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Hailu EM, Riddell CA, Bradshaw PT, Ahern J, Carmichael SL, Mujahid MS. Structural Racism, Mass Incarceration, and Racial and Ethnic Disparities in Severe Maternal Morbidity. JAMA Netw Open 2024; 7:e2353626. [PMID: 38277143 PMCID: PMC10818215 DOI: 10.1001/jamanetworkopen.2023.53626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024] Open
Abstract
Importance Racial and ethnic inequities in the criminal-legal system are an important manifestation of structural racism. However, how these inequities may influence the risk of severe maternal morbidity (SMM) and its persistent racial and ethnic disparities remains underinvestigated. Objective To examine the association between county-level inequity in jail incarceration rates comparing Black and White individuals and SMM risk in California. Design, Setting, and Participants This population-based cross-sectional study used state-wide data from California on all live hospital births at 20 weeks of gestation or later from January 1, 1997, to December 31, 2018. Data were obtained from hospital discharge and vital statistics records, which were linked with publicly available county-level data. Data analysis was performed from January 2022 to February 2023. Exposure Jail incarceration inequity was determined from the ratio of jail incarceration rates of Black individuals to those of White individuals and was categorized as tertile 1 (low), tertile 2 (moderate), tertile 3 (high), with mean cutoffs across all years of 0 to 2.99, 3.00 to 5.22, and greater than 5.22, respectively. Main Outcome and Measures This study used race- and ethnicity-stratified mixed-effects logistic regression models with birthing people nested within counties and adjusted for individual- and county-level characteristics to estimate the odds of non-blood transfusion SMM (NT SMM) and SMM including blood transfusion-only cases (SMM; as defined by the Centers for Disease Control and Prevention SMM index) associated with tertiles of incarceration inequity. Results This study included 10 200 692 births (0.4% American Indian or Alaska Native, 13.4% Asian or Pacific Islander, 5.8% Black, 50.8% Hispanic or Latinx, 29.6% White, and 0.1% multiracial or other [individuals who self-identified with ≥2 racial groups and those who self-identified as "other" race or ethnicity]). In fully adjusted models, residing in counties with high jail incarceration inequity (tertile 3) was associated with higher odds of SMM for Black (odds ratio [OR], 1.14; 95% CI, 1.01-1.29 for NT SMM; OR, 1.20, 95% CI, 1.01-1.42 for SMM), Hispanic or Latinx (OR, 1.24; 95% CI, 1.14-1.34 for NT SMM; OR, 1.20; 95% CI, 1.14-1.27 for SMM), and White (OR, 1.02; 95% CI, 0.93-1.12 for NT SMM; OR, 1.09; 95% CI, 1.02-1.17 for SMM) birthing people, compared with residing in counties with low inequity (tertile 1). Conclusions and Relevance The findings of this study highlight the adverse maternal health consequences of structural racism manifesting via the criminal-legal system and underscore the need for community-based alternatives to inequitable punitive practices.
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Affiliation(s)
- Elleni M. Hailu
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Corinne A. Riddell
- Division of Epidemiology, School of Public Health, University of California, Berkeley
- Division of Biostatistics, School of Public Health, University of California, Berkeley
| | - Patrick T. Bradshaw
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Jennifer Ahern
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Suzan L. Carmichael
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Palo Alto, California
- Division of Maternal-Fetal Medicine and Obstetrics, School of Medicine, Stanford University, Palo Alto, California
| | - Mahasin S. Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley
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McKenzie-Sampson S, Baer RJ, Jelliffe-Pawlowski LL, Karasek D, Riddell CA, Torres JM, Blebu BE. Structural racism, nativity and risk of adverse perinatal outcomes among Black women. Paediatr Perinat Epidemiol 2024; 38:89-97. [PMID: 38116814 DOI: 10.1111/ppe.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Black women in the United States (US) have the highest risk of preterm birth (PTB) and small for gestational age (SGA) births, compared to women of other racial groups. Among Black women, there are disparities by nativity whereby foreign-born women have a lower risk of PTB and SGA compared to US-born women. Differential exposure to racism may confer nativity-based differences in adverse perinatal outcomes between US- and foreign-born Black women. This remains unexplored among US- and African-born women in California. OBJECTIVES Evaluate the relationship between structural racism, nativity, PTB and SGA among US- and African-born Black women in California. METHODS We conducted a population-based study of singleton births to US- and African-born Black women in California from 2011 to 2017 (n = 131,424). We examined the risk of PTB and SGA by nativity and neighbourhoods with differing levels of structural racism, as measured by the Index of Concentration at the Extremes. We fit crude and age-adjusted Poisson regression models, estimated using generalized estimating equations, with risk ratios (RR) and 95% confidence intervals (CI) as the effect measure. RESULTS The proportions of PTB and SGA were 9.7% and 14.5%, respectively, for US-born women, while 5.6% and 8.3% for African-born women. US-born women (n = 24,782; 20.8%) were more likely to live in neighbourhoods with high structural racism compared to African-born women (n = 1474; 11.6%). Structural racism was associated with an elevated risk of PTB (RR 1.19, 95% CI 1.12, 1.26) and SGA (RR 1.19, 95% CI 1.13, 1.25) for all Black women, however, there was heterogeneity by nativity, with US-born women experiencing a higher magnitude of effect than African-born women. CONCLUSIONS Among Black women in California, exposure to structural racism and the impacts of structural racism on the risk of PTB and SGA varied by nativity.
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Affiliation(s)
- Safyer McKenzie-Sampson
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Rebecca J Baer
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Pediatrics, University of California San Diego School of Medicine, San Francisco, California, USA
| | - Laura L Jelliffe-Pawlowski
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Deborah Karasek
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, California, USA
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, USA
| | - Corinne A Riddell
- Divisions of Biostatistics and Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Jacqueline M Torres
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Bridgette E Blebu
- Department of Obstetrics and Gynecology, Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, University of California, Los Angeles, Los Angeles, California, USA
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Lam-Hine T, Riddell CA, Bradshaw PT, Omi M, Allen AM. Racial differences in associations between adverse childhood experiences and physical, mental, and behavioral health. SSM Popul Health 2023; 24:101524. [PMID: 37860706 PMCID: PMC10583167 DOI: 10.1016/j.ssmph.2023.101524] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/30/2023] [Accepted: 09/26/2023] [Indexed: 10/21/2023] Open
Abstract
Purpose Adverse childhood experiences (ACEs) are associated with poor adulthood health. Multiracial people have elevated mean ACEs scores and risk of several outcomes. We aimed to determine whether this group should be targeted for prevention efforts. Methods We analyzed three waves (1994-2009) of the National Longitudinal Study of Adolescent to Adult Health (n = 12,372) in 2023, estimating associations between four or more ACEs and physical (metabolic syndrome, hypertension, asthma), mental (anxiety, depression), and behavioral (suicidal ideation, drug use) outcomes. We estimated adjusted risk ratios for each outcome in modified Poisson models interacting race and ACEs. We used the interaction contrast to estimate race-specific excess cases per 1000 relative to Multiracial participants. Results Excess case estimates of asthma were smaller for White (-123 cases, 95% CI: -251, -4), Black (-141, 95% CI: -285, -6), and Asian (-169, 95% CI: -334, -7) participants compared to Multiracial participants. Black (-100, 95% CI: -189, -10), Asian (-163, 95% CI: -247, -79) and Indigenous (-144, 95% CI: -252, -42) participants had fewer excess cases of and weaker relative scale association with anxiety compared to Multiracial participants. Conclusions Adjusted associations with asthma and anxiety appear stronger for Multiracial people. Existing ACEs prevention strategies should be tailored to support Multiracial youth and families.
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Affiliation(s)
- Tracy Lam-Hine
- Stanford University School of Medicine, Division of Epidemiology & Population Health, 1701 Page Mill Road, Palo Alto, CA, USA
| | - Corinne A. Riddell
- University of California Berkeley School of Public Health, Division of Biostatistics, 2121 Berkeley Way West, Berkeley, CA, USA
- University of California Berkeley School of Public Health, Division of Epidemiology, 2121 Berkeley Way West, Berkeley, CA, USA
| | - Patrick T. Bradshaw
- University of California Berkeley School of Public Health, Division of Epidemiology, 2121 Berkeley Way West, Berkeley, CA, USA
| | - Michael Omi
- University of California Berkeley Department of Ethnic Studies, 506 Social Science Building, Berkeley, CA, USA
| | - Amani M. Allen
- University of California Berkeley School of Public Health, Division of Epidemiology, 2121 Berkeley Way West, Berkeley, CA, USA
- University of California Berkeley School of Public Health, Division of Community Health Sciences, 2121 Berkeley Way West, Berkeley, CA, USA
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Goin DE, Riddell CA. Comparing Two-way Fixed Effects and New Estimators for Difference-in-Differences: A Simulation Study and Empirical Example. Epidemiology 2023; 34:535-543. [PMID: 36943806 PMCID: PMC10771800 DOI: 10.1097/ede.0000000000001611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Two-way fixed effects methods have been used to estimate effects of policies adopted in different places over time, but they can provide misleading results when effects are heterogeneous or dynamic, and alternate methods have been proposed. METHODS We compared methods for estimating the average treatment effect on the treated (ATT) under staggered adoption of policies, including two-way fixed effects, group-time ATT, cohort ATT, and target-trial approaches. We applied each method to assess the impact of Medicaid expansion on preterm birth using the National Center for Health Statistics' birth records. We compared each estimator's performance in a simulation parameterized to mimic the empirical example. We generated constant, heterogeneous, and dynamic effects and calculated bias, mean squared error, and confidence interval coverage of each estimator across 1000 iterations. RESULTS Two-way fixed effects estimated that Medicaid expansion increased the risk of preterm birth (risk difference [RD], 0.12; 95% CI = 0.02, 0.22), while the group-time ATT, cohort ATT, and target-trial approaches estimated protective or null effects (group-time RD, -0.16; 95% CI = -0.58, 0.26; cohort RD, -0.02; 95% CI = -0.46, 0.41; target trial RD, -0.16; 95% CI = -0.59, 0.26). In simulations, two-way fixed effects performed well when treatment effects were constant and less well under heterogeneous and dynamic effects. CONCLUSIONS We demonstrated why new approaches perform better than two-way fixed effects when treatment effects are heterogeneous or dynamic under a staggered policy adoption design, and created simulation and analysis code to promote understanding and wider use of these methods in the epidemiologic literature.
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Affiliation(s)
- Dana E. Goin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Program on Reproductive Health and the Environment, School of Medicine, University of California, San Francisco, San Francisco, USA
| | - Corinne A. Riddell
- Division of Biostatistics, School of Public Health, University of California, Berkeley, USA
- Division of Epidemiology, School of Public Health, University of California, Berkeley, USA
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Lam-Hine T, Bradshaw PT, Allen AM, Omi M, Riddell CA. A hypothetical intervention to reduce inequities in anxiety for Multiracial people: simulating an intervention on childhood adversity. medRxiv 2023:2023.06.04.23290940. [PMID: 37333321 PMCID: PMC10274983 DOI: 10.1101/2023.06.04.23290940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Multiracial people report higher mean Adverse Childhood Experiences (ACEs) scores and prevalence of anxiety than other racial groups. Studies using statistical interactions to estimate racial differences in ACEs-anxiety associations do not show stronger associations for Multiracial people. Using data from Waves 1 (1995-97) through 4 (2008-09) of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we simulated a stochastic intervention over 1,000 resampled datasets to estimate the race-specific cases averted per 1,000 of anxiety if all racial groups had the same exposure distribution of ACEs as Whites. Simulated cases averted were greatest for the Multiracial group, (median = -4.17 cases per 1,000, 95% CI: -7.42, -1.86). The model also predicted smaller risk reductions for Black participants (-0.76, 95% CI: -1.53, -0.19). CIs around estimates for other racial groups included the null. An intervention to reduce racial disparities in exposure to ACEs could help reduce the inequitable burden of anxiety on the Multiracial population. Stochastic methods support consequentialist approaches to racial health equity, and can encourage greater dialogue between public health researchers, policymakers, and practitioners.
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Affiliation(s)
- Tracy Lam-Hine
- Stanford University School of Medicine, Division of Epidemiology & Population Health, Palo Alto CA
| | - Patrick T Bradshaw
- University of California Berkeley School of Public Health, Division of Epidemiology, Berkeley, CA
| | - Amani M Allen
- University of California Berkeley School of Public Health, Division of Community Health Sciences and Division of Epidemiology, Berkeley, CA
| | - Michael Omi
- University of California Berkeley Department of Ethnic Studies, Berkeley, CA
| | - Corinne A Riddell
- University of California Berkeley School of Public Health, Division of Biostatistics and Division of Epidemiology, Berkeley, CA
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Lam-Hine T, Riddell CA, Bradshaw PT, Omi M, Allen AM. Racial Differences in Associations Between Adverse Childhood Experiences and Physical, Mental, and Behavioral Health. medRxiv 2023:2023.06.02.23290905. [PMID: 37333236 PMCID: PMC10274984 DOI: 10.1101/2023.06.02.23290905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Introduction Adverse childhood experiences (ACEs) are associated with poor adulthood health, with individuals experiencing multiple ACEs at greatest risk. Multiracial people have high mean ACEs scores and elevated risk of several outcomes, but are infrequently the focus of health equity research. This study aimed to determine whether this group should be targeted for prevention efforts. Methods We analyzed Waves 1 (1994-95), 3 (2001-02), and 4 (2008-09) of the National Longitudinal Study of Adolescent to Adult Health (n = 12,372) in 2023, estimating associations between four or more ACEs and physical (metabolic syndrome, hypertension, asthma), mental (anxiety, depression), and behavioral (suicidal ideation, drug use) outcomes. We estimated risk ratios for each outcome in modified Poisson models with a race × ACEs interaction, adjusted for hypothesized confounders of the ACE-outcome relationships. We used the interaction contrast to estimate excess cases per 1,000 individuals for each group relative to Multiracial participants. Results Excess case estimates of asthma were significantly smaller for White (-123 cases, 95% CI: -251, -4), Black (-141, 95% CI: -285, -6), and Asian (-169, 95% CI: -334, -7) participants compared to Multiracial participants. Black (-100, 95% CI: -189, -10), Asian (-163, 95% CI: -247, -79) and Indigenous (-144, 95% CI: -252, -42) participants had significantly fewer excess cases of and weaker (p < 0.001) relative scale association with anxiety compared to Multiracial participants. Conclusions Adjusted associations between ACEs and asthma or anxiety appear stronger for Multiracial people than other groups. ACEs are universally harmful but may contribute disproportionately to morbidity in this population.
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Affiliation(s)
- Tracy Lam-Hine
- Stanford University School of Medicine, Division of Epidemiology & Population Health, Palo Alto, CA
| | - Corinne A Riddell
- University of California Berkeley School of Public Health, Division of Biostatistics and Division of Epidemiology, Berkeley, CA
| | - Patrick T Bradshaw
- University of California Berkeley School of Public Health, Division of Epidemiology, Berkeley, CA
| | - Michael Omi
- University of California Berkeley Department of Ethnic Studies, Berkeley, CA
| | - Amani M Allen
- University of California Berkeley School of Public Health, Division of Community Health Sciences and Division of Epidemiology, Berkeley, CA
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Riddell CA, Goin DE. Guide for Comparing Estimators of Policy Change Effects on Health. Epidemiology 2023; 34:e21-e22. [PMID: 36728377 PMCID: PMC10771122 DOI: 10.1097/ede.0000000000001586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Corinne A. Riddell
- Division of Biostatistics, School of Public Health, University of California, Berkeley, USA
- Division of Epidemiology, School of Public Health, University of California, Berkeley, USA
| | - Dana E. Goin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Program on Reproductive Health and the Environment, School of Medicine, University of California, San Francisco, San Francisco, USA
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Potter AL, Haridas C, Neumann K, Kiang MV, Fong ZV, Riddell CA, Pope HG, Yang CFJ. Incidence, Timing, and Factors Associated With Suicide Among Patients Undergoing Surgery for Cancer in the US. JAMA Oncol 2023; 9:308-315. [PMID: 36633854 PMCID: PMC9857808 DOI: 10.1001/jamaoncol.2022.6549] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/22/2022] [Indexed: 01/13/2023]
Abstract
Importance The risk and timing of suicide among patients who undergo surgery for cancer remain largely unknown, and, to our knowledge, there are currently no organized programs in place to implement regular suicide screening among this patient population. Objective To evaluate the incidence, timing, and factors associated with suicide among patients undergoing cancer operations. Design, Setting, and Participants This retrospective population-based cohort study used data from the Surveillance, Epidemiology, and End Results Program database to examine the incidence of suicide, compared with the general US population, and timing of suicide among patients undergoing surgery for the 15 deadliest cancers in the US from 2000 to 2016. A Fine-Gray competing risks regression model was used to identify factors associated with an increased risk of suicide among patients in the cohort. Data were analyzed from September 2021 to January 2022. Exposures Surgery for cancer. Main Outcomes and Measures Incidence, compared with the general US population, timing, and factors associated with suicide after surgery for cancer. Results From 2000 to 2016, 1 811 397 patients (74.4% female; median [IQR] age, 62.0 [52.0-72.0] years) met study inclusion criteria. Of these patients, 1494 (0.08%) committed suicide after undergoing surgery for cancer. The incidence of suicide, compared with the general US population, was statistically significantly higher among patients undergoing surgery for cancers of the larynx (standardized mortality ratio [SMR], 4.02; 95% CI, 2.67-5.81), oral cavity and pharynx (SMR, 2.43; 95% CI, 1.93-3.03), esophagus (SMR, 2.25; 95% CI, 1.43-3.38), bladder (SMR, 2.09; 95% CI, 1.53-2.78), pancreas (SMR, 2.08; 95% CI, 1.29-3.19), lung (SMR, 1.73; 95% CI, 1.47-2.02), stomach (SMR, 1.70; 95% CI, 1.22-2.31), ovary (SMR, 1.64; 95% CI, 1.13-2.31), brain (SMR, 1.61; 95% CI, 1.12-2.26), and colon and rectum (SMR, 1.28; 95% CI, 1.16-1.40). Approximately 3%, 21%, and 50% of suicides were committed within the first month, first year, and first 3 years after surgery, respectively. Patients who were male, White, and divorced or single were at greatest risk of suicide. Conclusions and Relevance In this cohort study, the incidence of suicide among patients undergoing cancer operations was statistically significantly elevated compared with the general population, highlighting the need for programs to actively implement regular suicide screening among such patients, especially those whose demographic and tumor characteristics are associated with the highest suicide risk.
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Affiliation(s)
- Alexandra L. Potter
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston
| | - Chinmay Haridas
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston
| | - Krista Neumann
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | - Zhi Ven Fong
- Department of Surgery, Massachusetts General Hospital, Boston
| | - Corinne A. Riddell
- Division of Epidemiology, School of Public Health, University of California, Berkeley
- Division of Biostatistics, School of Public Health, University of California, Berkeley
| | - Harrison G. Pope
- Biological Psychiatry Laboratory and Psychiatric Epidemiology Research Program, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston
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Neumann K, Mason SM, Farkas K, Santaularia NJ, Ahern J, Riddell CA. Harnessing Google Health Trends Data for Epidemiologic Research. Am J Epidemiol 2023; 192:430-437. [PMID: 36193858 PMCID: PMC9619602 DOI: 10.1093/aje/kwac171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/25/2022] [Accepted: 09/30/2022] [Indexed: 01/21/2023] Open
Abstract
Interest in using internet search data, such as that from the Google Health Trends Application Programming Interface (GHT-API), to measure epidemiologically relevant exposures or health outcomes is growing due to their accessibility and timeliness. Researchers enter search term(s), geography, and time period, and the GHT-API returns a scaled probability of that search term, given all searches within the specified geographic-time period. In this study, we detailed a method for using these data to measure a construct of interest in 5 iterative steps: first, identify phrases the target population may use to search for the construct of interest; second, refine candidate search phrases with incognito Google searches to improve sensitivity and specificity; third, craft the GHT-API search term(s) by combining the refined phrases; fourth, test search volume and choose geographic and temporal scales; and fifth, retrieve and average multiple samples to stabilize estimates and address missingness. An optional sixth step involves accounting for changes in total search volume by normalizing. We present a case study examining weekly state-level child abuse searches in the United States during the coronavirus disease 2019 pandemic (January 2018 to August 2020) as an application of this method and describe limitations.
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Affiliation(s)
- Krista Neumann
- Correspondence to Krista Neumann, Division of Epidemiology, School of Public Health, University of California, Berkeley, Room #5404, 2121 Berkeley Way West, Berkeley, California, 94720 ()
| | - Susan M Mason
- Division of Epidemiology and Community Health, University of Minnesota, Minnesota, United States
| | - Kriszta Farkas
- Division of Epidemiology, School of Public Health, University of California, Berkeley, United States
- Division of Epidemiology and Community Health, University of Minnesota, Minnesota, United States
| | - N Jeanie Santaularia
- Division of Epidemiology and Community Health, University of Minnesota, Minnesota, United States
| | - Jennifer Ahern
- Division of Epidemiology, School of Public Health, University of California, Berkeley, United States
| | - Corinne A Riddell
- Division of Epidemiology, School of Public Health, University of California, Berkeley, United States
- Division of Biostatistics, School of Public Health, University of California, Berkeley, United States
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Abstract
BACKGROUND In recent years, there has been growing interest in "moving beyond the individual" to measure area-level racism as a social determinant of health. Much of this work has aggregated racial prejudice data collected at the individual-level to the area-level. OBJECTIVE As this is a rapidly emerging area of research, we conducted a systematic literature review to describe evidence of the relationship between area-level racial prejudice and health, whether results differed by race/ethnicity, and to characterize key conceptual and methodological considerations to guide future research. METHOD We searched four interdisciplinary databases for US-based, peer-reviewed articles measuring area level racial prejudice by aggregating individual-level indicators of racial prejudice and examining associations with mental or physical health outcome(s). Data extraction followed PRISMA guidelines and also included theory and conceptualization, pathways to health, and strengths and limitations. RESULTS Fourteen of 14,632 identified articles met inclusion criteria and were included in the review. Health outcomes spanned all-cause (n = 4) and cause-specific (n = 4) mortality, birth outcomes (n = 4), cardiovascular outcomes (n = 2), mental health (n = 1), and self-rated health (n = 1). All studies found a positive association between area-level racial prejudice and adverse health outcomes among racial/ethnic minoritized groups, with four studies also showing a similar association among Whites. Engagement with formal theory was limited and exposure conceptualization was mixed. Methodological considerations included unmeasured confounding and trade-offs between generalizability, self-censorship, and specificity of measurement. CONCLUSIONS Future research should continue to develop the conceptual and methodological rigor of this work and test hypotheses to inform evidence-based interventions to advance population health and reduce racial health inequities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Eli K. Michaels
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Christine Board
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Mahasin S. Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Corinne A. Riddell
- Division of Epidemiology, School of Public Health, University of California, Berkeley
- Division of Biostatistics, School of Public Health, University of California, Berkeley
| | - David H. Chae
- Department of Global Community Health & Behavioral Sciences, Tulane School of Public Health and Tropical Medicine
| | | | - Amani M. Allen
- Division of Epidemiology, School of Public Health, University of California, Berkeley
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley
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Riddell CA, Goin DE, Morello-Frosch R, Apte JS, Glymour MM, Torres JM, Casey JA. Hyper-localized measures of air pollution and risk of preterm birth in Oakland and San Jose, California. Int J Epidemiol 2022; 50:1875-1885. [PMID: 34999861 PMCID: PMC8932296 DOI: 10.1093/ije/dyab097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND US preterm-birth rates are 1.6 times higher for Black mothers than for White mothers. Although traffic-related air pollution (TRAP) may increase the risk of preterm birth, evaluating its effect on preterm birth and disparities has been challenging because TRAP is often measured inaccurately. This study sought to estimate the effect of TRAP exposure, measured at the street level, on the prevalence of preterm birth by race/ethnicity. METHODS We linked birth-registry data with TRAP measured at the street level for singleton births in sampled communities during 2013-2015 in Oakland and San Jose, California. Using logistic regression and marginal standardization, we estimated the effects of exposure to black carbon, nitrogen dioxide and ultrafine particles on preterm birth after confounder adjustment and stratification by race/ethnicity. RESULTS There were 8823 singleton births, of which 760 (8.6%) were preterm. Shifting black-carbon exposure from the 10th to the 90th percentile was associated with: 6.8%age point higher risk of preterm birth (95% confidence interval = 0.1 to 13.5) among Black women; 2.1%age point higher risk (95% confidence interval = -1.1 to 5.2) among Latinas; and inconclusive null findings among Asian and White women. For Latinas, there was evidence of a positive association between the other pollutants and risk of preterm birth, although effect sizes were attenuated in models that co-adjusted for other TRAP. CONCLUSIONS Exposure to TRAP, especially black carbon, may increase the risk of preterm birth for Latina and Black women but not for Asian and White women.
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Affiliation(s)
- Corinne A Riddell
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, USA
| | - Dana E Goin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Program on Reproductive Health and the Environment, School of Medicine, University of California, San Francisco, San Francisco, USA
| | - Rachel Morello-Frosch
- Department of Environmental Science, College of Natural Resources, Policy, & Management, University of California, Berkeley, Berkeley, USA
- Division of Community Health Sciences & Environmental Health Sciences Graduate Group, School of Public Health, University of California, Berkeley, Berkeley, USA
| | - Joshua S Apte
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, USA
- Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, USA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Jacqueline M Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Joan A Casey
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, NY, USA
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12
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Abstract
In recent years, life expectancy in the United States has stagnated, followed by three consecutive years of decline. The decline is small in absolute terms but is unprecedented and has generated considerable research interest and theorizing about potential causes. Recent trends show that the decline has affected nearly all race/ethnic and gender groups, and the proximate causes of the decline are increases in opioid overdose deaths, suicide, homicide, and Alzheimer's disease. A slowdown in the long-term decline in mortality from cardiovascular diseases has also prevented life expectancy from improving further. Although a popular explanation for the decline is the cumulative decline in living standards across generations, recent trends suggest that distinct mechanisms for specific causes of death are more plausible explanations. Interventions to stem the increase in overdose deaths, reduce access to mechanisms that contribute to violent deaths, and decrease cardiovascular risk over the life course are urgently needed to improve mortality in the United States.
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Affiliation(s)
- Sam Harper
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec H3A 1A2, Canada; , .,Institute for Health and Social Policy, McGill University, Montreal, Quebec H3A 1A2, Canada.,Department of Public Health, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Corinne A Riddell
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California 94720, USA;
| | - Nicholas B King
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec H3A 1A2, Canada; , .,Institute for Health and Social Policy, McGill University, Montreal, Quebec H3A 1A2, Canada.,Biomedical Ethics Unit, McGill University, Montreal, Quebec H3A 1X1, Canada
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13
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Abstract
BACKGROUND Fetal growth restriction is commonly defined using small for gestational age (SGA) birth (birthweight < 10th percentile) as a proxy, but this approach is problematic because most SGA infants are small but healthy. In this proof-of-concept study, we sought to develop a new approach for identifying fetal growth restriction at birth that combines information on multiple, imperfect measures of fetal growth restriction in a probabilistic manner. METHODS We combined information on birthweight, placental weight, placental malperfusion lesions, maternal disease, and fetal acidemia using latent profile analysis to classify fetal growth in births at the Royal Victoria Hospital in Montreal, Canada, 2001-2009. We examined the clinical characteristics and health outcomes of infants classified as growth-restricted and nongrowth-restricted by our model, and among the subgroup of growth-restricted infants who had a birthweight ≥10th percentile (i.e., would have been missed by the conventional SGA proxy). RESULTS Among 26,077 births, 345 (1.3%) were classified as growth-restricted by our latent profile model. Growth-restricted infants were more likely than nongrowth-restricted infants to have an Apgar score <7 (10% vs. 2%), have hypoglycemia at birth (17% vs. 3%), require neonatal intensive care unit admission (59% vs. 6%), die in the perinatal period (3.8% vs. 0.2%), and require an emergency cesarean delivery (42% vs. 15%). Risks remained elevated in growth-restricted infants who were not SGA, suggesting our model identified at-risk infants not detected using the SGA proxy. CONCLUSIONS Latent profile analysis is a promising strategy for classifying growth restriction at birth in fetal growth restriction research.
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Affiliation(s)
- Jennifer A. Hutcheon
- From the Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Corinne A. Riddell
- Division of Biostatistics, School of Public Health, University of California at Berkeley, Berkeley, CA
- Division of Epidemiology, School of Public Health, University of California at Berkeley, Berkeley, CA
| | - Katherine P. Himes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA
- Magee-Womens Research Institute, Pittsburgh, PA
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14
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Driscoll AJ, Ortiz JR, Hartert TV, Riddell CA. Recalibrating public health expectations of respiratory syncytial virus lower respiratory tract illness prevention on chronic respiratory disease. Vaccine 2021; 39:5257-5258. [PMID: 34366146 PMCID: PMC9927872 DOI: 10.1016/j.vaccine.2021.07.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Amanda J Driscoll
- University of Maryland School of Medicine, 685 W. Baltimore St, Baltimore, MD 21201, USA
| | - Justin R Ortiz
- University of Maryland School of Medicine, 685 W. Baltimore St, Baltimore, MD 21201, USA.
| | - Tina V Hartert
- Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN 37232, USA
| | - Corinne A Riddell
- University of California, Berkeley, 2121 Berkeley Way West, Berkeley, CA 94720, USA
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15
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Eisen EA, Chen KT, Elser H, Picciotto S, Riddell CA, Combs MA, Dufault SM, Goldman-Mellor S, Cohen J. Suicide, overdose and worker exit in a cohort of Michigan autoworkers. J Epidemiol Community Health 2020; 74:907-912. [PMID: 32641405 PMCID: PMC7576581 DOI: 10.1136/jech-2020-214117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/01/2020] [Accepted: 06/20/2020] [Indexed: 12/05/2022]
Abstract
BACKGROUND In recent decades, suicide and fatal overdose rates have increased in the US, particularly for working-age adults with no college education. The coincident decline in manufacturing has limited stable employment options for this population. Erosion of the Michigan automobile industry provides a striking case study. METHODS We used individual-level data from a retrospective cohort study of 26 804 autoworkers in the United Autoworkers-General Motors cohort, using employment records from 1970 to 1994 and mortality follow-up from 1970 to 2015. We estimated HRs for suicide or fatal overdose in relation to leaving work, measured as active or inactive employment status and age at worker exit. RESULTS There were 257 deaths due to either suicide (n=202) or overdose (n=55); all but 21 events occurred after leaving work. The hazard rate for suicide was 16.1 times higher for inactive versus active workers (95% CI 9.8 to 26.5). HRs for suicide were elevated for all younger age groups relative to those leaving work after age 55. Those 30-39 years old at exit had the highest HR for suicide, 1.9 (95% CI 1.2 to 3.0). When overdose was included, the rate increased by twofold for both 19- to 29-year-olds and 30- to 39-year-olds at exit. Risks remained elevated when follow-up was restricted to 5 years after exit. CONCLUSIONS Autoworkers who left work had a higher risk of suicide or overdose than active employees. Those who left before retirement age had higher rates than those who left after, suggesting that leaving work early may increase the risk.
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Affiliation(s)
- Ellen A Eisen
- School of Public Health, Division of Environmental Health Sciences, University of California Berkeley, Berkeley, California, USA
| | - Kevin T Chen
- School of Public Health, Division of Environmental Health Sciences, University of California Berkeley, Berkeley, California, USA
| | - Holly Elser
- School of Medicine, Stanford University, Stanford, California, USA
| | - Sally Picciotto
- School of Public Health, Division of Environmental Health Sciences, University of California Berkeley, Berkeley, California, USA
| | - Corinne A Riddell
- School of Public Health, Division of Epidemiology and Biostatistics, University of California Berkeley, Berkeley, California, USA
| | - Mary A Combs
- School of Public Health, Division of Epidemiology and Biostatistics, University of California Berkeley, Berkeley, California, USA
| | - Suzanne M Dufault
- School of Public Health, Division of Epidemiology and Biostatistics, University of California Berkeley, Berkeley, California, USA
| | - Sidra Goldman-Mellor
- School of Social Sciences, Humanities, and Arts, Department of Public Health, University of California Merced, Merced, California, USA
| | - Joshua Cohen
- Apple University, Apple Inc, Cupertino, California, USA
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16
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Riddell CA, Kaufman JS, Torres JM, Harper S. Using change in a seat belt law to study racially-biased policing in South Carolina. Prev Med 2020; 130:105884. [PMID: 31705937 DOI: 10.1016/j.ypmed.2019.105884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/28/2019] [Accepted: 11/05/2019] [Indexed: 11/29/2022]
Abstract
Seat belt laws have increased seat belt use in the US and contributed to reduced fatalities and injuries. However, these policies provide the potential for increased discrimination. The objective of this study is to determine whether a change in seat belt use enforcement led to a differential change in the number of stops, arrests, and searches to White, Black and Hispanic drivers in one US state. We used data on 1,091,424 traffic stops conducted by state troopers in South Carolina in 2005 and 2006 to examine how the change from secondary to primary enforcement of seat belt use in December 2005 affected the number of stops, arrests, and searches to White, Black, and Hispanic drivers using quasi-Poisson and logistic regressions. We found that the policy led to a 50% increase in the number of non-speeding stops for White drivers, and that this increase was 5% larger among Black drivers [RR (95% CI) = 1.05 (1.00, 1.10)], but not larger among Hispanic drivers [1.00 (0.93, 1.08)]. The policy decreased arrests and searches among non-speeding stops, with larger decreases for Black vs. White drivers [RR searches = 0.86 (0.81, 0.91) and RR arrests = 0.90 (0.85, 0.96)]. For Hispanic drivers, effects of the policy change were also found among stops for speeding, which failed the falsification test and suggested that other changes likely affected this group. These findings may support the hypothesis of differential enforcement of seat belt policy in South Carolina for Black and White drivers.
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Affiliation(s)
- Corinne A Riddell
- Division of Epidemiology & Biostatistics, School of Public Health, UC Berkeley, 2121 Berkeley Way West, Berkeley, CA 94704, United States.
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, 1020 Pine Avenue West, Room 27, Montreal, QC H3A 1A2, Canada
| | - Jacqueline M Torres
- Department of Epidemiology & Biostatistics, UC San Francisco, 550 16th Street, San Francisco, CA 94143, USA
| | - Sam Harper
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, 1020 Pine Avenue West, Room 27, Montreal, QC H3A 1A2, Canada
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17
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Abstract
OBJECTIVES Racial differences in mortality in the United States have narrowed and vary by time and place. The objectives of our study were to (1) examine the gap in life expectancy between white and black persons (hereinafter, racial gap in life expectancy) in 4 states (California, Georgia, Illinois, and New York) and (2) estimate trends in the contribution of major causes of death (CODs) to the racial gap in life expectancy by age group. METHODS We extracted data on the number of deaths and population sizes for 1969-2013 by state, sex, race, age group, and 6 major CODs. We used a Bayesian time-series model to smooth and impute mortality rates and decomposition methods to estimate trends in sex- and age-specific contributions of CODs to the racial gap in life expectancy. RESULTS The racial gap in life expectancy at birth decreased in all 4 states, especially among men in New York (from 8.8 to 1.1 years) and women in Georgia (from 8.0 to 1.7 years). Although few deaths occurred among persons aged 1-39, racial differences in mortality at these ages (mostly from injuries and infant mortality) contributed to the racial gap in life expectancy, especially among men in California (1.0 year of the 4.3-year difference in 2013) and Illinois (1.9 years of the 6.7-year difference in 2013). Cardiovascular deaths contributed most to the racial gap in life expectancy for adults aged 40-64, but contributions decreased among women aged 40-64, especially in Georgia (from 2.8 to 0.5 years). The contribution of cancer deaths to inequality increased in California and Illinois, whereas New York had the greatest reductions in inequality attributable to cancer deaths (from 0.6 to 0.2 years among men and from 0.2 to 0 years among women). CONCLUSIONS Future research should identify policy innovations and economic changes at the state level to better understand New York's success, which may help other states emulate its performance.
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Affiliation(s)
- Jay S. Kaufman
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill
University, Montreal, Quebec, Canada
| | - Corinne A. Riddell
- Division of Epidemiology and Biostatistics, School of Public Health,
University of California, Berkeley, Berkeley, CA, USA
| | - Sam Harper
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill
University, Montreal, Quebec, Canada
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18
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Affiliation(s)
- Maya B Mathur
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA Quantitative Sciences Unit, Stanford University, Palo Alto, CA, Department of Statistics, University of California at Berkeley, Berkeley, CA Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Quebec, CA Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
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19
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Riddell CA, Bhat N, Bont LJ, Dupont WD, Feikin DR, Fell DB, Gebretsadik T, Hartert TV, Hutcheon JA, Karron RA, Nair H, Reiner RC, Shi T, Sly PD, Stein RT, Wu P, Zar HJ, Ortiz JR. Informing randomized clinical trials of respiratory syncytial virus vaccination during pregnancy to prevent recurrent childhood wheezing: A sample size analysis. Vaccine 2018; 36:8100-8109. [PMID: 30473186 PMCID: PMC6288067 DOI: 10.1016/j.vaccine.2018.10.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Early RSV illness is associated with wheeze-associated disorders in childhood. Candidate respiratory syncytial virus (RSV) vaccines may prevent acute RSV illness in infants. We investigated the feasibility of maternal RSV vaccine trials to demonstrate reductions in recurrent childhood wheezing in general paediatric populations. METHODS We calculated vaccine trial effect sizes that depended on vaccine efficacy, allocation ratio, rate of early severe RSV illness, risk of recurrent wheezing at age 3, and increased risk of RSV infection on recurrent wheezing. Model inputs came from systematic reviews and meta-analyses. For each combination of inputs, we estimated the sample size required to detect the effect of vaccination on recurrent wheezing. RESULTS There were 81 scenarios with 1:1 allocation ratio. Risk ratios between vaccination and recurrent wheezing ranged from 0.9 to 1.0 for 70% of the scenarios. Among the 57 more plausible scenarios, the lowest sample size required to detect significant reductions in recurrent wheezing was 6196 mother-infant pairs per trial arm; however, 75% and 47% of plausible scenarios required >31,060 and >100,000 mother-infant pairs per trial arm, respectively. Studies with asthma endpoints at age 5 will likely need to be larger. DISCUSSION Clinical efficacy trials of candidate maternal RSV vaccines undertaken for licensure are unlikely to demonstrate an effect on recurrent wheezing illness due to the large sample sizes likely needed to demonstrate a significant effect. Further efforts are needed to plan for alternative study designs to estimate the impact of maternal RSV vaccine programs on recurrent childhood wheezing in general populations.
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Affiliation(s)
- Corinne A Riddell
- Division of Epidemiology & Biostatistics, University of California, Berkeley, 2121 Berkeley Way, Suite 5404, Berkeley, CA, USA
| | - Niranjan Bhat
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Seattle, WA, USA
| | - Louis J Bont
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, Utrecht, the Netherlands; The ReSViNET Foundation, Zeist, the Netherlands
| | - William D Dupont
- Department of Biostatistics, Vanderbilt University School of Medicine, Suite 1100, Room 11119, 2525 West End Ave., Nashville, TN 37203-1741, USA
| | - Daniel R Feikin
- Initiative for Vaccine Research, World Health Organization, 20 Avenue Appia, Geneva, Switzerland
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, CPCR, Room L-1154, Ottawa, Ontario K1H 8L1, Canada
| | - Tebeb Gebretsadik
- Center for Asthma Research, Vanderbilt University School of Medicine, Department of Biostatistics, 2525 West End Ave, Suite 11000, Nashville, TN 37203, USA
| | - Tina V Hartert
- Center for Asthma Research, Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 450, Nashville, TN 37203, USA
| | - Jennifer A Hutcheon
- Department of Obstetrics & Gynaecology, University of British Columbia, Shaughnessy C408A, British Columbia Children's & Women's Hospital, 4500 Oak Street, Vancouver, British Columbia V6H 3N1, Canada
| | - Ruth A Karron
- Center for Immunization Research, Johns Hopkins University, 624 N. Broadway, Suite 217, Baltimore, MD, 21205, USA
| | - Harish Nair
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, Scotland, United Kingdom
| | - Robert C Reiner
- Department of Global Health, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA 98102, USA
| | - Ting Shi
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, Scotland, United Kingdom
| | - Peter D Sly
- Child Health Research Centre, University of Queensland, 62 Graham St., South Brisbane, QLD 4101, Australia
| | - Renato T Stein
- Pediatric Pulmonary Unit, Pontificia Univeridade Católica RS, Av. Ipiranga, 6690/420 Porto Alegre, Brazil
| | - Pingsheng Wu
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Suite 1130, Nashville, TN, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; SA-Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, 5th Floor ICH Building, Klipfontein Road, Cape Town, South Africa
| | - Justin R Ortiz
- Center for Vaccine Development, University of Maryland School of Medicine, 685 W. Baltimore St, Suite 480, Baltimore, MD, USA.
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20
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Riddell CA, Morrison KT, Kaufman JS, Harper S. Trends in the contribution of major causes of death to the black-white life expectancy gap by US state. Health Place 2018; 52:85-100. [PMID: 29864731 DOI: 10.1016/j.healthplace.2018.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 04/11/2018] [Accepted: 04/23/2018] [Indexed: 11/15/2022]
Abstract
Life expectancy has increased in the United States over many decades. The difference in life expectancy between black and white Americans has also decreased, but some states have made much more progress towards racial equality than others. This paper describes the pattern of contributions of six major causes of death to the black-white life expectancy gap within US states and the District of Columbia between 1969 and 2013, and identifies states diverging from the overall pattern. Across multiple causes, the District of Columbia, Illinois, Wisconsin, and Michigan had the highest contributions to black-white inequality, while New York, Massachusetts, and Rhode Island had the lowest contributions and have either achieved or are the closest to achieving black-white equality in life expectancy.
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Affiliation(s)
- Corinne A Riddell
- Department of Epidemiology, Biostatistics&Occupational Health, McGill University, 1020 Pine Avenue West, Room 27, Montreal, QC, Canada H3A 1A2.
| | - Kathryn T Morrison
- Department of Epidemiology, Biostatistics&Occupational Health, McGill University, 1020 Pine Avenue West, Room 27, Montreal, QC, Canada H3A 1A2
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics&Occupational Health, McGill University, 1020 Pine Avenue West, Room 27, Montreal, QC, Canada H3A 1A2
| | - Sam Harper
- Department of Epidemiology, Biostatistics&Occupational Health, McGill University, 1020 Pine Avenue West, Room 27, Montreal, QC, Canada H3A 1A2
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21
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Riddell CA, Harper S, Cerdá M, Kaufman JS. Comparison of Rates of Firearm and Nonfirearm Homicide and Suicide in Black and White Non-Hispanic Men, by U.S. State. Ann Intern Med 2018; 168:712-720. [PMID: 29710093 DOI: 10.7326/m17-2976] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The extent to which differences in homicide and suicide rates in black versus white men vary by U.S. state is unknown. OBJECTIVE To compare the rates of firearm and nonfirearm homicide and suicide in black and white non-Hispanic men by U.S. state and to examine whether these deaths are associated with state prevalence of gun ownership. DESIGN Surveillance study. SETTING 50 states and the District of Columbia, 2008 to 2016. Cause-of-death data were abstracted by using the Centers for Disease Control and Prevention's WONDER (Wide-ranging Online Data for Epidemiologic Research) database. PARTICIPANTS Non-Hispanic black and non-Hispanic white males, all ages. MEASUREMENTS Absolute rates of and rate differences in firearm and nonfirearm homicide and suicide in black and white men. RESULTS During the 9-year study period, 84 113 homicides and 251 772 suicides occurred. Black-white differences in rates of firearm homicide and suicide varied widely across states. Relative to white men, black men had between 9 and 57 additional firearm homicides per 100 000 per year, with black men in Missouri, Michigan, Illinois, Indiana, and Pennsylvania having more than 40 additional firearm homicides per 100 000 per year. White men had between 2 fewer and 16 more firearm suicides per 100 000 per year, with the largest inequalities observed in southern and western states and the smallest in the District of Columbia and densely populated northeastern states. LIMITATIONS Some homicides and suicides may have been misclassified as deaths due to unintentional injury. Survey data on state household gun ownership were collected in 2004 and may have shifted during the past decade. CONCLUSION The large state-to-state variation in firearm homicide and suicide rates, as well as the racial inequalities in these numbers, highlights states where policies may be most beneficial in reducing homicide and suicide deaths and the racial disparities in their rates. PRIMARY FUNDING SOURCE McGill University and the National Institutes of Health.
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Affiliation(s)
| | - Sam Harper
- McGill University, Montreal, Quebec, Canada (C.A.R., S.H., J.S.K.)
| | | | - Jay S Kaufman
- McGill University, Montreal, Quebec, Canada (C.A.R., S.H., J.S.K.)
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22
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Affiliation(s)
- Corinne A. Riddell
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Sam Harper
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jay S. Kaufman
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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Abstract
BACKGROUND Gestational weight gain is often characterized by the total amount of weight gained during pregnancy, however, the pattern of gain may be an important determinant of health outcomes. The SITAR (Super Imposition by Translation And Rotation) model has been used to describe childhood growth trajectories and has appeal because of the biological interpretability of its parameters. The objective of this study was to determine the feasibility of applying this model to gestational weight gain trajectories. METHODS The study cohort included 3470 normal-weight, overweight, and obese women delivering at Magee-Womens Hospital in Pittsburgh, Pennsylvania, 1998 to 2010. We applied the SITAR model, a non-linear mixed effects model, to serial prenatal weight gain measurements in each pre-pregnancy body mass index (BMI) category. We fit models of varying complexity, and chose the best-fitting model to describe the pattern of weight gain (by its absolute amount, timing, and acceleration) for each BMI group. RESULTS The most complex SITAR models failed to converge, but reduced models could successfully be fit by specifying fewer random effects and simplifying the modelling of gestational age. Best-fitting models for each BMI group explained between 95% and 97% of the variation in weight gain trajectories. Peak rates of weight gain were reached between the 20th and 22nd weeks, and were higher for normal and overweight women (0.59 kg/week and 0.57 kg/week, respectively) than obese women (0.46 kg/week). CONCLUSIONS Following some modifications, the SITAR model can be used to characterize pregnancy weight gain patterns.
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Affiliation(s)
- Corinne A Riddell
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada,Corresponding author. Dr. Corinne Riddell Purvis Hall, Room 27, 1020 Pine Avenue West Montreal, Quebec, Canada H3A 1A2. . Tel: 438-863-9219. Fax: 514-398-4503
| | - Robert W Platt
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Lisa M Bodnar
- Departments of Epidemiology and of Obstetrics, Gynecology, and Reproductive Sciences, Graduate School of Public Health and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
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24
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Hutcheon JA, Riddell CA, Strumpf EC, Lee L, Harper S. Safety of labour and delivery following closures of obstetric services in small community hospitals. CMAJ 2016; 189:E431-E436. [PMID: 27821464 DOI: 10.1503/cmaj.160461] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 07/12/2016] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In recent decades, many smaller hospitals in British Columbia, Canada, have stopped providing planned obstetric services. We examined the effect of these service closures on the labour and delivery outcomes of pregnant women living in affected communities. METHODS We used maternal postal codes to identify delivery records (1998-2014) of women residing in a community affected by service closure. The records were obtained from the British Columbia Perinatal Data Registry. We examined the effect of the closures using a within-communities fixed-effects framework and included similar-sized communities without service closures to control for underlying time trends. The primary outcome was a previously published composite measure of labour and delivery safety, the Adverse Outcome Index, which includes adverse events such as birth injury and unanticipated operative procedures, and includes weights for severity of adverse events. Secondary outcomes included maternal or newborn transfer, and use of obstetric interventions. RESULTS We found little evidence that closure of planned obstetric services affected the risk of composite adverse maternal-newborn outcome (-0.4 excess adverse events per 100 deliveries, 95% confidence interval [CI] -2.0 to 1.1), or most other secondary outcomes. The severity of composite outcome events decreased following the closures (rate ratio 0.58, 95% CI 0.36 to 0.89). Closures were associated with increases in use of epidural analgesia (3.4 excess events per 100 deliveries, 95% CI 0.4 to 6.3) and length of antepartum stay (0.6 h, 95% CI 0.1 to 1.0 h). INTERPRETATION Closure of planned obstetric services in low-volume hospitals was not associated with an increase or decrease in frequency of adverse events during labour and delivery.
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Affiliation(s)
- Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology (Hutcheon), University of British Columbia; Perinatal Services BC (Hutcheon, Lee), Vancouver, BC; Department of Epidemiology, Biostatistics and Occupational Health (Riddell, Strumpf, Harper) and Department of Economics (Strumpf), McGill University, Montréal, Que.
| | - Corinne A Riddell
- Department of Obstetrics and Gynaecology (Hutcheon), University of British Columbia; Perinatal Services BC (Hutcheon, Lee), Vancouver, BC; Department of Epidemiology, Biostatistics and Occupational Health (Riddell, Strumpf, Harper) and Department of Economics (Strumpf), McGill University, Montréal, Que
| | - Erin C Strumpf
- Department of Obstetrics and Gynaecology (Hutcheon), University of British Columbia; Perinatal Services BC (Hutcheon, Lee), Vancouver, BC; Department of Epidemiology, Biostatistics and Occupational Health (Riddell, Strumpf, Harper) and Department of Economics (Strumpf), McGill University, Montréal, Que
| | - Lily Lee
- Department of Obstetrics and Gynaecology (Hutcheon), University of British Columbia; Perinatal Services BC (Hutcheon, Lee), Vancouver, BC; Department of Epidemiology, Biostatistics and Occupational Health (Riddell, Strumpf, Harper) and Department of Economics (Strumpf), McGill University, Montréal, Que
| | - Sam Harper
- Department of Obstetrics and Gynaecology (Hutcheon), University of British Columbia; Perinatal Services BC (Hutcheon, Lee), Vancouver, BC; Department of Epidemiology, Biostatistics and Occupational Health (Riddell, Strumpf, Harper) and Department of Economics (Strumpf), McGill University, Montréal, Que
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Riddell CA, Kaufman JS, Strumpf EC, Abenhaim HA, Hutcheon JA. Cervical dilation at time of caesarean delivery in nulliparous women: a population-based cohort study. BJOG 2016; 124:1753-1761. [DOI: 10.1111/1471-0528.14275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- CA Riddell
- Department of Epidemiology, Biostatistics, and Occupational Health; McGill University; Montreal QC Canada
| | - JS Kaufman
- Department of Epidemiology, Biostatistics, and Occupational Health; McGill University; Montreal QC Canada
| | - EC Strumpf
- Department of Epidemiology, Biostatistics, and Occupational Health; McGill University; Montreal QC Canada
- Department of Economics; McGill University; Montreal QC Canada
| | - HA Abenhaim
- Department of Obstetrics and Gynecology; Jewish General Hospital; McGill University; Montreal QC Canada
- Centre for Clinical Epidemiology and Community Studies; Jewish General Hospital; Montreal QC Canada
| | - JA Hutcheon
- Department of Obstetrics and Gynaecology; University of British Columbia; Vancouver BC Canada
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Riddell CA, Hutcheon JA, Dahlgren LS. Differences in obstetric care among nulliparous First Nations and non-First Nations women in British Columbia, Canada. CMAJ 2015; 188:E36-E43. [PMID: 26527824 DOI: 10.1503/cmaj.150223] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Canada's Aboriginal population faces significantly higher rates of stillbirth and neonatal and postnatal death than those seen in the general population. The objective of this study was to compare indicators of obstetric care quality and use of obstetric interventions between First Nations and non-First Nations mothers in British Columbia, Canada. METHODS We linked obstetrical medical records with the First Nations Client File for all nulliparous women who delivered single infants in British Columbia from 1999 to 2011. Using logistic regression models, we examined differences in the proportion of women who received services aligned with best practice guidelines, as well as the overall use of obstetric interventions among First Nations mothers compared with the general population, controlling for geographic barriers (distance to hospital) and other relevant confounders. RESULTS During the study period, 215,993 single births occurred in nulliparous women in British Columbia, 9152 of which were to members of our First Nations cohort. First Nations mothers were less likely to have early ultrasonography (adjusted risk difference = 10.2 fewer women per 100 deliveries [95% confidence interval {CI} -11.3 to -9.3]), to have at least 4 antenatal care visits (3.6 fewer women per 100 deliveries [95% CI -4.6 to -2.6]), and to undergo labour induction after prolonged (> 24 hours) prelabour rupture of membranes (-5.9 [95% CI -11.8 to 0.1]) or at post-dates gestation (-10.6 [95% CI -13.8 to -7.5]). Obstetric interventions including epidural, labour induction, instrumental delivery and cesarean delivery were used less often in First Nations mothers. INTERPRETATION We identified differences in the obstetric care received by First Nations mothers compared with the general population. Such differences warrant further investigation, given increases in perinatal mortality that are consistently shown and that may be a downstream consequence of differences in care.
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Affiliation(s)
- Corinne A Riddell
- Department of Epidemiology, Biostatistics, and Occupational Health (Riddell), McGill University, Montréal, Qué.; Department of Obstetrics and Gynecology (Hutcheon, Dahlgren), University of British Columbia, Vancouver, BC
| | - Jennifer A Hutcheon
- Department of Epidemiology, Biostatistics, and Occupational Health (Riddell), McGill University, Montréal, Qué.; Department of Obstetrics and Gynecology (Hutcheon, Dahlgren), University of British Columbia, Vancouver, BC
| | - Leanne S Dahlgren
- Department of Epidemiology, Biostatistics, and Occupational Health (Riddell), McGill University, Montréal, Qué.; Department of Obstetrics and Gynecology (Hutcheon, Dahlgren), University of British Columbia, Vancouver, BC
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Abstract
BACKGROUND Most methodologists recommend intention-to-treat (ITT) analysis in order to minimize bias. Although ITT analysis provides an unbiased estimate for the effect of treatment assignment on the outcome, the estimate is biased for the actual effect of receiving treatment (active treatment) compared to some comparison group (control). Other common analyses include measuring effects in (1) participants who follow their assigned treatment (Per Protocol), (2) participants according to treatment received (As Treated), and (3) those who would comply with recommended treatment (Complier Average Causal Effect (CACE) as estimated by Principal Stratification or Instrumental Variable Analyses). As each of these analyses compares different study subpopulations, they address different research questions. PURPOSE For each type of analysis, we review and explain (1) the terminology being used, (2) the main underlying concepts, (3) the questions that are answered and whether the method provides valid causal estimates, and (4) the situations when the analysis should be conducted. METHODS We first review the major concepts in relation to four nuances of the clinical question, 'Does treatment improve health?' After reviewing these concepts, we compare the results of the different analyses using data from two published randomized controlled trials (RCTs). Each analysis has particular underlying assumptions and all require dichotomizing adherence into Yes or No. We apply sensitivity analyses so that intermediate adherence is considered (1) as adherence and (2) as non-adherence. RESULTS The ITT approach provides an unbiased estimate for how active treatment will improve (1) health in the population if a policy or program is enacted or (2) health of patients if a clinician changes treatment practice. The CACE approach generally provides an unbiased estimate of the effect of active treatment on health of patients who would follow the clinician's advice to take active treatment. Unfortunately, there is no current analysis for clinicians and patients who want to know whether active treatment will improve the patient's health if taken, which is different from the effect in patients who would follow the clinician's advice to take active treatment. Sensitivity analysis for the CACE using two published data sets suggests that the underlying assumptions appeared to be violated. LIMITATIONS There are several methods within each analytical approach we describe. Our analyses are based on a subset of these approaches. CONCLUSIONS Although adherence-based analyses may provide meaningful information, the analytical method should match the clinical question, and investigators should clearly outline why they believe assumptions hold and should provide empirical tests of the assumptions where possible.
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Affiliation(s)
- Ian Shrier
- aCentre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Riddell CA, Zhao Y, Petkau J. An adaptive clinical trials procedure for a sensitive subgroup examined in the multiple sclerosis context. Stat Methods Med Res 2013; 25:1330-45. [PMID: 23592713 DOI: 10.1177/0962280213480576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The biomarker-adaptive threshold design (BATD) allows researchers to simultaneously study the efficacy of treatment in the overall group and to investigate the relationship between a hypothesized predictive biomarker and the treatment effect on the primary outcome. It was originally developed for survival outcomes for Phase III clinical trials where the biomarker of interest is measured on a continuous scale. In this paper, generalizations of the BATD to accommodate count biomarkers and outcomes are developed and then studied in the multiple sclerosis (MS) context where the number of relapses is a commonly used outcome. Through simulation studies, we find that the BATD has increased power compared with a traditional fixed procedure under varying scenarios for which there exists a sensitive patient subgroup. As an illustration, we apply the procedure for two hypothesized markers, baseline enhancing lesion count and disease duration at baseline, using data from a previously completed trial. MS duration appears to be a predictive marker relationship for this dataset, and the procedure indicates that the treatment effect is strongest for patients who have had MS for less than 7.8 years. The procedure holds promise of enhanced statistical power when the treatment effect is greatest in a sensitive patient subgroup.
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Affiliation(s)
- Corinne A Riddell
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Yinshan Zhao
- MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Petkau
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
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Walter SD, Riddell CA, Rabachini T, Villa LL, Franco EL. Accuracy of p53 codon 72 polymorphism status determined by multiple laboratory methods: a latent class model analysis. PLoS One 2013; 8:e56430. [PMID: 23441193 PMCID: PMC3575334 DOI: 10.1371/journal.pone.0056430] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 01/14/2013] [Indexed: 11/19/2022] Open
Abstract
Introduction Studies on the association of a polymorphism in codon 72 of the p53 tumour suppressor gene (rs1042522) with cervical neoplasia have inconsistent results. While several methods for genotyping p53 exist, they vary in accuracy and are often discrepant. Methods We used latent class models (LCM) to examine the accuracy of six methods for p53 determination, all conducted by the same laboratory. We also examined the association of p53 with cytological cervical abnormalities, recognising potential test inaccuracy. Results Pairwise disagreement between laboratory methods occurred approximately 10% of the time. Given the estimated true p53 status of each woman, we found that each laboratory method is most likely to classify a woman to her correct status. Arg/Arg women had the highest risk of squamous intraepithelial lesions (SIL). Test accuracy was independent of cytology. There was no strong evidence for correlations of test errors. Discussion Empirical analyses ignore possible laboratory errors, and so are inherently biased, but test accuracy estimated by the LCM approach is unbiased when model assumptions are met. LCM analysis avoids ambiguities arising from empirical test discrepancies, obviating the need to regard any of the methods as a “gold” standard measurement. The methods we presented here to analyse the p53 data can be applied in many other situations where multiple tests exist, but where none of them is a gold standard.
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Affiliation(s)
- Stephen D Walter
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
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