2025-07-01 Epub Date: 2025-03-24 DOI: 10.1097/EDE.0000000000001851

Andi Camden, Isobel Sharpe, Hong Lu, Hilary K Brown

引用次数: 0

Effects of Prenatal Exposure to PM 2.5 Chemical Components on Adverse Birth Outcomes and Under-5 Mortality in South Korea. 韩国产前暴露于PM2.5化学成分对不良出生结局和5岁以下儿童死亡率的影响

IF 4.7 2区医学

Epidemiology Pub Date : 2025-07-01 Epub Date: 2025-04-21 DOI: 10.1097/EDE.0000000000001868

Garam Byun, Yongsoo Choi, Jong-Tae Lee, Michelle L Bell

{"title":"Effects of Prenatal Exposure to PM 2.5 Chemical Components on Adverse Birth Outcomes and Under-5 Mortality in South Korea.","authors":"Garam Byun, Yongsoo Choi, Jong-Tae Lee, Michelle L Bell","doi":"10.1097/EDE.0000000000001868","DOIUrl":"10.1097/EDE.0000000000001868","url":null,"abstract":"Background: Exposure to fine particulate matter (PM 2.5 ) during pregnancy has been associated with adverse birth outcomes. However, limited evidence exists on the effects of specific PM 2.5 components. We investigated the association of prenatal exposure to PM 2.5 and its components with birth outcomes and mortality at age <5 years in four metropolitan cities in South Korea.Methods: We obtained data from Statistic Korea linking birth records for 2013-2015 to death records under age 5 years. Data for PM 2.5 and 10 of its components were collected from four monitoring stations. We calculated exposures during pregnancy and each trimester for a total of 324,566 births. We used logistic regression to estimate the associations between exposure and risk of preterm birth (PTB) (<37 weeks), low birth weight (<2.5 kg), small for gestational age (birth weight <10 th percentile for the same gestational age), and under-5 mortality.Results: An interquartile range (8.7 µg/m 3 ) increase in exposure to PM 2.5 during the entire pregnancy was associated with increased odds of PTB (odds ratio [OR] = 1.17; 95% confidence interval [CI] = 1.11, 1.23). We observed no association with low birth weight, small for gestational age, or under-5 mortality for the entire pregnancy exposure. Elemental carbon and secondary inorganic aerosols showed higher effect estimates for PTB than did other components.Conclusions: In urban populations of South Korea, exposure to PM 2.5 during pregnancy was associated with an increased risk of PTB. Different components showed varying associations with adverse birth outcomes.","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"531-540"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12118620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Re: Don't Let Your Analysis Go to Seed: On the Impact of Random Seed on Machine Learning-based Causal Inference. 回复：不要让你的分析变成种子：关于随机种子对基于机器学习的因果推理的影响。

IF 4.7 2区医学

Epidemiology Pub Date : 2025-07-01 Epub Date: 2025-05-29 DOI: 10.1097/EDE.0000000000001860

Nicholas T Williams, Anton Hung, Kara E Rudolph

引用次数: 0

Erratum: Using Limited Trial Evidence to Credibly Choose Treatment Dosage when Efficacy and Adverse Effects Weakly Increase with Dose. 勘误：当疗效和不良反应随剂量增加而减弱时，利用有限的试验证据选择可靠的治疗剂量。

IF 4.7 2区医学

Epidemiology Pub Date : 2025-07-01 Epub Date: 2025-02-25 DOI: 10.1097/EDE.0000000000001842

Charles F Manski

引用次数: 0

Nicotine-Cannabis Transitions and Nicotine Abstinence Among United States Adults. 美国成年人的尼古丁-大麻过渡和尼古丁戒断。

IF 4.7 2区医学

Epidemiology Pub Date : 2025-07-01 Epub Date: 2025-03-31 DOI: 10.1097/EDE.0000000000001855

Dae-Hee Han, Adam M Leventhal, Andrew C Stokes, Janet E Audrain-McGovern, Sandrah P Eckel, Jessica Liu, Alyssa F Harlow

{"title":"Nicotine-Cannabis Transitions and Nicotine Abstinence Among United States Adults.","authors":"Dae-Hee Han, Adam M Leventhal, Andrew C Stokes, Janet E Audrain-McGovern, Sandrah P Eckel, Jessica Liu, Alyssa F Harlow","doi":"10.1097/EDE.0000000000001855","DOIUrl":"10.1097/EDE.0000000000001855","url":null,"abstract":"Background: Prior studies examining the association of cannabis use with nicotine abstinence did not distinguish between individuals co-using nicotine and cannabis versus those who switched from nicotine to exclusive cannabis use; these may have different effects on nicotine abstinence. We examined associations of cannabis use uptake with subsequent nicotine abstinence approximately 1 year later among adults using cigarettes and/or e-cigarettes.Methods: Using six waves of the Population Assessment of Tobacco and Health Study (2013-2021), we assessed transitions from exclusive nicotine use prebaseline (time t ) to (1) exclusive cannabis use, (2) nicotine-cannabis co-use, (3) nonuse of both nicotine and cannabis, and (4) continued exclusive nicotine use at baseline ( t + 1) as exposure variables. Analyses examined associations with nicotine abstinence (from both cigarettes and e-cigarettes) at 1-year follow-up ( t + 2).Results: Among 8382 adults (19,618 observations) reporting exclusive nicotine use prebaseline, 1% transitioned to exclusive cannabis use, 9% to nicotine-cannabis co-use, and 9% to nonuse of both drugs; 81% were still using nicotine exclusively at baseline. Transition to nicotine-cannabis co-use (6%) versus exclusive nicotine use (10%) was inversely associated with nicotine abstinence at follow-up (adjusted relative risk [aRR] = 0.68; 95% confidence interval [CI] = 0.55, 0.83). Transition to exclusive cannabis use (72%) was positively associated with nicotine abstinence compared with continued exclusive nicotine use (10%; aRR = 4.66; 95% CI = 3.83, 5.67) and with similar nicotine abstinence at follow-up (72%) compared with nonuse of both drugs (65%; aRR=0.98; 95% CI = 0.81, 1.18).Conclusion: Co-use of nicotine and cannabis was associated with lower nicotine abstinence. Switching to exclusive cannabis use was associated with similar or greater nicotine abstinence.","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"551-559"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Quantifying the Health Burden of COVID-19 Using Individual Estimates of Years of Life Lost Based on Population-wide Administrative Level Data. 利用基于全人口行政层面数据的个人寿命损失年数估计数，量化COVID-19的健康负担。

IF 4.7 2区医学

Epidemiology Pub Date : 2025-07-01 Epub Date: 2025-04-09 DOI: 10.1097/EDE.0000000000001854

Elena Milkovska, Bram Wouterse, Jawa Issa, Pieter van Baal

{"title":"Quantifying the Health Burden of COVID-19 Using Individual Estimates of Years of Life Lost Based on Population-wide Administrative Level Data.","authors":"Elena Milkovska, Bram Wouterse, Jawa Issa, Pieter van Baal","doi":"10.1097/EDE.0000000000001854","DOIUrl":"10.1097/EDE.0000000000001854","url":null,"abstract":"Background: The coronavirus disease 2019 (COVID-19) pandemic caused substantial health losses but not much is known about how these are distributed across the population. We aimed to estimate the distribution of years of life lost (YLL) due to COVID-19 and investigate its variation across the Dutch population, taking into account preexisting differences in health.Methods: We used linked administrative data covering the entire 50+ Dutch population over 2012-2018 (n = 6,102,334) to estimate counterfactual individual-level life expectancy for those who died from COVID-19 in 2020 and 2021. We estimated survival models and used Cox-LASSO and Cox-Elastic Net to perform variable selection among the large set of potential predictors in our data. Using individual-level life expectancy predictions, we generated the distribution of YLL due to COVID-19 for the entire 50+ population by age and income.Results: On average, we estimate that individuals who died of COVID-19 had a counterfactual life expectancy about 28% lower than that of the rest of the population. Within this average, there was substantial heterogeneity, with 20% of all individuals who died of COVID-19 having an estimated life expectancy exceeding that of the age-specific population average. Both the richest and poorest COVID-19 decedents lost the same average number of YLL, which were similarly dispersed.Conclusion: Accounting for preexisting health problems is crucial when estimating YLL due to COVID-19. While average life expectancy among COVID-19 decedents was substantially lower than for the rest of the population, the popular notion that only the frail died from COVID-19 is not true.","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"520-530"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12118614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0