American journal of epidemiology最新文献

We examined the association between ambient air pollution exposure and risk of spontaneous abortion (SAB) using Georgia state-wide fetal death records from 2005-2014. Each SAB case was matched to four non-SAB pregnancies by maternal residential county and conception month. Daily concentrations of ten pollutants were estimated and linked to maternal residential census tracts. Cox regression was used to estimate hazard ratios (HR) across four prenatal exposure windows (first month, weekly, cumulative weekly average over the first trimester, cumulative weekly average over the second trimester). Our dataset contained 47,649 SABs with a median gestational age of nine weeks. Carbon monoxide (CO) showed the strongest association, with an HR of 1.12 (1.05, 1.20) per 0.43 ppm increase in average first month exposure, and 1.06 (1.02, 1.10) per 0.42 ppm increase in average weekly exposure. Nitrogen dioxide (NO2) also exhibited elevated HRs. Other pollutants like nitrate compounds (NO3), nitrogen oxides (NOx), and organic carbon (OC) showed positive associations, while ozone (O3), PM2.5, PM10, elemental carbon (EC), and ammonium ions (NH4) were null. Early pregnancy exposure to traffic-related pollutants may increase SAB risk, highlighting potential benefits of air pollution regulation.

Area economic inequality may underlie social disparities in suicide mortality (SM). Differences in measuring inequality contribute to variability across empirical evidence. We contrasted common income measures - absolute poverty, Gini inequality index, Index of Concentration at the Extremes (ICE) - and examined their associations with age- and sex-standardized SM across 1381 US counties. We used the 2006-2019 National Violent Death Reporting System linked to 2006-2010 administrative data on socioeconomic factors and a Bayesian spatial multilevel approach. Compared to affluent areas, poorer areas had the highest relative risk (RR) of SM (ICE RR: 1.24, 95% Credible Interval (CI): 1.17 - 1.31 and absolute poverty RR: 1.33, CI: 1.25 - 1.41). Gini inequality was not linearly associated with SM. Cross-classifying Gini x ICE showed highest-risk areas had concentrated poverty (ICE) but varying Gini inequality. These high-risk poverty-segregated areas were more often medically underserved, had lower population density and high unemployment. African American or Indigenous suicide decedents often resided in high Gini inequality areas, while older, White decedents, with military backgrounds more often resided in lower Gini areas. The choice of inequality measure can lead to varied conclusions about social disparities in SM. Comparative approach offers more nuanced understanding of underlying socioeconomic marginalization.

Multiple imputation (MI) models can be improved with auxiliary covariates (AC), but their performance in high-dimensional data remains unclear. We aimed to develop and compare high-dimensional MI (HDMI) methods using structured and natural language processing (NLP)-derived AC in studies with partially observed confounders. We conducted a plasmode simulation with acute kidney injury as outcome and simulated 100 cohorts with a null treatment effect, incorporating creatinine labs, atrial fibrillation (AFib), and other investigator-derived confounders in the outcome generation. Missingness was imposed on creatinine based on creatinine itself and AFib. Different HDMI candidate AC were created using structured and NLP-derived features and we mimicked scenarios where AFib was unobserved by omitting it from all analyses. Using LASSO, we selected HDMI covariates for MI and propensity score models. The treatment effect was estimated after propensity score matching in MI datasets, and HDMI methods were compared to baseline imputation and complete case analysis. HDMI using claims data showed the lowest bias (0.072). Combining claims and sentence embeddings led to an improvement in the efficiency with a root-mean-squared-error of 0.173 and 94% coverage. NLP-derived AC alone did not outperform baseline MI. HDMI approaches may decrease bias in studies where confounder missingness depends on unobserved factors.

Non-vaccination and under-vaccination with the COVID-19 vaccine may be attributed to multifaceted barriers including hesitancy and access issues. Using data from the CDC's Research and Development Survey, a nationally representative survey fielded from November 3, 2022 - December 12, 2022 (n=6,821), we examined the adjusted population attribution fraction (PAF) of COVID-19 non-vaccination and under-vaccination attributed to vaccine hesitancy by sociodemographic characteristics. Overall, the adjusted PAF of non-vaccination attributed to vaccine hesitancy was 84.8%, and the adjusted PAF of under-vaccination attributed to vaccine hesitancy decreased with increasing COVID-19 vaccine doses (76.0%, 41.0%, and 16.9% for ≥2, ≥3, and ≥4 doses, respectively). The proportion of adults who considered the social benefit of the vaccine, risk of contracting COVID-19, and information received from a medical provider increased with greater number of COVID-19 vaccine doses received. In contrast, the proportion of adults who were concerned about long-term impacts, speed of vaccine development and personal risk of getting vaccinated decreased with greater number of COVID-19 vaccine doses received. Understanding the PAF estimates from the acute phase of the pandemic serves as an important comparison for post-pandemic vaccination estimates, and is needed for messaging as COVID-19 cases, hospitalizations, and deaths resurge in the fall of 2024.

Estimating the durability of immunity from vaccination is complicated by unreported re-vaccination, and unobserved natural infection or reexposure, which could result in overestimation of protection longevity. We tested serial cross-sectional serum samples from 2005 to 2015 (N=2,530) for IgG to examine measles seroprevalence, spatiotemporal patterns of titers across regions and antibody dynamics among children aged 1-9 years who grew up during varying measles circulation in Madagascar under a one-dose vaccination schedule. We found that measles seroprevalence has generally decreased over this time period. Furthermore, we conducted two nested serological surveys, analyzing 393 samples taken in 2005 (N=158), a time-point preceded by high levels of measles circulation, and 2015 (N=235), a time-point preceded by low levels of measles circulation. Among children alive during periods of limited measles circulation, we found lower measles seroprevalence in all age groups and lower antibody titers in children aged 7-9 years old. Notably, titers among children aged 7-9 dipped near the threshold of protection, highlighting the importance of additional measles vaccine doses. Our findings suggest that vulnerabilities might emerge during periods of limited measles circulation for countries with a one-dose schedule due to both the build-up of susceptible individuals and waning titers.

Objective: Uterine serous carcinoma (USC) is a rare diagnosis but associated with high mortality. There is limited data to guide adjuvant treatment decisions in early stage disease. The purpose of this study is to evaluate the impact of adjuvant therapy on recurrence-free survival (RFS) and overall survival (OS) in early stage USC.

Methods: Patients with stage I and II USC treated at a single institution from 1/2006-12/2019 were identified. Demographic, clinicopathologic, treatment and outcome data were collected. Data were compared using descriptive statistics. Survival analyses were performed using Kaplan-Meier and Cox proportional hazard methods.

Results: Ninety-four patients were identified. Median follow-up time was 33.5 months. The median age was 68 years (range 49-87), the majority of patients were white (n=78, 83.0%), and the median BMI was 30.7 (range 14.2-57.3). Minimally-invasive surgical staging was performed in 59.6% of cases (n=56). Most patients had stage IA disease (n=70, 74.5%). Most patients (n=79, 84.0%) received adjuvant therapy, and a majority of patients received a combination of systemic chemotherapy and radiation therapy (n=55, 58.5%), with the most common combination being chemotherapy plus vaginal brachytherapy (n=42, 44.7%). Most patients (n=77, 81.9%) remain without evidence of disease, while 17 patients (18.1%) have recurred. Patients receiving 6 cycles of adjuvant chemotherapy experienced improved OS (p=0.004) and improved RFS (p=0.02) compared to those receiving no adjuvant chemotherapy.

Conclusion: Patients with early stage USC who received six cycles of adjuvant chemotherapy had significantly improved OS and RFS when compared to those patients who did not receive adjuvant chemotherapy.

Background: The accuracy of low birth weight (LBW) and small for gestational age (SGA) in administrative healthcare records is crucial for perinatal studies but has few validity studies.

Methods: Using 1999-2010 MAX linked to birth certificates (BC), we identified mother-infant dyads (≥30 days enrollment after delivery, with valid gestational age (GA) and birth weight (BW)). LBW and SGA were identified based on ICD-9-CM codes. Infants with BW <10% of the U.S. reference were flagged as SGA. For LBW group diagnoses, we imputed birthweight using median, mean BW from BCs, and ICD code boundaries of infants in the same LBW group. We calculated the sensitivity, specificity, and positive/negative predictive values to assess performance.

Results: We identified 1,536,272 live births. All LBW groups had low SEs, high SPs, and NPVs, whereas PPVs varied. Among infants with SGA diagnoses based on GA/BW from the BC, SE of the SGA codes was 13.36%; SP 99.01%; PPV 67.37%. Combining imputation with LBW codes increased SE up to 22.09% (lower boundary) but decreased PPV to 41.53% (lower boundary).

Conclusions: ICD-9-CM codes from administrative healthcare records had low SE but high SP. Imputation based on GA and BW did not add much value to SGA identification.

Long-term exposure to ambient air pollution has been associated with epigenetic age acceleration (EAA) in adults, but its impact on children remains less understood. This study analyzed data from 457 children (mean age: 7.9 years) in the Project Viva cohort (2007-2010, eastern Massachusetts, USA). We calculated EAA from leukocytes: Horvath's Epigenetic Age Acceleration (HorvathEAA), Intrinsic Epigenetic Age Acceleration (IEAA), and Skin and Blood Epigenetic Age Acceleration (Skin&BloodEAA). We applied generalized additive models to evaluate associations of prior 365-day average and lifetime average exposure to PM2.5, NO2, and O3, and distance to major roadways with EAA. Results indicated that each interquartile range of prior 365-day average of PM2.5 corresponded with 0.26 years (95% CI: -0.49, -0.03) lower HorvathEAA, although it did not survive multiple testing adjustment. Similar patterns but with wider confidence intervals were observed for IEAA (-0.22, 95% CI: -0.44, 0.01) and Skin&BloodEAA (-0.04, 95% CI: -0.19, 0.11). No associations were observed of exposure to lifetime average PM2.5, prior-year or lifetime average NO2 or O3, or distance to major roadways with EAA. These findings suggest higher prior 365-day average PM2.5 exposure may relate to lower HorvathEAA in children.