Epidemiology最新文献

{"title":"Nesting a Target Study within a Target Trial: A Framework for Evaluating Intervention Effects on Disparities.","authors":"Xinyi Sun, Theodore J Iwashyna, Emmanuel F Drabo, Deidra C Crews, Kadija Ferryman, John W Jackson","doi":"10.1097/EDE.0000000000002024","DOIUrl":"10.1097/EDE.0000000000002024","url":null,"abstract":"<p><p>We present a novel framework (TS+TT) to nest a target study (TS) within a target trial (TT) for evaluating the effects of interventions on disparities. The TS component grounds the measurement of disparity in ethical assumptions, based on the concept of allowability, and anchors it to an explicit population within calendar time. It specifies an enrollment plan of stratified sampling of eligible persons to yield a sample where social groups are distributionally similar on covariates deemed allowable for measuring disparity. Within this enrolled sample, the TT component specifies randomization of intervention strategies within each social group. Because social groups are similarly situated on allowable covariates at baseline, and because assigned intervention arms are exchangeable within social groups, TS+TT reflects a meaningful causal estimand for evaluating how interventions impact disparity. We describe the framework's key components, its emulation, and demonstrate its application to evaluate how hypothetical interventions on pulse oximeter bias affect disparities in treatment receipt in clinical care. We also extend semiparametric G-computation to accommodate continuous stochastic interventions and estimate counterfactual disparities in time-to-event outcomes. The TS+TT framework offers a versatile and policy-relevant approach for generating ethically informed causal evidence to reduce disparities and avoid exacerbating disparities.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"727-737"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548192","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":"Harvest Now, Decrypt Later: A Case Study in Preparing for the Public Health Risks of New Technologies.","authors":"Sarah F Ackley, Michael D Flanders, Jingxuan Wang","doi":"10.1097/EDE.0000000000002032","DOIUrl":"https://doi.org/10.1097/EDE.0000000000002032","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":"37 6","pages":"848-853"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149059602","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":"Maternal Exposure to Air Pollution and Fetal Growth: Comparison of Three Exposure Modeling Approaches.","authors":"Yana Luo, Ioar Rivas, Maria Foraster, Toni Galmés, Gustavo Arévalo, Lluís Barril, Xavier Basagaña, Mariona Bustamante, Marta Cirach, Alan Domínguez, Michael Jerrett, Mireia Gascon, Jose Lao, Edurne Mazarico, Àlex Morillas, Teresa Moreno, Mark J Nieuwenhuijsen, Cecilia Persavento, Bruno Raimbault, Xavier Querol, Adrià Sentís, Joel Schwartz, Cathryn Tonne, María Dolores Gómez-Roig, Elisa Llurba, Jordi Sunyer, Payam Dadvand","doi":"10.1097/EDE.0000000000002011","DOIUrl":"10.1097/EDE.0000000000002011","url":null,"abstract":"<p><strong>Background: </strong>Maternal air pollution exposure has been associated with impaired fetal growth, yet most studies have overlooked microenvironmental and personal exposures.</p><p><strong>Objectives: </strong>To examine associations between maternal air pollution exposure in key microenvironments (home, workplace, and commuting route) and fetal growth (birth weight and small for gestational age) using three modeling approaches and personal, home-indoor, and home-outdoor monitoring.</p><p><strong>Methods: </strong>We used data from 1024 pregnant women in the Barcelona Life Study Cohort (2018-2021). Exposure to nitrogen dioxide, black carbon, and fine particulate matter (PM 2.5 ) and its metallic constituents (copper, iron, and zinc) in each microenvironment was estimated using land-use regression models, dispersion models, and hybrid land-use regression-dispersion models, and combined with time-activity data to estimate total microenvironment exposures. Personal, home-indoor, and home-outdoor nitrogen dioxide concentrations were measured using passive samplers. Associations with birth weight and small for gestational age were evaluated using linear and logistic mixed-effects models.</p><p><strong>Results: </strong>Higher nitrogen dioxide and black carbon exposure at home and in total microenvironments, estimated by land-use regression, dispersion, and hybrid models, were associated with lower birth weight. Increased black carbon exposure in the workplace (hybrid model) and PM 2.5 exposure both at home (land-use regression model) and in total microenvironments (land-use regression and dispersion models) were also associated with reduced birth weight, as were higher home, workplace, and total microenvironmental exposure to metallic components of PM 2.5 in land-use regression models, although higher workplace PM 2.5 -zinc was associated with higher birth weight in hybrid models. Higher personal and home-outdoor nitrogen dioxide exposure was further associated with reduced birth weight. Similar patterns were observed for small for gestational age.</p><p><strong>Conclusion: </strong>Maternal air pollution exposure was associated with impaired fetal growth. Home-based exposure estimates and short-term nitrogen dioxide measurements may serve as practical exposure proxies during pregnancy.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"819-827"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148014021","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":"Application of the E-value Under Nonproportional Hazards.","authors":"Carmen A T Reep, Evert-Jan Wils, Leo Heunks","doi":"10.1097/EDE.0000000000002017","DOIUrl":"10.1097/EDE.0000000000002017","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"e23-e24"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374905","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":"Reproductive Health in an Era of Cascading Inequity: The \"Double Jeopardy\" of Environmental Stressors and Gaps in the Social Safety Net.","authors":"Samantha Schildroth, Erin Campbell, Mary D Willis","doi":"10.1097/EDE.0000000000002028","DOIUrl":"10.1097/EDE.0000000000002028","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"784-787"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590982","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":"Vaccine Efficacy Against Naturally Asymptomatic Infections: A Novel Estimand for Quantifying Vaccine Effects.","authors":"Elizabeth T Rogawski McQuade, Razieh Nabi, Allison Codi, Natalie Dean, Marc Lipsitch, David Benkeser","doi":"10.1097/EDE.0000000000002021","DOIUrl":"10.1097/EDE.0000000000002021","url":null,"abstract":"<p><p>The naive approach to estimating the effects of a vaccine on asymptomatic infections, which compares the risk of asymptomatic infection among vaccinated and unvaccinated individuals, can be misleading because it comprises two effects: the vaccine preventing asymptomatic infections and the vaccine converting symptomatic to asymptomatic infections. When the latter effect is strong, vaccines can appear harmful with respect to asymptomatic infections. Using a causal principal stratification framework, we formalize an estimand, vaccine efficacy against naturally asymptomatic infection (VE NAI ), that describes the efficacy of a vaccine in preventing asymptomatic infections among individuals who would naturally (i.e., in the absence of vaccine) be expected to be asymptomatic. This estimand excludes vaccine effects that convert symptomatic cases to asymptomatic infections, and we demonstrate how this makes it a more natural analogue of the usual vaccine efficacy estimands against infection and symptomatic disease. We describe the assumptions under which this estimand can be identified and estimated from randomized and observational studies. We further identify and estimate bounds that do not require cross-world independence assumptions and characterize sensitivity analyses around the main assumption needed for identification. Finally, we apply these methods to a randomized trial of the coronavirus disease 2019 mRNA-1273 vaccine. In this trial, VE NAI was higher than standard estimates of efficacy against asymptomatic infections and was similar in magnitude to efficacy against any infection. Reporting VE NAI in vaccine trials in addition to other vaccine effects would improve interpretability and could broaden understanding of vaccine impact on transmission, providing insights into immunological mechanisms.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"867-876"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548264","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":"The Role of Assignment in Defining and Identifying Causal Effects in Randomized Trials.","authors":"Issa J Dahabreh, Lawson Ung, Miguel A Hernán, Yu-Han Chiu","doi":"10.1097/EDE.0000000000002034","DOIUrl":"10.1097/EDE.0000000000002034","url":null,"abstract":"<p><p>In randomized trials, the per-protocol effect is defined as the effect of being assigned a treatment strategy and receiving treatment according to the assigned strategy; therefore, it encompasses the effect of the treatment strategy and any effect of assignment that does not operate through the received treatment. However, the per-protocol effect is sometimes interpreted as reflecting the effect of the treatment strategy itself, regardless of assignment. Here, we argue by example that this is not necessarily the case. We examine causal structures for randomized trials where these two causal estimands - the per-protocol effect and the effect of the treatment strategy - are not equal, and where their corresponding identifying observed data functionals are not the same, but both require information on assignment for identification. Our examples clarify the conceptual difference between these estimands and the conditions that guarantee their equality. Our examples also highlight that in some cases identification of these estimands requires information on assignment, even when assignment is randomized, unless one makes additional assumptions - informally, that assignment does not affect the outcome except through treatment (i.e., an exclusion-restriction assumption), and that assignment is not a confounder of the treatment-outcome association conditional on other variables in the analysis. These assumptions may not be plausible, particularly when the treatment assignment process in the trial differs materially from routine practice in outcome-relevant ways (e.g., \"blinding\" investigators and participants to treatment assignment). Our examination emphasizes the important role of assignment in defining and estimating causal effects in randomized trials, with implications for statistical analysis and the interpretation of trial results.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"885-892"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701032","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":"Revisiting Severe Maternal Morbidity Recurrence: Selection Bias and the Implications for Risk Estimation Across Pregnancies.","authors":"Rashida S Smith-Webb, Martha M Werler, Samantha E Parker, Jennifer Weuve, Collette N Ncube","doi":"10.1097/EDE.0000000000002023","DOIUrl":"10.1097/EDE.0000000000002023","url":null,"abstract":"<p><strong>Background: </strong>Selective attrition may bias estimates of severe maternal morbidity (SMM) recurrence; however, no study has quantified this bias. Using inverse probability (IP) of continuation weights, we examined the bias from selective attrition for the effect of SMM (versus no SMM) at the index delivery on the risk of SMM at the second delivery.</p><p><strong>Methods: </strong>Using data from the Pregnancy to Early Life Longitudinal Data System in Massachusetts, we identified nulliparous individuals aged 12-55 years with singleton, in-hospital deliveries from 1998 to 2021. We followed individuals from their index delivery (N = 571,862) until a second hospital delivery, a competing event, loss to follow-up, or the administrative end of the study (31 December 2021). We applied logistic regression to model attrition from competing events and loss to follow-up and computed IP of continuation weights. Risk differences (RD, per 10,000 in-hospital deliveries) and risk ratios (RR), along with 95% confidence intervals (CIs), were estimated from modified Poisson regression models with identity-link and log-link functions, respectively.</p><p><strong>Results: </strong>In unweighted, multivariable-adjusted analyses, SMM at the index delivery was associated with an increased risk of SMM at the second delivery (RD: 506.1 [95% CI = 379.6, 632.7]; RR: 5.39 [4.37, 6.65]). Weighting to account for attrition resulted in a slight increase (RD: 510.6 [383.0, 638.0]; RR: 5.42 [4.39, 6.68]). Unweighted estimates were biased downward (<1%). Black individuals had the highest rates of SMM recurrence (RD: 1076.6 [624.2, 1528.9]; RR: 6.24 [4.27, 9.13]).</p><p><strong>Conclusion: </strong>Selective attrition had minimal influence on estimates of SMM recurrence in this setting.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"773-783"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548221","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":"Re: \"Survival and Recurrence With GLP-1 Receptor Agonists in Breast Cancer\".","authors":"Sixten Harborg, Signe Borgquist, Deirdre Cronin-Fenton","doi":"10.1097/EDE.0000000000002037","DOIUrl":"10.1097/EDE.0000000000002037","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"e23"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677388","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":"Neighborhood Deprivation and Hypertensive Disorders of Pregnancy: Does Social Support Modify the Association?","authors":"Meredith A Dixon, Suchitra Chandrasekaran, Howard H Chang, Michael R Kramer, Tené T Lewis, Penelope P Howards","doi":"10.1097/EDE.0000000000002025","DOIUrl":"10.1097/EDE.0000000000002025","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have reported associations between neighborhood deprivation and hypertensive disorders of pregnancy (HDP), but without considering effect measure modification by social support.</p><p><strong>Methods: </strong>This study used the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be longitudinal cohort, which recruited participants between 2010 and 2013 across the United States. We used linear probability models with robust standard errors to estimate risk differences for associations of the area deprivation index (ADI) and social support with HDP. Perceived social support was categorized as low/moderate versus high, and effect measure modification was assessed by comparing stratum-specific risk differences; analyses were stratified by race/ethnicity.</p><p><strong>Results: </strong>The analytic sample included n = 7,349 participants. A 25-percentile increase in ADI was associated with two excess cases of gestational hypertension per 100 pregnancies among non-Hispanic Black participants (risk difference = 0.02, 95% confidence interval = -0.01, 0.05), while estimates among Hispanic and Asian participants suggested reduced risk. Participants reporting high social support had three fewer cases of preeclampsia/eclampsia per 100 pregnancies (risk difference = -0.03, 95% confidence interval = -0.05, 0.00) compared with those reporting low or moderate social support, though this lower risk was observed only among non-Hispanic White and Asian participants. There was no evidence that high social support modified the association between neighborhood deprivation and HDP.</p><p><strong>Conclusion: </strong>Neighborhood deprivation was associated with increased incidence of HDP among non-Hispanic Black people, and social support was associated with lower incidence of preeclampsia/eclampsia among non-Hispanic White and Asian people. However, we did not find evidence of social support buffering the association between neighborhood deprivation and HDP.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"796-806"},"PeriodicalIF":4.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548249","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}