Epidemiology最新文献

{"title":"Investigating Symptom Duration Using Current Status Data: A Case Study of Postacute COVID-19 Syndrome.","authors":"Charles J Wolock, Susan Jacob, Julia C Bennett, Anna Elias-Warren, Jessica O'Hanlon, Avi Kenny, Nicholas P Jewell, Andrea Rotnitzky, Stephen R Cole, Ana A Weil, Helen Y Chu, Marco Carone","doi":"10.1097/EDE.0000000000001882","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001882","url":null,"abstract":"<p><strong>Background: </strong>For infectious diseases, characterizing symptom duration is of clinical and public health importance. Symptom duration may be assessed by surveying infected individuals and querying symptom status at the time of survey response. For example, in a severe acute respiratory syndrome coronavirus 2 testing program at the University of Washington, participants were surveyed at least 28 days after testing positive and asked to report current symptom status. This study design yielded current status data: outcome measurements for each respondent consisted only of the time of survey response and a binary indicator of whether symptoms had resolved by that time. Such study design benefits from limited risk of recall bias, but analyzing the resulting data necessitates tailored statistical tools.</p><p><strong>Methods: </strong>We review methods for current status data and describe a novel application of modern nonparametric techniques to this setting. The proposed approach is valid under weaker assumptions compared with existing methods, allows the use of flexible machine learning tools, and handles potential survey nonresponse. Our method relies on the assumption that the survey response time is conditionally independent of symptom resolution time within strata of measured covariates, and we propose an approach to assess the sensitivity of results to deviations from conditional independence.</p><p><strong>Results: </strong>From the university study, we estimate that 19% of participants experienced ongoing symptoms 30 days after testing positive, decreasing to 7% at 90 days. We found the estimates to be more sensitive to violations of the conditional independence assumption at 30 days compared with 90 days. Female sex, fatigue during acute infection, and higher viral load were associated with slower symptom resolution.</p><p><strong>Conclusion: </strong>The proposed method and accompanying sensitivity analysis procedure provide tools for investigators faced with current status data.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233558","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":"L or M1-Critical Challenges in Mediation Analysis.","authors":"Etsuji Suzuki","doi":"10.1097/EDE.0000000000001888","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001888","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208034","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":"Erratum: A Generalization of the Mechanism-based Approach for Age-Period-Cohort Models.","authors":"","doi":"10.1097/EDE.0000000000001885","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001885","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208032","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":"Estimating the effects of lifestyle interventions on mortality among cancer survivors: a methodological framework.","authors":"Emma E McGee, Miguel A Hernán, Edward Giovannucci, Lorelei A Mucci, Yu-Han Chiu, A Heather Eliassen, Barbra A Dickerman","doi":"10.1097/EDE.0000000000001889","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001889","url":null,"abstract":"<p><strong>Background: </strong>Many organizations recommend lifestyle modifications for cancer survivors. Effect estimates for these interventions are often based on observational data and are challenging to interpret due to vaguely defined questions, design-induced biases, and lack of comparability between individuals.</p><p><strong>Methods: </strong>We outlined a three-step procedure to address these challenges: target trial specification, emulation, and modification to explore lack of comparability due to unmeasured confounding or positivity violations. We illustrated this procedure by specifying the protocols of two target trials that estimate the effects of adhering to seven physical activity and dietary recommendations and abstaining from alcohol on 20-year mortality among adults with breast or prostate cancer. We emulated these target trials using data from the Nurses' Health Study (NHS), NHS II, and Health Professionals Follow-up Study.</p><p><strong>Results: </strong>In the main analysis, we included 9,107 adults (5,840 with breast cancer, 3,267 with prostate cancer); 1,791 deaths occurred. After we modified the target trial, mortality risk differences (95% CI) comparing the physical activity and dietary intervention vs. no intervention ranged from -4.8% (-7.5%, -2.3%) to -13.0% (-15.8%, -9.8%) for breast cancer and from -3.0% (-7.4%, 0.9%) to -12.8% (-17.6%, -7.6%) for prostate cancer. Risk differences comparing no alcohol consumption vs. no intervention ranged from 1.3% (0.1%, 2.4%) to 3.6% (2.5%, 4.9%) for breast cancer and from -1.7% (-4.3%, 1.0%) to 6.4% (4.0%, 9.0%) for prostate cancer.</p><p><strong>Conclusions: </strong>We described a three-step procedure that improves the interpretability of observational estimates of the effects of lifestyle interventions and showed how estimates varied under different modifications.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208033","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":"On definition and interpretation of separable path-specific effects with multiple ordered mediators.","authors":"Yan-Lin Chen, Sheng-Hsuan Lin","doi":"10.1097/EDE.0000000000001887","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001887","url":null,"abstract":"<p><p>Causal mediation analysis examines the mechanism by which exposure affects outcome via mediators. In contrast to single-mediator scenarios, the presence of multiple ordered mediators introduces complex pathways and corresponding path-specific effects, which are difficult to interpret due to the cross-world counterfactual definition. Path-specific effects also require convoluted and unverifiable assumptions for identification. This article proposes a framework of separable path-specific effects as an extension of the separable effect method to the case of multiple ordered mediators. Compared to the traditional approach, separable path-specific effects can be interpreted as the causal effects of several separated components on the outcome, facilitating a more intuitive understanding of underlying mechanisms. We elucidate the relationship between separable and traditional path-specific effects by demonstrating their equivalence under the individual-level isolation assumptions and identifying both effects under the finest fully randomized causally interpretable structured tree graph (FFRCISTG) model, which inherently makes individual-level isolation assumptions. Moreover, weakening the individual-level isolation assumptions to their population-level counterparts, separable path-specific effects remain identifiable under the FFRCISTG model. Under this causal model, the assumptions for identifying separable path-specific effects can be verified in future experiments, thereby addressing the problem of relying on unverifiable cross-world assumptions in the traditional method. We also discuss how this framework can detect violations of assumptions such as the presence of intermediate confounders and the misspecification of causal order among mediators. In summary, compared to the traditional path-specific effects method, the proposed separable method provides a more verifiable and interpretable approach for causal multiple mediation analysis.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208035","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":"Early detection of dengue outbreaks: transmission model analysis of a dengue outbreak in a remote setting in Ecuador.","authors":"Hannah Van Wyk, Andrew F Brouwer, Gwenyth O Lee, Sully Márquez, Paulina Andrade, Edward L Ionides, Josefina Coloma, Joseph Ns Eisenberg","doi":"10.1097/EDE.0000000000001874","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001874","url":null,"abstract":"<p><strong>Background: </strong>Pathogen transmission of an outbreak generally begins well before it is identified by a surveillance system, particularly for infectious diseases in which a high proportion of cases are subclinical, as is the case for arboviruses. We aimed to ascertain the most likely date of the primary case (the first infection, whether detected or not) in an outbreak.</p><p><strong>Methods: </strong>Using data from a 2019 dengue outbreak in a rural, riverine town in Northwestern Ecuador, we investigated potential undetected dengue virus transmission prior to the outbreak detected in mid-May. The outbreak was preceded by four reported cases on February 9th, February 13th, March 28th, and May 2nd. Using a hidden Markov model, we estimate the most likely date of the primary case for different assumed case reporting fractions.</p><p><strong>Results: </strong>For all reporting fractions, the most likely primary case occurred near the two February candidate index cases, ranging from February 7th to February 12th, over 2 months prior to the main outbreak. Individual simulations showed that earlier and later primary cases were also possible. Our results suggest that the dengue virus was circulating in the community for around 3 months before the outbreak.</p><p><strong>Conclusions: </strong>Surveillance systems that can detect low-level transmission in the early stages of an outbreak can provide time to intervene prior to the exponential phase of the outbreak, with the potential to substantially reduce transmission and disease burden.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208031","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":"Racial and ethnic differences in the relationship of SARS-CoV-2 infection and the COVID-19 pandemic period with perinatal health in California.","authors":"Emily F Liu, Shelley Jung, Kara E Rudolph, Mahasin S Mujahid, William H Dow, Dana E Goin, Rachel Morello-Frosch, Jennifer Ahern","doi":"10.1097/EDE.0000000000001878","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001878","url":null,"abstract":"<p><strong>Background: </strong>In this paper, we test the hypothesis that SARS-CoV-2 infection and the COVID-19 pandemic period had stronger adverse implications for perinatal outcomes among marginalized racial and ethnic groups in California.</p><p><strong>Methods: </strong>We used California birth certificate and hospital data from 2019-2021 to estimate marginal risk differences for SARS-CoV-2 infection and the COVID-19 pandemic period in relation to perinatal outcomes for Asian, Black, Hispanic, Multiracial, and White pregnant people using targeted maximum likelihood estimation.</p><p><strong>Results: </strong>Among 849,401 deliveries, there were racial and ethnic disparities in the burden of SARS-CoV-2 infection and perinatal outcomes, and in the magnitudes of risk associated with SARS-CoV-2 infection and the COVID-19 pandemic. Hispanic pregnant people had the highest incidence of SARS-CoV-2 infection. Asian and Black pregnant people had the greatest marginal risk differences for multiple outcomes, particularly outcomes already disproportionately experienced by these groups.</p><p><strong>Conclusions: </strong>Risks from SARS-CoV-2 infection and the COVID-19 pandemic period on perinatal outcomes were disproportionately experienced by marginalized racial and ethnic groups. Differential burdens of infection and larger risks experienced with pandemic exposures were associated with worse perinatal outcomes for Asian, Black, and Hispanic pregnant people in California compared with those for White pregnant people.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157429","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":"Potential impact of maternal nighttime light exposure and its interaction with sociodemographic characteristics on the risk of various congenital heart diseases.","authors":"Shanidewuhaxi Tuohetasen, Yanji Qu, Philip K Hopke, Kai Zhang, Yang Liu, Shao Lin, Haogao Gu, Ximeng Wang, Sam S S Lau, Xian Lin, Xiangmin Gao, Yong Wu, Xinli Zhou, Ziqiang Lin, Man Zhang, Yongqing Sun, Xiaoqing Liu, Jimei Chen, Wangjian Zhang","doi":"10.1097/EDE.0000000000001883","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001883","url":null,"abstract":"<p><strong>Background: </strong>Although maternal exposure to artificial light at night has shown negative associations with pregnancy outcomes, its impact on risk of congenital heart disease remains unclear. This study examined the association between maternal exposure to artificial light at night during pregnancy and occurrence of congenital heart disease in offspring, considering potential interactions with sociodemographics.</p><p><strong>Methods: </strong>We included newborns diagnosed prenatally with congential heart disease and healthy volunteers from 21 cities in Southern China. Using satellite data, we estimated annual exposure to artificial light at night at maternal residential addresses during pregnancy. We evaluated associations using marginal structural logistic models and assessed multiplicative and additive interaction between sociodemographics and light exposure.</p><p><strong>Results: </strong>Each one-unit increase in light at night during pregnancy was associated with elevated risk of total congenital heart disease (OR: 1.2, 95% CI: 1.2-1.3), and of almost all specific disease subtypes, in offspring. Using quartiles of light at night confirmed a monotonic dose-response relationship between exposure and disease. The association was more pronounced in severe disease. Some sociodemographic characteristics modified associations between light at night and congenital heart disease, with detrimental associations more pronounced among offspring of mothers with lower education (OR: 1.3, 95% CI: 1.2-1.3), lower income (OR: 1.2, 95% CI: 1.1-1.3), or being usual residents (OR: 1.3, 95% CI: 1.2-1.4), based on the continuous model.</p><p><strong>Conclusions: </strong>Maternal exposure to artificial light at night during pregnancy was substantially associated with elevated risk of congenital heart disease in offspring. This association was more pronounced among some sociodemographic groups.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157428","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":"\"Spatial Variability and Clustering of Life Expectancy in the US: 1990-2019\".","authors":"Isabel P De Ramos, Tara McAlexander, Usama Bilal","doi":"10.1097/EDE.0000000000001879","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001879","url":null,"abstract":"<p><strong>Background: </strong>Longevity has stagnated during the last decade in the US, but this stagnation has not been homogeneous. We aimed to explore the spatial variation of life expectancy by sex across commuting zones in the contiguous US from 1990 to 2019.</p><p><strong>Methods: </strong>We computed sex-specific life expectancy at birth for US commuting zones across six 5-year periods (1990-1994 to 2015-2019) and examined the spatial variability of life expectancy and clustering of baseline and changes in life expectancy during the study period.</p><p><strong>Results: </strong>Overall life expectancy increased over time for both males and females and recently stagnated, while variability has increased for females. Regardless of sex, commuting zones with low baseline life expectancy that worsened over time were concentrated in the Appalachian region and Deep South. Areas with high baseline life expectancy and improved the most over time were scattered throughout the Midwest, Northwest, and West.</p><p><strong>Conclusion: </strong>The recent stagnation in life expectancy reflects wide spatial heterogeneity in changes in longevity. Growing spatial differences in longevity render males and females in the South, specifically the Appalachia and along the Mississippi River, to consistently live disproportionate short lives. Further studies should explore the contribution of different causes of death and the potential contextual drivers of these patterns.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155936","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":"Medium-term exposure to wildfire smoke PM2.5 and cardiorespiratory hospitalization risks.","authors":"Yaguang Wei, Edgar Castro, Kanhua Yin, Alexandra Shtein, Bryan N Vu, Mahdieh Danesh Yazdi, Longxiang Li, Yuxi Liu, Adjani A Peralta, Joel D Schwartz","doi":"10.1097/EDE.0000000000001881","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001881","url":null,"abstract":"<p><strong>Background: </strong>Wildfire activity in the US has increased substantially in recent decades. Smoke PM2.5, a primary wildfire emission, can spike for months after a wildfire begins, yet large-scale evidence of its health effects remains limited.</p><p><strong>Methods: </strong>We obtained hospitalization records for the residents of 15 states between 2006-2016 from the State Inpatient Databases. We used existing daily smoke PM2.5 estimations at 10-km2 grid cells across the contiguous US, and aggregated them to ZIP codes to match the spatial resolution of hospitalization records. We extended traditional case-crossover design, a self-controlled design originally developed for studying acute effects, to examine associations between 3-month average exposure to smoke PM2.5 and hospitalization risks for a comprehensive range of cardiovascular (ischemic heart disease, cerebrovascular disease, heart failure, arrhythmia, hypertension, other cardiovascular diseases) and respiratory diseases (acute respiratory infections, pneumonia, COPD, asthma, other respiratory diseases).</p><p><strong>Results: </strong>We found that 3-month exposure to smoke PM2.5 was associated or marginally associated with increased hospitalization risks for most cardiorespiratory diseases. Hypertension showed the greatest susceptibility, with the highest hospitalization risk associated with 0.1 µg/m3 increase in 3-month smoke PM2.5 exposure (relative risk: 1.0051; 95% confidence interval: 1.0035, 1.0067). Results for single-month lagged exposures suggested that estimated effects persisted up to 3 months after exposure. Subgroup analyses estimated larger effects in neighborhoods with higher deprivation level or more vegetation, as well as among ever-smokers.</p><p><strong>Conclusions: </strong>Our findings provided unique insights into medium-term cardiorespiratory effects of smoke PM2.5, which can persist for months, even after a wildfire has ended.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157426","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}