American journal of epidemiology最新文献

Overdose prevention centers (OPCs) are associated with improved community health and decreased crime, but opponents argue that OPCs depress nearby property values. We estimated the association of the opening of the first two public recognized OPC in the United States with neighborhood residential rents and real estate sales in the East Harlem and Washington Heights neighborhoods of New York City (NYC). Using augmented synthetic controls, we analyzed quarterly and semiannual rental listings and annual and semiannual sales within 300- and 500-meter buffers around the OPCs. Donor units were buffers around syringe service programs without OPCs and opioid treatment programs. Primary outcomes were median quarterly rental listing price and median annual sales price. Overall, we found no changes in neighborhood rental or sales prices. For quarterly rentals at 300 m, we estimated (ATT, 95% CI) $145 (-$780, $1070) in East Harlem and -$505 (-$1279, $269) in Washington Heights. For annual sales at 500 m, we estimated -$542 993 (-$1 228 024, $142038) in East Harlem and $1 121 706 (-$431 285, $2674697) in Washington Heights. Conformal inference identified no detectable time-point effects. Overall, OPC implementation in NYC was not associated with changes in rents or sales, suggesting these facilities may not generate appreciable effects on local housing values.

Many older adults experience financial insecurity. While prior studies link lower later-life SES, financial stress, and financial shocks to worse cognitive outcomes, limited research has examined how dynamic changes in financial well-being-a multidimensional measure of financial circumstances-influence cognitive aging. Here, we examined associations between changes in financial well-being and memory outcomes among 7676 adults aged 50+ in the Health and Retirement Study ("HRS," 2010-2020). We developed and validated an 8-item index of poor financial well-being using existing HRS survey items aligned with domains from the Consumer Financial Protection Bureau's Financial Well-Being Scale. In confounder-adjusted linear mixed-effects models, we estimated associations of average financial well-being and significant improvements or worsening in financial well-being over four years with changes in memory z-scores calculated biennially from 2016-2020. Each 1-point worsening in average financial well-being was associated with poorer memory function (β = -0.009 SD, 95% CI, -0.020 to 0.003) and accelerated decline (β = -0.007 SD/year, 95% CI, -0.010 to -0.003). Associations were largest for participants with significant worsening of financial well-being and for those aged ≥65 at baseline. Results were robust to sensitivity analyses addressing potential reverse causation and attrition. These findings suggest that midlife and later-life declines in financial well-being may contribute to accelerated cognitive aging.

Epidemiologic studies often evaluate the association between an exposure and an event risk. When time-varying, exposure updates usually occur at discrete visits although changes are in continuous time and survival models require values to be constantly known. Moreover, exposures are likely measured with error, and their observation truncated at the event time. We aimed to quantify in a Cox regression the bias in the association resulting from intermittent measurements of an error-prone exposure. Using simulations under various scenarios, we compared five methods: last observation carried-forward (LOCF), classical two-stage regression-calibration using measurements up to the event (RC) or also after (PE-RC), multiple imputation (MI) and joint modeling of the exposure and the event (JM). The LOCF, and to a lesser extent the classical RC, showed substantial bias in almost all 45 scenarios. The RC bias was avoided when considering post-event information. The MI performed relatively well, as did the JM. Illustrations exploring the association of Body Mass Index and Executive Functioning with dementia risk showed consistent conclusions. Accounting for measurement error and discrete updates is critical when studying time-varying exposures. MI and JM techniques may be applied in this context, while classical RC should be avoided due to the informative truncation.

Public health departments need evidence-backed scenario projections to support decision making in infectious disease outbreaks. However, traditional infectious disease models are often not readily deployable or responsive to the urgent questions and priorities of public health departments or health systems. Moreover, uncertainty in model outputs is not always adequately assessed or communicated, potentially undermining trust among public health practitioners and the public. To address these issues, we, the Insight Net Modeling Guidance for Public Health Working Group, used early COVID-19 data from Michigan to illustrate modeling approaches that can be used to answer urgent questions in three key phases of outbreak response: prior to local introduction, early exponential growth, and established transmission with potential interventions. In each phase, we integrate case, hospitalization, and death data and capture ranges of plausible future trajectories. These models, which produce status quo and scenario projections, are intended to inform planning and motivate action rather than forecast precise future outcomes. Importantly, this work offers guidance to focus modeling efforts and provides examples and code for how to fit and implement these models, ultimately serving as both a conceptual guide and practical toolkit to support more transparent, timely, and appropriate use of models in outbreak response.

The ABO locus is associated with pancreatic ductal adenocarcinoma (PDAC). Potential metabolic mechanisms underlying these associations have not been investigated. We examined associations between genotype-derived ABO blood group (rs505922 and rs8176746) and 1478 pre-diagnostic serum metabolites in 4042 participants from eight nested case-control studies within the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial and Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study using linear regression and fixed-effect meta-analysis. We then examined associations between the identified ABO-associated metabolites and PDAC in two nested case-control studies (493 cases, 640 controls) using logistic regression and evaluated metabolite mediation of the ABO-PDAC association. Non-O and A (versus O) blood groups were associated with 13 and 20 metabolites, respectively, at false discovery rate < 0.20, with nine in common. The ABO-associated metabolites, sphingosine (non-O: β = 0.15), aspartate (A: β = -0.11), and aspartylphenylalanine (A: β = -0.16) were positively, and fibrinopeptide B (1-13) (non-O: β = 0.13; A: β = 0.21) was inversely associated with PDAC (P < 0.05). Non-O (OR = 1.50, 95% confidence interval [CI] = 1.16-1.94) and A (OR = 1.46, 95%CI = 1.10-1.92) (versus O) blood groups were associated with PDAC (OR = 0.96-1.07 per SD change log10-metabolite), however none significantly mediated the association between ABO blood group and PDAC. Our results suggest the ABO-associated metabolites are independent risk factors for PDAC.

Nutritional epidemiology has long relied on standard nutritional models to examine associations between dietary exposures and health outcomes, often interpreting model coefficients with causal intent. In this paper, we use the target trial framework to clarify common causal questions in nutritional research and connect them to established tools from causal inference. Using chicken and fish as motivating examples, we define two key causal estimands relevant to dietary strategies: the total effect of chicken consumption and the comparative effect of fish versus chicken. We then use the g-formula to estimate average causal effects of the target trials and examine how common nutritional models relate to the conditional outcome model used in the g-formula estimation. We show that several standard models are re-parameterizations of the same conditional outcome model used in g-formula estimation. We also caution that standard multivariate and residual models should not be used directly within g-formula implementations without updating total energy intake under each intervention, as doing so leads to inaccurate conditional mean counterfactual outcome predictions. By providing a unified framework that links traditional models to a causal framework, our findings offer guidance on models that yield valid estimates and align with actionable dietary interventions.

Modern causal methods are underutilized in occupational epidemiology, despite the development of robust methods to adequately control time-dependent confounding affected by prior exposure, the root of the healthy worker survivor effect. We demonstrate how to detect the healthy worker survivor effect empirically and explain how to interpret analyses that have not adjusted for it. For lymphohematopoietic cancer mortality and female breast cancer mortality, we performed pathway analyses assessing whether employment is a time-varying confounder affected by prior workplace exposure to ethylene oxide. These analyses ascertained whether the relevant causal relationships depicted in a directed acyclic graph were present. For both outcomes, workers employed longer were at lower risk. Workers exposed to higher levels of ethylene oxide were also more likely to leave work. Thus, employment is a time-varying confounder affected by prior exposure. The directions of these associations imply that healthy worker survivor effect is operating. Previously published estimates of health effects of workplace exposures to ethylene oxide on both lymphohematopoietic cancer mortality and female breast cancer mortality are underestimates of the true impacts. Applying these methods to other occupational cohorts can aid interpretations of analyses that have not adjusted for the healthy worker survivor effect.

Segregation measures over time likely mask the movement of Latinos into predominantly non-Hispanic Black (NHB) areas. Due to systematic disinvestment, the co-location of NHB and Latinos may correlate with environmental and social stressors. We construct a combined racial isolation (RI) measure for Blacks and Latinos for the 72 246 contiguous U.S. census tracts. We compare trends (1990-2015) in RI of NHB individuals and RI of NHB and Hispanic individuals (RI-NHB + H). We estimate correlations between RI-NHB + H and CDC Environmental Justice Index (EJI) components. We assess associations between EJI, RI-NHB + H, and birthweight percentiles using North Carolina detailed birth records (n = 504 363; 2015-2019). Between 1990-2015, RI-NHB + H and RI-NHB increased in most (88.7%) and the majority (69.1%) of U.S. census tracts, respectively. The largest local, spatial correlations between RI-NHB + H and EJI occurred in the southeast, southwest, and parts of the west coast, where both are high. For NHB and NHW mothers, the association between EJI and birthweight percentiles was increasingly negative at higher levels of RI-NHB + H. Among Hispanic mothers, the association was negative at mid RI levels, but not at high RI levels. Our results underscore the changing nature of segregation in the U.S. and illuminate cumulative impacts experienced by NHB and Latino populations on reproductive health.

Loneliness is associated with faster memory decline in mid- and late-life, but it remains unclear whether interventions to ameliorate loneliness protect memory function. We examined the impact of sustained and one-time loneliness interventions on memory function among US middle-aged and older adults. Using the nationally representative Health and Retirement Study in 2006-2018, we estimated counterfactual average memory scores over 12 years of follow-up under the following scenarios: [A] a hypothetical intervention eliminating loneliness only at baseline (baseline intervention), [B] a hypothetical intervention eliminating loneliness for 10 years (sustained intervention), and [C] the natural course (no intervention). We used targeted maximum likelihood estimation to account for time-varying confounding. The analytic sample included 10 136 participants (median baseline age 64 years; representing 50 million community-dwelling adults). Over 12 years, estimated mean memory scores declined by 0.58 standardized units (95% CI, 0.56, 0.60) under the natural course; the difference in decline (vs. natural course) was 0.00 standardized units (95% CI, -0.01, 0.01) under the baseline intervention and 0.02 standardized units (95% CI, -0.02, 0.05) under the sustained intervention. Compared to the natural course, we did not find evidence that either the baseline or sustained interventions was associated with better memory function over follow-up.

Empirical evidence on the indirect herd benefits of COVID-19 vaccination and/or prior infection is limited. We examined how area-level immunity interacts with individual-level immunity to affect COVID-19 diagnoses and deaths. Ontario residents aged ≥18 years were followed from August-01-2021 to January-30-2022. Individual-level immunity was defined as receipt of a primary series of COVID-19 vaccines or a positive SARS-CoV-2 test in the past 165 days. Area-level immunity was based on the proportion of immune individuals in an individual's residing area. Logistic regression and cause-specific hazard models were used to examine the relationship between immunity and COVID-19 diagnosis, and between immunity and COVID-19 death, with an interaction term between individual-level and area-level immunity. Of 11,122,816 adults, 7,518,015 (67.6%) were classified as having individual-level immunity at baseline. After accounting for potential confounders, area-level immunity (highest vs. lowest quintiles) was associated with lower odds of COVID-19 diagnosis. Higher area-level immunity (highest vs. lowest quintiles) was also associated with lower hazard of COVID-19 death among non-immune individuals (hazard ratio: 0.77 [0.60, 1.00]). Findings provide evidence supporting the herd benefits of vaccination or prior infection on COVID-19 diagnosis and deaths, and provide insights for interpreting vaccine effectiveness estimates in the context of herd immunity.