American journal of epidemiology最新文献

Primary care providers (PCPs) may consider referring patients with cognitive impairment to clinicians specializing in memory care. We evaluated whether referrals are associated with quality-of-care and diagnostic outcomes, comparing estimates based on traditional and instrumental variables (IV) analyses. Analyses included individuals diagnosed with memory loss, mild cognitive impairment, or Alzheimer's disease and related dementias (ADRD) in a single healthcare system after 2005. Electronic health records were used to define referral to specialists and PCP preference (instrument) for referring. We modeled traditional and IV associations between referral to care and 14 patient-centered outcomes over 5 years of follow-up using adjusted Aalen additive hazards models. Overall, 1019 (15%) older adults were referred at diagnosis. Preference strongly predicted actual referral (F-statistic = 637). Referral was observationally associated with increased cumulative hazard of receiving a more specific cognitive diagnosis (hazard difference at year 5: 0.09, 95% CI: 0.04-0.15) and depression (0.09, 95% CI, 0.01-0.18). Using IV, referral was significantly associated with decreased hazard of ICD-defined weight loss (-0.35, 95% CI: -0.60,-0.09); other estimates were imprecise and consistent with possible benefits or harms. Given barriers in accessing specialty care, it is critical to further investigate how specialty care affects outcomes of individuals with living with cognitive impairment.

Extreme Risk Protection Orders (ERPO) are state laws intended to prevent gun violence by preemptively and temporarily removing firearms from individuals determined to be at risk of self-harm or violence against others. Here, we propose a framework for tackling questions about how well ERPOs have been targeted to those at highest risk of suicide and how effective ERPOs are at preventing suicide among those who were targeted. This framework makes use of novel causal inference approaches using data on ERPOs issued and suicide deaths that could be reasonably obtained in many states with ERPO policies. More specifically, we formalize estimands related to effectiveness and risk-targeting and describe the conditions under which these estimands can be identified or bounded with available data. We provide adaptable R code for implementing these approaches and highlight key considerations for using these methods in practice.

This review article provides a summary of findings on the social determinants of chronic disease prevalence, incidence, and mortality from the Atherosclerosis Risk in Communities (ARIC) Study, community surveillance of coronary heart disease conducted in four geographically distinct United States communities from 1987 through 2014 and an ongoing longitudinal cohort of 15,792 men and women recruited from those communities. The ARIC community surveillance documented the contribution of poor neighborhood socioeconomic status to trends in heart disease and to disparities in associated medical care. Data from members of the ARIC Study cohort, provide evidence on the importance of neighborhood and individual-level social determinants to the prevalence of cardiovascular risk factors and to the burden of cardiovascular disease and mortality, dementia, and kidney disease. Findings from the unique ARIC Lifecourse Socioeconomic Study conducted within the ARIC cohort, underscore the importance of socioeconomic exposures across the lifecourse to the prevention of chronic disease. The rich ARIC data on neighborhood deprivation, environmental exposures, physical and built environments, and racial and economic segregation, provide a foundation for innovative methodological approaches that integrate demographic, socioeconomic, behavioral, and clinical risk factors-enabling researchers to identify optimal targets for effective chronic disease prevention.

Using state-level opioid overdose mortality data (1999-2016), we evaluated the performance of panel data estimators for capturing time-varying impacts of state-level policies. Most health policy evaluations assume static treatment effects, yet many interventions exhibit dynamic impacts, raising methodological questions about optimal estimation strategies. We simulated four time-varying treatment scenarios reflecting common policy dynamics (gradual increase, gradual decline, temporary effects, and inconsistent trajectories) and compared seven methods: two-way fixed effects event study, debiased autoregressive model, augmented synthetic control, difference-in-differences with staggered adoption, event study with heterogeneous treatment, two-stage differences-in-differences, and differences-in-differences imputation. Performance was assessed using bias, standard errors, coverage probability, and root mean squared error. Estimator performance varied substantially across scenarios. Augmented synthetic controls showed lower bias but higher variance when policy effectiveness diminished over time. Difference-in-difference approaches provided reasonable coverage in some scenarios but struggled with non-monotonic effects, while autoregressive methods exhibited lower variability but underestimated uncertainty. Overall, no single estimator performed best across settings. For epidemiological policy evaluations, particularly time-sensitive interventions like opioid-related policies, researchers should weigh bias-variance tradeoffs and align methodological choices with expected effect trajectories. Careful selection of analytic approaches is critical to avoid misattribution of policy effects and ensure valid conclusions about population health outcomes.

Background: Damp housing is associated with poor mental health. However, it is unknown whether people with chronic respiratory conditions (CRCs) have increased risk of negative mental health effects, given their increased susceptibility to dampness-related physical health effects.

Methods: Data from the British Household Panel Survey were used to quantify the differential effect of damp housing exposure on psychological distress by CRC status. Adjusted fixed effects logistic regression models stratified by CRC were performed, followed by models testing for statistical interaction.

Results: In stratified models, people living with a CRC at baseline reported greater odds of psychological distress associated with damp housing (OR = 1·27, 95% CI: [1·14, 1·41], p<0·01) compared with people in good respiratory health (OR = 1·07, 95% CI: [1·02, 1·12], p=0·01). There was weak evidence of effect modification by change in CRC status (interaction term OR = 1·09, 95% CI: [0·98, 1·20], p=0·10). However, there was strong evidence of effect modification by baseline CRC status (interaction term OR = 1·19, 95% CI: [1·06, 1·34], p<0·01).

Conclusion: Our analysis suggests that remediating sources of dampness in the home may alleviate some of the mental toll of living with a chronic respiratory condition.

This study investigated associations between social determinants of health (SDoHs) and life expectancy and health risks among rheumatoid arthritis patients in China and the UK. Analyzing data from China Kadoorie Biobank (10,298 patients aged 30-79 years) and UK Biobank (4,975 patients aged 37-73 years), composite SDoH scores incorporating five domains (financial circumstances, education, healthcare access, neighborhood environment, and social context) were generated based on mortality associations and categorized into favorable, medium, and unfavorable groups. During median follow-up of 10.4 years (China) and 13.8 years (UK), unfavorable SDoH was associated with higher mortality risk in both cohorts (China: HR 1.62 [95% CI 1.36-1.92]; UK: HR 1.80 [95% CI 1.50-2.16]). Life expectancy reduction at age 45 due to unfavorable SDoH showed sex-specific patterns within each cohort: in China, women lost 4.7 years and men lost 4 years; in UK, men lost 6.8 years and women lost 4 years. Phenome-wide analysis for incident diseases identified 51 conditions with 1.2-5.2-fold increased risks among those with unfavorable SDoH, including heart failure, obstructive chronic bronchitis, and renal failure. Findings suggest that disadvantaged SDoH were associated with significantly lower life expectancy and higher risks of multiple adverse health outcomes among adults with rheumatoid arthritis.

Background: The National Health Interview Survey (NHIS) is used to measure progress on cancer screening. We assessed validity of questions on cervical, colorectal, breast, and lung cancer screening from the 2020, 2021, and 2022 NHIS, using electronic medical records as our standard for accuracy.

Methods: We surveyed 1,770 adults ages 21+ years for breast, cervical, colorectal, and lung cancer from four US health systems. We made slight changes in question order and wording to improve understanding of questions. We compared survey responses for screening adherence with electronic medical record (EMR) data as a gold standard, calculating sensitivity, specificity, positive predictive value, negative predictive value, Cohen's Kappa, and reports-to-records ratio.

Results: Self-reported screening adherence had high sensitivity for most cancer types (range 0.79-0.96). We found good agreement for breast cancer screening using Cohen's Kappa (0.81) and more modest agreement for the other three cancer sites (0.59-0.65). The reports-to-records ratio showed over-reporting cancer screening ranging from 12% to ⁓50% more screening reported for the USPSTF recommended screening periodicity compared to medical record data.

Conclusions: NHIS questions that assess cancer screening provide reasonably accurate estimates. However, some misclassification with expected bias toward over-reporting screening suggests that improvements in measuring screening adherence are needed.

Experiencing discrimination may be a risk factor for cardiovascular disease (CVD), which disproportionately impacts Black adults in the United States. With the few prospective, time-varying investigations, evidence of everyday discrimination impacting incident CVD is sparse, especially among older Black adults. This study examined the association between everyday discrimination and incident CVD across a 12-year period using a nationally representative population of older Black adults from the Health and Retirement Study. Weighted Cox proportional hazards regression estimated the association between everyday discrimination (measured on a continuous scale) and incident CVD. Supplemental analyses examined the association between everyday discrimination and incident CVD among those who experienced racial versus non-racial discrimination. Covariates included sociodemographic characteristics, health behaviors, and CVD risk factors. At baseline, participants (N=988) were 65 years old on average and 57.3% were female. During the 12-year period, 16.3% of participants developed CVD. Each increase in everyday discrimination was associated with a higher incidence of CVD in fully adjusted models (adjusted hazard ratio: 1.28, 95% CI: 1.03-1.59). Older Black adults who experience frequent everyday discrimination may be at higher risk of developing CVD. Clinical and non-clinical interventions assessing and addressing experiences of discrimination may help in CVD prevention efforts among Black adults.