Epidemiology最新文献

英文中文

A Quantitative Bias Analysis Approach to Informative Presence Bias in Electronic Health Records. 电子健康记录中信息存在偏差的定量偏差分析方法。

IF 5.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Epidemiology

Pub Date : 2024-04-18 DOI: 10.1097/ede.0000000000001714

Hanxi Zhang, Amy S Clark, Rebecca A Hubbard

Accurate outcome and exposure ascertainment in electronic health record (EHR) data, referred to as EHR phenotyping, relies on the completeness and accuracy of EHR data for each individual. However, some individuals, such as those with a greater comorbidity burden, visit the health care system more frequently and thus have more complete data, compared with others. Ignoring such dependence of exposure and outcome misclassification on visit frequency can bias estimates of associations in EHR analysis. We developed a framework for describing the structure of outcome and exposure misclassification due to informative visit processes in EHR data and assessed the utility of a quantitative bias analysis approach to adjusting for bias induced by informative visit patterns. Using simulations, we found that this method produced unbiased estimates across all informative visit structures, if the phenotype sensitivity and specificity were correctly specified. We applied this method in an example where the association between diabetes and progression-free survival in metastatic breast cancer patients may be subject to informative presence bias. The quantitative bias analysis approach allowed us to evaluate robustness of results to informative presence bias and indicated that findings were unlikely to change across a range of plausible values for phenotype sensitivity and specificity. Researchers using EHR data should carefully consider the informative visit structure reflected in their data and use appropriate approaches such as the quantitative bias analysis approach described here to evaluate robustness of study findings.

电子健康记录（EHR）数据中准确的结果和暴露确定，即 EHR 表型分析，依赖于每个人 EHR 数据的完整性和准确性。然而，与其他人相比，有些人，如合并症负担较重的人，会更频繁地访问医疗保健系统，因此拥有更完整的数据。如果忽略了暴露和结果误分类对就诊频率的这种依赖性，就会使电子病历分析中对相关性的估计出现偏差。我们建立了一个框架，用于描述电子病历数据中信息性就诊过程导致的结果和暴露误分类的结构，并评估了定量偏倚分析方法在调整信息性就诊模式导致的偏倚方面的实用性。通过模拟实验，我们发现如果表型敏感性和特异性指定正确，该方法可在所有信息性就诊结构中产生无偏估计值。我们在一个例子中应用了这种方法，在这个例子中，转移性乳腺癌患者的糖尿病与无进展生存期之间的关联可能会受到信息性存在偏差的影响。定量偏倚分析方法使我们能够评估结果对信息性存在偏倚的稳健性，并表明在表型敏感性和特异性的一系列可信值范围内，研究结果不太可能发生变化。使用电子病历数据的研究人员应仔细考虑其数据中反映的信息性就诊结构，并使用适当的方法（如本文所述的定量偏倚分析方法）来评估研究结果的稳健性。

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引用次数: 0

Prediction Under Interventions: Evaluation of Counterfactual Performance Using Longitudinal Observational Data. 干预下的预测：利用纵向观察数据评估反事实绩效。

IF 5.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Epidemiology

Pub Date : 2024-04-18 DOI: 10.1097/ede.0000000000001713

Ruth H Keogh, Nan Van Geloven

Predictions under interventions are estimates of what a person's risk of an outcome would be if they were to follow a particular treatment strategy, given their individual characteristics. Such predictions can give important input to medical decision-making. However, evaluating the predictive performance of interventional predictions is challenging. Standard ways of evaluating predictive performance do not apply when using observational data, because prediction under interventions involves obtaining predictions of the outcome under conditions that are different from those that are observed for a subset of individuals in the validation dataset. This work describes methods for evaluating counterfactual performance of predictions under interventions for time-to-event outcomes. This means we aim to assess how well predictions would match the validation data if all individuals had followed the treatment strategy under which predictions are made. We focus on counterfactual performance evaluation using longitudinal observational data, and under treatment strategies that involve sustaining a particular treatment regime over time. We introduce an estimation approach using artificial censoring and inverse probability weighting that involves creating a validation dataset mimicking the treatment strategy under which predictions are made. We extend measures of calibration, discrimination (c-index and cumulative/dynamic AUCt) and overall prediction error (Brier score) to allow assessment of counterfactual performance. The methods are evaluated using a simulation study, including scenarios in which the methods should detect poor performance. Applying our methods in the context of liver transplantation shows that our procedure allows quantification of the performance of predictions supporting crucial decisions on organ allocation.

干预措施下的预测是指根据一个人的个体特征，估计如果他采取某种治疗策略，会有多大的结果风险。此类预测可为医疗决策提供重要参考。然而，评估干预预测的预测性能是一项挑战。评估预测性能的标准方法不适用于使用观察数据的情况，因为干预预测涉及在不同于对验证数据集中的子集个体进行观察的条件下获得结果预测。这项工作介绍了评估时间到事件结果干预下预测的反事实性能的方法。这意味着，我们的目标是评估，如果所有个体都采用了预测所依据的治疗策略，预测结果与验证数据的匹配程度如何。我们的重点是利用纵向观察数据，在涉及长期维持特定治疗机制的治疗策略下进行反事实绩效评估。我们引入了一种使用人工删减和反概率加权的估算方法，其中包括创建一个验证数据集，模仿预测所依据的治疗策略。我们扩展了校准、区分度（c 指数和累积/动态 AUCt）和总体预测误差（布赖尔评分）的测量方法，以便评估反事实绩效。我们通过模拟研究对这些方法进行了评估，其中包括这些方法应能检测出性能不佳的情况。将我们的方法应用于肝脏移植表明，我们的程序可以量化支持器官分配关键决策的预测性能。

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引用次数: 0

Long-term Impact of Tropical Cyclones on Disease Exacerbation Among Children with Asthma in the Eastern United States, 2000-2018. 2000-2018年热带气旋对美国东部哮喘儿童病情加重的长期影响。

IF 5.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Epidemiology

Pub Date : 2024-04-18 DOI: 10.1097/ede.0000000000001728

Kate R Weinberger, Nina Veeravalli, Xiao Wu, Nicholas J Nassikas, Keith R Spangler, Nina R Joyce, Gregory A Wellenius

Tropical cyclones are associated with acute increases in mortality and morbidity, but few studies have examined their longer-term health consequences. We assessed whether tropical cyclones are associated with a higher frequency of symptom exacerbation among children with asthma in the following 12 months in eastern United States counties, 2000-2018.

热带气旋与死亡率和发病率的急剧上升有关，但很少有研究对其长期健康后果进行调查。我们评估了热带气旋是否与 2000-2018 年美国东部各县哮喘儿童在随后 12 个月中症状加重的频率较高有关。

引用次数: 0

A rare disease: ZAP70 deficiency. 一种罕见疾病：ZAP70 缺乏症。

IF 1 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Epidemiology

Pub Date : 2024-04-18 eCollection Date: 2024-01-01 DOI: 10.14744/nci.2022.89646

Seher Erdogan, Selen Ceren Cakmak, Atay Gurkan, Canan Hasbal Akkus, Burcu Karakayali, Ozlem Akgun Dogan, Betul Sozeri

Zeta associated protein (ZAP) 70 deficiency is a rare disease. ZAP70 deficiency results in an autosomal recessive form of severe combined immunodeficiency (SCID) that is characterized by a selective absence of CD8 T cells. The diagnosis should be suspected in patients presenting with a severe combined immunodeficiency phenotype and selective deficiency of CD8 T cells. Sequencing of the ZAP70 gene can confirm the diagnosis. We wanted to emphasize that immunodeficiencies should also be remembered in the differential diagnosis by presenting a 5-month-old patient who applied to our clinic with complaints of skin rash and cough, was given respiratory support with mechanical ventilation for a long time, and was diagnosed with ZAP70 deficiency.

Zeta 相关蛋白（ZAP）70 缺乏症是一种罕见疾病。ZAP70 缺乏症会导致常染色体隐性遗传的重症联合免疫缺陷病（SCID），其特征是 CD8 T 细胞选择性缺乏。如果患者表现为重症联合免疫缺陷表型和 CD8 T 细胞选择性缺乏，则应怀疑该病的诊断。ZAP70 基因测序可以确诊。我们想通过介绍一名 5 个月大的患者，强调在鉴别诊断中也应注意免疫缺陷，该患者以皮疹和咳嗽为主诉来我院就诊，长期使用机械通气进行呼吸支持，并被诊断为 ZAP70 缺乏症。

引用次数: 0

Improving Inverse Probability Weighting by Post-calibrating Its Propensity Scores. 通过后校准倾向分数改进反概率加权法

IF 5.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Epidemiology

Pub Date : 2024-04-15 DOI: 10.1097/ede.0000000000001733

Rom Gutman, Ehud Karavani, Yishai Shimoni

Theoretical guarantees for causal inference using propensity scores are partially based on the scores behaving like conditional probabilities. However, scores between zero and one do not necessarily behave like probabilities, especially when output by flexible statistical estimators. We perform a simulation study to assess the error in estimating the average treatment effect before and after applying a simple and well-established postprocessing method to calibrate the propensity scores. We observe that postcalibration reduces the error in effect estimation and that larger improvements in calibration result in larger improvements in effect estimation. Specifically, we find that expressive tree-based estimators, which are often less calibrated than logistic regression-based models initially, tend to show larger improvements relative to logistic regression-based models. Given the improvement in effect estimation and that postcalibration is computationally cheap, we recommend its adoption when modeling propensity scores with expressive models.

使用倾向分数进行因果推断的理论保证部分是基于分数表现得像条件概率。然而，介于 0 和 1 之间的分数并不一定表现得像概率，尤其是在由灵活的统计估计器输出时。我们进行了一项模拟研究，以评估在采用一种简单、成熟的后处理方法校准倾向分数前后，估计平均治疗效果的误差。我们发现，后校准可减少效果估计中的误差，而且校准的改进越大，效果估计的改进也越大。具体地说，我们发现基于树状结构的表达式估计模型在最初的校准程度往往低于基于逻辑回归的模型，但相对于基于逻辑回归的模型，表达式估计模型往往显示出更大的改进。考虑到效果估计的改进以及后校准在计算上的低成本，我们建议在用表达式模型建立倾向得分模型时采用后校准。

引用次数: 0

Reporting and Description of Research Methodology in Studies Estimating Effects of Firearm Policies. 在估算枪支政策影响的研究中报告和描述研究方法。

IF 5.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Epidemiology

Pub Date : 2024-04-09 DOI: 10.1097/ede.0000000000001741

Camerin A Rencken, Julia P Schleimer, Matthew Miller, Sonja A Swanson, Ali Rowhani-Rahbar

Evidence about which firearm policies work, to what extent, and for whom is hotly debated, perhaps partly because variation in research methodology has produced mixed and inconclusive effect estimates. We conducted a scoping review of firearm policy research in the health sciences in the United States, focusing on methodological considerations for causal inference.

关于哪些枪支政策有效、在多大程度上有效以及对谁有效的证据引起了激烈的争论，部分原因可能是研究方法的不同导致了效果评估的混杂和不确定。我们对美国健康科学领域的枪支政策研究进行了一次范围界定审查，重点关注因果推断的方法论因素。

引用次数: 0

Validation of ICD-10 codes for severe maternal morbidity at delivery in a public hospital. 公立医院产妇分娩时严重发病的 ICD-10 编码验证。

IF 5.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Epidemiology

Pub Date : 2024-03-29 DOI: 10.1097/ede.0000000000001743

Sheree L Boulet, Kaitlyn K Stanhope, Arielle N Valdez-Sinon, Danielle Vuncannon, Jessica Preslar, Hannah Bergbower, Brendan Gray, Asmita Gathoo, Nora Hansen, Kerri Andre, Sabrine Bensouda, Braun Cally, Marissa Platner

Severe maternal morbidity is a composite measure of serious obstetric complications that is often identified in administrative data using International Classification of Diseases (ICD) diagnosis and procedure codes for a set of 21 indicators. Prior studies of screen-positive cases have demonstrated low predictive value for ICD codes relative to the medical record. To our knowledge, the validity of ICD-10 codes for identifying severe maternal morbidity has not been fully described.

严重孕产妇发病率是严重产科并发症的综合衡量指标，通常在行政数据中使用《国际疾病分类》（ICD）诊断和手术代码对一组 21 项指标进行识别。之前对筛查阳性病例的研究表明，相对于医疗记录，ICD 编码的预测价值较低。据我们所知，ICD-10 编码在识别严重孕产妇发病率方面的有效性尚未得到充分说明。

引用次数: 0

Risk of adverse perinatal outcomes among African-born Black women in California, 2011-2020. 2011-2020 年加利福尼亚州非洲裔黑人妇女围产期不良后果的风险。

IF 5.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Epidemiology

Pub Date : 2024-03-29 DOI: 10.1097/ede.0000000000001745

Safyer McKenzie-Sampson, Rebecca J Baer, Brittany D Chambers Butcher, Laura L Jelliffe-Pawlowski, Deborah Karasek, Scott P Oltman, Corinne A Riddell, Elizabeth E Rogers, Jacqueline M Torres, Bridgette Blebu

African-born women have a lower risk of preterm birth and small for gestational age (SGA) birth compared to United States (US)-born Black women, however variation by country of origin is overlooked. Additionally, the extent that nativity disparities in adverse perinatal outcomes to Black women are explained by individual-level factors remains unclear.

与在美国出生的黑人妇女相比，在非洲出生的妇女早产和胎龄过小（SGA）的风险较低，但人们忽视了原籍国的差异。此外，黑人妇女围产期不良结局的本土差异在多大程度上是由个人层面的因素造成的仍不清楚。

引用次数: 0

Validation of long-term recall of pregnancy-related weight in the Life-course Experiences And Pregnancy (LEAP) study. 妊娠期生活经历（LEAP）研究中与妊娠有关的体重长期回忆的验证。

IF 5.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Epidemiology

Pub Date : 2024-03-29 DOI: 10.1097/ede.0000000000001734

Kriszta Farkas, Lisa M Bodnar, Rebecca L Emery Tavernier, Jessica K Friedman, Sydney T Johnson, Richard F MacLehose, Susan M Mason

Pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are determinants of maternal and child health. However, many studies of these factors rely on error-prone self-reported measures.

孕前体重指数（BMI）和妊娠体重增加（GWG）是孕产妇和儿童健康的决定因素。然而，对这些因素的许多研究都依赖于容易出错的自我报告测量。

引用次数: 0

Perceptions of Racial/Ethnic Inequities in COVID-19 Healthcare and Willingness to Receive the COVID-19 Vaccine. 对 COVID-19 医疗保健中种族/族裔不平等的看法以及接种 COVID-19 疫苗的意愿。

IF 5.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Epidemiology

Pub Date : 2024-03-28 DOI: 10.1097/ede.0000000000001722

Juliana S Sherchan, Jessica R Fernandez, Anuli Njoku, Tyson H Brown, Allana T Forde

Perceptions of the U.S. healthcare system can impact individuals' healthcare utilization, including vaccination intentions. This study examined the association between perceived racial-ethnic inequities in COVID-19 healthcare and willingness to receive the COVID-19 vaccine.

对美国医疗保健系统的看法会影响个人的医疗保健利用率，包括疫苗接种意愿。本研究探讨了在 COVID-19 医疗保健中感知到的种族-民族不平等与接种 COVID-19 疫苗意愿之间的关联。

引用次数: 0

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