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Fieder M, Huber S. Detecting month and year of birth effects on reproduction and marriage patterns in two long-term data sets. Early Hum Dev 2024; 195:106073. [PMID: 39043080 DOI: 10.1016/j.earlhumdev.2024.106073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/03/2024] [Accepted: 07/03/2024] [Indexed: 07/25/2024]
Abstract
This study examines the effects of birth month on reproduction and mating behavior using historical and contemporary census data from 1820 to 1970. The research examines the effect of birth month on the number of children for women and their male spouses, finding a monthly cycle for both men and women. In addition, the study examines whether birth month influences whether a person has ever been married. In support of previous research, we find clear birth month effects on the number of children for both women and their spouses, while the time series of ever being married shows a 60-month and a 10-year cycle, the latter possibly related to the solar cycle. Although the effects are small, both results, based on a large and representative dataset, indicate the importance of early life factors on mating and reproduction.
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Affiliation(s)
- Martin Fieder
- Departement of Evolutionary Anthropology, University of Vienna, Djerassiplatz 1, 1030 Wien, Austria.
| | - Susanne Huber
- Departement of Evolutionary Anthropology, University of Vienna, Djerassiplatz 1, 1030 Wien, Austria
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Uddin M, Nursetyo AA, Iqbal U, Nguyen PA, Jian WS, Li YC, Syed-Abdul S. Assessment of effects of moon phases on hospital outpatient visits: An observational national study. AIMS Public Health 2023; 10:324-332. [PMID: 37304591 PMCID: PMC10251051 DOI: 10.3934/publichealth.2023024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/08/2023] [Accepted: 03/12/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives A vast amount of literature has been conducted for investigating the association of different lunar phases with human health; and it has mixed reviews for association and non-association of diseases with lunar phases. This study investigates the existence of any impact of moon phases on humans by exploring the difference in the rate of outpatient visits and type of diseases that prevail in either non-moon or moon phases. Methods We retrieved dates of non-moon and moon phases for eight years (1st January 2001-31st December 2008) from the timeanddate.com website for Taiwan. The study cohort consisted of 1 million people from Taiwan's National Health Insurance Research Database (NHIRD) followed over eight years (1st January 2001-31st December 2008). We used the two-tailed, paired-t-test to compare the significance of difference among outpatient visits for 1229 moon phase days and 1074 non-moon phase days by using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes from NHIRD records. Results We found 58 diseases that showed statistical differences in number of outpatient visits in the non-moon and moon phases. Conclusions The results of our study identified diseases that have significant variations during different lunar phases (non-moon and moon phases) for outpatient visits in the hospital. In order to fully understand the reality of the pervasive myth of lunar effects on human health, behaviors and diseases, more in-depth research investigations are required for providing comprehensive evidence covering all the factors, such as biological, psychological and environmental aspects.
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Affiliation(s)
- Mohy Uddin
- Research Quality Management Section, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | | | - Usman Iqbal
- Health ICT, Department of Health, Tasmania, Australia
- Global Health and Health Security Department, College of Public Health, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology, Taipei Medical University, Taiwan
| | - Phung-Anh Nguyen
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Research Center of Health Care Industry Data Science, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Wen-Shan Jian
- School of Hospital Health care Administration, Taipei Medical University, Taiwan. No 250 Wu-Hsing Street, Taipei 110, Taiwan
| | - Yu-Chuan Li
- International Center for Health Information Technology, Taipei Medical University, Taiwan
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan. No 250 Wu-Hsing Street, Taipei 110, Taiwan
- Research Center of Cancer Translational Medicine, Taipei Medical University, Taiwan
| | - Shabbir Syed-Abdul
- International Center for Health Information Technology, Taipei Medical University, Taiwan
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan. No 250 Wu-Hsing Street, Taipei 110, Taiwan
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Begum MR, Ehsan M, Ehsan N. Impact of Environmental Pollution on Female Reproduction. FERTILITY & REPRODUCTION 2022. [DOI: 10.1142/s266131822230001x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The increased pollution in the world atmosphere is a global concern. Water, air, and soil are polluted by various sources, such as farm fertilizer, sewage industrial waste products, fumes, and plastics, which in turn impact human health. Plastics and other mixtures of waste affect live in the water. Moreover, the ecosystem is disrupted by the use of heavy metal-containing chemicals in agriculture, and those are eventually consumed by humans. The consequences are a significant negative impact on health including reproductive health, which impairs fertility in the human population. Reproductive functions are severely affected by different chemicals which may interfere with hormonal functions. Greater consequences are faced by the women as the number of germ cells present in the ovary is fixed during fetal life, and which are nonrenewable. From the production of ovum to fertilization, to implantation, and finally continuation of pregnancy, all are affected by the heavy metals and endocrine disruptors. Lifestyle modifications such as consumption of organic foods, plastic product avoidance, separation of residential areas from industrial/agricultural areas, proper waste disposal, and so on, may help to improve the situation.
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Affiliation(s)
| | - Mariya Ehsan
- Infertility Care and Research Center (ICRC), Dhaka, Bangladesh
| | - Nazia Ehsan
- Infertility Care and Research Center (ICRC), Dhaka, Bangladesh
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Pan D, Shao Y, Song Y, Huang D, Liu S, Zeng X, Liang J, Juan Jennifer Tan H, Qiu X. Association between maternal per- and polyfluoroalkyl substance exposure and newborn telomere length: Effect modification by birth seasons. ENVIRONMENT INTERNATIONAL 2022; 161:107125. [PMID: 35183942 DOI: 10.1016/j.envint.2022.107125] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/27/2022] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Telomere length (TL) is an important biomarker of biological aging and disease that may be affected by prenatal exposure to environmental pollutants. Birth seasons have been linked to reproductive and immune-related diseases. Prenatal exposure to per- and polyfluoroalkyl substance (PFAS) has been associated with adverse birth outcomes, but the effects of PFAS and birth seasons on newborn TL are poorly understood. OBJECTIVES To explore the individual and combined effects of maternal PFAS exposure on newborn TL, with exploration of the interaction between PFAS and birth seasons on newborn TL. METHODS Between June 2015 and May 2018, a total of 499 mother-newborn pairs were recruited for a birth cohort study in Guangxi, China. Maternal blood samples were collected during pregnancy. Nine PFASs were measured by ultraperformance liquid chromatography-mass spectrometry. Newborn TL was assessed using quantitative real-time polymerase chain reaction. Modeling newborn TL as the outcome, multivariable linear regressions were performed for individual PFAS exposures, and Bayesian Kernel Machine Regressions were performed for PFAS mixtures. Furthermore, interaction analyses were conducted to evaluate the effect modification by birth seasons in these relationships. RESULTS For both single and multipollutant models, PFASs exposure were inversely associated with newborn TL, although none of the relationships were significant. The mixture of PFASs showed a potential positive trend of combined effect on newborn TL but non-statistically significant. Each ln-transformed unit concentration increase in PFOA was related to a 20.41% (95% CI: -30.44%, -8.93%) shorter TL in spring-born infants but not in those born in other birth seasons. Mothers in the middle and highest tertiles of PFOA exposure had 11.69% and 10.71% shorter TLs in spring-born infants, respectively. CONCLUSION Maternal PFAS exposure showed little association with newborn TL. The results suggested potential effect modification by birth season on the association between PFOA exposure and newborn TL.
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Affiliation(s)
- Dongxiang Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Yantao Shao
- The Third Affiliated Hospital of Guangxi Medical University, Nanning 530031, Guangxi, China
| | - Yanye Song
- The Third Affiliated Hospital of Guangxi Medical University, Nanning 530031, Guangxi, China
| | - Dongping Huang
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Shun Liu
- Department of Child and Adolescent Health & Maternal and Child Health, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Xiaoyun Zeng
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Jun Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Hui Juan Jennifer Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore
| | - Xiaoqiang Qiu
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China.
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Boland MR, Fieder M, John LH, Rijnbeek PR, Huber S. Female Reproductive Performance and Maternal Birth Month: A Comprehensive Meta-Analysis Exploring Multiple Seasonal Mechanisms. Sci Rep 2020; 10:555. [PMID: 31953469 PMCID: PMC6969210 DOI: 10.1038/s41598-019-57377-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 12/23/2019] [Indexed: 01/21/2023] Open
Abstract
Globally, maternal birth season affects fertility later in life. The purpose of this systematic literature review is to comprehensively investigate the birth season and female fertility relationship. Using PubMed, we identified a set of 282 relevant fertility/birth season papers published between 1972 and 2018. We screened all 282 studies and removed 131 non-mammalian species studies on fertility and 122 studies that were on non-human mammals. Our meta-analysis focused on the remaining 29 human studies, including twelve human datasets from around the world (USA, Europe, Asia). The main outcome was change in female fertility as observed by maternal birth month and whether this change was correlated with either temperature or rainfall. We found that temperature was either strongly correlated or anti-correlated in studies, indicating that another factor closely tied to temperature may be the culprit exposure. We found that rainfall only increases fertility in higher altitude locations (New Zealand, Romania, and Northern Vietnam). This suggests the possibility of a combined or multi-factorial mechanism underlying the female fertility - birth season relationship. We discuss other environmental and sociological factors on the birth season - female fertility relationship. Future research should focus on the role of birth season and female fertility adjusting for additional factors that modulate female fertility as discussed in this comprehensive review.
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Affiliation(s)
- Mary Regina Boland
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, USA.
- Center for Excellence in Environmental Toxicology, University of Pennsylvania, Philadelphia, USA.
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA.
| | - Martin Fieder
- Department of Evolutionary Anthropology, University Vienna, Vienna, Austria
| | - Luis H John
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Susanne Huber
- Department of Evolutionary Anthropology, University Vienna, Vienna, Austria
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Boland MR. A model investigating environmental factors that play a role in female fecundity or birth rate. PLoS One 2018; 13:e0207932. [PMID: 30481214 PMCID: PMC6258536 DOI: 10.1371/journal.pone.0207932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/08/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Over 12% of women in the United States have reduced fertility and/or fecundity. Environmental factors, such as temperature, and socioeconomic factors have been implicated in reducing female fecundity. The purpose of this study is to investigate the effect of environmental factors coupled with socioeconomic factors on birth rate at the country-level. We use birth rate as a proxy for female fecundity. This will enable us to identify the most important factors affecting female fecundity. METHODS Using country-specific data from 182 countries, we constructed a regression model of the effects of environmental and socioeconomic factors on birth rate at the country-level. Our model assesses the role of temperature, Gross Domestic Product (GDP) per capita, fine air particulate matter (PM 2.5), and prevalence of male and female Body Mass Index (BMI) > = 25 (age-standardized) on birth rate per country. Because many of these factors are inter-dependent, we include all possible two-way interaction terms to assess the role of individual factors and interactions between multiple factors in the model. RESULTS In the full regression model, we found that GDP per capita along with 5 interaction terms were significant after adjusting for multiple testing. Female BMI was only nominally significant. GDP per capita was independently associated with birth rate (adjusted p-value <0.001). Prevalence of BMI > = 25 age-standardized in males and females were also significant when interacting with air pollution or GDP on female fecundity (birth rate). Temperature did not affect birth rate either independently or as an interaction unless BMI was removed from the model. CONCLUSION A country's economic wealth was the most significant factor in predicting birth rate in a statistical model that includes environmental and socioeconomic variables. This is important for future studies investigating environmental factors involved in increasing or decreasing female fecundity.
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Affiliation(s)
- Mary Regina Boland
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, United States of America
- Center for Excellence in Environmental Toxicology, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- * E-mail:
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Reynolds JD, Case LK, Krementsov DN, Raza A, Bartiss R, Teuscher C. Modeling month-season of birth as a risk factor in mouse models of chronic disease: from multiple sclerosis to autoimmune encephalomyelitis. FASEB J 2017; 31:2709-2719. [PMID: 28292961 DOI: 10.1096/fj.201700062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/21/2017] [Indexed: 12/13/2022]
Abstract
Month-season of birth (M-SOB) is a risk factor in multiple chronic diseases, including multiple sclerosis (MS), where the lowest and greatest risk of developing MS coincide with the lowest and highest birth rates, respectively. To determine whether M-SOB effects in such chronic diseases as MS can be experimentally modeled, we examined the effect of M-SOB on susceptibility of C57BL/6J mice to experimental autoimmune encephalomyelitis (EAE). As in MS, mice that were born during the M-SOB with the lowest birth rate were less susceptible to EAE than mice born during the M-SOB with the highest birth rate. We also show that the M-SOB effect on EAE susceptibility is associated with differential production of multiple cytokines/chemokines by neuroantigen-specific T cells that are known to play a role in EAE pathogenesis. Taken together, these results support the existence of an M-SOB effect that may reflect seasonally dependent developmental differences in adaptive immune responses to self-antigens independent of external stimuli, including exposure to sunlight and vitamin D. Moreover, our documentation of an M-SOB effect on EAE susceptibility in mice allows for modeling and detailed analysis of mechanisms that underlie the M-SOB effect in not only MS but in numerous other diseases in which M-SOB impacts susceptibility.-Reynolds, J. D., Case, L. K., Krementsov, D. N., Raza, A., Bartiss, R., Teuscher, C. Modeling month-season of birth as a risk factor in mouse models of chronic disease: from multiple sclerosis to autoimmune encephalomyelitis.
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Affiliation(s)
- Jacob D Reynolds
- Department of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Laure K Case
- Department of Medicine, University of Vermont, Burlington, Vermont, USA
| | | | - Abbas Raza
- Department of Medicine, University of Vermont, Burlington, Vermont, USA
| | | | - Cory Teuscher
- Department of Medicine, University of Vermont, Burlington, Vermont, USA; .,Department of Pathology, University of Vermont, Burlington, Vermont, USA
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Herteliu C, Ileanu BV, Ausloos M, Rotundo G. Effect of religious rules on time of conception in Romania from 1905 to 2001. Hum Reprod 2015; 30:2202-14. [PMID: 26040476 DOI: 10.1093/humrep/dev129] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/14/2015] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does the interdiction of sexual intercourse during Nativity and Lent fasting periods have any effect on when babies are conceived in Romania, in the 20th century? SUMMARY ANSWER Based on date of birth records from the 20th century, Lent had a greater effect than the Nativity fast on conception within the Eastern Orthodox (ORTHD) population. WHAT IS KNOWN ALREADY Seasonality of births (and therefore of conception) is affected by geographical factors (latitude, weather, day-length). Other demographic, economic and socio-cultural characteristics (education, ethnicity, religion) have been proved to have an influence on conception. STUDY DESIGN, SIZE, DURATION The analyzed data consists of registered daily birth records for a long time series (35 429 points = 365 (days/year) × 97 years + 24 leap years), with 24 947 061 births in Romania over the period 1905-2001. The data were obtained from the 1992 and 2002 censuses. PARTICIPANTS/MATERIALS, SETTING, METHODS Based on the reported birth date of each person, the estimated date of conception is computed using a standard gestation period of 280 days. The population was grouped into two categories (ORTHD and Non-Orthodox (NORTHD)) based on religious affiliation. Data analysis is performed in the same manner for both groups. Preliminary data analyses regarding seasonal variations in conception are considered first. Econometric models are applied and tested. The dependent variable in these models is the calculated date of conception, while the independent variables are: (i) religious affiliation; (ii) dates of Nativity and Lent fasts (the latter varies slightly from year to year); (iii) rural versus urban residence; (iv) length of day-light; (v) non-working days and (vi) trend. The models are tested for validity using analysis of variance while the regression coefficients are tested by the Student t-test. MAIN RESULTS AND THE ROLE OF CHANCE All models are statistically valid (P < 0.01); all regression coefficients for the ORTHD group are valid (P < 0.01, except for rurality between 1990 and 2001, with P < 0.05). The data analysis indicates smaller standard error bars on the parameters for the ORTHD group as compared with the NORTHD group. The conclusion is that religious affiliation is an important factor in date of conception. LIMITATIONS, REASONS FOR CAUTION The data do not refer to all births during the analyzed period, but only to those persons still alive at the 1992 and 2002 censuses. The date of conception was estimated assuming 280 days for gestation, which is a medically accepted time interval but will undoubtedly vary. However, the primary independent variables (Lent and Nativity fast at 48 and 40 days, respectively) are long enough to overlap the uncertainty in the conception date following the sexual intercourse event. We also must assume that the religious affiliation of the parents is well defined, based on the information given by their offspring at census time, and is the same for both parents. WIDER IMPLICATIONS OF THE FINDINGS Our findings are consistent with other studies, which show differences between religious groups on date of conception, although we reach different conclusions regarding the influence of weather on fertility in Romania. STUDY FUNDING/COMPETING INTERESTS B.V.I., M.A. and G.R. have no competing interests to declare. There is no connection to the current paper, but C.H. declares that (i) he is currently conducting a research titled 'Chronic Diseases' Direct Costs within the Romanian Health System' funded by Local American Working Group; (ii) his wife is employed to a Romanian company (A&D Pharma) that does business in the pharmaceutical sector. This paper is a part of G.R. and M.A. scientific activities in COST Action TD1210. This work by C.H. was co-financed by the European Social Fund through project number POSDRU/1.5/S/59184.
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Affiliation(s)
- Claudiu Herteliu
- Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania
| | - Bogdan Vasile Ileanu
- Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania
| | - Marcel Ausloos
- School of Management, University of Leicester, Leicester, UK eHumanities Group, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands GRAPES, Angleur, Belgium
| | - Giulia Rotundo
- Department of Methods and Models for Economics, Territory and Finance, Sapienza University of Rome, Rome, Italy
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Boland MR, Shahn Z, Madigan D, Hripcsak G, Tatonetti NP. Birth month affects lifetime disease risk: a phenome-wide method. J Am Med Inform Assoc 2015; 22:1042-53. [PMID: 26041386 PMCID: PMC4986668 DOI: 10.1093/jamia/ocv046] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/18/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE An individual's birth month has a significant impact on the diseases they develop during their lifetime. Previous studies reveal relationships between birth month and several diseases including atherothrombosis, asthma, attention deficit hyperactivity disorder, and myopia, leaving most diseases completely unexplored. This retrospective population study systematically explores the relationship between seasonal affects at birth and lifetime disease risk for 1688 conditions. METHODS We developed a hypothesis-free method that minimizes publication and disease selection biases by systematically investigating disease-birth month patterns across all conditions. Our dataset includes 1 749 400 individuals with records at New York-Presbyterian/Columbia University Medical Center born between 1900 and 2000 inclusive. We modeled associations between birth month and 1688 diseases using logistic regression. Significance was tested using a chi-squared test with multiplicity correction. RESULTS We found 55 diseases that were significantly dependent on birth month. Of these 19 were previously reported in the literature (P < .001), 20 were for conditions with close relationships to those reported, and 16 were previously unreported. We found distinct incidence patterns across disease categories. CONCLUSIONS Lifetime disease risk is affected by birth month. Seasonally dependent early developmental mechanisms may play a role in increasing lifetime risk of disease.
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Affiliation(s)
- Mary Regina Boland
- Department of Biomedical Informatics Observational Health Data Sciences and Informatics (OHDSI)
| | | | - David Madigan
- Observational Health Data Sciences and Informatics (OHDSI) Department of Statistics
| | - George Hripcsak
- Department of Biomedical Informatics Observational Health Data Sciences and Informatics (OHDSI)
| | - Nicholas P Tatonetti
- Department of Biomedical Informatics Observational Health Data Sciences and Informatics (OHDSI) Department of Systems Biology Department of Medicine, Columbia University, New York, NY, USA
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