Epidemiology最新文献

{"title":"An Expedited Chart Review Process for Large Database Studies Using Natural Language Processing and Multiwave Adaptive Sampling.","authors":"Shirley V Wang, Georg Hahn, Sreedhara Sushama Kattinakere, Mufaddal Mahesri, Haritha S Pillai, Rajendra Aldis, Joyce Lii, Sarah K Dutcher, Rhoda Eniafe, Jamal T Jones, Keewan Kim, Jiwei He, Hana Lee, Sengwee Toh, Rishi J Desai, Jie Yang","doi":"10.1097/EDE.0000000000001978","DOIUrl":"10.1097/EDE.0000000000001978","url":null,"abstract":"<p><strong>Background: </strong>One of the ways to enhance analyses conducted with large claims databases is by validating the measurement characteristics of the code-based algorithms used to identify health outcomes or other key study parameters of interest. These metrics can be used in quantitative bias analyses to assess the robustness of results for an inferential study, given potential bias from outcome misclassification. However, performing this validation through manual chart review of free-text notes from linked electronic health records requires extensive time and resource allocation.</p><p><strong>Methods: </strong>We describe an expedited process for validating code-based algorithms that introduces efficiency using two distinct mechanisms: (1) use of natural language processing to reduce the time spent by human reviewers to review each chart, and (2) a multiwave adaptive sampling approach with predefined criteria to stop the validation study once performance characteristics are identified with sufficient precision. We illustrate this process in a case study that validates the performance of a claims-based outcome algorithm for intentional self-harm in patients with obesity.</p><p><strong>Results: </strong>We empirically demonstrate that the natural language processing-assisted annotation process reduced the time spent on review per chart by 40%, and the use of the predefined stopping rule with multiwave samples would have prevented review of 77% of patient charts with limited compromise to the precision of performance characteristics.</p><p><strong>Conclusion: </strong>This approach could facilitate more routine validation of code-based algorithms used to define key study parameters, ultimately enhancing understanding of the reliability of findings derived from database studies.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"504-514"},"PeriodicalIF":4.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627595","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":"Julianne Skarha, Winner of the 2026 Rothman Prize.","authors":"","doi":"10.1097/EDE.0000000000001988","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001988","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":"37 4","pages":"407"},"PeriodicalIF":4.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148053337","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":"Use of Health Administrative Data to Identify Migraine in Individuals With a Recognized Pregnancy: A Validation Study in Ontario, Canada: Erratum.","authors":"Carmela Melina Albanese, Susan J Bondy, Christine Lay, Zhiyin Li, Jun Guan, Hilary K Brown","doi":"10.1097/EDE.0000000000001989","DOIUrl":"10.1097/EDE.0000000000001989","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"e12"},"PeriodicalIF":4.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716331","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":"Electrical Power Outages and Asthma-related Emergency Department Visits in New York City, 2018-2022.","authors":"Nina M Flores, Kara E Rudolph, Ariel Spira-Cohen, Sarah Walters, Vivian Do, Alexander J Northrop, Diana Hernández, Stephanie Lovinsky-Desir, Matthew S Perzanowski, Joan A Casey","doi":"10.1097/EDE.0000000000001991","DOIUrl":"10.1097/EDE.0000000000001991","url":null,"abstract":"<p><strong>Background: </strong>To minimize the health impacts of power outages, which have steadily increased with climate change and aging infrastructure, it is crucial to recognize their range of effects and identify the most vulnerable individuals and communities. Here, we investigate the health consequences of outages among those with asthma residing in New York City.</p><p><strong>Methods: </strong>We combined administrative emergency department (ED) visit data from 2018 to 2022 with two granular power outage data sources: the New York State Department of Public Service (locality-level) and the New York City Housing Authority (NYCHA, building-level). We applied an augmented synthetic control approach to four large-scale outages in the New York State Department of Public Service data to assess their association with asthma-related ED visits. We used a case-crossover design to assess the impact of same-day, building-level outage exposure in the NYCHA data on asthma-related ED visits.</p><p><strong>Results: </strong>A large, localized outage on 21 July 2019 was associated with 0.20 (95% confidence interval: 0.00, 0.34) per 1000 sub-daily increases in asthma-related ED visits the same evening of the outage start. For NYCHA residents, in the summer months, outage days were associated with elevated odds of asthma-related ED visits (2.23, 95% confidence interval: 0.92, 5.37), and these effects were particularly relevant for children and for lag days 0-1.</p><p><strong>Conclusions: </strong>Climate change impacts communities through severe weather events and their subsequent disruptions to critical infrastructure, such as electricity service. We add to the limited evidence that these disruptions carry health risks, in this case acute care asthma visits.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"544-552"},"PeriodicalIF":4.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147671537","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":"Validation of Body Mass Index-For-Age Percentile Curves in Older Adults Using Data From the Canadian Longitudinal Study on Aging.","authors":"Christopher D Kim, Claire E Cook, Hailey R Banack","doi":"10.1097/EDE.0000000000001973","DOIUrl":"10.1097/EDE.0000000000001973","url":null,"abstract":"<p><strong>Background: </strong>The use of a standard body mass index (BMI) cut-point (e.g., BMI ≥30 kg/m 2 ) to define obesity across the lifespan does not reflect our current understanding of changes in adiposity that occur throughout the aging process. The objective of the present study was to examine the validity of BMI-for-age percentiles as a measure of obesity in older adults, compared with an objective gold-standard measure of obesity status, total body fat percent (BF%) measured by dual energy X-ray absorptiometry scan.</p><p><strong>Methods: </strong>Using data from the Canadian Longitudinal Study on Aging (n = 28,764), sensitivity, specificity, positive predictive value, and negative predictive value were calculated for BMI ≥85th percentile and other thresholds against BF% ≥35%, 38%, and 40%, respectively.</p><p><strong>Results: </strong>When comparing obesity defined by BMI percentile values (≥85th percentile) to BF% (≥40% BF) as a measure of true obesity status, sensitivity, specificity, positive predictive value, and negative predictive value values were 0.32 (0.31, 0.33), 0.98 (0.98, 0.98), 0.94 (0.93, 0.95), and 0.61 (0.60, 0.62) in women and 0.85 (0.81, 0.89), 0.86 (0.85, 0.86), 0.14 (0.13, 0.16), and 1.00 (0.99, 1.00) in men, respectively.</p><p><strong>Conclusion: </strong>Incorporating age and sex information, BMI-for-age percentile is a highly specific and moderately sensitive measure of obesity in older adults, with potential as a valuable screening tool. Further research on BMI-for-age percentiles could help develop more accurate obesity screening tools than the current standard BMI cut-points.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"559-564"},"PeriodicalIF":4.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147480081","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":"Illustrating Poststratification Methods in Medical Claims Data: A Korean Example.","authors":"Yeon Woo Oh","doi":"10.1097/EDE.0000000000001980","DOIUrl":"10.1097/EDE.0000000000001980","url":null,"abstract":"<p><strong>Background: </strong>Observational studies often rely on nonprobability samples that may not represent the target population, limiting the generalizability of findings. Health examination data from the Korean National Health Insurance Service (NHIS) faces this challenge, as voluntary participation introduces sampling bias. Poststratification offers a potential solution by reweighting samples to match population distributions.</p><p><strong>Methods: </strong>Using the NHIS-National Sample Cohort, we demonstrated three poststratification approaches-simple poststratification, raking, and multilevel regression with poststratification-to estimate obesity prevalence among adults 20-39 years of age in 2019. The Korea National Health and Nutrition Examination Survey served as the reference standard for population-level estimates. We compared these methods with inverse probability sampling weights. Additionally, we applied poststratification to evaluate the accuracy of self-reported disease history for hypertension, diabetes, dyslipidemia, and stroke.</p><p><strong>Results: </strong>Crude obesity prevalence from NHIS-National Sample Cohort was 36.3% (95% confidence interval: 36.0, 36.6), substantially higher than the Korea National Health and Nutrition Examination Survey reference of 31.4% (28.8, 33.9). Simple poststratification using age and sex reduced this estimate to 33.9% (33.6, 34.2), ranking with additional smoking and alcohol variables yielded 34.7% (33.9, 35.5), and multilevel regression with poststratification incorporating region produced 34.2% (33.3, 35.0). Inverse probability sampling weights yielded comparable results (33.9%-34.1%). For self-reported disease history, poststratification consistently produced modest decreases in sensitivity estimates, suggesting that health examination participants may report disease history more accurately than the general population.</p><p><strong>Conclusion: </strong>Poststratification provides a principled framework for improving population-level inferences from nonprobability samples. These methods warrant broader application in epidemiological research using administrative and electronic health record data.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"494-503"},"PeriodicalIF":4.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147618532","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 Cardiovascular Outcomes Following Bariatric Surgery: Reconciling Seemingly Conflicting Evidence.","authors":"Sebastien Haneuse, Luke Benz, Valerie A Smith, David Arterburn, Matthew L Maceijewski","doi":"10.1097/EDE.0000000000001952","DOIUrl":"10.1097/EDE.0000000000001952","url":null,"abstract":"<p><p>Substantial observational evidence exists in support of bariatric surgery being associated with a reduction in risk for a wide range of outcomes, including cardiovascular disease (CVD) in patients with diabetes. Two recent studies, however, argued that much of that prior work suffers from various sources of underappreciated bias as well as design decisions that compromise whether one can conceive of a corresponding target trial. Furthermore, results based on analyses of claims data from Optum and electronic health record data from the Veterans Administration are presented as providing evidence of no CVD benefit for bariatric surgery in patients with diabetes. In this paper, we use data from a prior Kaiser Permanente study to emulate a trial that mimics the methods employed in the Veterans Administration study. This new analysis finds a reduction in risk of CVD in patients with diabetes, consistent with preexisting evidence. We discuss possible mechanisms by which the discrepant results can be reconciled, including issues of statistical validity that arise from small samples, whether recent work on transportability indicates that we should not always expect results to always be concordant, and the role of conservatism associated with \"clinical trial thinking.\" We conclude with a discussion of what standards should be used when considering the work of others in the literature and the role that evidence triangulation may be play in the future.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"467-475"},"PeriodicalIF":4.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13254903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028736","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":"Defining and Estimating Outcomes Directly Averted by a Vaccination Program when Rollout Occurs Over Time.","authors":"Katherine M Jia, Christopher B Boyer, Alyssa Bilinski, Marc Lipsitch","doi":"10.1097/EDE.0000000000001953","DOIUrl":"10.1097/EDE.0000000000001953","url":null,"abstract":"<p><p>During the COVID-19 pandemic, estimating the total deaths averted by vaccination was of great public health interest. Instead of estimating total deaths averted by vaccination among both vaccinated and unvaccinated individuals, some studies empirically estimated only \"directly averted\" deaths among vaccinated individuals, typically suggesting that vaccines prevented more deaths among unvaccinated and vaccinated individuals than directly among vaccinated individuals only, due to the indirect effect. Here, we define the causal estimand to quantify outcomes \"directly averted\" by vaccination-that is, the impact of vaccination for vaccinated individuals, holding vaccination coverage fixed-for vaccination at multiple time points, which is a lower bound on the total outcomes averted when the indirect effect is non-negative. We develop an unbiased estimator for the causal estimand in a one-stage randomized controlled trial and explore the bias of a popular \"hazard difference\" estimator frequently used in empirical studies. We show that even in a randomized controlled trial, the hazard difference estimator is biased if vaccination has a non-null effect, as it fails to incorporate the greater depletion of susceptibles among the unvaccinated individuals. In simulations, the overestimation is small for averted deaths when the infection-fatality rate is low, as for many important pathogens. However, the overestimation can be large for averted infections given a high basic reproduction number and a high vaccine efficacy against infection. Additionally, we define and compare estimand and estimators for avertible outcomes (i.e., outcomes that could have been averted by vaccination, but were not due to failure to vaccinate). Future studies can explore the identifiability of the causal estimand in observational settings.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"408-416"},"PeriodicalIF":4.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12922481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028594","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":"The Authors Respond.","authors":"Stephen Burgess, Emily Bassett","doi":"10.1097/EDE.0000000000001986","DOIUrl":"https://doi.org/10.1097/EDE.0000000000001986","url":null,"abstract":"","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":"37 4","pages":"e9"},"PeriodicalIF":4.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148053509","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 Association Between Outdoor Temperature During the Past Weeks and Current Fluid Homeostasis.","authors":"Sofia Enhörning, Olle Melander, Sölve Elmståhl, Gunnar Engström, Mats Pihlsgård, Simon Timpka","doi":"10.1097/EDE.0000000000001968","DOIUrl":"10.1097/EDE.0000000000001968","url":null,"abstract":"<p><strong>Background: </strong>It remains unclear why cool temperatures cause more persistent adverse health effects compared with hot weather. Fluid homeostasis may constitute a causal link between past temperatures and adverse health effects. In this study, we investigated the association between past outdoor temperatures and current fluid homeostasis.</p><p><strong>Methods: </strong>We studied participants from five cohorts during three decades in Sweden (total n = 29,755, age 18-86 years, 50.4% women). We quantified fluid homeostasis through indicators of hormonal regulation (vasopressin biomarker plasma copeptin), urine concentration (urine osmolality), and replenishment of fluid loss (total water intake) and related these parameters to past outdoor temperatures (21 days) using distributed nonlinear lag models.</p><p><strong>Results: </strong>Past temperatures were nonlinearly associated with current copeptin and urine osmolality. Cool temperatures during days and weeks prior contributed to distinct patterns of high copeptin with concomitant influence on urine osmolality. Overall, a scenario of temperatures of 0 °C for 21 days showed 14.9% (95% confidence interval = 11.5%, 18.3%) higher copeptin levels compared with reference temperatures of 14.3 °C for 21 days. Associations between copeptin and warm temperatures were less complex and of shorter duration, linking elevated temperatures within 24 hours with higher copeptin compared with the reference temperature.</p><p><strong>Conclusions: </strong>Alterations in human fluid homeostasis may partly explain the observed link between moderately cool outdoor temperatures and adverse health effects weeks later. If so, avoiding altered water balance through moderately increased water intake might mitigate the adverse health effects of cool weather.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"447-455"},"PeriodicalIF":4.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13218588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369164","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}