Claire E Margerison, Natasha V Pilkauskas, Grace Joachim, Zhehui Luo, Tim Bruckner
{"title":"Impacts of the 2021 Child Tax Credit advance monthly payments on birth outcomes in the United States: a natural experiment.","authors":"Claire E Margerison, Natasha V Pilkauskas, Grace Joachim, Zhehui Luo, Tim Bruckner","doi":"10.1093/aje/kwaf211","DOIUrl":"https://doi.org/10.1093/aje/kwaf211","url":null,"abstract":"<p><p>We estimated impacts of monthly cash transfers during pregnancy on birth outcomes in the US through the natural experiment of the 2021 expanded Child Tax Credit. We used US vital statistics birth certificate data 2016 to 2023. We estimated the association between total amount of CTC a pregnant person was eligible to receive during pregnancy (based on number of previous live births, time since last previous live birth, and timing of pregnancy relative to CTC payments) and small for gestational age (SGA, <10th percentile weight for gestational age) and low birth weight (LBW, <2500 grams). We controlled for time-dependent autocorrelation, individual-level characteristics, COVID-19 hospitalizations, and presence of other pandemic-era safety net programs. We found that a $1,000 increase in total pregnancy CTC was associated with an 0.72 percentage point decrease in SGA (95% CI: -0.74, -0.70) and an 0.49 percentage point decrease in LBW (95% CI: -0.50, -0.47), correlating to 6.7 and 8.2 percent decreases in SGA and LBW, respectively. The association between the CTC and birth outcomes was largest among non-Hispanic White and smallest among foreign-born Hispanic people. Our results align with prior studies' findings that cash transfers during pregnancy are associated with moderate declines in adverse birth outcomes.</p>","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147464","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}
Bo-Yu Hsiao, Chun-Ju Chiang, Ya-Wen Yang, Wen-Chung Lee
{"title":"Suicide mortality trends among cancer patients in Taiwan: suicide prevention efforts and cancer care improvements.","authors":"Bo-Yu Hsiao, Chun-Ju Chiang, Ya-Wen Yang, Wen-Chung Lee","doi":"10.1093/aje/kwaf201","DOIUrl":"https://doi.org/10.1093/aje/kwaf201","url":null,"abstract":"<p><strong>Background: </strong>Cancer patients face a suicide risk 2 to 4 times higher than the general population. This study examines trends in suicide mortality among cancer patients in Taiwan and explores potential links with national suicide prevention efforts and advancements in cancer care.</p><p><strong>Methods: </strong>Data from the Taiwan Cancer Registry and mortality files were analyzed for invasive cancer cases diagnosed from 1985 to 2018. Trends of age-standardized suicide rates were analyzed using joinpoint regression, and standardized mortality ratios compared rates between cancer patients and the general population, stratified by sex, age, cancer type, stage, and time since diagnosis.</p><p><strong>Results: </strong>Suicide mortality declined in the general population after 2005[annual percent change, APC(95% confidence interval), -1.98(-2.61,-1.43) for men; -1.69(-2.31,-1.15) for women; both P < 0.0001], with a greater decline among cancer patients, particularly women[APC: -2.74(-5.09,1.70) for men, P = 0.0652; -5.46(-7.94,-1.27) for women, P = 0.0436]. Pancreatic, lung, and oral cancers had higher suicide rates but showed steady declines. Elevated risks persisted in subgroups such as male stomach cancer patients. Suicide rates generally decreased over time post-diagnosis but remained higher in advanced-stage cancers.</p><p><strong>Conclusion: </strong>National suicide prevention efforts and improved cancer care appear linked to reduced suicide mortality among cancer patients. However, high-risk subgroups require targeted interventions.</p>","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136130","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}
Arti V Virkud, Eric Tchetgen Tchetgen, Enrique F Schisterman, Beth Pineles, Lisa D Levine, Stephen R Cole, Stefanie N Hinkle, Sunni Mumford, Kristin D Gerson, Brandie D Taylor, Sean Blackwell, Alan Peaceman, Samuel Parry, Maria T Johnson, Dalynn Willis, Ellen C Caniglia
{"title":"Clarifying Contradictions: Transportability in 17OHP-C Trials and Preterm Birth Outcomes Using Doubly Debiased Machine Learning.","authors":"Arti V Virkud, Eric Tchetgen Tchetgen, Enrique F Schisterman, Beth Pineles, Lisa D Levine, Stephen R Cole, Stefanie N Hinkle, Sunni Mumford, Kristin D Gerson, Brandie D Taylor, Sean Blackwell, Alan Peaceman, Samuel Parry, Maria T Johnson, Dalynn Willis, Ellen C Caniglia","doi":"10.1093/aje/kwaf202","DOIUrl":"https://doi.org/10.1093/aje/kwaf202","url":null,"abstract":"<p><p>Following the Meis et al. trial that identified a benefit of 17-alpha-hydroxyprogesterone caproate (17OHP-C) in reducing the risk of recurrent preterm birth (PTB) (risk difference (RD) -18.6%, 95% confidence interval (CI): -28.2%, -9.2%), a confirmatory trial (PROLONG) identified no benefit of 17OHP-C (RD: 1.2%, 95% CI: -3.0%, 5.3%). The leading hypothesis is that the difference was due to the heterogeneity in PTB risk. We implemented state-of-the-art methods, using doubly debiased machine learning for transportability to investigate whether the conflicting trial results could be explained by measured differences between trial populations. The estimated RD when transporting the effect in Meis to the PROLONG trial population was -18.6% (95% CI: -55.9%, 8.8%) comparing 17OHP-C to placebo. The estimated RD when transporting PROLONG to Meis was 5.2% (95% CI: -17.3%, 18.1%) comparing 17OHP-C to placebo. Transporting from PROLONG to Meis did not recover the protective effect observed in Meis, which we hypothesize is due to a hidden violation of one or more causal assumptions for transportability, such as the presence of unmeasured effect measure modifiers. Transporting from Meis to PROLONG did not recover the null point estimate observed in PROLONG, though the confidence interval was wide. Future studies should explore effect heterogeneity PTB.</p>","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129847","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}
Sakurako S Okuzono, Koichiro Shiba, David T Zhu, Sarah Oh, Yu-Tien Hsu, Aki Yazawa, Hiroyuki Hikichi, Jun Aida, Katsunori Kondo, Henning Tiemeier, Ichiro Kawachi
{"title":"Disaster-related home loss, mental health, and risk of cognitive disability: causal mediation analysis using longitudinal data of disaster survivors.","authors":"Sakurako S Okuzono, Koichiro Shiba, David T Zhu, Sarah Oh, Yu-Tien Hsu, Aki Yazawa, Hiroyuki Hikichi, Jun Aida, Katsunori Kondo, Henning Tiemeier, Ichiro Kawachi","doi":"10.1093/aje/kwaf208","DOIUrl":"https://doi.org/10.1093/aje/kwaf208","url":null,"abstract":"<p><strong>Background: </strong>Emerging evidence links disaster-related home loss to increased cognitive impairment, yet the mechanisms underlying this association remain unclear. This study examines whether psychopathology and diminished social connection mediate the relationship between home loss and cognitive disability among older disaster survivors.</p><p><strong>Methods: </strong>We conducted a prospective cohort study of survivors of the 2011 Great East Japan Earthquake and Tsunami. Causal mediation analysis was used to estimate the role of post-disaster depressive symptoms, post-traumatic stress symptoms, social support, social participation, and social cohesion in mediating the association. Analyses adjusted for pre-disaster confounders.</p><p><strong>Results: </strong>Among 3,138 survivors, 140 experienced disaster-related home loss, and 498 experienced mild to severe cognitive disability. Home loss was associated with increased cognitive impairment, increased psychopathology, as well as decreased social connections. 48% of the total effect of home loss on cognitive impairment was mediated by depressive symptoms, but not post-traumatic stress symptoms. Although the effect was marginal, 19% was also explained by a decline in social cohesion.</p><p><strong>Conclusion: </strong>Disaster-related home loss was associated with subsequent cognitive impairment through post-disaster depressive symptoms and decline in social cohesion. Group relocation and early intervention for those with depressive symptoms might ameliorate the adverse effects of home loss in cognitive disability.</p>","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111465","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}
Yunxuan Zhang, Thomas M Gill, Karen Bandeen-Roche, Robert D Becher, Kendra Davis-Plourde, Emma X Zang
{"title":"Obtaining population-based estimates for survey data using Bayesian hierarchical models with Poststratification.","authors":"Yunxuan Zhang, Thomas M Gill, Karen Bandeen-Roche, Robert D Becher, Kendra Davis-Plourde, Emma X Zang","doi":"10.1093/aje/kwaf209","DOIUrl":"https://doi.org/10.1093/aje/kwaf209","url":null,"abstract":"<p><p>For large-scale surveys such as the National Health and Aging Trends Study (NHATS), investigators may wish to combine data from two (or more) cohorts in a single analysis to obtain larger sample sizes. Unfortunately, it is not possible to combine the 2011 and 2015 NHATS cohorts while retaining the sample weights. We applied Bayesian hierarchical models with poststratification as an alternative strategy for obtaining population-based estimates from NHATS. As proof of principle, we compared prevalence estimates of frailty obtained from our Bayesian approach with those obtained from the 2011 and 2015 cohorts using the NHATS sample weights. Once validated, we applied our strategy to combine the cohorts into a single analytical dataset without overlap of participants, and generated Bayesian estimates of frailty for the combined cohort. Estimates from the Bayesian model closely matched the weighted NHATS estimates. The ability to combine cohorts while generating population-based estimates will allow investigators to address questions that require larger sample sizes, thereby enhancing the value of NHATS to the scientific community.</p>","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111491","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}
Shekhar Chauhan, Dawn Carr, Miles Taylor, Amanda Sonnega
{"title":"Differences in Protective Resources and Risks for Depressive Symptoms Among Recent Widows in the United States and India.","authors":"Shekhar Chauhan, Dawn Carr, Miles Taylor, Amanda Sonnega","doi":"10.1093/aje/kwaf210","DOIUrl":"https://doi.org/10.1093/aje/kwaf210","url":null,"abstract":"<p><p>Widowhood is among the most consequential stressful events for mental health. Although certain resources have been identified as protective of mental health following widowhood, these findings are based on United States (U.S.) samples. This study uses novel harmonized data to evaluate differences in depressive symptoms and related factors among those recently widowed (i.e., within the last 2 years) in the U.S. (Health and Retirement Study) and India (Longitudinal Ageing Study in India). We find U.S. widows have greater elevation in depressive symptoms (-0.36 standard deviations) than widows in India (-0.15) on average. We identify three protective resources for widows that are dependent on country context: having close friends versus no friends (-0.58 versus -0.13) and living with others versus alone (-0.79 versus -0.23) are both larger for widows in the U.S. Self-rated health that is good, fair, or poor is related to higher depressive symptoms for widows in the US versus India (between 0.55 and 1.12). Findings suggest protective resources among recently widowed individuals designed to protect mental health following this stressful event will require consideration of country context. In particular, social engagement-based interventions may offer more significant benefits to widows in the U.S.</p>","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111496","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}
Catherine Bunting, Amanda Clery, Rebecca Cassidy, Eirini-Christina Saloniki, Sally Kendall, Louise Mc Grath-Lone, Jenny Woodman, Katie Harron
{"title":"Combining target trial emulation and qualitative research to understand the effect of health visiting on child hospital admissions in England.","authors":"Catherine Bunting, Amanda Clery, Rebecca Cassidy, Eirini-Christina Saloniki, Sally Kendall, Louise Mc Grath-Lone, Jenny Woodman, Katie Harron","doi":"10.1093/aje/kwaf207","DOIUrl":"https://doi.org/10.1093/aje/kwaf207","url":null,"abstract":"<p><p>Health visiting is a complex public health intervention in which specialist nurses work with families to support the healthy development of children up to five years of age. Using routinely collected administrative health data, we emulated a target trial to estimate the effect of enhanced health visiting services on potentially avoidable hospital admissions for children born in 10 local areas in England between 2016 and 2019. We found that receiving additional support from the health visiting team in the early weeks of life was associated with an increased odds of a child experiencing a potentially avoidable hospitalisation (OR = 1.28, 95% confidence interval 1.02 to 1.60). Health visiting may encourage families to seek secondary health care, for example by building confidence in public services or heightening parental anxiety about the risks of childhood health conditions. However, qualitative research and sensitivity analyses indicated that our effect estimate may have been subject to residual confounding, selection bias or both. An in-depth understanding of the intervention and the mechanisms through which treatments are assigned is essential for generating valid estimates of causal effects.</p>","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145090881","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}
Charlotte Gaughan, David Braunholtz, Leanne Massie, Tarnjit Khera, Paul J Birrell, Daniela De Angelis, Josh Blake, Joy Preece, Koen Pouwels, Ann Sarah Walker, The Covid- Infection Survey Team
{"title":"The cumulative incidence and infection hospitalisation risk of SARS-CoV-2 by variant; a longitudinal study in England.","authors":"Charlotte Gaughan, David Braunholtz, Leanne Massie, Tarnjit Khera, Paul J Birrell, Daniela De Angelis, Josh Blake, Joy Preece, Koen Pouwels, Ann Sarah Walker, The Covid- Infection Survey Team","doi":"10.1093/aje/kwaf203","DOIUrl":"https://doi.org/10.1093/aje/kwaf203","url":null,"abstract":"<p><p>The COVID Infection Survey monitored daily positivity through the COVID-19 pandemic from April 26, 2020 to March 13, 2023. In total 451 079 participants in private residential households were enrolled in England and tested at regular intervals for SARS-CoV-2. Here, we estimated the cumulative incidence of PCR-positive infections using a multilevel regression and post-stratification model to obtain estimates of daily positivity, combined with a distribution of the duration of positivity from regular testing data. We estimated cumulative incidence by epoch (approximated by the dominance of successive SARS-CoV-2 variants) and calculated the corresponding infection-hospitalisation ratios. We found cumulative incidence was relatively low during pre-Alpha and Alpha-dominant epochs, rose steadily during the Delta-dominant epoch, and was highest during successive Omicron-dominant epochs. High cumulative incidences in successive Omicron-dominant epochs are consistent with lack of protection from previous infections. However, infection-hospitalisation ratios, whilst higher at the start of the pandemic, remained low after the Delta-dominant epoch and vaccine introduction. Stratified estimates show hospitalisation risk was consistently very low for younger age groups, increasing with age. Surveys with random sampling and longitudinal designs facilitate direct estimation of prevalence and incidence, however should be complemented by dense sampling to estimate duration of infection to maximise their value.</p>","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145090906","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":"Revisiting the social determinants of health with explainable AI: a cross-country perspective.","authors":"Jiani Yan","doi":"10.1093/aje/kwaf205","DOIUrl":"https://doi.org/10.1093/aje/kwaf205","url":null,"abstract":"<p><p>In social science and epidemiological research, individual risk factors for mortality are often examined in isolation, while approaches that consider multiple risk factors simultaneously remain less common. Using the Health and Retirement Study in the US, the Survey of Health, Ageing and Retirement in Europe, and the English Longitudinal Study of Ageing in the UK, we explore the predictability of death with machine learning and explainable AI algorithms, which integrate explanation and prediction simultaneously. Specifically, we extract information from all datasets in seven health-related domains, including demographic, socioeconomic, psychology, social connections, childhood adversity, adulthood adversity, and health behaviours. Our self-devised algorithm reveals consistent domain-level patterns across datasets, with demography and socioeconomic factors being the most significant. However, at the individual risk-factor level, notable differences emerge, emphasising the context-specific nature of certain predictors.</p>","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145090859","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}
Belay Birlie Yimer, Fangyuan Zhang, Jenny Humphreys, Mark Lunt, Meghna Jani, John McBeth, William G Dixon
{"title":"Improving disease misclassification and prevalence estimates by linking primary and secondary care electronic health records: an illustration from arthritis research.","authors":"Belay Birlie Yimer, Fangyuan Zhang, Jenny Humphreys, Mark Lunt, Meghna Jani, John McBeth, William G Dixon","doi":"10.1093/aje/kwaf206","DOIUrl":"https://doi.org/10.1093/aje/kwaf206","url":null,"abstract":"<p><p>Prevalence estimates using primary care data health identify cases via code lists. Validation studies can discover and exclude false positives, but it is often difficult or impossible to find false negatives. This study aimed, using the example of psoriatic arthritis (PsA), to examine the extent of and adjust for misclassification by linking primary care records with text-mined outpatient letters from a North-West regional hospital (2014-2019). 245 cases of PsA were identified among 188,286 adults registered with primary care, giving an observed prevalence of 0.13% [95%CI 0.11%-0.15%]. Among a subgroup of 7,532 primary care patients attending the hospital rheumatology clinic, 202 had a primary care PsA code: 188 were confirmed as true PsA, while 14 were false positives. Primary care codes failed to identify 196 hospital-diagnosed PsA cases, leading to a more than two-fold underestimation. The adjusted prevalence, accounting for misclassification, was 0.25% [95% CI 0.21%-0.28%]. Linking primary care with hospital records identified false positives and negatives, enabling correction of prevalence estimates. This highlights the value of text-mining hospital letters to replace the national absence of coded secondary care diagnosis data from outpatient departments, and the importance of considering the impact of false negatives.</p>","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145090903","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}