Annals of Epidemiology最新文献

{"title":"Methods for estimating public transit travel times to healthcare services as a measure of equitable healthcare access","authors":"Noah Mancuso ,&nbsp;Patrick S. Sullivan","doi":"10.1016/j.annepidem.2025.09.010","DOIUrl":"10.1016/j.annepidem.2025.09.010","url":null,"abstract":"<div><h3>Purpose</h3><div>To introduce an equity-based method for assessing public transit access to health services and apply it to pre-exposure prophylaxis (PrEP) clinics in metro-Atlanta.</div></div><div><h3>Methods</h3><div>Census block groups (CBGs) were analyzed with PrEP clinics identified via <em>PrEP Locator</em>. One-way public transit times were estimated using the <em>Google Maps Distance Matrix</em> API. CBGs were classified as public transit deserts if transit options were unavailable or if travel time was &gt; 30 min. T-tests compared sociodemographic characteristics of CBGs with and without public transit. Linear regression assessed the association of a 5 % increase in priority populations with transit times.</div></div><div><h3>Results</h3><div>Among 2466 CBGs, one-quarter lacked public transit access to PrEP and two-thirds were transit deserts. Median travel time was 32 min. CBGs with transit access had significantly higher proportions of Black, Hispanic/Latinx, young men (aged 25–34), and residents living below the poverty line (P &lt; .001). Increases in the proportion of Hispanic/Latinx residents, young men, and residents living under the poverty line were associated with shorter transit times, with no association for Black residents.</div></div><div><h3>Conclusions</h3><div>Public transit access to PrEP was low in Atlanta, and overall public transit times were long. Current PrEP locations are aligned with priority populations, but additional work is needed to ensure equity is met for Black and Hispanic/Latinx residents.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"111 ","pages":"Pages 24-29"},"PeriodicalIF":3.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between adverse childhood experiences and obesity among young US adults","authors":"Kiran Thapa PhD ,&nbsp;Ye Shen PhD ,&nbsp;José F. Cordero MD, MPH ,&nbsp;Emily Anne Vall PhD ,&nbsp;Janani Rajbhandari-Thapa PhD","doi":"10.1016/j.annepidem.2025.09.009","DOIUrl":"10.1016/j.annepidem.2025.09.009","url":null,"abstract":"<div><h3>Purpose</h3><div>We examined whether adverse childhood experiences (ACEs) are associated with obesity in young adulthood, and whether these associations differ by sex.</div></div><div><h3>Methods</h3><div>We used data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative cohort of U.S. adolescents followed into adulthood (age 33–43 years) across five waves. Our sample included 5193 participants with measured anthropometrics at wave V (2016–18). Modified Poisson regression estimated risk ratios (RR) for general obesity (body mass index ≥ 30 kg/m²) and abdominal obesity (waist circumference &gt;102 cm for males, &gt;88 cm for females) associated with individual and cumulative ACEs, adjusting for baseline BMI, co-occurring ACEs, and sociodemographic covariates. Sex-stratified models assessed heterogeneity in effects.</div></div><div><h3>Results</h3><div>Childhood physical abuse was independently associated with higher risk of general obesity, particularly among females (aRR: 1.23; 95 % CI: 1.05–1.45). Exposure to ≥ 4 ACEs was associated with increased risk of both general (aRR: 1.32; 95 % CI: 1.15–1.52) and abdominal obesity (aRR: 1.18; 95 % CI: 1.02–1.37), independent of childhood obesity.</div></div><div><h3>Conclusions</h3><div>ACEs, especially physical abuse and cumulative exposure, were linked to higher risk of obesity, suggesting that traumatic events may play an important role in young adulthood obesity, especially in females.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"111 ","pages":"Pages 51-57"},"PeriodicalIF":3.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence and natural language processing of patient narratives to evaluate semaglutide for weight loss","authors":"Akshaya Srikanth Bhagavathula PhD, FACE","doi":"10.1016/j.annepidem.2025.09.003","DOIUrl":"10.1016/j.annepidem.2025.09.003","url":null,"abstract":"<div><h3>Purpose</h3><div>This study used artificial intelligence (AI) and natural language processing (NLP) to analyze patient reviews of semaglutide, with the goal of better understanding its real-world effectiveness and safety for weight management.</div></div><div><h3>Methods</h3><div>A retrospective, cross-sectional analysis was conducted on 772 user-generated reviews of semaglutide posted on Drugs.com (July 2021–March 2025). Sentiment analysis was performed using a transformer-based BERT model on a five-point scale. Topic modeling with Latent Dirichlet Allocation (LDA) and Latent Semantic Analysis (LSA) was used to identify dominant themes. Cluster analysis was applied to segment users based on weight loss outcomes and side effect severity. Reviewers (n = 95) that explicitly reporting both weight loss and treatment duration were analyzed for real-world efficacy and safety.</div></div><div><h3>Results</h3><div>Users who took semaglutide more than 60 days reported a mean weight loss of 32.2 ± 3.1 lbs (14.6 kg). Frequently mentioned side effects included nausea (46.9 %), headache (18.4 %), vomiting (14.3 %), fatigue (9.2 %), and dizziness (4.8 %). The highest sentiment scores were observed in the ≤ 30-day group (mean: 3.38). Topic modeling identified themes such as appetite suppression, medication cost and access, and long-term experiences. Clusters analysis revealed distinct user profile, including super-responder group with substantial weight loss and another with more side effects.</div></div><div><h3>Conclusions</h3><div>AI and NLP methods offer valuable tools for analyzing patient-reported outcomes, revealing semaglutide’s real-world efficacy and safety profile for weight management. These findings contribute to ongoing efforts to integrate patient-reported data into post-marketing surveillance and treatment decision-making.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"111 ","pages":"Pages 9-13"},"PeriodicalIF":3.0,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular disease burden attributable to estimated glomerular filtration rate: Insights from the ATTICA study (2002–2022)","authors":"Evangelia Damigou ,&nbsp;Matilda Florentin ,&nbsp;Christina Chrysohoou ,&nbsp;Costas Anastasiou ,&nbsp;Fotios Barkas ,&nbsp;Evangelos Liberopoulos ,&nbsp;Petros P. Sfikakis ,&nbsp;Costas Tsioufis ,&nbsp;Christos Pitsavos ,&nbsp;Demosthenes Panagiotakos","doi":"10.1016/j.annepidem.2025.09.007","DOIUrl":"10.1016/j.annepidem.2025.09.007","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to estimate cardiovascular disease (CVD) burden attributable to chronic kidney disease (CKD) and whether this burden varies in participants with different population characteristics.</div></div><div><h3>Methods</h3><div>Our sample included 1988 adults free-of-CVD at baseline who took part in the ATTICA study (2002–2022). Estimated glomerular filtration rate (eGFR) was calculated based on the Chronic Kidney Disease Epidemiology Collaboration equation. CKD was defined in 2002, according to Kidney Disease Improving Global Outcomes (KDIGO) guidelines, as an eGFR ≤ 60 mL/min/1.73 m². Combined fatal or non-fatal CVD events were assessed in 2006, 2012 and 2022 based on WHO-ICD-10. Population attributable fractions for multiadjusted models were computed based on Miettinen’s formula. Stratified analyses were also performed.</div></div><div><h3>Results</h3><div>At baseline, CKD prevalence was 4.7 % (n = 94). During the 20-year period, 36.1 % of participants developed CVD. A higher percentage of participants with CKD developed CVD compared to those without (77 % vs. 34 %). Approximately 6 out of a 100 new CVD cases (95 %CI: 1.7 %, 8.1 %) would have been prevented if CKD had been properly managed. Variations in these fractions were observed by sex and presence of comorbidities.</div></div><div><h3>Conclusions</h3><div>Albeit more research is warranted, our study supports that CKD should become a public health priority, and specifically a CVD priority.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"111 ","pages":"Pages 1-8"},"PeriodicalIF":3.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Migration and cardiovascular disease: A comparative study of prevalence and risk factor profiles in resettlers from the German National Cohort (NAKO)","authors":"Glenna Walther ,&nbsp;Tilman Brand ,&nbsp;Nico Dragano ,&nbsp;Claudia Meinke-Franze ,&nbsp;Amand Führer ,&nbsp;Karin Halina Greiser ,&nbsp;Olga Hovardovska ,&nbsp;Jamin Kiekert ,&nbsp;Lilian Krist ,&nbsp;Michael Leitzmann ,&nbsp;Wolfgang Lieb ,&nbsp;Rafael Mikolajczyk ,&nbsp;Ute Mons ,&nbsp;Fiona Niedermayer ,&nbsp;Nadia Obi ,&nbsp;Cara Övermöhle ,&nbsp;Marvin Reuter ,&nbsp;Börge Schmidt ,&nbsp;Ilais Moreno Velásquez ,&nbsp;Henry Völzke ,&nbsp;Volker Winkler","doi":"10.1016/j.annepidem.2025.09.008","DOIUrl":"10.1016/j.annepidem.2025.09.008","url":null,"abstract":"<div><h3>Aims</h3><div>Resettlers from the former Soviet Union are one of the largest migrant groups in Germany. Previous studies found lower cardiovascular disease (CVD) mortality among resettlers compared to Germans without migration background (autochthonous). Other studies have shown a higher prevalence of CVD risk factors among resettlers, suggesting a higher CVD mortality. The German National Cohort (NAKO) provides an opportunity to explore these discrepancies.</div></div><div><h3>Methods</h3><div>This study used baseline data from NAKO and compared age-adjusted percentages of self-reported CVD and associated risk factors between the two groups. Logistic regression models estimated adjusted odds ratios (OR) for associations between resettler status and outcomes.</div></div><div><h3>Results</h3><div>Among 204,751 participants aged 19–75, 3580 were resettlers and 169,538 autochthonous Germans. Male resettlers had lower odds of risky alcohol consumption (OR: 0.55; 95 %CI: 0.49–0.63) but higher odds of ever smoking (OR: 1.26; 95 %CI: 1.13–1.41) compared to autochthonous German men. Female resettlers showed higher prevalence of hypertension, diabetes mellitus, obesity, and elevated cholesterol/triglycerides, but lower prevalence of risky alcohol consumption and smoking.</div><div>In men, the odds of peripheral artery disease (PAD) (OR: 0.46; 95 %CI: 0.21–0.97) and any CVD (OR: 0.81; 95 %CI: 0.66–0.98) were lower among resettlers. No other notable differences in clinical CVDs were observed in men.</div></div><div><h3>Conclusion</h3><div>Resettlers showed differences regarding CVD risk factor distribution compared to autochthonous Germans. These differences appear to balance out, leading to similar overall CVD prevalence, except for a lower prevalence of PAD and total CVD in male resettlers. Future longitudinal data will allow to explore long-term CVD trajectories.</div></div><div><h3>Lay summary</h3><div>We compared the prevalence of cardiovascular diseases (CVD) in a special group of migrants (resettlers from the former Soviet Union; German: (Spät-)Aussiedler) and autochthonous Germans, using data from the German National Cohort (NAKO) and investigated risk factors frequencies for these diseases in both groups. We found that male resettlers had less of risky alcohol consumption but smoked more than autochthonous German men. Female resettlers showed higher prevalence of hypertension, diabetes mellitus, obesity, and elevated cholesterol and triglyceride levels, but lower prevalence of risky alcohol consumption and smoking. The prevalence of most CVDs was similar in both groups, except of peripheral artery disease and all CVDs combined which we found less frequent in male resettlers.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"111 ","pages":"Pages 14-23"},"PeriodicalIF":3.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards modeling evolving longitudinal health trajectories with a transformer-based deep learning model","authors":"Hans Moen ,&nbsp;Vishnu Raj ,&nbsp;Andrius Vabalas ,&nbsp;Markus Perola ,&nbsp;Samuel Kaski ,&nbsp;Andrea Ganna ,&nbsp;Pekka Marttinen","doi":"10.1016/j.annepidem.2025.08.025","DOIUrl":"10.1016/j.annepidem.2025.08.025","url":null,"abstract":"<div><h3>Purpose:</h3><div>Health registers provide valuable insights into individuals’ health trajectories. This study explores the use of deep learning to model and analyze these trajectories using a nationwide longitudinal dataset containing coded features such as clinical codes, procedures, and drug purchases.</div></div><div><h3>Methods:</h3><div>We introduce <span>Evolve</span>, a transformer-based deep learning model designed to provide continuous multi-label predictions over time. The model predicts disease onsets at each time step conditioned on the health history up to that time step and the time until a given 5-year forecast window. <span>Evolve</span> is evaluated against several baseline models for basic prediction performance. Additionally, we analyze health trajectories by tracking changes in prediction probabilities and in the latent embedding neighborhood to identify important events.</div></div><div><h3>Results:</h3><div><span>Evolve</span> performed comparably to baseline models in disease onset prediction while offering unique trajectory modeling capabilities. The model identified early predictive events and demonstrated that changes in embedding space could indicate shifts in health trajectories. Visualization of evolving health trajectories showed how individuals may become most similar to others with similar profiles and outcomes over time.</div></div><div><h3>Conclusions:</h3><div>The <span>Evolve</span> model seems promising at enabling continuous health monitoring, early disease detection, and retrospective analysis, making it a promising tool for personalized healthcare interventions.</div><div>Code available at: <span><span>https://github.com/hansmoen/evolvehealth</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"111 ","pages":"Pages 30-43"},"PeriodicalIF":3.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV incidence and associated risk factors among key populations accessing routine testing through the national health coverage system in Thailand: A nationwide real-world study","authors":"Sadiporn Phuthomdee ,&nbsp;Sirinya Teeraananchai ,&nbsp;Rattaphon Triamwichanon ,&nbsp;Patchara Benjarattanaporn ,&nbsp;David C. Boettiger ,&nbsp;Nittaya Phanuphak","doi":"10.1016/j.annepidem.2025.09.006","DOIUrl":"10.1016/j.annepidem.2025.09.006","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess HIV incidence and associated factors among key populations (KPs) including men who have sex with men (MSM), transgender women (TGW), sex workers (SW), and people who inject drugs (PWID) using data from the Universal Health Coverage program.</div></div><div><h3>Methods</h3><div>HIV testing data were collected from KP individuals aged ≥ 15 years diagnosed HIV-negative at least once between 2015 and 2022. Flexible parametric survival analysis was used to estimate HIV incidence and identify associated factors.</div></div><div><h3>Results</h3><div>Among 373,300 individuals tested, 65 % were MSM, 26 % SW, 8 % PWID, and 2 % TGW. HIV incidence rates were highest among MSM (2.23 per 100 person-years, PYs), followed by TGW (2.06 per 100 PYs), PWID (0.46 per 100 PYs), and SW (0.41 per 100 PYs). In multivariable analysis, MSM had significantly higher risk compared to PWID (adjusted hazard ratio (aHR 0.13), SW (aHR 0.20), and TGW (aHR 0.77). Youth among KPs had a 7.30-fold higher risk compared to those aged ≥ 50 years. A decline in incidence was observed in more recent years.</div></div><div><h3>Conclusions</h3><div>HIV incidence is declining all KPs but remains highest among MSM and TGW, particularly youth, highlighting the need for targeted prevention to end HIV in Thailand.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"110 ","pages":"Pages 178-186"},"PeriodicalIF":3.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to ‘Estimating the population need for preexposure prophylaxis for HIV in the United States’ [Ann Epidemiol 106 (2025) 48–54]","authors":"Athena P. Kourtis ,&nbsp;Jeffery Wiener ,&nbsp;Weiming Zhu ,&nbsp;Minttu M. Rönn ,&nbsp;Joshua Salomon ,&nbsp;Ya-Lin A. Huang ,&nbsp;Cynthia Lyles ,&nbsp;Rupa R. Patel ,&nbsp;Karen W. Hoover ,&nbsp;Robyn Neblett Fanfair ,&nbsp;Jonathan Mermin","doi":"10.1016/j.annepidem.2025.09.005","DOIUrl":"10.1016/j.annepidem.2025.09.005","url":null,"abstract":"","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"110 ","pages":"Page 166"},"PeriodicalIF":3.0,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145003683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between maternal sexually transmitted diseases and birth defects in the United States: A nationwide population-based study","authors":"Wangnan Cao ,&nbsp;Chunrong Li ,&nbsp;Feng Sun ,&nbsp;Valery A. Danilack ,&nbsp;Ian J. Saldanha ,&nbsp;Yuhui Shi ,&nbsp;Ying Ji ,&nbsp;Hao Lin ,&nbsp;Mojun Ni ,&nbsp;Ruiyi Liu ,&nbsp;Shengzhi Sun ,&nbsp;Chun Chang","doi":"10.1016/j.annepidem.2025.09.004","DOIUrl":"10.1016/j.annepidem.2025.09.004","url":null,"abstract":"<div><h3>Purpose</h3><div>We estimated the association between maternal sexually transmitted diseases (STDs) and the risk of specific birth defects among live singleton births in the United States (US).</div></div><div><h3>Methods</h3><div>We conducted a population-based study using data from birth certificates for 14,602,822 live singleton births occurring from 2016 to 2019 in the US. We used logistic regression to estimate the associations between three maternal STDs (chlamydia, gonorrhea, and syphilis) and the risk of four specific birth defects (gastroschisis, cleft lip with or without cleft palate, spina bifida, and hypospadias), adjusting for socio-demographic and pregnancy-related factors.</div></div><div><h3>Results</h3><div>Maternal chlamydia infection was associated with a higher risk of gastroschisis (adjusted odds ratio [aOR], 1.23; (95 % CI: 1.03, 1.46), cleft lip with or without cleft palate (aOR, 1.26; 95 % CI: 1.08, 1.47), and hypospadias (aOR, 1.26; 95 % CI: 1.08, 1.47). It was not associated with an increased risk of spina bifida. These associations were consistent across subgroups defined by maternal age, race and ethnicity, education, body mass index, and infant sex. We found no evidence of an association between gonorrhea or syphilis infections and the studied birth defects.</div></div><div><h3>Conclusions</h3><div>Among live singleton births in the US, maternal chlamydia infection may be associated with increased risks of gastroschisis, cleft lip with or without cleft palate, and hypospadias.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"110 ","pages":"Pages 172-177"},"PeriodicalIF":3.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of data in the Veteran health administration electronic medical record for identification of tobacco use","authors":"Brian J. Douthit PhD, RN, NI-BC ,&nbsp;Julie Kim PharmD ,&nbsp;Amber J. Hackstadt PhD ,&nbsp;Daniel Park BS ,&nbsp;Robert Winter BS ,&nbsp;Jessica Deere PN, BSN, MSN ,&nbsp;Lucy B. Spalluto MD, MPH ,&nbsp;Sally J. York MD, PhD ,&nbsp;Fred Hendler MD, PhD ,&nbsp;Robert S. Dittus MD, MPH ,&nbsp;Dana E. Christofferson PhD ,&nbsp;Michael E. Matheny MD, MS, MPH ,&nbsp;Hilary A. Tindle ,&nbsp;Christianne L. Roumie MD, MPH ,&nbsp;Jennifer A. Lewis MD, MS, MPH","doi":"10.1016/j.annepidem.2025.09.001","DOIUrl":"10.1016/j.annepidem.2025.09.001","url":null,"abstract":"<div><h3>Purpose</h3><div>Tobacco use is not commonly represented as computable information in the electronic health record (EHR). We developed an algorithm in the Veterans Health Administration (VHA) to identify tobacco ever-use among Veterans.</div></div><div><h3>Methods</h3><div>We used the VHA corporate data warehouse to develop an algorithm comprised of multiple data types (health factors [semi-structured template data entry and decision support tools], billing, orders, medication, and encounter codes) to identify tobacco ever-use (current or former) versus never use. Algorithm accuracy was compared to two reference standards: (1) EHR abstraction cohort and (2) Veteran self-reported survey cohort. We calculated the sensitivity and positive predictive values (PPV) for the algorithm and stratified by its data types for the EHR abstraction cohort. We calculated the sensitivity, specificity, PPV, and negative predictive value (NPV) for the algorithm and stratified by its data types for the survey cohort.</div></div><div><h3>Results</h3><div>The algorithm correctly identified 424 of 426 individuals with tobacco ever-use when compared to data abstracted from the EHR: sensitivity 1.00 (95 % CI 0.98–1.00); PPV 1.00 (95 % CI 0.98–1.00). Compared to survey data, the algorithm correctly identified 514 of 547 participants with tobacco ever-use: sensitivity 0.94 (95 % CI 0.92–0.96); PPV 0.88 (95 % CI 0.85–0.91). The specificity was 0.53 (95 % CI 0.45–0.62), and NPV of 0.70 (95 % CI 0.61–0.79). Of all data types, health factors had the highest sensitivity in both cohorts.</div></div><div><h3>Conclusions</h3><div>This novel tool had excellent sensitivity and PPV for tobacco ever-use in two cohorts. Future research should study this tool to support preventive healthcare services.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"110 ","pages":"Pages 167-171"},"PeriodicalIF":3.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}