Epidemiology最新文献

{"title":"Can the All of Us Sample be Reweighted to Mirror a Nationally Representative Sample? A Comparison of Mortality Predictors.","authors":"Jingxuan Wang, Peter Buto, Erin L Ferguson, Ruijia Chen, Anna Pederson, Minhyuk Choi, Audrey R Murchland, Sarah F Ackley, Deborah Blacker, Eleanor Hayes-Larson, Elizabeth Rose Mayeda, M Maria Glymour","doi":"10.1097/EDE.0000000000002016","DOIUrl":"10.1097/EDE.0000000000002016","url":null,"abstract":"<p><strong>Background: </strong>Participants in the All of Us (AoU) research study differ from the US population in myriad characteristics, limiting the generalizability of findings. A statistical reweighting tool to improve generalizability would enhance the scientific value of the data.</p><p><strong>Methods: </strong>To account for differences between AoU and the nationally representative 1999-2018 National Health and Nutrition Examination Survey (NHANES), we generated selection weights using four models incorporating sociodemographic, self-reported health, and clinical characteristics. We assessed covariate balance and compared predictors of all-cause mortality in weighted AoU to NHANES using the ratio of hazard ratios (RHRs), where an RHR of one indicates unbiased estimates in (weighted) AoU relative to NHANES.</p><p><strong>Results: </strong>Weighting improved balance on measured variables between AoU and NHANES. Among the four weighting models, the most complex model, which included sociodemographic, health, and clinical variables and their interactions, achieved HRs in AoU most similar to those in NHANES. For example, the RHR for hypertension for unweighted AoU vs. NHANES (RHR = 1.5; 95% confidence interval [CI] = 1.4, 1.7) was reduced to 1.2 (95% CI = 0.9, 1.5) after applying weights from the clinical-interaction model. Even in this model, 17 of 35 HRs evaluated diverged by >20% (RHR <0.8 or >1.2) between weighted AoU and NHANES.</p><p><strong>Conclusions: </strong>Predictors of mortality in AoU differ from those in the US population both in their distribution and in their associations with mortality. Reweighting can mitigate selection bias, but no model we tested comprehensively achieved generalizability.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"854-866"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316456","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}

{"title":"Toward a Clearer Definition of the Per-protocol Effect.","authors":"Haidong Lu, Buket Öztürk Esen, Rachael K Ross","doi":"10.1097/EDE.0000000000002035","DOIUrl":"10.1097/EDE.0000000000002035","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"893-896"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701084","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}

{"title":"Timothy J. Wade, 1967-2026.","authors":"Andrey I Egorov, John M Colford","doi":"10.1097/EDE.0000000000002026","DOIUrl":"https://doi.org/10.1097/EDE.0000000000002026","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":"37 6","pages":"725-726"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149059563","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}

{"title":"Long-term Effect of the Medicaid Expansion Program on Cancer Mortality by US Region, Gender, and Race/Ethnicity.","authors":"Mina Habib, Roshan Bastani, Beth Glenn, Zuo-Feng Zhang, Roch A Nianogo","doi":"10.1097/EDE.0000000000002030","DOIUrl":"10.1097/EDE.0000000000002030","url":null,"abstract":"<p><strong>Background: </strong>Cancer remains the second leading cause of death in the United States, with persistent racial/ethnic and socioeconomic disparities. Expanding healthcare access is a key strategy for addressing these inequities. We considered Medicaid expansion as a natural experiment to assess whether broader access is associated with changes in cancer mortality overall and by US region, gender, and race/ethnicity.</p><p><strong>Methods: </strong>Using 2005-2019 state-level data from the U.S. Census, CDC WONDER, Kaiser Family Foundation, and America's Health Rankings, we compared age-adjusted cancer mortality (per 100,000 adults aged 25-64) between 27 expansion and 24 nonexpansion states. We applied a person-time weighted generalized synthetic control method, adjusting for demographic, socioeconomic, and healthcare access variables. This improves robustness to violations of the parallel trends assumption that may have limited prior analyses.</p><p><strong>Results: </strong>Expansion was associated with an overall reduction in cancer mortality (mean difference [MD]: -2.06; 95% confidence interval [CI]: -4.24 to 0.11). Subgroup analyses revealed reductions in cancer mortality among women (MD: -3.02; 95% CI: -5.28 to -0.77), non-Hispanic Whites (MD: -2.27; 95% CI: -4.15 to -0.38), and Northeastern states (MD: -4.46; 95% CI: -7.40 to -0.89).</p><p><strong>Conclusion: </strong>Findings suggest Medicaid expansion had a heterogeneous impact on cancer mortality. While reductions were evident overall, particularly among White individuals, women, and those in the Northeast, imprecise estimates limited evidence of benefit for racial/ethnic minorities, men, and other regions, where disparities are more pronounced. This may also reflect inequities in healthcare access, quality, utilization, and risk factor distribution (e.g., smoking). Future research should assess long-term impacts across broader outcomes and populations.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"747-755"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591000","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}

{"title":"Temporal Connectivity of Social Contact Networks in Urban and Rural India.","authors":"Dehao Chen, Prasanna Samuel, Rajan Srinivasan, Adrien Le Guillou, Venkata Raghava Mohan, Saad B Omer, Benjamin A Lopman, Samuel M Jenness","doi":"10.1097/EDE.0000000000002019","DOIUrl":"10.1097/EDE.0000000000002019","url":null,"abstract":"<p><strong>Background: </strong>The epidemic potential of infectious diseases depends on how contacts connect individuals over time-a form of temporal connectivity that has rarely been quantified in resource-poor settings. We used the forward-reachable path (FRP)-the proportion of population reachable from an index person via direct or indirect connections-to quantify temporal connectivity in contact networks relevant for acute respiratory transmission.</p><p><strong>Methods: </strong>From empirical social-contact data collected in rural and urban Tamil Nadu, India, we derived contact-location-specific network statistics. These statistics were used to parameterize dynamic network models, simulate daily networks over 1 year, and compute FRPs.</p><p><strong>Results: </strong>In both rural and urban networks, mean FRPs rose sharply on day 1, then either increased steadily at school and work or plateaued at home and at locations included in the other layer (that is, locations other than home, school, and work). By day 365, mean FRPs followed the order: home (0.06% [rural] and 0.03% [urban]) < school (11.96% [rural] and 9.14% [urban]) < work (12.55% [rural] and 26.72% [urban]) < other (40.54% [rural] and 67.99% [urban]). The mean FRP peaked at home among those aged ≥60 years, at school among those aged 10-19 years, and at work among those aged 40-59 years.</p><p><strong>Conclusions: </strong>Although FRP at home was bounded by household size, reachability expanded substantially through school, work, and other contacts. These findings indicate high temporal connectivity and substantial epidemic potential for acute respiratory transmission in these settings.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"756-764"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396441","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}

{"title":"Nonrandom Selection With and Without Bias Due to Selecting on an Exposure.","authors":"Chanelle J Howe, Han-Chih T Hsieh, Jason R Gantenberg, Arman Oganisian, Charles B Eaton, Haidong Lu","doi":"10.1097/EDE.0000000000002018","DOIUrl":"10.1097/EDE.0000000000002018","url":null,"abstract":"<p><p>Nonrandom selection represents a potential threat to valid estimation of causal effects. However, nonrandom selection does not always lead to bias. Whether bias occurs depends on the causal structure and the estimand. Although settings when nonrandom selection is expected not to result in bias have been discussed in the epidemiologic literature, such settings are underexplored due to the emphasis on when bias will occur rather than when it will not. Identifying when selection bias will not occur can deepen understanding of selection bias, including how to prevent it; can promote more rigorous study design and data analysis; or can aid in responding to peer reviews. Thus, we use motivating examples involving selecting on an exposure level, causal diagrams, and simulations to illustrate scenarios where nonrandom selection is not expected to result in bias. SAS and R code are provided to facilitate reproducibility and more in-depth understanding.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"877-884"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396452","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}

{"title":"Air Pollution Exposure in Infancy and Incidence of Atopic Dermatitis in Preschool-Aged Children.","authors":"Macarena Racciatti, Logan C Dearborn, Joan A Casey, Adam A Szpiro, Kecia N Carroll, Joel D Kaufman, Kaja Z LeWinn, Qi Zhao, Karen Derefinko, Sheela Sathyanarayana, Catherine J Karr, Christine T Loftus","doi":"10.1097/EDE.0000000000002033","DOIUrl":"10.1097/EDE.0000000000002033","url":null,"abstract":"<p><strong>Background: </strong>Atopic dermatitis (AD) is the most common inflammatory skin condition in children, influenced by genetic and environmental factors. The role of air pollution in AD development is understudied, and it is unclear whether early-life air pollution is a target for primary prevention. We aimed to evaluate infancy exposure to fine particulate matter (PM 2.5 ), nitrogen dioxide (NO 2 ), and ozone (O 3 ) and AD at ages 4-6 years and assess modification by child sex or maternal education.</p><p><strong>Methods: </strong>We conducted a pooled, longitudinal cohort study on 1587 children in six US cities in the ECHO-PATHWAYS Consortium (2017-2023). Three AD and eczema outcomes were ascertained using standardized caregiver questionnaires, and outdoor pollutant concentrations in the first year of life were estimated using validated national spatiotemporal models. Multivariable Poisson regression models were used to examine associations between pollutants and outcomes, adjusted for confounders.</p><p><strong>Results: </strong>O 3 was associated with the primary outcomes of current and location-specific AD (adjusted relative risks per 1-ppb increase = 1.07 [95% confidence interval (CI) = 1.01, 1.13] and 1.06 [95% CI = 0.99, 1.13], respectively). No associations were evident for NO 2 or PM 2.5 , and there was little evidence of effect modification by sex. Associations between O 3 and outcomes were evident only in children of mothers with lower educational attainment.</p><p><strong>Conclusions: </strong>If confirmed, this suggests that reducing early-life O 3 exposure could mitigate child health disparities related to AD. Notably, O 3 concentrations were relatively low in this setting, suggesting that current regulatory standards may not adequately protect child health.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"828-836"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148619045","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}

{"title":"Impact of Abortion-limiting Legislation on Preterm and Early Term Birth in Atlanta, Georgia, 2020-2023.","authors":"Stephanie M Eick, Xiaping Zheng, Howard H Chang, Suchitra Chandrasekaran, Anne L Dunlop, Dana E Goin","doi":"10.1097/EDE.0000000000002029","DOIUrl":"10.1097/EDE.0000000000002029","url":null,"abstract":"<p><strong>Background and objectives: </strong>Abortion restrictions, including the United States Supreme Court decision in Dobbs v. Jackson Women's Health Organization , have led to higher rates of adverse pregnancy outcomes and stress among pregnant women. It remains unknown whether the Dobbs decision or subsequent state-level legislation influenced early births. We assessed changes in the weekly number of conceptions and rates of preterm birth (PTB) (<37 weeks) and early term birth (ETB) (37-38 weeks) following the Dobbs decision (leak of draft and official ruling) and Georgia House Bill (HB) 481.</p><p><strong>Methods: </strong>We analyzed deliveries from hospitals affiliated with Emory University between 2020 and 2023. We calculated the weekly number of live-birth weekly pregnancy counts by the first day of gestation, the percentage of preterm and ETBs over time, and estimated hazard ratios (HR) for preterm and ETB in association with three events: leak of the Dobbs draft opinion, the Dobbs official ruling, and HB481 implementation.</p><p><strong>Results: </strong>Following the leak of the Dobbs decision, the number of pregnancy counts declined. Among pregnancies conceived following HB481 implementation, there was an increase in the risk of PTB (HR = 1.16, 95% confidence interval [CI] = 1.03, 1.29) and ETB (HR = 1.05, 95% CI = 0.99, 1.12). Similar patterns were observed following the leak of the Dobbs decision and the official ruling.</p><p><strong>Conclusions: </strong>Among pregnancies conceived post-HB481 implementation, there was an increase in the risk of PTB. These findings suggest that abortion-related legal changes may influence fertility patterns and perinatal outcomes.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"765-772"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590984","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}

{"title":"Everything All at Once: On Choosing an Estimand for Multi-component Environmental Exposures.","authors":"Kara E Rudolph, Shodai Inose, Nicholas T Williams, Iván Díaz, Lucia Calderon, Jacqueline M Torres, Marianthi-Anna Kioumourtzoglou","doi":"10.1097/EDE.0000000000002022","DOIUrl":"10.1097/EDE.0000000000002022","url":null,"abstract":"<p><p>Many research questions-particularly those in environmental health-do not involve binary exposures. In environmental epidemiology, this includes multivariate exposure mixtures with nondiscrete components. Causal inference estimands and estimators to quantify the relationship between an exposure mixture and an outcome are relatively few. We propose an approach to quantify a relationship between a shift in the exposure mixture and the outcome-either in a single timepoint or longitudinal setting. The shift in the exposure mixture can be defined flexibly in terms of shifting one or more components, including examining the interaction between mixture components, and in terms of shifting the same or different amounts across components. The estimand we discuss has a similar interpretation as a main effect regression coefficient. First, we focus on choosing a shift in the exposure mixture supported by observed data. We demonstrate how to assess extrapolation and modify the shift to minimize reliance on extrapolation. Second, we propose estimating the relationship between the exposure mixture shift and outcome completely nonparametrically, using machine learning in model fitting. This is in contrast to other common approaches, which employ parametric modeling for at least some relationships, which we would like to avoid, because parametric modeling assumptions in complex, nonrandomized settings are tenuous at best. We are motivated by longitudinal data on pesticide exposures among participants in the Center for the Health Assessment of Mothers and Children of Salinas Maternal Cognition cohort. We examine the relationship between longitudinal exposure to agricultural pesticides and risk of hypertension. We provide step-by-step code to facilitate the easy replication and adaptation of the proposed approach.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"807-818"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548232","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}

{"title":"Indoor Radon Concentrations and Hematologic Traits in the Women's Health Initiative.","authors":"Cuiran Shi, Jason M Collins, Ayesha Ekanayaka, James D Stewart, Karen N Conneely, David Y Huang, Su Yon Jung, JoAnn E Manson, Gary G Schwartz, A J Silverman, Mara Z Vitolins, Mark R Williamson, Alexander P Reiner, Richard L Smith, Eric A Whitsel","doi":"10.1097/EDE.0000000000002020","DOIUrl":"10.1097/EDE.0000000000002020","url":null,"abstract":"<p><strong>Background: </strong>We examined radon's association with the complete blood count and leukocyte differential to better understand radon-related risks of stroke and myocardial infarction previously observed in the Women's Health Initiative.</p><p><strong>Methods: </strong>We conducted a repeated-measures analysis in this prospective cohort of postmenopausal women enrolled between 1993 and 1998 and examined at 5 visits over 19 years in 40 US clinical centers (n = 154,630). We estimated indoor radon concentrations (pCi/L) at time-varying, geocoded addresses of participants (1993-2013) by linking them to the US Geological Survey Radon Index (1993) zoned by US Environmental Protection Agency Action Levels. We estimated covariate-adjusted, longitudinal associations of radon concentrations with complete blood count components using linear mixed-effects models. In a subset (n = 6,313), we evaluated cross-sectional associations with the complete blood count differential using multivariate compositional data analysis.</p><p><strong>Results: </strong>At 2-4 and >4 pCi/L, adjusted mean (95% confidence interval) leukocytes were 48 (33, 63) and 78 (58, 98) cells/μL lower than at <2 pCi/L, while platelets, hematocrit, and hemoglobin were higher: 315 (-280, 910) and 2,033 (1,248, 2,818) cells/μL; 0.27% (0.24%, 0.30%) and 0.23% (0.19%, 0.27%); and 0.09 (0.08, 0.10) and 0.09 (0.07, 0.10) g/dL. Nonlinear spline models of the Radon Index revealed similar associations. Lymphocyte percentages were lower, and other percentages were higher at higher (>4 pCi/L) versus lower (<2 pCi/L) radon concentrations in nonlinear compositional data analysis.</p><p><strong>Conclusion: </strong>The radon-related cardiovascular implications of these modest, prothrombotic, myeloid shifts in the complete blood count/differential among postmenopausal women in the Women's Health Initiative remain unknown.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"837-847"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13430616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396483","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}