American journal of epidemiology最新文献

Subjective cognitive decline and objective cognitive performance across diverse intersectional identities by gender, race/ethnicity, and educational attainment. 不同性别、种族/民族和受教育程度的主观认知衰退和客观认知表现。

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-19 DOI: 10.1093/aje/kwag253

Nancy X Chen, Miriam T Ashford, Chengshi Jin, L Paloma Rojas-Saunero, Elizabeth Rose Mayeda, Alejandra Morlett-Paredes, Erika Cavallone, Sarah Tomaszewski Farias, Rachel L Nosheny, Kristen M George

{"title":"Subjective cognitive decline and objective cognitive performance across diverse intersectional identities by gender, race/ethnicity, and educational attainment.","authors":"Nancy X Chen, Miriam T Ashford, Chengshi Jin, L Paloma Rojas-Saunero, Elizabeth Rose Mayeda, Alejandra Morlett-Paredes, Erika Cavallone, Sarah Tomaszewski Farias, Rachel L Nosheny, Kristen M George","doi":"10.1093/aje/kwag253","DOIUrl":"https://doi.org/10.1093/aje/kwag253","url":null,"abstract":"Subjective cognitive decline and subtle objective cognitive impairment are important early clinical stages of dementia, but the extent to which they vary across intersectional identities remains poorly understood. We examined differences in subjective and objective cognition across intersectional identities defined by gender, race/ethnicity, and education. We analyzed 20,814 participants aged 45+ from the Brain Health Registry. Subjective cognition was measured using the 39-item Everyday Cognition Scale. Objective cognition was measured using the Cambridge Cognition Paired Associates Learning test. We defined 24 intersectional strata based on gender (men, women), race/ethnicity (Latino, Asian, Black, White), and education (≤associate's, bachelor's, graduate degree). Using Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), we estimated age-adjusted linear mixed models then additionally adjusted for the additive effects of gender, race/ethnicity, and education to evaluate whether random effects of the intersectional identity strata explained variance beyond individual fixed effects. Between-stratum variance accounted for ≤6% of the total variance in subjective and objective cognition. Most (79-98%) of this between-stratum variance was explained by additive effects of gender, race/ethnicity, and education. Additive sociodemographic effects explained most disparities in mid- to late-life subjective and objective cognition across intersectional strata, with limited residual intersectional heterogeneity beyond these additive effects.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223101","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}

引用次数: 0

A Bayesian Approach to Estimating Changes in Small Area Life Expectancy Disparities in Philadelphia. 估算费城小区域预期寿命差异变化的贝叶斯方法。

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-16 DOI: 10.1093/aje/kwag262

Giancarlo Anfuso, Harrison Quick, Alina Schnake-Mahl, Usama Bilal

{"title":"A Bayesian Approach to Estimating Changes in Small Area Life Expectancy Disparities in Philadelphia.","authors":"Giancarlo Anfuso, Harrison Quick, Alina Schnake-Mahl, Usama Bilal","doi":"10.1093/aje/kwag262","DOIUrl":"https://doi.org/10.1093/aje/kwag262","url":null,"abstract":"There is substantial geographic variation in life expectancy (LE). The COVID-19 pandemic caused a mortality crisis, but it is unclear how small-area variations in LE changed during the pandemic. We estimated gender-specific LE by census tract in Philadelphia, Pennsylvania (2017-2019 and 2020-2022), and compared disparities in LE at birth before and during the pandemic. To account for small counts, we employed a Bayesian Poisson model borrowing strength from neighboring census tracts by using conditional autoregressive priors, and from known age-specific mortality patterns by using an adaptation of the TOPALS (tool for projecting age patterns using linear splines) method. We then summarized LE and computed total and income-based disparities in LE by period. The median [10th-90th percentile] change in LE during the pandemic was -2.10 [-5.39 to 0.40] and -1.37 [-3.23 to 0.39] years for men and women, respectively. Declines were concentrated in the same areas that had lower LE at baseline. We found widening disparities due to a steeper decline in LE in lower-income areas during the pandemic. Our study leveraged Bayesian models to produce reliable local-level estimates in small areas, highlighting the disparate impacts that the pandemic had on population health.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190758","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}

引用次数: 0

Classification Matters: Divergent Estimates of Dementia Risk Factors in the Health and Retirement Study. 分类事项：健康与退休研究中痴呆危险因素的不同估计。

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-15 DOI: 10.1093/aje/kwag260

Gina E Nam, Junxian Liu, Suhani Amin, Karla Renata Flores Romero, Zachary J Kunicki, M Maria Glymour, Kaitlin Casaletto, Jacqueline M Torres, Eleanor Hayes-Larson

{"title":"Classification Matters: Divergent Estimates of Dementia Risk Factors in the Health and Retirement Study.","authors":"Gina E Nam, Junxian Liu, Suhani Amin, Karla Renata Flores Romero, Zachary J Kunicki, M Maria Glymour, Kaitlin Casaletto, Jacqueline M Torres, Eleanor Hayes-Larson","doi":"10.1093/aje/kwag260","DOIUrl":"https://doi.org/10.1093/aje/kwag260","url":null,"abstract":"Clinical dementia diagnosis requires substantial expertise and is complex and costly. Therefore, large population-based studies often lack gold-standard longitudinal diagnoses and instead use classification algorithms employing cognitive, functional, and health-related measures to identify dementia. We evaluated whether algorithm choice affects conclusions regarding dementia risk in the nationally representative Health and Retirement Study (HRS; 2010-2020). We constructed four algorithm-specific samples of participants age 70+ without dementia in 2010: Langa-Weir (n=6,498), Hudomiet (n=6,556), Expert (n=5,751), and Wu (n=5,935). Participants were followed until first dementia classification, death, or censoring. We estimated dementia incidence rates (IRs) and used adjusted Cox models to estimate hazard ratios (HRs) for known risk factors. Dementia IRs per 1000 person-years meaningfully varied across algorithms, from 26.5 (95% CI 24.5-28.5, Hudomiet) to 62.8 (59.9-65.8, Expert). Sociodemographic risk factor associations also varied substantially. HRs for education (< vs. ≥high school) ranged from 1.36 (1.19-1.54, Hudomiet) to 2.22 (1.98-2.50, Langa-Weir), and HRs non-Hispanic Black vs. non-Hispanic White ranged from 1.86 (1.53-2.27, Expert) to 2.74 (2.40-3.12, Langa-Weir). Differences were less pronounced for health-related risk factors. In the absence of gold standard longitudinal diagnosis in HRS, researchers should examine the robustness of findings across multiple algorithms.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190692","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}

引用次数: 0

The effect of hypothetical interventions to limit weight gain on incident type 2 diabetes mellitus among people with HIV initiating antiretroviral therapy in the United States, 2012-2021. 2012-2021年美国开始抗逆转录病毒治疗的HIV感染者中，限制体重增加的假设干预措施对2型糖尿病的影响

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-14 DOI: 10.1093/aje/kwag255

Catherine R Lesko, Katherine Kurgansky, Elizabeth Humes, Parastu Kasaie, Emily P Hyle, Jennifer O Lam, Sita Lujintanon, Anna Rubtsova, Michael Horberg, Sean X Leng, Raynell Lang, Anthony T Fojo, Vincent C Marconi, Thibaut Davy-Mendez, Keri N Althoff

{"title":"The effect of hypothetical interventions to limit weight gain on incident type 2 diabetes mellitus among people with HIV initiating antiretroviral therapy in the United States, 2012-2021.","authors":"Catherine R Lesko, Katherine Kurgansky, Elizabeth Humes, Parastu Kasaie, Emily P Hyle, Jennifer O Lam, Sita Lujintanon, Anna Rubtsova, Michael Horberg, Sean X Leng, Raynell Lang, Anthony T Fojo, Vincent C Marconi, Thibaut Davy-Mendez, Keri N Althoff","doi":"10.1093/aje/kwag255","DOIUrl":"10.1093/aje/kwag255","url":null,"abstract":"Among people with HIV (PWH), initiating antiretroviral therapy (ART) is associated with weight gain that might increase the risk of cardiometabolic outcomes. We estimated the effect of hypothetical interventions to restrict increases in body mass index (BMI) in the two years after ART initiation on the 7-year risk of incident type-2 diabetes mellitus (T2DM) among PWH in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) clinical cohorts using the parametric extended g-formula. Among 13,822 normal weight or overweight PWH (BMI ≥18.5 and ≤29.9 kg/m2) who initiated ART between 2012-2021, the 7-year risk of T2DM was 5.6% (95% confidence interval [CI]: 4.8%, 6.3%). Compared to no intervention on BMI, if BMI increase during the first 2 years was capped at 5% of baseline BMI, the risk ratio (RR) for T2DM risk was 0.94 (95% CI, 0.86, 1.03); if BMI was capped at 29.9 kg/m2, RR=0.88 (95% CI, 0.80, 0.97); and if PWH were prevented from gaining any weight over the first 2 years, RR=0.81 (95% CI, 0.72, 0.92). These results provide preliminary evidence to promote studies of real weight maintenance interventions among PWH initiating ART.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178733","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}

引用次数: 0

Those Confounded Examples. 那些令人困惑的例子。

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-14 DOI: 10.1093/aje/kwag256

Stephen R Cole, Ashley I Naimi, Paul N Zivich, Jess K Edwards

引用次数: 0

A Law of Iterated Expectation Primer for Causal Inference. 因果推理的迭代期望引物律。

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-13 DOI: 10.1093/aje/kwag258

Ashley I Naimi, Razieh Nabi, Lindsay J Collin, Zhaohua Zeng, Paul N Zivich, Stephen R Cole

{"title":"A Law of Iterated Expectation Primer for Causal Inference.","authors":"Ashley I Naimi, Razieh Nabi, Lindsay J Collin, Zhaohua Zeng, Paul N Zivich, Stephen R Cole","doi":"10.1093/aje/kwag258","DOIUrl":"https://doi.org/10.1093/aje/kwag258","url":null,"abstract":"The g-formula is a foundational tool for identifying causal effects in observational data. This tool is based on the law of iterated expectation, a key mathematical identity in statistics. However, the notation with which the law of iterated expectation and the g-formula is expressed can be opaque to those with little background in statistics. We provide a primer introducing the law of iterated expectation, the integration notation used to express it, and its role for causal effect identification via the g-formula. Combined with the assumptions of causal consistency, positivity, and conditional exchangeability, the law of iterated expectation yields a causal standardization formula (the g-formula) in two nonparametrically equivalent forms: a non-iterative conditional expectation (NICE) form involving a single weighted average of conditional outcome means, and an iterative conditional expectation (ICE) form involving nested expectations. We illustrate both forms using three progressively complex numerical examples: a time-fixed example with a single binary confounder, a time-fixed example with discrete and continuous confounders, and a time-varying example with two timepoints. We provide clarity on what the law of iterated expectation is, how it is related to the g-formula, and how to gain intuition of its mathematical formulations in actual data examples that can be generalized to a range of settings.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163568","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}

引用次数: 0

Correction to: Simple graphical rules for assessing selection bias in general-population and selected-sample treatment effects. 修正：评估一般人群和选定样本治疗效果的选择偏倚的简单图形规则。

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-13 DOI: 10.1093/aje/kwag251

引用次数: 0

Racial discrimination and preterm birth subtype among a prospective cohort of nulliparous Black women in the United States, 2010-2013. 2010-2013年美国未生育黑人妇女前瞻性队列中种族歧视与早产亚型的关系

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-13 DOI: 10.1093/aje/kwag252

Ashley S Judge, Collette N Ncube, Erika T Beidelman, Tera Howard, Kelli Ryckman, Christina Ludema

{"title":"Racial discrimination and preterm birth subtype among a prospective cohort of nulliparous Black women in the United States, 2010-2013.","authors":"Ashley S Judge, Collette N Ncube, Erika T Beidelman, Tera Howard, Kelli Ryckman, Christina Ludema","doi":"10.1093/aje/kwag252","DOIUrl":"https://doi.org/10.1093/aje/kwag252","url":null,"abstract":"Racial discrimination has been associated with an increased risk of preterm birth (PTB) among Black women. Few studies have examined whether this association differs by clinical presentation of PTB. We examined the association between racial discrimination and PTB subtype using data from a 2010-2013 clinic-based prospective cohort study of nulliparous women among women who self-reported Black race. Lifetime racial discrimination was measured with the revised Experiences of Discrimination scale. We used inverse probability of exposure and post-stratification weights with the cumulative incidence function to estimate associations between racial discrimination and spontaneous PTB and indicated PTB within a competing risk framework. We estimated standard errors via bootstrapping. We stratified by education and age group to examine effect modification. Compared to none, racial discrimination in ≥3 situations was associated with 1.66 (95% CI, 0.72, 3.82) times the risk of spontaneous PTB and 0.37 (95% CI, 0.15, 0.93) times the risk of indicated PTB. Point estimates between racial discrimination and spontaneous PTB were strongest among women with some college education and ≥20 year-olds. Future studies should consider clinical subtype in assessments of the association between racism and preterm birth and include in the study design late prenatal care initiators.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165044","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}

引用次数: 0

Estimate Optimal Dynamic Treatment Regimes with Partial Compatibility: An Application to data from a TREAT Asia HIV Observational Database (TAHOD) site in Pune, India. 估计具有部分相容性的最优动态治疗方案：对印度浦那治疗亚洲艾滋病观察数据库（TAHOD）站点数据的应用。

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-13 DOI: 10.1093/aje/kwag254

Chloe Si, David A Stephens, Erica E M Moodie, Ivan Marbaniang, Vidya Mave, Haridas Prasad

{"title":"Estimate Optimal Dynamic Treatment Regimes with Partial Compatibility: An Application to data from a TREAT Asia HIV Observational Database (TAHOD) site in Pune, India.","authors":"Chloe Si, David A Stephens, Erica E M Moodie, Ivan Marbaniang, Vidya Mave, Haridas Prasad","doi":"10.1093/aje/kwag254","DOIUrl":"https://doi.org/10.1093/aje/kwag254","url":null,"abstract":"Dynamic treatment regimes (DTRs) formalize sequences of treatment decision rules that adapt to a patient's evolving clinical status. In observational studies, estimation of the value of a DTR (i.e., the expected population-outcome of a treatment strategy) using inverse probability weighting (IPW) and augmented IPW can be unstable when strict regime compatibility yields few valid participant trajectories, leading to highly variable weights and noisy estimates. In this paper, we introduce two adaptive weighting frameworks: generalized compatibility weighting (GCW) and bootstrap compatibility windowing (BCW), that allow near-compatible trajectories to contribute information in limited samples, with diminishing information-borrowing in larger samples. We illustrate how these estimators reduce noise in estimation and stabilize empirical optimal treatment threshold identification. Using data from adults living with HIV in one site of the TREAT Asia HIV Observational Database in India observed from 2013-2024, we evaluate clinically interpretable threshold-based decision rules based on baseline CD4 count and weight. In this application, GCW and BCW produced more stable estimated regime values than standard IPW-based approaches, with reduced variability across candidate thresholds and more reliable identification of empirically optimal treatment rules. These methods provide practical tools for improving treatment rule evaluation in observational studies.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163641","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}

引用次数: 0

Health consequences of spousal health shocks: evidence from a matched event study in the United States. 配偶健康冲击对健康的影响：来自美国匹配事件研究的证据。

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-07 DOI: 10.1093/aje/kwag178

Ah-Reum Lee, Ashwin Kotwal, Jacqueline M Torres

{"title":"Health consequences of spousal health shocks: evidence from a matched event study in the United States.","authors":"Ah-Reum Lee, Ashwin Kotwal, Jacqueline M Torres","doi":"10.1093/aje/kwag178","DOIUrl":"10.1093/aje/kwag178","url":null,"abstract":"Major disease diagnoses can create shocks that ripple through households. Population-level evidence in the US on how spouses and partners fare after a partner's major diagnosis remains sparse and is often limited to caregiver or employment-related outcomes. Using the US Health and Retirement Study (1992-2020), we evaluated population-level health spillovers to spouses after a partner's first diagnosis of cancer, stroke, or heart disease, employing a stacked event-study design with matching (n = 29 166). Outcomes included subjective health, doctor-diagnosed conditions, limitations in basic and instrumental activities of daily living (ADL/IADL), and health behaviors and use of preventive care. We evaluated heterogeneity by sociodemographic and economic conditions. Spouses of newly diagnosed patients experienced modest but persistent declines: more frequent reports of poor health ($boldsymbol{beta}$ = .02, 95% CI, 0.00, 0.03), more doctor-diagnosed conditions ($boldsymbol{beta}$ = .05, 95% CI, 0.01, 0.08), and higher depressive symptoms ($boldsymbol{beta}$ = .08, 95% CI, 0.01, 0.16). Effects were greater among women whose male partners received a diagnosis and among spouses with lower education or fewer assets. Health and preventive care behaviors were largely unchanged. Findings motivate early, spouse-focused support and underscore the need for targeted interventions for spouses at highest risk.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":"2518-2527"},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576743","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}

引用次数: 0