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Liu J, Hansen A, Varghese BM, Dear K, Tong M, Prescott V, Dolar V, Gourley M, Driscoll T, Zhang Y, Morgan G, Capon A, Bi P. Estimating the burden of disease attributable to high ambient temperature across climate zones: methodological framework with a case study. Int J Epidemiol 2023; 52:783-795. [PMID: 36511334 PMCID: PMC10244055 DOI: 10.1093/ije/dyac229] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 11/30/2022] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND With high temperature becoming an increasing health risk due to a changing climate, it is important to quantify the scale of the problem. However, estimating the burden of disease (BoD) attributable to high temperature can be challenging due to differences in risk patterns across geographical regions and data accessibility issues. METHODS We present a methodological framework that uses Köppen-Geiger climate zones to refine exposure levels and quantifies the difference between the burden observed due to high temperatures and what would have been observed if the population had been exposed to the theoretical minimum risk exposure distribution (TMRED). Our proposed method aligned with the Australian Burden of Disease Study and included two parts: (i) estimation of the population attributable fractions (PAF); and then (ii) estimation of the BoD attributable to high temperature. We use suicide and self-inflicted injuries in Australia as an example, with most frequent temperatures (MFTs) as the minimum risk exposure threshold (TMRED). RESULTS Our proposed framework to estimate the attributable BoD accounts for the importance of geographical variations of risk estimates between climate zones, and can be modified and adapted to other diseases and contexts that may be affected by high temperatures. CONCLUSIONS As the heat-related BoD may continue to increase in the future, this method is useful in estimating burdens across climate zones. This work may have important implications for preventive health measures, by enhancing the reproducibility and transparency of BoD research.
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Affiliation(s)
- Jingwen Liu
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Alana Hansen
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Blesson M Varghese
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Keith Dear
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Michael Tong
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Vanessa Prescott
- Burden of Disease and Mortality Unit, Australian Institute of Health and Welfare, Canberra, ACT, Australia
| | - Vergil Dolar
- Burden of Disease and Mortality Unit, Australian Institute of Health and Welfare, Canberra, ACT, Australia
| | - Michelle Gourley
- Burden of Disease and Mortality Unit, Australian Institute of Health and Welfare, Canberra, ACT, Australia
| | - Timothy Driscoll
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Ying Zhang
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Geoffrey Morgan
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Anthony Capon
- Monash Sustainable Development Institute, Monash University, Melbourne, VIC, Australia
| | - Peng Bi
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
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Ryu B, Yoo S, Kim S, Choi J. Thirty-day hospital readmission prediction model based on common data model with weather and air quality data. Sci Rep 2021; 11:23313. [PMID: 34857799 PMCID: PMC8639801 DOI: 10.1038/s41598-021-02395-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/29/2021] [Indexed: 12/03/2022] Open
Abstract
Although several studies have attempted to develop a model for predicting 30-day re-hospitalization, few attempts have been made for sufficient verification and multi-center expansion for clinical use. In this study, we developed a model that predicts unplanned hospital readmission within 30 days of discharge; the model is based on a common data model and considers weather and air quality factors, and can be easily extended to multiple hospitals. We developed and compared four tree-based machine learning methods: decision tree, random forest, AdaBoost, and gradient boosting machine (GBM). Above all, GBM showed the highest AUC performance of 75.1 in the clinical model, while the clinical and W-score model showed the best performance of 73.9 for musculoskeletal diseases. Further, PM10, rainfall, and maximum temperature were the weather and air quality variables that most impacted the model. In addition, external validation has confirmed that the model based on weather and air quality factors has transportability to adapt to other hospital systems.
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Affiliation(s)
- Borim Ryu
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, 172, Dolma-ro, Bundang-gu, Seongnam-si, 13605, Gyeonggi-do, Republic of Korea.,Department of Biomedical Engineering, College of Medicine, Seoul National University, 28 Yongon-Dong Chongro-Gu, Seoul, 110-799, Korea
| | - Sooyoung Yoo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, 172, Dolma-ro, Bundang-gu, Seongnam-si, 13605, Gyeonggi-do, Republic of Korea.
| | - Seok Kim
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, 172, Dolma-ro, Bundang-gu, Seongnam-si, 13605, Gyeonggi-do, Republic of Korea
| | - Jinwook Choi
- Department of Biomedical Engineering, College of Medicine, Seoul National University, 28 Yongon-Dong Chongro-Gu, Seoul, 110-799, Korea. .,Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, South Korea.
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Andraka-Christou B, Nguyen T, Bradford DW, Simon K. Assessing the impact of drug courts on provider-directed marketing efforts by manufactures of medications for the treatment of opioid use disorder. J Subst Abuse Treat 2019; 110:49-58. [PMID: 31952628 DOI: 10.1016/j.jsat.2019.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/31/2019] [Accepted: 12/05/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Opioid use disorder (OUD) has become an increasingly consequential public health concern, especially in the United States where 47,600 opioid overdose deaths occurred in 2017 (Scholl, Seth, Kariisa, Wilson, & Baldwin, 2019). Medications for OUD (MOUD) are effective for decreasing opioid-related morbidity and mortality, including within the criminal justice system (Hedrich et al., 2012; Medications for Opioid Use Disorder Save Lives, 2019; Moore et al., 2019).While a stronger evidence base exists for agonist MOUD than for antagonist MOUD, a national study of drug courts found that half prohibited agonist MOUD (Matusow et al., 2013).Furthermore, recent media reports suggest that the pharmaceutical manufacturer of an antagonist MOUD has marketed its product towards drug court judges (Goodnough & Zernike, 2017; Harper, 2017). However, no study to date has systematically examined the relationship between MOUD marketing practices and drug courts. This ecological study examines the association at the county level between MOUD manufacturer payments to prescribers and drug court locations. METHOD We extracted provider-directed payments from Centers for Medicare and Medicaid Services (CMS)'s Sunshine Act Open Payments data 2014-2017, isolating those records mentioning any MOUD. We compared provider-directed payments for two major MOUDs: buprenorphine and extended-release naltrexone, in counties with and without drug courts. RESULTS The presence of any adult drug courts in the county is associated with a 7.86 percentage-point increase in the likelihood of providers in that county receiving any MOUD-related payments (about 22.46% of the sample mean, p<0.001) and with a 10.70% increase in the amount of these payments per 1000 county residents (p<0.001). The association between other forms of drug courts such as juvenile drug courts and Driving-Under-the-Influence courts (DUI) courts are less significant and slightly smaller in magnitude compared to those of adult drug courts. We did not find significant difference between payments by the manufacturer of Vivitrol and manufacturers of Zubsolv, Bunavail, and Suboxone (oral forms of buprenorphine). CONCLUSIONS Our results show an ecological association at the county level between MOUD manufacturer payments to prescribers and drug court presence. However, we did not examine a causal association between these variables.
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Affiliation(s)
- Barbara Andraka-Christou
- Department of Health Management & Informatics, University of Central Florida, United States of America.
| | - Thuy Nguyen
- Paul H. O'Neill School of Public & Environmental Affairs, Indiana University-Bloomington, United States of America
| | - David W Bradford
- Department of Public Administration and Policy, University of Georgia, United States of America
| | - Kosali Simon
- Paul H. O'Neill School of Public & Environmental Affairs, Indiana University-Bloomington, United States of America
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Nguyen T, Andraka-Christou B, Simon K, Bradford WD. Comparison of Rural vs Urban Direct-to-Physician Commercial Promotion of Medications for Treating Opioid Use Disorder. JAMA Netw Open 2019; 2:e1916520. [PMID: 31790568 PMCID: PMC6902747 DOI: 10.1001/jamanetworkopen.2019.16520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE In the United States, access to medications prescribed for opioid use disorder (OUD) is lower in rural counties than in urban counties. Considering the positive associations between direct-to-physician promotion of opiates and OUD medications and their prescribing rates, a study examining the association between pharmaceutical promotion of these medications and county-level rurality has merit. OBJECTIVE To assess whether rural counties received less pharmaceutical promotion of OUD medications compared with urban counties. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional county-level study used all reported direct-to-physician pharmaceutical payments from manufacturers of medications prescribed for OUD from January 1, 2014, through December 31, 2017, as well as demographic and economic data at the county level from 3140 US counties. Logistic regression was used with year and state-level fixed effects to compare rural county and urban county odds of receiving any promotion of OUD medications. A negative binomial model was used with year and state-level fixed effects to compare the mean pharmaceutical payments per physician and per population in rural vs urban counties. MAIN OUTCOMES AND MEASURES A binary indicator for whether physicians in a county received any promotion related to OUD medications in a year. The second outcome was the value of promotion (eg, meals), with dollar amount of payments for each county by year. Counties were separated into metropolitan, micropolitan, and rural categories using the National Center for Health Statistics Urban-Rural Classification Scheme. RESULTS Of 3140 US counties with 18 318 physicians to whom promotion of OUD medications was directed, 1166 (37.1%) were metropolitan (16 740 physicians [91.4%]), 641 (20.4%) were micropolitan (1049 physicians [5.7%]), and 1333 (42.5%) were rural (529 physicians [2.9%]). Compared with physicians in metropolitan counties, physicians in rural counties had reduced odds of receiving any promotion (adjusted odds ratio, 0.57; 95% CI, 0.44-0.74) and received lower payments (adjusted incidence rate ratio, 0.24; 95% CI, 0.17-0.34). CONCLUSIONS AND RELEVANCE The study findings suggest that promotion for OUD medications is less likely to occur in rural counties and that this difference in promotion of OUD medications may be associated with differential commercial costs and benefits of promotion in rural settings.
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Affiliation(s)
- Thuy Nguyen
- O’Neill School of Public and Environmental Affairs, Indiana University, Bloomington
| | | | - Kosali Simon
- O’Neill School of Public and Environmental Affairs, Indiana University, Bloomington
- National Bureau of Economic Research, Cambridge, Massachusetts
| | - W. David Bradford
- Department of Public Administration and Policy, University of Georgia, Athens, Georgia
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Nguyen T, Andraka-Christou B, Simon K, Bradford WD. Provider-directed marketing may increase prescribing of medications for opioid use disorder. J Subst Abuse Treat 2019; 104:104-115. [PMID: 31370974 DOI: 10.1016/j.jsat.2019.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Opioid use disorder (OUD) has become an increasingly grave public health concern, especially in the United States where approximately 80% of the global opioid supply is consumed. Despite greater awareness of the present overdose crisis, potentially life-saving OUD pharmacotherapy (medications for opioid use disorder or MOUD) utilization remains low. This study examines the extent of provider-directed marketing (detailing) for MOUD drugs and identifies any associations between a provider's receipt of detailing and their prescribing of MOUD drugs to Medicare Part D beneficiaries. METHOD We combined Open Payments data on all provider-directed payments from pharmaceutical manufacturers with physician-level data on all MOUD prescriptions filled in Medicare Part D. We estimated the adjusted difference in Medicare days supply for all MOUD drugs (collectively) and separately for each MOUD drug that was associated with receipt of payments. RESULTS The Open Payments data show that $7.0 million MOUD-specific promotional payments were made by pharmaceutical manufacturers to 12,056 US physicians from 2014 to 2016, which is <1/6th of the $50.3 million made in overall non-MOUD opioid-related promotional payments to 76,992 US physicians during that same period. Prescribers who received any MOUD-specific payments prescribed 1080 daily MOUD-related doses per year more than peers who did not receive any MOUD-specific payments (p < 0.001). The data also show the relatively greater association between receipt of detailing and Suboxone prescriptions compared to Vivitrol. CONCLUSIONS Provider-directed marketing by MOUD manufacturers has been found to be significantly and positively associated with incidence of MOUD prescribing in Medicare Part D, as well as with the quantity of MOUD prescribed.
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Affiliation(s)
- Thuy Nguyen
- O'Neill School of Public and Environmental Affairs, Indiana University, 1315 East Tenth Street, Bloomington, IN 47405, United States of America.
| | - Barbara Andraka-Christou
- Department of Health Management & Informatics, University of Central Florida, 4000 Central Florida Blvd, Orlando, FL 32816, United States of America.
| | - Kosali Simon
- O'Neill School of Public and Environmental Affairs, Indiana University, 1315 East Tenth Street, Bloomington, IN 47405, United States of America; NBER, 1050 Massachusetts Ave, Cambridge, MA 02138, United States of America.
| | - W David Bradford
- Department of Public Administration and Policy, University of Georgia, 201C Baldwin Hall, Athens, GA 30602, United States of America.
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Boland MR, Parhi P, Li L, Miotto R, Carroll R, Iqbal U, Nguyen PAA, Schuemie M, You SC, Smith D, Mooney S, Ryan P, Li YCJ, Park RW, Denny J, Dudley JT, Hripcsak G, Gentine P, Tatonetti NP. Uncovering exposures responsible for birth season - disease effects: a global study. J Am Med Inform Assoc 2017; 25:275-288. [PMID: 29036387 PMCID: PMC7282503 DOI: 10.1093/jamia/ocx105] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/24/2017] [Accepted: 09/05/2017] [Indexed: 01/08/2023] Open
Abstract
Objective Birth month and climate impact lifetime disease risk, while the underlying exposures remain largely elusive. We seek to uncover distal risk factors underlying these relationships by probing the relationship between global exposure variance and disease risk variance by birth season. Material and Methods This study utilizes electronic health record data from 6 sites representing 10.5 million individuals in 3 countries (United States, South Korea, and Taiwan). We obtained birth month–disease risk curves from each site in a case-control manner. Next, we correlated each birth month–disease risk curve with each exposure. A meta-analysis was then performed of correlations across sites. This allowed us to identify the most significant birth month–exposure relationships supported by all 6 sites while adjusting for multiplicity. We also successfully distinguish relative age effects (a cultural effect) from environmental exposures. Results Attention deficit hyperactivity disorder was the only identified relative age association. Our methods identified several culprit exposures that correspond well with the literature in the field. These include a link between first-trimester exposure to carbon monoxide and increased risk of depressive disorder (R = 0.725, confidence interval [95% CI], 0.529-0.847), first-trimester exposure to fine air particulates and increased risk of atrial fibrillation (R = 0.564, 95% CI, 0.363-0.715), and decreased exposure to sunlight during the third trimester and increased risk of type 2 diabetes mellitus (R = −0.816, 95% CI, −0.5767, −0.929). Conclusion A global study of birth month–disease relationships reveals distal risk factors involved in causal biological pathways that underlie them.
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Affiliation(s)
- Mary Regina Boland
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA.,Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, USA.,Center for Excellence in Environmental Toxicology, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Biomedical Informatics, Columbia University, New York, NY, USA.,Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA
| | - Pradipta Parhi
- Department of Earth and Environmental Engineering, Columbia University, New York, NY, USA
| | - Li Li
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute for Next Generation Healthcare, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Riccardo Miotto
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute for Next Generation Healthcare, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Carroll
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Usman Iqbal
- Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA.,Masters Program in Global Health and Development Department, College of Public Health, Taipei Medical University, Taiwan.,College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Phung-Anh Alex Nguyen
- Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA.,Masters Program in Global Health and Development Department, College of Public Health, Taipei Medical University, Taiwan.,International Center for Health Information Technology, Taipei Medical University, Taiwan
| | - Martijn Schuemie
- Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA.,Janssen Research and Development, Raritan, NJ, USA
| | - Seng Chan You
- Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA.,Department of Biomedical Informatics, Ajou University School of Medicine, Republic of Korea
| | - Donahue Smith
- Department of Biomedical Informatics, University of Washington, Seattle, Washington, USA
| | - Sean Mooney
- Department of Biomedical Informatics, University of Washington, Seattle, Washington, USA
| | - Patrick Ryan
- Department of Biomedical Informatics, Columbia University, New York, NY, USA.,Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA.,Janssen Research and Development, Raritan, NJ, USA
| | - Yu-Chuan Jack Li
- Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA.,College of Medical Science and Technology, Taipei Medical University, Taiwan.,International Center for Health Information Technology, Taipei Medical University, Taiwan
| | - Rae Woong Park
- Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA.,Department of Biomedical Informatics, Ajou University School of Medicine, Republic of Korea
| | - Josh Denny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joel T Dudley
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute for Next Generation Healthcare, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, USA.,Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA
| | - Pierre Gentine
- Department of Earth and Environmental Engineering, Columbia University, New York, NY, USA
| | - Nicholas P Tatonetti
- Department of Biomedical Informatics, Columbia University, New York, NY, USA.,Observational Health Data Sciences and Informatics, Columbia University, New York, NY, USA
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