American journal of epidemiology最新文献

{"title":"Immortal time bias from selection: a principal stratification perspective.","authors":"Bronner P Gonçalves, Etsuji Suzuki","doi":"10.1093/aje/kwaf146","DOIUrl":"https://doi.org/10.1093/aje/kwaf146","url":null,"abstract":"<p><p>Immortal time bias due to post-treatment definition of eligibility criteria can affect experimental and observational studies, and yet, in contrast to the extensive literature on the classical form of immortal time bias, it has seldom been the focus of methodological discussions. Here, we propose an account of eligibility-related immortal time bias that uses the principal stratification framework to explain the non-comparability of treatment arms (or exposure groups) conditional on selection. In particular, we show that the statistical estimand that conditions on observed eligibility after time zero of follow-up can be interpreted using partially overlapping principal strata. Further, we show that, under this perspective, as the timing of eligibility approaches time zero of follow-up, the probabilities of the outcome for eligible individuals monotonically approach the corresponding unconditional (in absence of selection) expected potential outcomes under different treatment levels. Our study provides a potential outcomes-based explanation of eligibility-related immortal time bias, and indicates that, in addition to the target trial emulation framework, principal effects might, for some studies, be useful causal estimands.</p>","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635967","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":"Evaluating administrative measures of school quality as mediators of the relationship between attending a segregated school and cognitive function among older Black individuals: The STAR Study.","authors":"Sirena Gutierrez, Rachel A Whitmer, Marilyn D Thomas, Kristen M George, Rachel Peterson, Lisa L Barnes, Isabel E Allen, M Maria Glymour, Jacqueline M Torres, Paola Gilsanz","doi":"10.1093/aje/kwaf150","DOIUrl":"https://doi.org/10.1093/aje/kwaf150","url":null,"abstract":"<p><p>Research highlights school segregation's impact on cognitive aging for older Black adults, yet the mediating role of school quality-reflecting systemic (dis)investment in segregated schools-remains unexplored. This study included 726 community-dwelling Black adults from the Study of Healthy Aging in African Americans. Participants self-reported segregated school attendance, while administrative measures of state-level school quality (term length, percent attendance, student-teacher ratio, composite z-score) were linked to their grade-specific state of residence. We estimated the extent to which associations between segregated schooling and domain-specific cognition were mediated by school quality. Sensitivity analyses examined grade-specific effects. Attending a segregated school was associated with poorer school quality (e.g., βterm-length= -1.71 [-2.52,-0.91]) and lower semantic memory (β= -0.17 [-0.32,-0.02]). The school quality composite measure mediated 30% of the overall association with semantic memory (natural indirect effect: β= -0.05 [-0.09,-0.01]; direct effect: β= -0.14 [-0.30,0.02]). Total effect estimates were imprecise for executive function and verbal episodic memory. Our results suggest that state-level (dis)investments in school quality may be an important mechanism by which school-based segregation contributes to late-life cognitive function. Interventions that target the upstream, structural drivers of school-based segregation and related disinvestments may be important strategies for reducing cognitive aging inequities.</p>","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635966","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":"COVID-19 pandemic impact on clinical condition capture in real-world data: an assessment framework.","authors":"Yehua Wang, Yanning Wang, Earl J Morris, Nicole E Smolinski, Thuy N Thai, Almut G Winterstein","doi":"10.1093/aje/kwaf153","DOIUrl":"https://doi.org/10.1093/aje/kwaf153","url":null,"abstract":"<p><p>Background The COVID-19 pandemic has impacted healthcare utilization and, consequently, real-world data. In this study, we used analytical and data visualization approaches to untangle effects on condition measurement and true shifts in the patient population seeking healthcare. Methods We used MerativeTM MarketScan® 2018-2020 commercial claims data to develop 24 monthly cohorts of patients aged ≥18 years with 12 months baseline enrollment and an encounter for diabetes, cancer, hypertension, depression, myocardial infarction (MI), atrial fibrillation (Afib), or urinary tract infections (UTI) as the index condition in a given month. We compared monthly prevalence of each condition in 2020 vs. 2019. We then imposed 3, 6, and 12-month look-back periods (LBP) to capture comorbidities grouped by Clinical Classifications Software Refined (CCSR) or summarized in the Charleson Comorbidity Index (CCI) and conducted similar 2020 versus 2019 prevalence comparisons. Results Changes in condition prevalence varied across conditions with strongest declines for cancer in April 2020 (-57.4%) and strongest increases for depression in December 2020 (+11.8%). The mean CCI was higher for most conditions during the spring of 2020 and this difference was accentuated by applying a longer LBP. Similar trends were found regarding the number of CCSR categories. Conclusion Pandemic-related changes in condition capture were complex, involving both increases and decreases in encounters for specific conditions and in comorbidities, along with variations in comorbidity capture dependent on look-back periods. We provided a practical approach to untangle these phenomena along with open-source algorithms and visualization tools to assess these changes and inform study design and analysis.</p>","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635965","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":"Two-Stage Interrupted Time Series Analysis with Machine Learning: Evaluating the Health Effects of the 2018 Wildfire Smoke Event in San Francisco County as a Case Study.","authors":"Arnab K Dey, Yiqun Ma, Gabriel Carrasco-Escobar, Changwoo Han, François Rerolle, Tarik Benmarhnia","doi":"10.1093/aje/kwaf147","DOIUrl":"https://doi.org/10.1093/aje/kwaf147","url":null,"abstract":"<p><p>Randomized controlled trials (RCTs) are considered a key identification strategy for establishing causal relationships between exposures and outcomes. When evaluating the health impacts of extreme weather events, however, RCTs are generally infeasible due to ethical issues, costs, and the lack of a suitable control group. Quasi-experimental designs capitalizing on the timing of natural experiments, such as Interrupted Time Series (ITS), offer a valuable alternative to estimate causal effects when control groups are not available. This paper explores the application of a two-stage ITS framework that compares traditional autoregressive integrated moving average (ARIMA) models and two machine learning algorithms: Neural Network Autoregressive (NNETAR) and Prophet-Extreme Gradient Boosting (XGBoost). As a case study, we assess the impacts of the 2018 wildfire smoke event on respiratory hospitalizations in San Francisco County, California. We split the data into pre- and post-event periods to train and evaluate the models, perform cross-validation for hyperparameter tuning, and predict hospitalizations under the counterfactual scenario. Data and R code are provided for reproducibility. In the case study, the Prophet-XGBoost shows the best model performance and was used to generate the counterfactual trends. We estimate that the 2018 smoke event resulted in a total of 92 (95% empirical confidence interval: 24, 125) excess respiratory hospitalizations (12.5% of the observed hospitalization count during the event period). Our proposed approach offers a powerful tool for assessing the effects of extreme weather events and can be broadly applied to other epidemiological contexts, such as public health policy evaluation.</p>","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635968","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":"Emotional and instrumental social support and older adults' depressive symptoms: Collaborative individual participant data meta-analysis of 11 population-based studies of ageing.","authors":"Suraj Samtani, Gowsaly Mahalingam, Ben C P Lam, Darren M Lipnicki, Katya Numbers, Maria Fernanda Lima-Costa, Sergio Luis Blay, Erico Castro Costa, Shifu Xiao, Steffi Reidel-Heller, Susanne Röhr, Alexander Pabst, Nikolaos Scarmeas, Mary Yannakoulia, Mary Kosmidis, Murali Krishna, Kalyanaraman Kumaran, Suzana Shahar, Tze Pin Ng, Roger Ho, Ki-Woong Kim, Ingmar Skoog, Jenna Najar, Therese Rydberg Sterner, Mary Ganguli, Chung-Chou Ho Chang, Tiffany F Hughes, Perminder S Sachdev, Henry Brodaty, For The Cohort Studies Of Memory In An International Consortium Cosmic","doi":"10.1093/aje/kwaf137","DOIUrl":"https://doi.org/10.1093/aje/kwaf137","url":null,"abstract":"<p><p>Social support is considered a protective factor against depression, but there are inconsistent findings regarding social support and depression in older adults. We aimed to clarify the association between emotional and instrumental social support and depressive symptoms in older adults cross-sectionally and longitudinally (mean follow-up = 1.96 years). We meta-analyzed raw individual participant level data from adults in mid- and late-life (N = 23,973) who completed questionnaires about physical health, mental health, and social support and completed neuropsychological assessments. These were COSMIC (Cohort Studies of Memory in an International Consortium) cohort studies carried out in Australia, Brazil, China, Germany, Greece, India, Indonesia, Singapore, South Korea, Sweden, and the United States in mostly urban settings. After controlling for depression risk factors, emotional support (B = -0.40, 95%CI: -0.60,-0.21), but not instrumental support (B = 0.17, 95%CI: -0.26,0.59), was associated with lower depressive symptoms cross-sectionally and at follow-up [emotional support (B = -0.37, 95%CI: -0.54,-0.20); instrumental support (B = 0.09, 95%CI: -0.30,0.49)]. Emotional support was associated with lower depressive scores cross-sectionally and longitudinally, while instrumental support was not associated with depressive symptoms. Our findings can help inform the nature of interventions to prevent and reduce risk of depression among older adults.</p>","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607083","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":"Validity of diagnostic codes used to ascertain maternal injuries during pregnancy.","authors":"Asma M Ahmed, Riyan Deria, Rosalba Barojas Chavarria, Allie Sakowicz, David Stamilio, Elizabeth T Jensen","doi":"10.1093/aje/kwaf145","DOIUrl":"https://doi.org/10.1093/aje/kwaf145","url":null,"abstract":"<p><strong>Background: </strong>Previous research has relied on International Classification of Diseases (ICD) codes to define maternal injuries. However, the validity of these codes remains unclear. We aimed to validate ICD-10 codes used to ascertain maternal injuries using medical chart reviews as the gold standard.</p><p><strong>Methods: </strong>A retrospective cohort study of all births occurring at Atrium Health Wake Forest Baptist Medical Center in 2022-2023. We randomly selected 100 subjects with ICD-10-indicated injury and 100 subjects without indication of injury. Two independent reviewers, blinded to the ICD-10-based classification, conducted the chart review. We examined the validity of relevant injury-related codes (V00-Y38; S00-T79; O9A.2-O9A.4) and calculated positive predictive values (PPV) for different algorithms defined by varying the encounter type and the list of codes used.</p><p><strong>Results: </strong>The algorithm that included all injury-related ICD-10 codes without encounter type restrictions showed moderate PPV (71%, 95% confidence interval (CI): 61%-79%) and high negative predictive value (96% (90%-98%)). PPV was maximized when including codes V00-Y38 and restricting encounter type to inpatient or emergency department encounters (PPV 100% (93%-100%).</p><p><strong>Conclusions: </strong>This study characterizes the accuracy of ICD-10-based algorithms for ascertaining maternal injuries during pregnancy. These findings can help improve inference by providing bias parameters for future research.</p>","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590248","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":"Childhood Social and Economic Disadvantage and the Risk of Uterine Fibroids among Black Women.","authors":"Sefanit Admasu, Alexandra Sitarik, Chantel L Martin, Quaker E Harmon, Lauren A Wise, Donna D Baird, Ganesa Wegienka, Anissa I Vines","doi":"10.1093/aje/kwaf143","DOIUrl":"https://doi.org/10.1093/aje/kwaf143","url":null,"abstract":"<p><p>The association of childhood social and economic disadvantage (\"disadvantage\") and uterine fibroid risk is understudied. We examined the association between disadvantage and fibroid incidence using standardized ultrasound exams at repeated visits, among 1,230 participants 23-35 years of age in the Study of Environment, Lifestyle and Fibroids. Six disadvantage variables collected at baseline (i.e., food insecurity, neighborhood safety, childhood income, mother's educational attainment, household composition, and quiet bedroom for sleep) were evaluated separately, and using a latent class dichotomous (high/low) disadvantage variable. We also looked at possible modifying effects of a supportive childhood environment. Using Cox models to estimate incidence rate ratios (RR) and 95% confidence intervals (CI), with age as the time scale, we found little evidence for an increased risk of fibroids for any of the disadvantage variables or with the latent class construct. Having a supportive social environment in childhood had little impact on the associations between disadvantage and fibroid incidence. These findings are consistent with and expand upon prior findings from large studies with more limited data on social and economic disadvantage and less accurate data on timing of fibroid incidence.</p>","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558799","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":"Bidirectional associations of Physical Activity and Cognitive Function in Midlife Adults: A Longitudinal Analysis across 26 years follow-up.","authors":"John J Mitchell, Mark Hamer, Sarah N James, Tom Norris, Barbara J Jefferis, S Goya Wannamethee, Joanna M Blodgett","doi":"10.1093/aje/kwaf144","DOIUrl":"https://doi.org/10.1093/aje/kwaf144","url":null,"abstract":"<p><p>Prior studies linking physical activity (PA) and cognition typically assume a causal association between PA and subsequent cognition. Yet, there remains speculation regarding the direction of this association. We investigated bidirectional associations between PA and cognition. Participants of the Medical Research Council National Survey of Health and Development cohort, all born in 1946 reported their PA frequency, undertook processing speed and word recall memory tasks throughout midlife (ages 43 years(y), 53y, 63y and 69y). There was evidence of bidirectional associations in initial structural equation models. To quantify this relationship, mixed-effects models were fitted with a lagged predictor and controlling for childhood cognition, socioeconomic and health factors, attrition and mortality. Among 2,888 participants (51% female) we report bidirectional associations between cognition and PA in midlife. A 1-standard deviation increase in verbal memory was associated with an increased probability of being in the mid-active category at the subsequent wave for females (Relative Risk Ratio (RRR):1.30 (95% Confidence Interval (CI):1.15-1.46)), while becoming active was associated with a minimally greater subsequent verbal memory z-score (β= 0.08, 95%CI: 0.01-0.14). Bidirectional associations proved more robust for males. Results suggest that reciprocal associations exist between PA and cognition, yet stronger in the direction of cognition to PA.</p>","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558798","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":"Evaluating the generalizability of commercial healthcare claims data.","authors":"Alex Dahlen, Yaowei Deng, Vivek Charu","doi":"10.1093/aje/kwaf142","DOIUrl":"10.1093/aje/kwaf142","url":null,"abstract":"<p><p>Commercial healthcare claims datasets area non-random sample of the US population, affecting generalizability. Rigorous comparisons of claims-derived results to ground-truth data that quantify external validity bias are lacking. Our goal is to (1) quantify external validity of commercial healthcare claims data, and (2) evaluate how socioeconomic/demographic factors are related to the bias. We analyzed inpatient discharge records occurring between 01/01/2019 to 12/31/2019 in five states: California, Iowa, Maryland, Massachusetts, and New Jersey, and compared rates (per person-year) of the 250 most common inpatient procedures between claims and reference data for each target population. We used Merative™ MarketScan® Commercial Database for the claims data and State Inpatient Databases (SID) and the US Census as reference. For a target population of all Americans, commercial healthcare claims underestimate the rate of overall inpatient discharges by 23.1%. The extent of bias varied across procedures, with the rates of ~25% of procedures being underestimated by a factor of 2. Socioeconomic factors were significantly associated with the magnitude of bias (${R}^2=69.4%,$p < 0.001). When the target population was restricted to commercially insured Americans, the bias decreased substantially (1.4% of procedures were biased by more than factor of 2), but some variation across procedures remained.</p>","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551667","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":"Firearm Control Regulations and Firearm-related Mortality: A Cross-National Ecological Study.","authors":"Siddhesh Zadey, Leah E Roberts, Brady Bushover, Adam M Whalen, Christina A Mehranbod, Stan Chihuri, Evan L Eschliman, Christopher N Morrison","doi":"10.1093/aje/kwaf141","DOIUrl":"10.1093/aje/kwaf141","url":null,"abstract":"","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551668","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}