American journal of epidemiology最新文献

Socioeconomic Status (SES), a complex, multidimensional construct, is commonly assessed using education or combinations of education, income, and/or occupation. Though epidemiological studies tend to collect occupational data, focus on occupation-based SES measures has been limited. We describe a method to process and derive occupational status measures and then compare them for application in epidemiological research. Using US Census Bureau's Industry and Occupational Codes to standardize self-reported baseline occupational and industry data for 1,053 Black/African American participants in the Study of Environment, Lifestyle & Fibroids, we derived three established occupational status measures: Hauser Warren Socioeconomic Index (HWSEI), Nam-Powers-Boyd Occupational Status Score (NPBOSS90) and Nakao-Treas Prestige Score (PRENT). All three scores range from 0 to 100 where higher scores reflect higher status. Participants averaged in age of 29 years with 62% employed at baseline, most commonly in Customer Service. Median scores varied across HWSEI (30.3), NPBOSS90 (43.2) and PRENT (41.7). The occupational status derivation process contributes to epidemiological methods by providing guidance to those seeking to elucidate the SES-health relationship beyond merely income or education. If education and income are already being collected, PRENT, which does not incorporate these factors, may offer unique insights.

Cohort studies are often challenged by incomplete adherence to sampling regimens, limiting the full capture of disease burden. We describe the detection of respiratory syncytial virus (RSV) infections achieved in a birth cohort using a combination of weekly nasal sample testing and serology. The PREVAIL Cohort followed 245 maternal-child dyads from birth to age 18-24 months. Weekly mid-turbinate nasal swabs were tested for RSV using real-time polymerase chain reaction (RT-qPCR). Serum was tested for RSV pre-fusion F IgG and IgA antibody at age 6 weeks and biannually from 6-24 months. Mixed effects classification and regression trees (CART) identified antibody thresholds consistent with a RT-qPCR-identified RSV infection using a subset of participants having ≥90% weekly sample adherence (n=53, 21%). Resulting thresholds were applied to participants with either ≥70% of weekly samples or serum at age 18-24 months (n=194, 79%) Incidence rates were compared using Fisher's exact test. CART identified a log10 change in IgG>0.32 or IgA>0.20 as indicative of an RSV infection. Comparing RT-qPCR-only to a combination of RT-qPCR and serology, RSV cumulative incidence (49% vs 75%, p<0.001) and incidence rate (0.33 vs 0.71 infections/child-year, p<0.001) increased; these rates did not differ from those calculated in those with ≥90% sample adherence.

The potential for a bidirectional relationship between the experience of a negative wealth shock (a loss of ≥75% in total household wealth over two years) and accelerated memory decline among mid-to-later-life adults in the United States remains unclear. We used population-based longitudinal data on 14,969 adults aged ≥51 in the US Health and Retirement Study from 1998 to 2020. One in three participants in this cohort experienced a negative wealth shock over the 22-year follow-up period (5,184/14,969; 34.6%). Participants who experienced a negative wealth shock had faster aging-related memory decline in the years before the shock than their counterparts who did not experience a negative wealth shock (an additional 0.04 SD units per decade; 95% CI: -0.07, -0.01) and an acute drop in their level of memory function concurrent with the negative wealth shock (-0.08 SD units; 95% CI: -0.10, -0.05), yet slower memory aging after the negative wealth shock (0.04 SD units per decade; 95% CI: 0.01, 0.06). We recommend strategies to support healthy memory aging of the large share of middle-aged and older US adults who are at risk of experiencing a negative wealth shock.

A challenge to research in big data is the inherent computational intensity of analyses, particularly when using rigorous methods to address biases. We demonstrate the use of sampling methods in big data to estimate parameters using fewer resources. Our motivating question was whether lung cancer incidence differs by baseline HIV status, using a cohort of nearly 30 million Medicaid beneficiaries. We targeted three parameters (with listed estimator): incidence rate ratio (IRR, Poisson model), hazard ratio (HR, Cox model), and risk ratio (RR, Kaplan-Meier). We controlled for confounders using inverse probability weighting. We ran analyses using the full sample and several sampling schemes: divide-and-recombine (10, 20, 50 samples), sub-cohort, and case-cohort. We compared point estimates, standard errors, computation time, and memory used. We observed 1113 incident lung cancer diagnoses among 180,980 beneficiaries with HIV and 33,106 diagnoses among 29,179,940 beneficiaries without HIV. Findings were similar across target parameters. The sub-cohort and case-cohort approaches had estimates closer to the full sample and were faster and less memory-intensive than divide-and-recombine, especially when estimating the RR. Including non-sampled cases in the case-cohort resulted in increases in computation time and memory relative to the sub-cohort approach.

Temporal imprecision and unaddressed confounding limit inferences whether e-cigarette vaping provides real-world benefits or harms for combustible cigarette smoking cessation. This naturalistic, multilevel longitudinal study of US adults examined whether (semi-)monthly transitions in e-cigarette vaping were associated with attaining smoking abstinence and subsequent post-quit relapse. A nationally representative panel of 1,255 adults who smoked at baseline completed up to 22 bi-weekly and 13 monthly surveys between May 2020 and May 2022. Using multilevel longitudinal models, we assessed within-person transitions in past-7-day vaping status (none, non-daily, daily) as time-lagged, time-varying predictors of 7-day point-prevalence smoking outcomes (0 vs. 1-7 days). Results showed that daily vaping was associated with higher odds of achieving smoking abstinence two weeks later (30.4% vs. 16.3%; adjusted-RR[95%CI]=2.27[1.41-3.69]), while non-daily vaping was not significantly associated (22.5% vs. 16.3%; adjusted-RR[95%CI]=1.05[0.85-1.37]). In 557 instances where participants had achieved at least one month of smoking abstinence, both daily (adjusted-HR[95%CI]=1.31[1.09-1.70]) and non-daily (adjusted-HR[95%CI]=2.82[2.07-4.61]) vaping were linked to increased relapse risk compared to no vaping. These findings suggest that while daily vaping may support short-term smoking cessation, it is associated with a heightened risk of relapse among individuals who have already quit.

Household transmission studies provided key insights on SARS-CoV-2 transmission in high-income countries but were rarely implemented in Africa. To help fill this gap, we analyzed SARS-CoV-2 seroprevalence studies with a household-based recruitment, focussing on households with ≤7 members, in four Sub-Saharan African cities: Kinshasa (82 households, 370 individuals), Lubumbashi (225 households, 970 individuals), Conakry (149 households, 649 individuals), and Yaoundé (311 households, 1,183 individuals), between late 2020 and mid-2021. Using an extended chain-binomial model accounting for missing serology, we estimated both the probability of community-acquired infection and within-household transmission. The proportion infected in the community rose sharply over time, reaching up to 73% by June 2021. Household transmission varied by location, with secondary attack rates (SAR) ranging from 8.9% to 26.7%, and households accounting for 9% to 28% of infections. Simulations showed that including households with missing serology improved the precision of estimates without introducing bias. SAR estimates were consistent with findings from South Africa and slightly lower than global pooled estimates, mostly from high-income settings, suggesting different transmission dynamics in African contexts. Our approach for handling missing serology can improve transmission estimates accuracy.

We estimated the association between redlining, a historic racist practice of mortgage lending discrimination, and fecundability, the per-cycle probability of conception. We analyzed data from 1901 U.S. female participants aged 21-45 in Pregnancy Study Online (PRESTO; 2013-2023), a prospective preconception cohort study. Participants completed self-administered questionnaires at baseline and every 2 months until conception or 12 months, whichever came first. Using participants' baseline residential addresses, we linked to neighborhoods graded by the U.S. Home Owners' Loan Corporation (HOLC) during the 1930s for perceived riskiness of mortgage lending: A + B (best or still desirable), C (definitely declining), and D (hazardous; ie, redlined). We used proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs), adjusting for age, calendar year of enrollment, and geographic region of residence. Most participants resided in neighborhoods with riskier grades: 47.1% grade C and 21.7% grade D. Compared with neighborhoods graded A + B, FRs were 0.91 (95% CI, 0.81-1.03) and 0.86 (95% CI, 0.74-1.00) for neighborhoods graded C and D, respectively. In this preconception cohort study, current residence in a historically redlined or declining neighborhood was associated with a moderate decrease in fecundability.

Emulating the target trial framework in pharmacoepidemiology is challenging when there is no active comparator. We evaluate six approaches to finding surrogate index dates for untreated patients with the goal of identifying one or more solutions that indicate they would give potentially unbiased results. This numerical experiment used 73,070 patients from the MarketScan administrative databases (2013-2019) with type II diabetes, first-line therapy with metformin, and second-line therapy with either sodium-glucose cotransporter 2 inhibitors (SGLT2i's) or sulfonylureas. Patients taking sulfonylureas were converted into an experimental "untreated" arm. Part 1 sought to find surrogate index dates for the untreated arm. Part 2 compared the experimental estimates of the effect of SGLT2i's on cardiovascular disease (CVD) compared to sulfonylureas, using the surrogate index dates, to the reference estimate. The reference hazard ratio (HR) was 0.69. The HRs after the respective approaches for selecting surrogate index dates are as follows: rejection sampling 0.61, 0.63; median 1.10, 1.15; prediction model 0.96; matching algorithm 1.07. Only the rejection sampling approaches for selecting a surrogate index date provided results which indicate low amounts of potential bias. Extreme care should be taken when making study design decisions for observational research questions that lack an active comparator group.

Mounting evidence suggests that early-life lead exposure alters immune system functions, including T-cell-dependent antibody responses to childhood immunizations. However, no studies have identified critical windows of susceptibility to lead exposure. The aim of this study was to identify perinatal critical windows of lead exposure that are associated with antibody responses to anti-MMR (measles, mumps, and rubella virus) and anti-DTP (anti-diphtheria, tetanus, and pertussis toxoids) vaccinations in Hispanic school-aged (mean ± standard deviation: 4.8 ± 0.6 years) children. Weekly lead exposure-from 16 weeks before to 14 weeks after birth-was measured in deciduous teeth from 271 children enrolled in the PROGRESS study. Serum levels of anti-MMR and anti-DTP antibodies were measured by a Luminex multiplexed microbead array immunoassay. Time-varying associations between log2-transformed dentine lead concentrations and log2-transformed antibody levels were estimated by fitting distributed lag nonlinear models. A 2-fold higher dentine lead concentration in the first 3 weeks postpartum was associated with an average -4.29% lower antitetanus level (95% CI, -8.22 to -0.20). A perinatal (1 week before to 1 week after birth) critical window of lead exposure demonstrated an average -3.44% (95% CI, -7.05 to 0.30) lower anti-diphtheria antibody level. Our study suggests that early-life lead exposure may contribute to immune dysfunction by reducing children's antibody responses to scheduled vaccinations.