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Vandenbroucke JP, Sørensen HT, Rehkopf DH, Gradus JL, Mackenbach JP, Glymour MM, Galea S, Henderson VW. Report on the Joint Workshop on the Relations between Health Inequalities, Ageing and Multimorbidity, Iceland, May 3-4, 2023. Clin Epidemiol 2024; 16:9-22. [PMID: 38259327 PMCID: PMC10801289 DOI: 10.2147/clep.s443152] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024] Open
Abstract
This paper is a summary of key presentations from a workshop in Iceland on May 3-4, 2023 arranged by Aarhus University and with participation of the below-mentioned scientists. Below you will find the key messages from the presentations made by: Professor Jan Vandenbroucke, Department of Clinical Epidemiology, Aarhus University, Emeritus Professor, Leiden University; Honorary Professor, London School of Hygiene & Tropical Medicine, UKProfessor, Chair Henrik Toft Sørensen, Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, DenmarkProfessor David H. Rehkopf, Director, the Stanford Center for Population Health Sciences, Stanford University, CA., USProfessor Jaimie Gradus, Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USProfessor Johan Mackenbach, Emeritus Professor, Department of Public Health, Erasmus University Rotterdam, HollandProfessor, Chair M Maria Glymour, Department of Epidemiology, Boston University School of Public Health, Boston University, Boston, Massachusetts, USProfessor, Dean Sandro Galea, School of Public Health, Boston University, Boston, Massachusetts, USProfessor Victor W. Henderson, Departments of Epidemiology & Population Health and of Neurology & Neurological Sciences, Stanford University, Stanford, CA, US; Department of Clinical Epidemiology, Aarhus University, Aarhus, DK.
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Affiliation(s)
- Jan P Vandenbroucke
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Leiden University, Leiden, Netherlands
- London School of Hygiene & Tropical Medicine, London, UK
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Aarhus University Hospital, Aarhus, Denmark
| | - David H Rehkopf
- Stanford Center for Population Health Sciences, Stanford University, CA, USA
| | - Jaimie L Gradus
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - Johan P Mackenbach
- Department of Public Health, Erasmus University Rotterdam, Rotterdam, Holland
| | - M Maria Glymour
- Department of Epidemiology, Boston University School of Public Health, Boston University, Boston, MA, USA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
| | - Victor W Henderson
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Departments of Epidemiology & Population Health and of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
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Rehkopf DH, Wojcicki JM, Haydel KF, Lin J, Smith DL, Kapphahn KI, Robinson TN. Changes in leukocyte telomere length among children with obesity participating in a behavioural weight control program. Pediatr Obes 2023; 18:e13082. [PMID: 37873898 PMCID: PMC10843039 DOI: 10.1111/ijpo.13082] [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: 02/23/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE To examine changes in leukocyte telomere length (LTL) during and after a behavioural weight control program for children with obesity. METHODS We measured LTL among a cohort of 158 children 8-12 years of age with a body mass index greater than or equal to the 95th percentile for age and sex. Children were 55% female, 29% white, 52% Latinx, 8% Asian and 11% Pacific Islander, other or multiethnic. All children participated in a 6-month, family-based, group behavioural weight control program and were assessed before treatment, after treatment and 1 year after the end of treatment. To test the sample population slope of LTL over the intervention and maintenance time periods, we fit spline mixed-effect regression models. RESULTS LTL increased an average of 0.09 T/S units per year (95% confidence interval [CI] 0.04 to 0.13; p = 0.0001) during the weight control program intervention period, followed by an average decline of -0.05 T/S units per year (95% CI -0.08 to -0.03; p < 0.0001) during the 1 year of follow-up after the completion of the intervention. Among 26 social, psychological, behavioural and physiological factors we examined, we did not find any predictors of these changes. CONCLUSIONS LTL increased in response to a behavioural weight control program among children with obesity, suggesting an impact on biological health and cellular aging from participation in a behavioural weight control intervention. LTL may be a useful biomarker for assessing changes in response to behavioural interventions.
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Affiliation(s)
- David H Rehkopf
- Departments of Epidemiology and Population Health, Medicine, Pediatrics and Sociology, Stanford University
| | - Janet M. Wojcicki
- Departments of Pediatrics and Epidemiology and Biostatistics, University of California San Francisco
| | | | - Jue Lin
- Department of Biochemistry and Biophysics, University of California San Francisco
| | - Dana L. Smith
- Department of Biochemistry and Biophysics, University of California San Francisco
| | | | - Thomas N. Robinson
- Departments of Pediatrics and Medicine and by courtesy Epidemiology and Population Health, Stanford University
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Liang R, Kiang MV, Grant P, Jackson C, Rehkopf DH. Associations between county-level public health expenditures and community health planning activities with COVID-19 incidence and mortality. Prev Med Rep 2023; 36:102410. [PMID: 37732021 PMCID: PMC10507150 DOI: 10.1016/j.pmedr.2023.102410] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 09/22/2023] Open
Abstract
The COVID-19 pandemic has revealed consequences of past defunding of the U.S. public health system, but the extent to which public health infrastructure is associated with COVID-19 burden is unknown. We aimed to determine whether previous county-level public health expenditures and community health planning activities are associated with COVID-19 cases and deaths. We examined 3050 of 3143 U.S. counties and county equivalents from March 1, 2020 to February 28, 2022. Multivariable-adjusted linear regression and generalized additive models were used to estimate associations between county-level public health expenditures and completion of community health planning activities by a county health department with outcomes of county-level COVID-19 cases and deaths per 100,000 population. After adjusting for county-level covariates, counties in the highest tertile of public health expenditures per capita had on average 542 fewer COVID-19 cases per 100,000 population (95% CI, -1004 to -81) and 21 fewer deaths per 100,000 population (95% CI, -32 to -10) than counties in the lowest tertile. For analyses of community health planning activities, adjusted estimates of association remained negative for COVID-19 deaths, but confidence intervals included negative and positive values. In conclusion, higher levels of local public health expenditures and community health planning activities were associated with fewer county-level COVID-19 deaths, and to a lesser extent, cases. Future public health funding should be aligned with evidence for the value of county health departments programs and explore further which types of spending are most cost effective.
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Affiliation(s)
- Richard Liang
- Stanford University School of Medicine, Department of Epidemiology and Population Health, Alway Building, 300 Pasteur Drive, Stanford, CA 94305, United States
| | - Mathew V. Kiang
- Stanford University School of Medicine, Department of Epidemiology and Population Health, Alway Building, 300 Pasteur Drive, Stanford, CA 94305, United States
| | - Philip Grant
- Stanford University School of Medicine, Department of Medicine – Infectious Diseases, 300 Pasteur Drive, Lane Building 134, Stanford, CA 94305, United States
| | - Christian Jackson
- Stanford University School of Medicine, Department of Epidemiology and Population Health, Alway Building, 300 Pasteur Drive, Stanford, CA 94305, United States
| | - David H. Rehkopf
- Stanford University School of Medicine, Department of Epidemiology and Population Health, Alway Building, 300 Pasteur Drive, Stanford, CA 94305, United States
- Stanford University School of Medicine, Division of Primary Care and Population Health, 1265 Welch Road, Stanford, CA 94305, United States
- Stanford University, Department of Sociology, 450 Jane Stanford Way, Building 120, Room 160, Stanford, CA 94305, United States
- Stanford University, Center for Population Health Sciences, 1701 Page Mill Road, Palo Alto, CA 94304, United States
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Hao S, Rehkopf DH, Velasquez E, Vala A, Bazemore AW, Phillips RL. COVID-19 Vaccine Strategy Left Small Primary Care Practices On The Sidelines. Health Aff (Millwood) 2023; 42:1147-1151. [PMID: 37549323 DOI: 10.1377/hlthaff.2023.00114] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
We report on the experience of small primary care practices participating in a national clinical registry with COVID-19 vaccines and vaccination data. At the end of 2021, 11.2 percent of these practices' 3.9 million patients had records of COVID-19 vaccination; 43.1 percent of clinics had no record of patients' COVID-19 vaccinations, but 93.4 percent of clinics had provided or recorded other routine vaccinations.
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Affiliation(s)
- Shiying Hao
- Shiying Hao, Stanford University, Stanford, California
| | | | | | | | - Andrew W Bazemore
- Andrew W. Bazemore, American Board of Family Medicine, Lexington, Kentucky
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Kim K, Yaffe K, Rehkopf DH, Zheng Y, Nannini DR, Perak AM, Nagata JM, Miller GE, Zhang K, Lloyd-Jones DM, Joyce BT, Hou L. Association of Adverse Childhood Experiences With Accelerated Epigenetic Aging in Midlife. JAMA Netw Open 2023; 6:e2317987. [PMID: 37306997 PMCID: PMC10261996 DOI: 10.1001/jamanetworkopen.2023.17987] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 12/14/2022] [Accepted: 04/05/2023] [Indexed: 06/13/2023] Open
Abstract
Importance Adverse childhood experiences (ACEs) are associated with the risk of poorer health, and identifying molecular mechanisms may lay the foundation for health promotion in people with ACEs. Objective To investigate the associations of ACEs with changes in epigenetic age acceleration (EAA), a biomarker associated with various health outcomes in middle-aged adults, in a population with balanced race and sex demographics. Design, Setting, and Participants Data for this cohort study were from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants in CARDIA underwent 8 follow-up exams from baseline (year 0 [Y0]; 1985-1986) to Y30 (2015-2016), and participant blood DNA methylation information was obtained at Y15 (2000-2001) and Y20 (2005-2006). Individuals from Y15 and Y20 with available DNA methylation data and complete variables for ACEs and covariates were included. Data were analyzed from September 2021 to August 2022. Exposures Participant ACEs (general negligence, emotional negligence, physical violence, physical negligence, household substance abuse, verbal and emotional abuse, and household dysfunction) were obtained at Y15. Main Outcomes and Measures The primary outcome consisted of results from 5 DNA methylation-based EAA measurements known to be associated with biological aging and long-term health: intrinsic EAA (IEAA), extrinsic EAA (EEAA), PhenoAge acceleration (PhenoAA), GrimAge acceleration (GrimAA), and Dunedin Pace of Aging Calculated From the Epigenome (DunedinPACE), measured at Y15 and Y20. Linear regression and generalized estimating equations were used to assess associations of the burden of ACEs (≥4 vs <4 ACEs) with EAA adjusting for demographics, health-related behaviors, and early life and adult socioeconomic status. Results A total of 895 participants for Y15 (mean [SD] age, 40.4 [3.5] years; 450 males [50.3%] and 445 females [49.7%]; 319 Black [35.6%] and 576 White [64.4%]) and 867 participants for Y20 (mean [SD] age, 45.4 [3.5] years; 432 males [49.8%] and 435 females [50.2%]; 306 Black [35.3%] and 561 White [64.7%]) were included after excluding participants with missing data. There were 185 participants with (20.7%) vs 710 participants without (79.3%) 4 or more ACEs at Y15 and 179 participants with (20.6%) vs 688 participants without (79.4%) 4 or more ACEs at Y20. Having 4 or more ACEs was positively associated with EAA in years at Y15 (EEAA: β = 0.60 years; 95% CI, 0.18-1.02 years; PhenoAA: β = 0.62 years; 95% CI = 0.13-1.11 years; GrimAA: β = 0.71 years; 95% CI, 0.42-1.00 years; DunedinPACE: β = 0.01; 95% CI, 0.01-0.02) and Y20 (IEAA: β = 0.41 years; 95% CI, 0.05-0.77 years; EEAA: β = 1.05 years; 95% CI, 0.66-1.44 years; PhenoAA: β = 0.57 years; 95% CI, 0.08-1.05 years; GrimAA: β = 0.57 years; 95% CI, 0.28-0.87 years; DunedinPACE: β = 0.01; 95% CI, 0.01-0.02) after adjusting for demographics, health-related behaviors, and socioeconomic status. Conclusions and Relevance In this cohort study, ACEs were associated with EAA among middle-aged adults after controlling for demographics, behavior, and socioeconomic status. These findings of the associations between early life experience and the biological aging process in midlife may contribute to health promotion in a life course perspective.
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Affiliation(s)
- Kyeezu Kim
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - David H. Rehkopf
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California
| | - Yinan Zheng
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Drew R. Nannini
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amanda M. Perak
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Jason M. Nagata
- Department of Pediatrics, University of California, San Francisco
| | - Greg E. Miller
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer
| | - Donald M. Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Potocsnak Longevity Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brian T. Joyce
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Potocsnak Longevity Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Rehkopf DH, Phillips RL. The Neighborhood Atlas Area Deprivation Index And Recommendations For Area-Based Deprivation Measures. Health Aff (Millwood) 2023; 42:710-711. [PMID: 37126740 DOI: 10.1377/hlthaff.2023.00282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Edward Hannan and colleagues found that a lack of standardization of input variables to the Area Deprivation Index (ADI) available from the Neighborhood Atlas overweights the index for median home value and thus potentially further disadvantages already disadvantaged communities. We recommend that a revised ADI be created that addresses the error, and we offer five steps to avoid future errors in the creation of area deprivation measures.
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Affiliation(s)
| | - Robert L Phillips
- Robert L. Phillips Jr. , American Board of Family Medicine, Washington, D.C
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Dec E, Clement J, Cheng K, Church GM, Fossel MB, Rehkopf DH, Rosero-Bixby L, Kobor MS, Lin DT, Lu AT, Fei Z, Guo W, Chew YC, Yang X, Putra SED, Reiner AP, Correa A, Vilalta A, Pirazzini C, Passarino G, Monti D, Arosio B, Garagnani P, Franceschi C, Horvath S. Centenarian clocks: epigenetic clocks for validating claims of exceptional longevity. GeroScience 2023:10.1007/s11357-023-00731-7. [PMID: 36964402 PMCID: PMC10400760 DOI: 10.1007/s11357-023-00731-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/09/2023] [Indexed: 03/26/2023] Open
Abstract
Claims surrounding exceptional longevity are sometimes disputed or dismissed for lack of credible evidence. Here, we present three DNA methylation-based age estimators (epigenetic clocks) for verifying age claims of centenarians. The three centenarian clocks were developed based on n = 7039 blood and saliva samples from individuals older than 40, including n = 184 samples from centenarians, 122 samples from semi-supercentenarians (aged 105 +), and 25 samples from supercentenarians (aged 110 +). The oldest individual was 115 years old. Our most accurate centenarian clock resulted from applying a neural network model to a training set composed of individuals older than 40. An epigenome-wide association study of age in different age groups revealed that age effects in young individuals (age < 40) are correlated (r = 0.55) with age effects in old individuals (age > 90). We present a chromatin state analysis of age effects in centenarians. The centenarian clocks are expected to be useful for validating claims surrounding exceptional old age.
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Affiliation(s)
- Eric Dec
- Department of Pediatrics, Division of Genetics and Genomic Medicine, University of California, Irvine, USA.
| | - James Clement
- Betterhumans Inc., Gainesville, FL, USA
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Kaiyang Cheng
- Medical Informatics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - George M Church
- Department of Genetics, Harvard Medical School, Boston, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, USA
| | | | - David H Rehkopf
- Epidemiology & Population Health and Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Luis Rosero-Bixby
- Centro Centroamericano de Población, Universidad de Costa Rica, San Pedro, Costa Rica
| | - Michael S Kobor
- Edwin S.H. Leong Healthy Aging Program, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - David Ts Lin
- Edwin S.H. Leong Healthy Aging Program, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Ake T Lu
- Dept. of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Altos Labs, San Diego, CA, USA
| | - Zhe Fei
- Dept. of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Wei Guo
- Zymo Research Corp, Irvine, CA, USA
| | | | | | - Sulistyo E Dwi Putra
- Department of Biology, Faculty of Biotechnology, University of Surabaya, Surabaya, 60293, Indonesia
| | - Alex P Reiner
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Adolfo Correa
- Medicine and Population Health Science, University of Mississippi Medical Center, Jackson, USA
| | | | - Chiara Pirazzini
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Giuseppe Passarino
- Department of Biology Ecology and Earth Science, University of Calabria, Rende, Italy
| | - Daniela Monti
- Department of Experimental and Clinical, Biomedical Sciences "Mario Serio" University of Florence, Florence, Italy
| | - Beatrice Arosio
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Garagnani
- Department of Medical and Surgical Sciences, University of Bologna, 40126, Bologna, Italy
- Alma Mater Research Institute On Global Challenges and Climate Change (Alma Climate), University of Bologna, Bologna, Italy
- Department of Laboratory Medicine, Clinical Chemistry, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- CNR Institute of Molecular Genetics "Luigi Luca Cavalli-Sforza", Unit of Bologna, Bologna, Italy
| | - Claudio Franceschi
- Department of Medical and Surgical Sciences, University of Bologna, 40126, Bologna, Italy
- Institute of Information Technologies, Mathematics and Mechanics, Lobachevsky State University, Nizhny Novgorod, Russia
| | - Steve Horvath
- Dept. of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
- Altos Labs, San Diego, CA, USA.
- Dept. of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.
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Liang R, Panelli DM, Stevenson DK, Rehkopf DH, Shaw GM. Associations between pregnancy glucose measurements and risk of preterm birth: a retrospective cohort study of commercially insured women in the United States from 2003-2021. Ann Epidemiol 2023; 81:31-39.e19. [PMID: 36905977 DOI: 10.1016/j.annepidem.2023.03.002] [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] [Received: 07/22/2022] [Revised: 02/16/2023] [Accepted: 03/05/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE To investigate associations between glucose measurements during pregnancy and risk of preterm birth (PTB). METHODS Retrospective cohort study of commercially insured women with singleton live births in the United States from 2003-2021 using longitudinal medical claims, socioeconomic data, and eight glucose results from different types of fasting and post-load tests performed between 24-28 weeks of gestation for gestational diabetes screening. Risk ratios of PTB (<37 weeks) were estimated via Poisson regression for z-standardized glucose measures. Non-linear relationships for continuous glucose measures were examined via generalized additive models. RESULTS Elevations in all eight glucose measures were associated with increased risk (adjusted risk ratio point estimates: 1.05-1.19) of PTB for 196,377 women with non-fasting 50-gram glucose challenge test (one glucose result), 31,522 women with complete 100-gram, 3-hour fasting oral glucose tolerance test (OGTT) results (four glucose results), and 10,978 women with complete 75-gram, 2-hour fasting OGTT results (three glucose results). Associations were consistent after adjusting for and stratifying by sociodemographic and clinical factors. Substantial non-linear relationships (U-, J-, and S-shaped) were observed between several glucose measurements and PTB. CONCLUSIONS Elevations in various glucose measures were linearly and non-linearly associated with increased risk of PTB, even before diagnostic thresholds for gestational diabetes.
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Affiliation(s)
- Richard Liang
- Stanford University School of Medicine, Department of Epidemiology and Population Health, Alway Building, Stanford, CA.
| | - Danielle M Panelli
- Stanford University School of Medicine, Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Palo Alto, CA
| | - David K Stevenson
- Stanford University School of Medicine, Department of Pediatrics, Division of Neonatal and Developmental Medicine, March of Dimes Prematurity Research Center at Stanford University School of Medicine, Palo Alto, CA
| | - David H Rehkopf
- Stanford University School of Medicine, Department of Epidemiology and Population Health, Alway Building, Stanford, CA; Stanford University School of Medicine, Division of Primary Care and Population Health, Stanford, CA; Stanford University, Department of Sociology, Stanford, CA; Stanford University, Center for Population Health Sciences, Palo Alto, CA.
| | - Gary M Shaw
- Stanford University School of Medicine, Department of Pediatrics, Division of Neonatal and Developmental Medicine, March of Dimes Prematurity Research Center at Stanford University School of Medicine, Palo Alto, CA.
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White J, Borgia S, Rehkopf DH. Socioeconomic inequalities in the risk of suicide attempts among sexual minority adolescents: Findings from the UK's Millennium Cohort Study. Lancet Reg Health Eur 2023; 26:100570. [PMID: 36619211 PMCID: PMC9813783 DOI: 10.1016/j.lanepe.2022.100570] [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] [Received: 10/13/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/27/2022]
Abstract
Background Both sexual minority and socioeconomically deprived young people are at an increased risk of making a suicide attempt. Intersectionality theory predicts these risk factors will interact synergistically to create unique vulnerabilities. We investigated the risk of suicide attempts in sexual minority socioeconomically deprived young people in a contemporary national cohort. Methods The Millennium Cohort Study (MCS) is a birth cohort study in the UK following children born 2000-2002. Children in the MCS have been followed up over seven sweeps to date at ages 9 months, 3, 5, 7, 11, 14 and 17 years. The relative risk (RR) of self-reported suicide attempts at 17 years by sexual minority status and parental unemployment was estimated using multivariable log-binomial regression. Additive interaction, representing the synergistic effect, was estimated using the relative excess risk due to interaction (RERI). Findings Between January, 2018 and March, 2019, 10,247 adolescents provided their sexuality and parents their employment status. 758 (7.4%) of 10,247 adolescents had made a suicide attempt. Relative to heterosexual young people living with no unemployed parents, the RR for sexual minorities living with no unemployed parents/carers was 2.93 (95% CI 2.26-3.79), one unemployed was 4.46 (95% CI 2.94-6.77), and two was 6.35 (95% CI 3.62-11.14). There was evidence of a positive additive interaction. The RERI for having one unemployed parent was 1.08 (95% CI -0.54 to 2.69) and two was 3.10 (95% CI -1.58 to 7.78). Sensitivity analyses using housing tenure and in a sample with no missing data generated comparable results. Interpretation To our knowledge, this is the first evidence that socioeconomically deprived sexual minority adolescents are uniquely vulnerable to making a suicide attempt. Health and educational practitioners need to be aware of the increased risk of suicide attempts in socioeconomically deprived sexual minority adolescents. Funding Economic and Social Research Council (ESRC).
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Affiliation(s)
- James White
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Sophie Borgia
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - David H. Rehkopf
- Department of Epidemiology and Population Health, Department of Medicine, Department of Sociology, Center for Population Health Sciences, Stanford University, Stanford, USA
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Elser H, Caunca M, Rehkopf DH, Andres W, Gottesman RF, Kasner SE, Yaffe K, Schneider ALC. Trends and inequities in the diagnosis and treatment of poststroke depression: a retrospective cohort study of privately insured patients in the USA, 2003-2020. J Neurol Neurosurg Psychiatry 2023; 94:220-226. [PMID: 36400454 PMCID: PMC9931658 DOI: 10.1136/jnnp-2022-330179] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Depression is a common neuropsychiatric consequence of stroke, but there is little empiric evidence regarding clinical diagnosis and management of poststroke depression. METHODS Retrospective cohort study among 831 471 privately insured patients with first stroke in the USA from 2003 to 2020. We identified diagnoses of poststroke depression using codes from the International Classification of Diseases. We identified treatment based on prescriptions for antidepressants. We used Cox proportional hazards regression analysis to examine rates of poststroke depression diagnosis by gender, age and race/ethnicity. Among individuals who received a diagnosis of poststroke depression, we estimated treatment rates by gender, race/ethnicity and age using negative binomial regression analysis. RESULTS Annual diagnosis and treatment rates for poststroke depression increased from 2003 to 2020 (both p for trend<0.001). Diagnosis rates were higher in women than men (HR 1.53, 95% CI 1.51 to 1.55), lower among members of racial/ethnic minorities (vs white patients: Asian HR 0.63, 95% CI 0.60 to 0.66; Black HR 0.76, 95% CI 0.74 to 0.78; Hispanic HR 0.88, 95% CI 0.86 to 0.90) and varied by age. Among individuals diagnosed with poststroke depression, 69.8% were prescribed an antidepressant. Rates of treatment were higher in women vs men (rate ratio, RR=1.19, 95% CI: 1.17 to 1.21), lower among members of racial/ethnic minorities (vs white patients: Asian RR 0.85, 95% CI 0.80 to 0.90; Black RR 0.92, 95% CI 0.89 to 0.94; Hispanic RR 0.96, 95% CI 0.93 to 0.99) and higher among older patients. CONCLUSIONS In this insured population, we identify potential inequities in clinical management of poststroke depression by gender, race/ethnicity and age that may reflect barriers other than access to healthcare.
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Affiliation(s)
- Holly Elser
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA .,Center for Population Health Sciences, Stanford University, Stanford, California, USA
| | - Michelle Caunca
- Department of Neurology, University of California, San Francisco, California, USA
| | - David H Rehkopf
- 4. Epidemiology and Population Health, Stanford University, Stanford, California, USA
| | - Wells Andres
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebecca F Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program, National Institutes of Health, Bethesda, Maryland, USA
| | - Scott E Kasner
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kristine Yaffe
- Departments of Psychiatry, Neurology and Epidemiology, University of California, San Francisco, California, USA
| | - Andrea L C Schneider
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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11
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Lee M, Harrati A, Rehkopf DH, Modrek S. Associations of local area level new deal employment in childhood with late life cognition: evidence from the census-linked health and retirement study. J Epidemiol Community Health 2023; 77:81-88. [PMID: 36600558 PMCID: PMC9839563 DOI: 10.1136/jech-2022-219259] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Emergency employment programmes during the 1930s and 1940s invested income, infrastructure and social services into communities affected by the Great Depression. We estimate the long-term associations of growing up in an area exposed to New Deal emergency employment in 1940 with cognitive functioning in later life. METHODS Members of the Health and Retirement Study cohort (N=5095; mean age 66.3 at baseline) who were age 0-17 in 1940 were linked to their census record from that year, providing prospective information about childhood contextual and family circumstances. We estimated the association between subcounty-level emergency employment participation in 1940 and baseline cognition and rate of cognitive decline between 1998 and 2016. RESULTS Compared with those living in the lowest emergency employment quintile in 1940, those who were exposed to moderate levels of emergency employment (third quintile) had better cognitive functioning in 1998 (b=0.092 SD, 95% CI 0.011 to 0.173), conditional on sociodemographic factors. This effect was modestly attenuated after adjusting for respondents' adult education, finances and health factors. There were no significant effects of area-level emergency employment on rate of cognitive decline. CONCLUSIONS Exposure to New Deal employment policies during childhood is associated with long-term cognitive health benefits. This is partially explained by increases in educational attainment among those with greater levels of emergency employment activity in the place where they were raised. Future research should investigate which types of New Deal investments may most be related to long-term cognitive health, or if the associations we observe are due to co-occurring programmes.
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Affiliation(s)
- Mark Lee
- Minnesota Population Center, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | | | | | - Sepideh Modrek
- Health Equity Institute, San Francisco State University, San Francisco, CA
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12
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Schell RC, Dow WH, Fernald LC, Bradshaw PT, Rehkopf DH. Does educational attainment modify the causal relationship between adiposity and cardiovascular disease? A Mendelian randomization study. SSM Popul Health 2023; 21:101351. [PMID: 36819121 PMCID: PMC9932564 DOI: 10.1016/j.ssmph.2023.101351] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
A greater risk of cardiovascular disease is associated with low educational attainment and high adiposity. Despite the correlation between low educational attainment and high adiposity, whether educational attainment modifies the risk of CVD caused by high adiposity remains poorly understood. We investigated the effect of adiposity (body mass index [BMI] and waist-to-hip ratio adjusted for BMI [WHRadjBMI]) on incident CVD among individuals with varying education levels, using associational and one-sample Mendelian randomization (MR) survival analyses. Data were collected from 2006 to 2021, and sample sizes were 254,281 (27,511 CVD cases) for BMI and 253,968 (27,458 CVD cases) for WHRadjBMI. In the associational model, a standard deviation (SD) higher BMI was associated with 19.81 (95% CI: 18.55-21.06) additional cases of incident CVD per 10,000 person-years for individuals with a secondary education, versus 32.96 (95% CI: 28.75-37.17) for those without. When university degree served as the education variable, education group differences attenuated, with 18.26 (95% CI: 16.37-20.15) cases from a one SD higher BMI for those with a university degree versus 23.18 [95% CI: 21.56-24.72] for those without. For the MR model, an SD higher BMI resulted in 11.75 (95% CI: -0.84-24.38) and 29.79 (95% CI: 17.20-42.44) additional cases of incident CVD per 10,000 person-years for individuals with versus without a university degree. WHRadjBMI exhibited no effect differences by education. While the associational model showed evidence of educational attainment modifying the relationship between adiposity and incident CVD, it does not modify the association between adiposity and incident CVD in the MR models. This suggests either less education does not cause greater risk of incident CVD from high adiposity, or MR models cannot detect the effect difference. The associational point estimates exist within the MR models' confidence intervals in all BMI analyses, so we cannot rule out the effect sizes in the associational models.
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Affiliation(s)
- Robert C. Schell
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, USA
- Corresponding author. 2121 Berkeley Way, Berkeley, CA, 94704, USA.
| | - William H. Dow
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, USA
- Department of Demography, University of California, Berkeley, CA, USA
| | - Lia C.H. Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Patrick T. Bradshaw
- Division of Epidemiology & Biostatistics, University of California, School of Public Health, Berkeley, Berkeley, CA, USA
| | - David H. Rehkopf
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA
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13
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Engelbrecht HR, Merrill SM, Gladish N, MacIsaac JL, Lin DTS, Ecker S, Chrysohoou CA, Pes GM, Kobor MS, Rehkopf DH. Sex differences in epigenetic age in Mediterranean high longevity regions. Front Aging 2022; 3:1007098. [PMID: 36506464 PMCID: PMC9726738 DOI: 10.3389/fragi.2022.1007098] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/21/2022] [Indexed: 11/24/2022]
Abstract
Sex differences in aging manifest in disparities in disease prevalence, physical health, and lifespan, where women tend to have greater longevity relative to men. However, in the Mediterranean Blue Zones of Sardinia (Italy) and Ikaria (Greece) are regions of centenarian abundance, male-female centenarian ratios are approximately one, diverging from the typical trend and making these useful regions in which to study sex differences of the oldest old. Additionally, these regions can be investigated as examples of healthy aging relative to other populations. DNA methylation (DNAm)-based predictors have been developed to assess various health biomarkers, including biological age, Pace of Aging, serum interleukin-6 (IL-6), and telomere length. Epigenetic clocks are biological age predictors whose deviation from chronological age has been indicative of relative health differences between individuals, making these useful tools for interrogating these differences in aging. We assessed sex differences between the Horvath, Hannum, GrimAge, PhenoAge, Skin and Blood, and Pace of Aging predictors from individuals in two Mediterranean Blue Zones and found that men displayed positive epigenetic age acceleration (EAA) compared to women according to all clocks, with significantly greater rates according to GrimAge (β = 3.55; p = 1.22 × 10-12), Horvath (β = 1.07; p = 0.00378) and the Pace of Aging (β = 0.0344; p = 1.77 × 10-08). Other DNAm-based biomarkers findings indicated that men had lower DNAm-predicted serum IL-6 scores (β = -0.00301, p = 2.84 × 10-12), while women displayed higher DNAm-predicted proportions of regulatory T cells than men from the Blue Zone (p = 0.0150, 95% Confidence Interval [0.00131, 0.0117], Cohen's d = 0.517). All clocks showed better correlations with chronological age in women from the Blue Zones than men, but all clocks showed large mean absolute errors (MAE >30 years) in both sexes, except for PhenoAge (MAE <5 years). Thus, despite their equal survival to older ages in these Mediterranean Blue Zones, men in these regions remain biologically older by most measured DNAm-derived metrics than women, with the exception of the IL-6 score and proportion of regulatory T cells.
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Affiliation(s)
- Hannah-Ruth Engelbrecht
- Edwin S. H. Leong Healthy Aging Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada,Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada,British Columbia Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada,Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Sarah M. Merrill
- Edwin S. H. Leong Healthy Aging Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada,Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada,British Columbia Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada,Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Nicole Gladish
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Julie L. MacIsaac
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada,British Columbia Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada,Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - David T. S. Lin
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada,British Columbia Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada,Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Simone Ecker
- UCL Cancer Institute, University College London, London, United Kingdom
| | | | - Giovanni M. Pes
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Michael S. Kobor
- Edwin S. H. Leong Healthy Aging Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada,Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada,British Columbia Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada,Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, BC, Canada,*Correspondence: Michael S. Kobor, ; David H. Rehkopf,
| | - David H. Rehkopf
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Palo Alto, CA, United States,*Correspondence: Michael S. Kobor, ; David H. Rehkopf,
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14
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Qian ZJ, Rehkopf DH. Association Between Social Disadvantage and Otitis Media Treatment in US Children With Commercial Insurance. JAMA Otolaryngol Head Neck Surg 2022; 149:2798548. [PMID: 36355356 PMCID: PMC9650625 DOI: 10.1001/jamaoto.2022.3560] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/14/2022] [Indexed: 11/12/2023]
Abstract
Importance It is well established that social disadvantage is associated with earlier, more frequent, and more severe otitis media in children. Appropriate medical and surgical treatment of otitis media can prevent hearing loss and other complications, which may affect future academic and employment opportunities in socially disadvantaged populations. Clinical treatment patterns for otitis media in the US are unclear. Objective To describe and quantify social disparities in the treatment patterns of otitis media in children in the US. Design, Setting, and Participants This cross-sectional study included claims data from the Optum Clinformatics Data Mart Database between January 1, 2003, and March 31, 2021, with linked inpatient, outpatient, and pharmaceutical claims for 4 831 408 children with otitis media. Exposures Age at first otitis media diagnosis, sex, environmental allergies, gastroesophageal reflux, adenotonsillar hyperplasia, zip code, social deprivation index score, social vulnerability index score. Main Outcomes and Measures Treatment of recurrent and suppurative otitis media in children, insertion of tympanostomy tubes, and treatment for severe complications of undertreated otitis media. The principal measure of social disadvantage was the social deprivation index. The social vulnerability index was used for sensitivity analyses to ensure external validity. Multiple logistic regression analyses were used to quantify the association of all projected variables with the study outcomes. Results Among 4 831 408 US children with otitis media (median [IQR] age, 4 [1-8] years; 2 491 557 boys [51.57%]), 994 921 (20.59%) were treated for recurrent otitis media, 717 978 (14.86%) were treated for suppurative otitis media, 335 949 (6.95%) received tympanostomy tubes, and 10 975 (0.23%) had severe complications of otitis media. In multivariable regression models including patient factors and social indices, earlier age at diagnosis, male sex, environmental allergies, gastroesophageal reflux, and adenotonsillar hyperplasia were associated with increased treatment for otitis media, whereas social deprivation index was associated with lower odds of medical treatment for recurrent otitis media (odds ratio [OR], 0.86; 95% CI, 0.85-0.87), suppurative otitis media (OR, 0.61; 95% CI, 0.60-0.62), and insertion of tympanostomy tubes (OR, 0.76; 95% CI, 0.75-0.78) but higher odds of having severe complications (OR, 1.28; 95% CI, 1.19-1.37). Conclusions and Relevance The findings of this cross-sectional study suggest that children with otitis media who were socially disadvantaged were less likely to receive treatment and more likely to experience complications for undertreated otitis media. As otitis media is a modifiable risk factor for hearing loss, efforts need to be made to ensure equitable access to treatment for all children.
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Affiliation(s)
- Z. Jason Qian
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - David H. Rehkopf
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
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15
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Leist AK, Klee M, Kim JH, Rehkopf DH, Bordas SPA, Muniz-Terrera G, Wade S. Mapping of machine learning approaches for description, prediction, and causal inference in the social and health sciences. Sci Adv 2022; 8:eabk1942. [PMID: 36260666 PMCID: PMC9581488 DOI: 10.1126/sciadv.abk1942] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/01/2022] [Indexed: 05/20/2023]
Abstract
Machine learning (ML) methodology used in the social and health sciences needs to fit the intended research purposes of description, prediction, or causal inference. This paper provides a comprehensive, systematic meta-mapping of research questions in the social and health sciences to appropriate ML approaches by incorporating the necessary requirements to statistical analysis in these disciplines. We map the established classification into description, prediction, counterfactual prediction, and causal structural learning to common research goals, such as estimating prevalence of adverse social or health outcomes, predicting the risk of an event, and identifying risk factors or causes of adverse outcomes, and explain common ML performance metrics. Such mapping may help to fully exploit the benefits of ML while considering domain-specific aspects relevant to the social and health sciences and hopefully contribute to the acceleration of the uptake of ML applications to advance both basic and applied social and health sciences research.
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Affiliation(s)
- Anja K. Leist
- Department of Social Sciences, Institute for Research on Socio-Economic Inequality (IRSEI), University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Corresponding author.
| | - Matthias Klee
- Department of Social Sciences, Institute for Research on Socio-Economic Inequality (IRSEI), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Jung Hyun Kim
- Department of Social Sciences, Institute for Research on Socio-Economic Inequality (IRSEI), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - David H. Rehkopf
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA
| | | | - Graciela Muniz-Terrera
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
- Ohio University, Athens, OH, USA
| | - Sara Wade
- School of Mathematics, University of Edinburgh, Edinburgh, UK
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16
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Cardenas A, Ecker S, Fadadu RP, Huen K, Orozco A, McEwen LM, Engelbrecht HR, Gladish N, Kobor MS, Rosero-Bixby L, Dow WH, Rehkopf DH. Epigenome-wide association study and epigenetic age acceleration associated with cigarette smoking among Costa Rican adults. Sci Rep 2022; 12:4277. [PMID: 35277542 PMCID: PMC8917214 DOI: 10.1038/s41598-022-08160-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/03/2022] [Indexed: 12/12/2022] Open
Abstract
Smoking-associated DNA methylation (DNAm) signatures are reproducible among studies of mostly European descent, with mixed evidence if smoking accelerates epigenetic aging and its relationship to longevity. We evaluated smoking-associated DNAm signatures in the Costa Rican Study on Longevity and Healthy Aging (CRELES), including participants from the high longevity region of Nicoya. We measured genome-wide DNAm in leukocytes, tested Epigenetic Age Acceleration (EAA) from five clocks and estimates of telomere length (DNAmTL), and examined effect modification by the high longevity region. 489 participants had a mean (SD) age of 79.4 (10.8) years, and 18% were from Nicoya. Overall, 7.6% reported currently smoking, 35% were former smokers, and 57.4% never smoked. 46 CpGs and five regions (e.g. AHRR, SCARNA6/SNORD39, SNORA20, and F2RL3) were differentially methylated for current smokers. Former smokers had increased Horvath’s EAA (1.69-years; 95% CI 0.72, 2.67), Hannum’s EAA (0.77-years; 95% CI 0.01, 1.52), GrimAge (2.34-years; 95% CI1.66, 3.02), extrinsic EAA (1.27-years; 95% CI 0.34, 2.21), intrinsic EAA (1.03-years; 95% CI 0.12, 1.94) and shorter DNAmTL (− 0.04-kb; 95% CI − 0.08, − 0.01) relative to non-smokers. There was no evidence of effect modification among residents of Nicoya. Our findings recapitulate previously reported and novel smoking-associated DNAm changes in a Latino cohort.
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Affiliation(s)
- Andres Cardenas
- Division of Environmental Health Sciences, School of Public Health and Center for Computational Biology, University of California, Berkeley, 2121 Berkeley Way, #5121, Berkeley, CA, 94720, USA.
| | - Simone Ecker
- UCL Cancer Institute, University College London, London, UK
| | - Raj P Fadadu
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Karen Huen
- Division of Environmental Health Sciences, School of Public Health and Center for Computational Biology, University of California, Berkeley, 2121 Berkeley Way, #5121, Berkeley, CA, 94720, USA
| | - Allan Orozco
- School of Health Technology, Faculty of Medicine, University of Costa Rica (UCR), San José, San Pedro, Costa Rica
| | - Lisa M McEwen
- Faculty of Human and Social Development, School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Hannah-Ruth Engelbrecht
- Department of Medical Genetics, Centre for Molecular Medicine and Therapeutics, and BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Nicole Gladish
- Department of Medical Genetics, Centre for Molecular Medicine and Therapeutics, and BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Michael S Kobor
- Department of Medical Genetics, Centre for Molecular Medicine and Therapeutics, and BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Luis Rosero-Bixby
- Centro Centroamericano de Población (CCP), Universidad de Costa Rica, San José, Costa Rica
| | - William H Dow
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - David H Rehkopf
- Department of Epidemiology and Population Health and Department of Medicine, School of Medicine, Stanford University, Palo Alto, CA, USA
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17
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Hamad R, Glymour MM, Calmasini C, Nguyen TT, Walter S, Rehkopf DH. Explaining the Variance in Cardiovascular Disease Risk Factors: A Comparison of Demographic, Socioeconomic, and Genetic Predictors. Epidemiology 2022; 33:25-33. [PMID: 34799480 PMCID: PMC8633061 DOI: 10.1097/ede.0000000000001425] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 01/03/2023]
Abstract
BACKGROUND Efforts to explain the burden of cardiovascular disease (CVD) often focus on genetic factors or social determinants of health. There is little evidence on the comparative predictive value of each, which could guide clinical and public health investments in measuring genetic versus social information. We compared the variance in CVD-related outcomes explained by genetic versus socioeconomic predictors. METHODS Data were drawn from the Health and Retirement Study (N = 8,720). We examined self-reported diabetes, heart disease, depression, smoking, and body mass index, and objectively measured total and high-density lipoprotein cholesterol. For each outcome, we compared the variance explained by demographic characteristics, socioeconomic position (SEP), and genetic characteristics including a polygenic score for each outcome and principal components (PCs) for genetic ancestry. We used R-squared values derived from race-stratified multivariable linear regressions to evaluate the variance explained. RESULTS The variance explained by models including all predictors ranged from 3.7% to 14.3%. Demographic characteristics explained more than half this variance for most outcomes. SEP explained comparable or greater variance relative to the combination of the polygenic score and PCs for most conditions among both white and Black participants. The combination of SEP, polygenic score, and PCs performed substantially better, suggesting that each set of characteristics may independently contribute to the prediction of CVD-related outcomes. Philip R. Lee Institute for Health Policy Studies, Department of Family & Community Medicine, UCSF. CONCLUSIONS Focusing on genetic inputs into personalized medicine predictive models, without considering measures of social context that have clear predictive value, needlessly ignores relevant information that is more feasible and affordable to collect on patients in clinical settings. See video abstract at, http://links.lww.com/EDE/B879.
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Affiliation(s)
- Rita Hamad
- Department of Family & Community Medicine, University of California San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco
| | - M. Maria Glymour
- Department of Epidemiology & Biostatistics, University of California San Francisco
| | - Camilla Calmasini
- Department of Epidemiology & Biostatistics, University of California San Francisco
| | - Thu T. Nguyen
- Department of Family & Community Medicine, University of California San Francisco
| | - Stefan Walter
- Department of Medicine and Public Health, Rey Juan Carlos University, Madrid, Spain
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18
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Kiang MV, Tsai AC, Alexander MJ, Rehkopf DH, Basu S. Correction to: Racial/Ethnic Disparities in Opioid-Related Mortality in the USA, 1999-2019: the Extreme Case of Washington DC. J Urban Health 2021; 98:833. [PMID: 34799823 PMCID: PMC8688590 DOI: 10.1007/s11524-021-00592-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Mathew V Kiang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
- Harvard FXB Center for Health and Human Rights, Boston, MA, USA.
- Center for Population Health Sciences, Stanford University, 1701 Page Mill Road, Palo Alto, CA, 94304, USA.
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Monica J Alexander
- Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Sociology, University of Toronto, Toronto, ON, Canada
| | - David H Rehkopf
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Sanjay Basu
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- School of Public Health, Imperial College, London, UK
- Center for Primary Care, Harvard Medical School, Boston, MA, USA
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19
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Huynh BQ, Kwong LH, Kiang MV, Chin ET, Mohareb AM, Jumaan AO, Basu S, Geldsetzer P, Karaki FM, Rehkopf DH. Public health impacts of an imminent Red Sea oil spill. Nat Sustain 2021; 4:1084-1091. [PMID: 34926834 PMCID: PMC8682806 DOI: 10.1038/s41893-021-00774-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/20/2021] [Indexed: 06/14/2023]
Abstract
The possibility of a massive oil spill in the Red Sea is increasingly likely. The Safer, a deteriorating oil tanker containing 1.1 million barrels of oil, has been deserted near the coast of Yemen since 2015 and threatens environmental catastrophe to a country presently in a humanitarian crisis. Here, we model the immediate public health impacts of a simulated spill. We estimate that all of Yemen's imported fuel through its key Red Sea ports would be disrupted and that the anticipated spill could disrupt clean-water supply equivalent to the daily use of 9.0-9.9 million people, food supply for 5.7-8.4 million people and 93-100% of Yemen's Red Sea fisheries. We also estimate an increased risk of cardiovascular hospitalization from pollution ranging from 5.8 to 42.0% over the duration of the spill. The spill and its potentially disastrous impacts remain entirely preventable through offloading the oil. Our results stress the need for urgent action to avert this looming disaster.
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Affiliation(s)
- Benjamin Q. Huynh
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Laura H. Kwong
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Harvard FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA
| | - Elizabeth T. Chin
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Amir M. Mohareb
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Aisha O. Jumaan
- Yemen Relief and Reconstruction Foundation, Mercer Island, WA, USA
| | - Sanjay Basu
- Center for Primary Care, Harvard Medical School, Boston, MA, USA
- School of Public Health, Imperial College, London, UK
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Fatima M. Karaki
- Refugee and Asylum-seeker Health Initiative, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- These authors contributed equally: Fatima M. Karaki, David H. Rehkopf
| | - David H. Rehkopf
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- These authors contributed equally: Fatima M. Karaki, David H. Rehkopf
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20
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Kiang MV, Tsai AC, Alexander MJ, Rehkopf DH, Basu S. Racial/Ethnic Disparities in Opioid-Related Mortality in the USA, 1999-2019: the Extreme Case of Washington DC. J Urban Health 2021; 98:589-595. [PMID: 34664185 PMCID: PMC8566633 DOI: 10.1007/s11524-021-00573-8] [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] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
In 2019, there were nearly 50,000 opioid-related deaths in the US, with substantial variation across sociodemographic groups and geography. To systematically investigate patterns of racial/ethnic inequities in opioid-related mortality, we used joinpoint regression models to estimate the trajectory of the opioid epidemic among non-Hispanic Black versus non-Hispanic white residents in Washington DC, 45 states, and 81 sub-state areas. We highlight the unique inequities observed in Washington DC. In 2019, the observed opioid-related mortality rate among Black DC residents was 11.3 times higher than white DC residents, resulting in 56.0 more deaths per 100,000 (61.5 vs. 5.5 per 100,000). This inequity was substantially higher than any other jurisdiction on both the relative and absolute scales. Most opioid-related deaths in DC involved synthetic opioids, which was present in 92% (N=198) of deaths among Black DC residents and 69% (N=11) of deaths among white DC residents. Localized, equitable, culturally-appropriate, targeted interventions are necessary to reduce the uniquely disproportionate burden of opioid-related mortality among Black DC residents.
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Affiliation(s)
- Mathew V Kiang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
- Harvard FXB Center for Health and Human Rights, Boston, MA, USA.
- Center for Population Health Sciences, Stanford University, 1701 Page Mill Road, CA, 94304, Palo Alto, USA.
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Monica J Alexander
- Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Sociology, University of Toronto, Toronto, ON, Canada
| | - David H Rehkopf
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Sanjay Basu
- Institute of Health Policy, Management, and Evaluation, University of Toronto, ON, Toronto, Canada
- School of Public Health, Imperial College, London, UK
- Center for Primary Care, Harvard Medical School, Boston, MA, USA
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21
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Soerensen SJC, Thomas IC, Schmidt B, Daskivich TJ, Skolarus TA, Jackson C, Osborne TF, Chertow GM, Brooks JD, Rehkopf DH, Leppert JT. AUTHOR REPLY. Urology 2021; 155:76. [PMID: 34489006 DOI: 10.1016/j.urology.2021.05.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/09/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Simon John Christoph Soerensen
- Department of Urology, Stanford University School of Medicine, Stanford, CA; Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - I-Chun Thomas
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Bogdana Schmidt
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | | | - Ted A Skolarus
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Urology, Dow Division of Health Services Research, University of Michigan Medical School, Ann Arbor, MI
| | - Christian Jackson
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Thomas F Osborne
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Glenn M Chertow
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - James D Brooks
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - David H Rehkopf
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - John T Leppert
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Urology, Stanford University School of Medicine, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA
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22
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O'Leary D, Uysal A, Rehkopf DH, Gross JJ. Subjective social status and physical health: The role of negative affect and reappraisal. Soc Sci Med 2021; 291:114272. [PMID: 34717282 DOI: 10.1016/j.socscimed.2021.114272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 07/16/2021] [Accepted: 07/25/2021] [Indexed: 11/19/2022]
Abstract
RATIONALE Having low subjective social status is associated with an array of negative health outcomes. However, the mechanisms linking subjective social status to health are not yet clear. One candidate mechanism is negative affect. Researchers have proposed that having low subjective social status may be associated with higher levels of negative affect, and these higher levels of negative affect may be associated with poor health. However, research demonstrating that status-related negative affect is prospectively associated with health in humans is limited. OBJECTIVE We examined whether negative affect prospectively mediates the relationship between subjective social status and physical health. In addition, we tested whether reappraisal - an affect regulation strategy used to downregulate negative affect - moderates the links among subjective social status, negative affect, and physical health. METHOD We used two-wave longitudinal data from the Midlife in the United States (MIDUS) project to conduct a series of regression, mediation, and moderated mediation analyses to examine the relationships among subjective social status, negative affect, reappraisal, and health (i.e., four outcomes, chronic conditions, somatic symptoms, self-reported health and mortality). RESULTS Negative affect mediates the relationship between status and change in morbidity (n = 3289; i.e., change in number of chronic conditions, somatic symptoms, self-reported health) and mortality (n = 4953), such that subjective social status is inversely associated with negative affect, and negative affect is positively associated with poor health. Reappraisal moderates each of these relationships, such that individuals who are low on subjective social status and have high scores on a novel measure of reappraisal experience lower levels of negative affect and better health than individuals who are low on subjective social status but who have low scores on this measure. CONCLUSION These results have important implications for our understanding of subjective social status and how it relates to physical health.
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Affiliation(s)
- Daniel O'Leary
- Department of Psychology, Stanford University Ahmet Uysal, Department of Psychology, Stanford University David H. Rehkopf, School of Medicine, Stanford University James J. Gross, Department of Psychology, Stanford University, USA.
| | - Ahmet Uysal
- Department of Psychology, Stanford University Ahmet Uysal, Department of Psychology, Stanford University David H. Rehkopf, School of Medicine, Stanford University James J. Gross, Department of Psychology, Stanford University, USA
| | - David H Rehkopf
- Department of Psychology, Stanford University Ahmet Uysal, Department of Psychology, Stanford University David H. Rehkopf, School of Medicine, Stanford University James J. Gross, Department of Psychology, Stanford University, USA
| | - James J Gross
- Department of Psychology, Stanford University Ahmet Uysal, Department of Psychology, Stanford University David H. Rehkopf, School of Medicine, Stanford University James J. Gross, Department of Psychology, Stanford University, USA
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23
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Soerensen SJC, Thomas IC, Schmidt B, Daskivich TJ, Skolarus TA, Jackson C, Osborne TF, Chertow GM, Brooks JD, Rehkopf DH, Leppert JT. Using an Automated Electronic Health Record Score To Estimate Life Expectancy In Men Diagnosed With Prostate Cancer In The Veterans Health Administration. Urology 2021; 155:70-76. [PMID: 34139251 DOI: 10.1016/j.urology.2021.05.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/11/2021] [Accepted: 05/09/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine if an automatically calculated electronic health record score can estimate intermediate-term life expectancy in men with prostate cancer to provide guideline concordant care. METHODS We identified all men (n = 36,591) diagnosed with prostate cancer in 2013-2015 in the VHA. Of the 36,591, 35,364 (96.6%) had an available Care Assessment Needs (CAN) score (range: 0-99) automatically calculated in the 30 days prior to the date of diagnosis. It was designed to estimate short-term risks of hospitalization and mortality. We fit unadjusted and multivariable Cox proportional hazards regression models to determine the association between the CAN score and overall survival among men with prostate cancer. We compared CAN score performance to two established comorbidity measures: The Charlson Comorbidity Index and Prostate Cancer Comorbidity Index (PCCI). RESULTS Among 35,364 men, the CAN score correlated with overall stage, with mean scores of 46.5 ( ± 22.4), 58.0 ( ± 24.4), and 68.1 ( ± 24.3) in localized, locally advanced, and metastatic disease, respectively. In both unadjusted and adjusted models for prostate cancer risk, the CAN score was independently associated with survival (HR = 1.23 95%CI 1.22-1.24 & adjusted HR = 1.17 95%CI 1.16-1.18 per 5-unit change, respectively). The CAN score (overall C-Index 0.74) yielded better discrimination (AUC = 0.76) than PCCI (AUC = 0.65) or Charlson Comorbidity Index (AUC = 0.66) for 5-year survival. CONCLUSION The CAN score is strongly associated with intermediate-term survival following a prostate cancer diagnosis. The CAN score is an example of how learning health care systems can implement multi-dimensional tools to provide fully automated life expectancy estimates to facilitate patient-centered cancer care.
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Affiliation(s)
- Simon John Christoph Soerensen
- Department of Urology, Stanford University School of Medicine, Stanford, CA; Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - I-Chun Thomas
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Bogdana Schmidt
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | | | - Ted A Skolarus
- Department of Urology, Dow Division of Health Services Research, University of Michigan Medical School, VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Ann Arbor, MI
| | - Christian Jackson
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Thomas F Osborne
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Glenn M Chertow
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - James D Brooks
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - David H Rehkopf
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - John T Leppert
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA.
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24
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Zimmerman LP, Kershaw KN, Rehkopf DH, Luo Y, Lloyd-Jones DM. Abstract MP18: Association Of Longitudinal Social Determinants Through Young Adulthood With Mid-life Cardiovascular Health: The Coronary Artery Risk Development In Young Adults (CARDIA) Study. Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.mp18] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Deeper understanding of the longitudinal associations of social determinants of health (SDOH) at younger ages with cardiovascular health (CVH) in middle age is needed to address persistent health disparities.
Methods:
We used repeated measures of individual and neighborhood-level SDOH data from CARDIA participants (ppts) to understand how SDOH change from ages 18-44 years. There were 48 diverse SDOH exposures measured. Using a novel, machine learning, sequential pattern mining method (Subgraph Augmented Non-negative Matrix Factorization), we identified clusters of time-dependent SDOH variables occurring in 5% or more of ppts. Clusters were then used as independent variables in logistic regression models to assess associations with CVH at age ≥45 years. CVH status was defined using the AHA’s Simple 7 metrics on diet, physical activity, smoking, BMI, cholesterol, blood pressure, and blood glucose, and summarized by a 14-point score (poor 0-7, moderate 8-11, high 12-14 points). We tested associations of clusters with the outcome of poor CVH at age ≥45 years, and identified the characteristics of significant SDOH clusters.
Results:
There were 3,522 ppts included (46.3% Black, 55.9% women; mean age 25.3 years at baseline). Mean CVH score (out of 14) was 10.4 ± 1.8 points at baseline and 8.9 ± 2.3 points at age ≥45 years; 483 ppts (13.7%) had high, 2026 (57.5%) had moderate, and 1013 (28.8%) had poor CVH in middle age. The best performing logistic model included 4 SDOH trend clusters (Table). SDOH Clusters 1, 2, and 3 were each associated with significant 50-80% lower odds of having poor CVH in middle age, whereas Cluster 4 was associated with 2.5-fold higher odds of poor CVH. The most informative variables over time comprising each SDOH cluster are also shown in the Table.
Conclusions:
Specific SDOH clusters through young adulthood are significantly associated with reaching mid-life with poor CVH status. Components of these SDOH clusters may be potential targets for social interventions and policies to improve CVH.
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25
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Cohen AK, Ozer EJ, Rehkopf DH, Abrams B. High School Composition and Health Outcomes in Adulthood: A Cohort Study. Int J Environ Res Public Health 2021; 18:3799. [PMID: 33917294 PMCID: PMC8038652 DOI: 10.3390/ijerph18073799] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND A multitude of empirical evidence documents links between education and health, but this focuses primarily on educational attainment and not on characteristics of the school setting. Little is known about the extent to which aggregate characteristics of the school setting, such as student body demographics, are associated with adult health outcomes. METHODS We use the U.S. nationally representative National Longitudinal Survey of Youth 1979 cohort to statistically assess the association between two different measures of high school student composition (socioeconomic composition, racial/ethnic composition) and two different health outcomes at age 40 (self-rated health and obesity). RESULTS After adjusting for confounders, high school socioeconomic composition, but not racial/ethnic composition, was weakly associated with both obesity and worse self-rated health at age 40. However, after adding adult educational attainment to the model, only the association between high school socioeconomic composition and obesity remained statistically significant. CONCLUSIONS Future research should explore possible mechanisms and also if findings are similar across other populations and in other school contexts. These results suggest that education policies that seek to break the link between socioeconomic composition and negative outcomes remain important but may have few spillover effects onto health.
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Affiliation(s)
- Alison K. Cohen
- Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, CA 94158, USA
| | - Emily J. Ozer
- School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA; (E.J.O.); (B.A.)
| | - David H. Rehkopf
- Departments of Epidemiology & Population Health and Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA;
| | - Barbara Abrams
- School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA; (E.J.O.); (B.A.)
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26
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Elser H, Parks RM, Moghavem N, Kiang MV, Bozinov N, Henderson VW, Rehkopf DH, Casey JA. Anomalously warm weather and acute care visits in patients with multiple sclerosis: A retrospective study of privately insured individuals in the US. PLoS Med 2021; 18:e1003580. [PMID: 33901187 PMCID: PMC8109782 DOI: 10.1371/journal.pmed.1003580] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/10/2021] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As the global climate changes in response to anthropogenic greenhouse gas emissions, weather and temperature are expected to become increasingly variable. Although heat sensitivity is a recognized clinical feature of multiple sclerosis (MS), a chronic demyelinating disorder of the central nervous system, few studies have examined the implications of climate change for patients with this disease. METHODS AND FINDINGS We conducted a retrospective cohort study of individuals with MS ages 18-64 years in a nationwide United States patient-level commercial and Medicare Advantage claims database from 2003 to 2017. We defined anomalously warm weather as any month in which local average temperatures exceeded the long-term average by ≥1.5°C. We estimated the association between anomalously warm weather and MS-related inpatient, outpatient, and emergency department visits using generalized log-linear models. From 75,395,334 individuals, we identified 106,225 with MS. The majority were women (76.6%) aged 36-55 years (59.0%). Anomalously warm weather was associated with increased risk for emergency department visits (risk ratio [RR] = 1.043, 95% CI: 1.025-1.063) and inpatient visits (RR = 1.032, 95% CI: 1.010-1.054). There was limited evidence of an association between anomalously warm weather and MS-related outpatient visits (RR = 1.010, 95% CI: 1.005-1.015). Estimates were similar for men and women, strongest among older individuals, and exhibited substantial variation by season, region, and climate zone. Limitations of the present study include the absence of key individual-level measures of socioeconomic position (i.e., race/ethnicity, occupational status, and housing quality) that may determine where individuals live-and therefore the extent of their exposure to anomalously warm weather-as well as their propensity to seek treatment for neurologic symptoms. CONCLUSIONS Our findings suggest that as global temperatures rise, individuals with MS may represent a particularly susceptible subpopulation, a finding with implications for both healthcare providers and systems.
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Affiliation(s)
- Holly Elser
- Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
| | - Robbie M. Parks
- Earth Institute, Columbia University, New York, New York, United States of America
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Nuriel Moghavem
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States of America
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, United States of America
| | - Nina Bozinov
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States of America
| | - Victor W. Henderson
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States of America
| | - David H. Rehkopf
- Center for Population Health Sciences, Stanford, California, United States of America
| | - Joan A. Casey
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
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27
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Lund AJ, Rehkopf DH, Sokolow SH, Sam MM, Jouanard N, Schacht AM, Senghor S, Fall A, Riveau G, De Leo GA, Lopez-Carr D. Land use impacts on parasitic infection: a cross-sectional epidemiological study on the role of irrigated agriculture in schistosome infection in a dammed landscape. Infect Dis Poverty 2021; 10:35. [PMID: 33745442 PMCID: PMC7983278 DOI: 10.1186/s40249-021-00816-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/05/2021] [Indexed: 01/20/2023] Open
Abstract
Background Water resources development promotes agricultural expansion and food security. But are these benefits offset by increased infectious disease risk? Dam construction on the Senegal River in 1986 was followed by agricultural expansion and increased transmission of human schistosomes. Yet the mechanisms linking these two processes at the individual and household levels remain unclear. We investigated the association between household land use and schistosome infection in children. Methods We analyzed cross-sectional household survey data (n = 655) collected in 16 rural villages in August 2016 across demographic, socio-economic and land use dimensions, which were matched to Schistosoma haematobium (n = 1232) and S. mansoni (n = 1222) infection data collected from school-aged children. Mixed effects regression determined the relationship between irrigated area and schistosome infection presence and intensity. Results Controlling for socio-economic and demographic risk factors, irrigated area cultivated by a household was associated with an increase in the presence of S. haematobium infection (odds ratio [OR] = 1.14; 95% confidence interval [95% CI]: 1.03–1.28) but not S. mansoni infection (OR = 1.02; 95% CI: 0.93–1.11). Associations between infection intensity and irrigated area were positive but imprecise (S. haematobium: rate ratio [RR] = 1.05; 95% CI: 0.98–1.13, S. mansoni: RR = 1.09; 95% CI: 0.89–1.32). Conclusions Household engagement in irrigated agriculture increases individual risk of S. haematobium but not S. mansoni infection. Increased contact with irrigated landscapes likely drives exposure, with greater impacts on households relying on agricultural livelihoods.![]() Supplementary Information The online version contains supplementary material available at 10.1186/s40249-021-00816-5.
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Affiliation(s)
- Andrea J Lund
- Emmett Interdisciplinary Program in Environment and Resources, Stanford University, 473 Via Ortega Suite 226, Stanford, CA, USA.
| | - David H Rehkopf
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford University, 1701 Page Mill Road Room 229, Palo Alto, CA, USA
| | - Susanne H Sokolow
- Woods Institute for the Environment, Stanford University, 473 Via Ortega, Stanford, CA, USA.,Hopkins Marine Station, Stanford University, 120 Ocean View Blvd, Pacific Grove, CA, USA
| | - M Moustapha Sam
- Centre de Recherche Biomédicale-Espoir Pour La Sante, 263 Route de la Corniche, BP 226, Saint-Louis, Sénégal
| | - Nicolas Jouanard
- Station d'Innovation Aquacole, UGB Cote Cite SAED, BP 524, Saint-Louis, Sénégal.,Center for Infection and Immunology of Lille, Institut Pasteur de Lille, 1 Rue du Professeur Calmette, 59800, Lille, France
| | - Anne-Marie Schacht
- Centre de Recherche Biomédicale-Espoir Pour La Sante, 263 Route de la Corniche, BP 226, Saint-Louis, Sénégal.,Center for Infection and Immunology of Lille, Institut Pasteur de Lille, 1 Rue du Professeur Calmette, 59800, Lille, France
| | - Simon Senghor
- Centre de Recherche Biomédicale-Espoir Pour La Sante, 263 Route de la Corniche, BP 226, Saint-Louis, Sénégal
| | - Assane Fall
- Centre de Recherche Biomédicale-Espoir Pour La Sante, 263 Route de la Corniche, BP 226, Saint-Louis, Sénégal
| | - Gilles Riveau
- Centre de Recherche Biomédicale-Espoir Pour La Sante, 263 Route de la Corniche, BP 226, Saint-Louis, Sénégal.,Center for Infection and Immunology of Lille, Institut Pasteur de Lille, 1 Rue du Professeur Calmette, 59800, Lille, France
| | - Giulio A De Leo
- Hopkins Marine Station, Stanford University, 120 Ocean View Blvd, Pacific Grove, CA, USA
| | - David Lopez-Carr
- Department of Geography, University of California, 4836 Ellison Hall, Santa Barbara, CA, USA
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28
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Wang S, Li LZ, Zhang J, Rehkopf DH. Leisure time activities and biomarkers of chronic stress: The mediating roles of alcohol consumption and smoking. Scand J Public Health 2021; 49:940-950. [PMID: 33570003 DOI: 10.1177/1403494820987461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/15/2022]
Abstract
AIMS Previous research found an association between leisure time activities such as arts and cultural activities and self-reported health over the life course-a measure prone to response bias. This study tested the relationship between arts and cultural activities and allostatic load, a biomarker of chronic stress, and examined risky health behaviors, including alcohol consumption and smoking, as possible mediators. METHODS The sample consists of 8948 adults from the second wave of the United Kingdom Household Longitudinal Study, which is representative of the British population. The cross-sectional association between arts and cultural activities and allostatic load was tested with negative binomial models, and the mediation roles of alcohol consumption and smoking in the association was tested with the Karlson-Holm-Breen (KHB) decomposition method. RESULTS Frequent participation in arts, frequent attendance of cultural events, visits to museums or galleries, and visits to historical sites have negative associations with allostatic load. The associations are mediated by lower frequency of alcohol drinking and smoking. CONCLUSIONS Cultural capital may promote health by reducing the frequency of health risk behaviors such as drinking alcohol and smoking. Future research and public health policies should consider whether cultural capital acts as a social determinant of health to promote healthy leisure activities over the life course.
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Affiliation(s)
- Senhu Wang
- Department of Sociology, National University of Singapore, Singapore
| | | | - Juan Zhang
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, PR China
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29
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Chan JE, Mann AK, Kapp DS, Rehkopf DH. Income, inflammation and cancer mortality: a study of U.S. National Health and Nutrition Examination Survey mortality follow-up cohorts. BMC Public Health 2020; 20:1805. [PMID: 33243216 PMCID: PMC7689964 DOI: 10.1186/s12889-020-09923-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/18/2020] [Indexed: 01/05/2023] Open
Abstract
Background To estimate the relationship between inflammatory biomarkers and cancer mortality in a nationally representative sample of the U.S. population while controlling for education, occupation, and income. Methods Data were obtained from the U.S. National Health and Nutrition Examination Survey from 1988 to 1994 (N = 7817) and 1999–2002 (N = 2344). We fit Cox proportional hazard models to examine the relationship between C-reactive protein (CRP) and fibrinogen with cancer mortality. Results In the full Cox multivariate model, clinically raised CRP was associated with cancer mortality in NHANES 1988–1994 (> 0.99 mg/dL: 95%CI: 1.04–2.13). However, across two inflammatory biomarkers (CRP and Fibrinogen), two NHANES time periods (1998–1994 and 1999–2002) and three income levels (12 strata in total), Hazard ratio confidence intervals did not include the null only for one association: CRP and cancer mortality among low income participants from 1988 to 1994 (HR = 1.83, 95% CI: 1.10–3.04). Conclusions We find evidence that only in one unique stratum is earlier life CRP, and not fibrinogen, associated with prospective cancer mortality. After more complete control for socioeconomic confounding, CRP and fibrinogen do not predict cancer mortality in most subpopulations. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09923-8.
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Affiliation(s)
- Joshua E Chan
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, 1701 Page Mill Road, Room 229, Palo Alto, Stanford, CA, 94304, USA
| | - Amandeep K Mann
- Division of Gynecologic Oncology, Palo Alto Medical Foundation, Sutter Research Institute, Palo Alto, CA, USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - David H Rehkopf
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, 1701 Page Mill Road, Room 229, Palo Alto, Stanford, CA, 94304, USA.
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Weiss J, Puterman E, Prather AA, Ware EB, Rehkopf DH. A data-driven prospective study of dementia among older adults in the United States. PLoS One 2020; 15:e0239994. [PMID: 33027275 PMCID: PMC7540891 DOI: 10.1371/journal.pone.0239994] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 06/03/2020] [Accepted: 09/16/2020] [Indexed: 11/18/2022] Open
Abstract
Background Studies examining risk factors for dementia have typically focused on testing a priori hypotheses within specific risk factor domains, leaving unanswered the question of what risk factors across broad and diverse research fields may be most important to predicting dementia. We examined the relative importance of 65 sociodemographic, early-life, economic, health and behavioral, social, and genetic risk factors across the life course in predicting incident dementia and how these rankings may vary across racial/ethnic (non-Hispanic white and black) and gender (men and women) groups. Methods and findings We conducted a prospective analysis of dementia and its association with 65 risk factors in a sample of 7,908 adults aged 51 years and older from the nationally representative US-based Health and Retirement Study. We used traditional survival analysis methods (Fine and Gray models) and a data-driven approach (random survival forests for competing risks) which allowed us to account for the semi-competing risk of death with up to 14 years of follow-up. Overall, the top five predictors across all groups were lower education, loneliness, lower wealth and income, and lower self-reported health. However, we observed variation in the leading predictors of dementia across racial/ethnic and gender groups such that at most four risk factors were consistently observed in the top ten predictors across the four demographic strata (non-Hispanic white men, non-Hispanic white women, non-Hispanic black men, non-Hispanic black women). Conclusions We identified leading risk factors across racial/ethnic and gender groups that predict incident dementia over a 14-year period among a nationally representative sample of US aged 51 years and older. Our ranked lists may be useful for guiding future observational and quasi-experimental research that investigates understudied domains of risk and emphasizes life course economic and health conditions as well as disparities therein.
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Affiliation(s)
- Jordan Weiss
- Population Studies Center and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail: (DHR); (JW)
| | - Eli Puterman
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Aric A. Prather
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, United States of America
| | - Erin B. Ware
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, United States of America
| | - David H. Rehkopf
- School of Medicine, Stanford University, Palo Alto, California, United States of America
- * E-mail: (DHR); (JW)
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Collin DF, Shields-Zeeman LS, Batra A, Vable AM, Rehkopf DH, Machen L, Hamad R. Short-term effects of the earned income tax credit on mental health and health behaviors. Prev Med 2020; 139:106223. [PMID: 32735990 PMCID: PMC7494578 DOI: 10.1016/j.ypmed.2020.106223] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/21/2019] [Revised: 06/16/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
Poverty has consistently been linked to poor mental health and risky health behaviors, yet few studies evaluate the effectiveness of programs and policies to address these outcomes by targeting poverty itself. We test the hypothesis that the earned income tax credit (EITC)-the largest U.S. poverty alleviation program-improves short-term mental health and health behaviors in the months immediately after income receipt. We conducted parallel analyses in two large longitudinal national data sets: the National Health Interview Survey (NHIS, 1997-2016, N = 379,603) and the Panel Study of Income Dynamics (PSID, 1985-2015, N = 29,808). Outcomes included self-rated health, psychological distress, tobacco use, and alcohol consumption. We employed difference-in-differences analysis, a quasi-experimental technique. We exploited seasonal variation in disbursement of the EITC, which is distributed as a tax refund every spring: we compared outcomes among EITC-eligible individuals interviewed immediately after refund receipt (Feb-Apr) with those interviewed in other months more distant from refund receipt (May-Jan), "differencing out" seasonal trends among non-eligible individuals. For most outcomes, we were unable to rule out the null hypothesis that there was no short-term effect of the EITC. Findings were cross-validated in both data sets. The exception was an increase in smoking in PSID, although this finding was not robust to sensitivity analyses. While we found no short-term "check effect" of the EITC on mental health and health behaviors, others have found long-term effects on these outcomes. This may be because recipients anticipate EITC receipt and smooth their income accordingly.
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Affiliation(s)
- Daniel F Collin
- Department of Family & Community Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Laura S Shields-Zeeman
- Department of Family & Community Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Akansha Batra
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States of America
| | - Anusha M Vable
- Department of Family & Community Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - David H Rehkopf
- Department of Medicine, Stanford University, Stanford, CA, United States of America
| | - Leah Machen
- Department of Medicine, University of California, San Francisco, CA, United States of America
| | - Rita Hamad
- Department of Family & Community Medicine, University of California San Francisco, San Francisco, CA, United States of America; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States of America.
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Hiatt RA, Engmann NJ, Balke K, Rehkopf DH. A Complex Systems Model of Breast Cancer Etiology: The Paradigm II Conceptual Model. Cancer Epidemiol Biomarkers Prev 2020; 29:1720-1730. [PMID: 32641370 DOI: 10.1158/1055-9965.epi-20-0016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/09/2020] [Accepted: 06/04/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The etiology of breast cancer is a complex system of interacting factors from multiple domains. New knowledge about breast cancer etiology continues to be produced by the research community, and the communication of this knowledge to other researchers, practitioners, decision makers, and the public is a challenge. METHODS We updated the previously published Paradigm model (PMID: 25017248) to create a framework that describes breast cancer etiology in four overlapping domains of biologic, behavioral, environmental, and social determinants. This new Paradigm II conceptual model was part of a larger modeling effort that included input from multiple experts in fields from genetics to sociology, taking a team and transdisciplinary approach to the common problem of describing breast cancer etiology for the population of California women in 2010. Recent literature was reviewed with an emphasis on systematic reviews when available and larger epidemiologic studies when they were not. Environmental chemicals with strong animal data on etiology were also included. RESULTS The resulting model illustrates factors with their strength of association and the quality of the available data. The published evidence supporting each relationship is made available herein, and also in an online dynamic model that allows for manipulation of individual factors leading to breast cancer (https://cbcrp.org/causes/). CONCLUSIONS The Paradigm II model illustrates known etiologic factors in breast cancer, as well as gaps in knowledge and areas where better quality data are needed. IMPACT The Paradigm II model can be a stimulus for further research and for better understanding of breast cancer etiology.
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Affiliation(s)
- Robert A Hiatt
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California. .,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | | | - Kaya Balke
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
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O’Leary D, Gross JJ, Rehkopf DH. Psychological Distress Mediates the Prospective Association of Household Income with Body Mass Index in Adolescent Girls. Affect Sci 2020; 1:97-106. [PMID: 36042968 PMCID: PMC9383009 DOI: 10.1007/s42761-020-00010-0] [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] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 04/28/2020] [Indexed: 06/15/2023]
Abstract
The primary objective of this study was to examine whether psychological distress mediates the relationship between income and increases in body mass index in adolescent girls. To answer this question, we analyzed data from 2379 participants in the longitudinal NHLBI Growth and Health Study using regularized regression and path analysis. The exposure was household income at age 9-10 and the outcome was body mass index at age 18-19. Income negatively predicted psychological distress, which in turn predicted psychological and behavioral factors that were associated with increases in body mass index. Overall, psychological distress and related variables accounted for around 20% of the relationship between income and increases in body mass index in adolescent girls. The impacts of income on a complex constellation of psychological risks for obesity support the evaluation of income support policies for reducing economic inequalities in obesity. Obesity reduction programs focused on changing psychological distress should be developed with consideration of the household economic environment.
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Affiliation(s)
- Daniel O’Leary
- Department of Psychology, Stanford University, Stanford, CA USA
| | - James J. Gross
- Department of Psychology, Stanford University, Stanford, CA USA
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34
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Abstract
This cross-sectional study of respondents to the Behavioral Risk Factor Surveillance System survey assesses trends between 2003 and 2017 in mental and physical health-related quality of life in low-income US individuals 60 years or older.
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Affiliation(s)
| | | | - John W. Rowe
- Columbia University Mailman School of Public Health, New York, New York
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35
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Hamad R, Nguyen TT, Glymour MM, Vable A, Manly JJ, Rehkopf DH. Quality and quantity: The association of state-level educational policies with later life cardiovascular disease. Prev Med 2019; 126:105750. [PMID: 31195021 PMCID: PMC6697595 DOI: 10.1016/j.ypmed.2019.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/17/2019] [Revised: 05/02/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
Education is a powerful predictor of cardiovascular morbidity and mortality. While the majority of the literature has focused on years of educational attainment or degree attainment, fewer studies examine the role of educational quality in the prevention of cardiovascular disease (CVD). We tested the hypothesis that average state-level educational quality was associated with CVD, linking state-level data on educational quality with individual demographic and health data from multiple waves of the National Health and Nutrition Examination Survey (N = 34,770). We examined thirteen CVD-related outcomes-including blood pressure, cholesterol, and heart attack-to understand the multiple pathways through which educational quality may influence CVD. The primary predictor was a composite index of educational quality, combining state-level measures of student-teacher ratios, per-pupil expenditures, and school term length. We fit multivariable models, regressing each outcome on the educational quality composite index and adjusting for individual- and state-level covariates. We also assessed whether the association between state educational quality and CVD differed for less educated individuals. Overall, higher educational quality was associated with less smoking (OR = 0.86, 95%CI: 0.77, 0.97), but there was no statistically significant association for the other 12 outcomes. Interaction tests indicated that less educated individuals benefited less from higher educational quality relative to those with more education for several outcomes. Our study suggests that state-level educational quality is not strongly associated with CVD, and that this null association overall may mask heterogeneous benefits that accrue disproportionately to those with higher levels of education.
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Affiliation(s)
- Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA; Department of Family & Community Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Thu T Nguyen
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - M Maria Glymour
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Anusha Vable
- Department of Family & Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer J Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain and the Department of Neurology, Columbia University Medical Center, New York City, New York, USA
| | - David H Rehkopf
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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36
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Hastings KG, Kapphahn K, Boothroyd DB, Rehkopf DH, Cullen MR, Palaniappan L. Transition From Heart Disease to Cancer as the Leading Cause of Death in the United States. Ann Intern Med 2019; 171:225. [PMID: 31382280 DOI: 10.7326/l19-0203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Katherine G Hastings
- Stanford University School of Medicine, Stanford, California (K.G.H., K.K., D.B.B., D.H.R., M.R.C., L.P.)
| | - Kristopher Kapphahn
- Stanford University School of Medicine, Stanford, California (K.G.H., K.K., D.B.B., D.H.R., M.R.C., L.P.)
| | - Derek B Boothroyd
- Stanford University School of Medicine, Stanford, California (K.G.H., K.K., D.B.B., D.H.R., M.R.C., L.P.)
| | - David H Rehkopf
- Stanford University School of Medicine, Stanford, California (K.G.H., K.K., D.B.B., D.H.R., M.R.C., L.P.)
| | - Mark R Cullen
- Stanford University School of Medicine, Stanford, California (K.G.H., K.K., D.B.B., D.H.R., M.R.C., L.P.)
| | - Latha Palaniappan
- Stanford University School of Medicine, Stanford, California (K.G.H., K.K., D.B.B., D.H.R., M.R.C., L.P.)
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Hamad R, Nguyen TT, Bhattacharya J, Glymour MM, Rehkopf DH. Educational attainment and cardiovascular disease in the United States: A quasi-experimental instrumental variables analysis. PLoS Med 2019; 16:e1002834. [PMID: 31237869 PMCID: PMC6592509 DOI: 10.1371/journal.pmed.1002834] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/21/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is ongoing debate about whether education or socioeconomic status (SES) should be inputs into cardiovascular disease (CVD) prediction algorithms and clinical risk adjustment models. It is also unclear whether intervening on education will affect CVD, in part because there is controversy regarding whether education is a determinant of CVD or merely correlated due to confounding or reverse causation. We took advantage of a natural experiment to estimate the population-level effects of educational attainment on CVD and related risk factors. METHODS AND FINDINGS We took advantage of variation in United States state-level compulsory schooling laws (CSLs), a natural experiment that was associated with geographic and temporal differences in the minimum number of years that children were required to attend school. We linked census data on educational attainment (N = approximately 5.4 million) during childhood with outcomes in adulthood, using cohort data from the 1992-2012 waves of the Health and Retirement Study (HRS; N = 30,853) and serial cross-sectional data from 1971-2012 waves of the National Health and Nutrition Examination Survey (NHANES; N = 44,732). We examined self-reported CVD outcomes and related risk factors, as well as relevant serum biomarkers. Using instrumental variables (IV) analysis, we found that increased educational attainment was associated with reduced smoking (HRS β -0.036, 95%CI: -0.06, -0.02, p < 0.01; NHANES β -0.032, 95%CI: -0.05, -0.02, p < 0.01), depression (HRS β -0.049, 95%CI: -0.07, -0.03, p < 0.01), triglycerides (NHANES β -0.039, 95%CI: -0.06, -0.01, p < 0.01), and heart disease (HRS β -0.025, 95%CI: -0.04, -0.002, p = 0.01), and improvements in high-density lipoprotein (HDL) cholesterol (HRS β 1.50, 95%CI: 0.34, 2.49, p < 0.01; NHANES β 0.86, 95%CI: 0.32, 1.48, p < 0.01), but increased BMI (HRS β 0.20, 95%CI: 0.002, 0.40, p = 0.05; NHANES β 0.13, 95%CI: 0.01, 0.32, p = 0.05) and total cholesterol (HRS β 2.73, 95%CI: 0.09, 4.97, p = 0.03). While most findings were cross-validated across both data sets, they were not robust to the inclusion of state fixed effects. Limitations included residual confounding, use of self-reported outcomes for some analyses, and possibly limited generalizability to more recent cohorts. CONCLUSIONS This study provides rigorous population-level estimates of the association of educational attainment with CVD. These findings may guide future implementation of interventions to address the social determinants of CVD and strengthen the argument for including educational attainment in prediction algorithms and primary prevention guidelines for CVD.
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Affiliation(s)
- Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, Department of Family & Community Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Thu T. Nguyen
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Jay Bhattacharya
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | - M. Maria Glymour
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - David H. Rehkopf
- Department of Medicine, Stanford University, Stanford, California, United States of America
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Luecke E, Cohen AK, Brillante M, Rehkopf DH, Coyle J, Hendrick CE, Abrams B. Similarities in Maternal Weight and Birth Weight Across Pregnancies and Across Sisters. Matern Child Health J 2019; 23:138-147. [PMID: 30032445 DOI: 10.1007/s10995-018-2602-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/19/2022]
Abstract
Objectives The current study examined how prepregnancy body mass index (BMI), gestational weight gain, and birth weight cluster between births within women and between women who are sisters. Methods Using data from the National Longitudinal Survey of Youth 1979 cohort, we utilized nested, multivariable hierarchical linear models to examine the correlation of these three outcomes between births (n = 6006) to women (n = 3605) and sisters (n = 3170) so that we can quantify the clustering by sibship and by woman for these three pregnancy-related outcomes. Results After controlling for confounding covariates, prepregnancy BMI (intraclass correlation (ICC) 0.24, 95% CI 0.16, 0.32), gestational weight gain (ICC 0.23, 95% CI 0.16, 0.31), and infant's birthweight (ICC 0.07, 95% CI 0.003, 0.13) were correlated between sisters. Additionally, all three outcomes were significantly correlated between births for each sister, suggesting that prepregnancy BMI (ICC 0.82, 95% CI 0.81, 0.83), gestational weight gain (ICC 0.45, 95% CI 0.42, 0.49), and birth weight (ICC 0.31, 95% CI 0.28, 0.35) track between pregnancies in the same woman. Conclusions for Practice The observed clustering both within women and between sisters suggests that shared genetic and environmental factors among sisters play a role in pregnancy outcomes above and beyond that of women's own genetic and environmental factors. Findings suggest that asking a woman about her sisters' pregnancy outcomes could provide insight into the possible outcomes for her current pregnancy. Future research should test if collecting such a family history and providing tailored clinical recommendations accordingly would be useful.
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Affiliation(s)
- Ellen Luecke
- RTI International, Women's Global Health Imperative, San Francisco, USA
| | - Alison K Cohen
- Department of Public and Nonprofit Administration, University of San Francisco, San Francisco, CA, USA
| | - Miranda Brillante
- University of California Berkeley School of Public Health, 50 University Hall, Berkeley, CA, 94720, USA
| | - David H Rehkopf
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, USA
| | - Jeremy Coyle
- University of California Berkeley School of Public Health, 50 University Hall, Berkeley, CA, 94720, USA
| | - C Emily Hendrick
- Division of Reproduction and Population Health, University of Wisconsin-Madison School of Medicine and Public Health, Madison, USA
| | - Barbara Abrams
- University of California Berkeley School of Public Health, 50 University Hall, Berkeley, CA, 94720, USA. .,Division of Epidemiology, UC Berkeley School of Public Health, 103 Haviland Hall, Berkeley, CA, 94720, USA.
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Hastings KG, Boothroyd DB, Kapphahn K, Hu J, Rehkopf DH, Cullen MR, Palaniappan L. Socioeconomic Differences in the Epidemiologic Transition From Heart Disease to Cancer as the Leading Cause of Death in the United States, 2003 to 2015: An Observational Study. Ann Intern Med 2018; 169:836-844. [PMID: 30422275 DOI: 10.7326/m17-0796] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recent data suggest that the United States is in the midst of an epidemiologic transition in the leading cause of death. OBJECTIVE To examine county-level sociodemographic differences in the transition from heart disease to cancer as the leading cause of death in the United States. DESIGN Observational study. SETTING U.S. death records, 2003 to 2015. PARTICIPANTS Decedents aged 25 years or older, classified by racial/ethnic group. MEASUREMENTS All-cause, heart disease, and cancer mortality stratified by quintiles of county median household income. Age- and sex-adjusted mortality rates and average annual percentage of change were calculated. RESULTS Heart disease was the leading cause of death in 79% of counties in 2003 and 59% in 2015. Cancer was the leading cause of death in 21% of counties in 2003 and 41% in 2015. The shift to cancer as the leading cause of death was greatest in the highest-income counties. Overall, heart disease mortality rates decreased by 28% (30% in high-income counties vs. 22% in low-income counties) from 2003 to 2015, and cancer mortality rates decreased by 16% (18% in high-income counties vs. 11% in low-income counties). In the lowest-income counties, heart disease remained the leading cause of death among all racial/ethnic groups, and improvements were smaller for both heart disease and cancer. LIMITATION Use of county median household income as a proxy for socioeconomic status. CONCLUSION Data show that heart disease is more likely to be the leading cause of death in low-income counties. Low-income counties have not experienced the same decrease in mortality rates as high-income counties, which suggests a later transition to cancer as the leading cause of death in low-income counties. PRIMARY FUNDING SOURCE National Institute on Minority Health and Health Disparities.
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Affiliation(s)
- Katherine G Hastings
- Stanford University School of Medicine, Stanford, California (K.G.H., D.B.B., K.K., J.H., D.H.R., M.R.C., L.P.)
| | - Derek B Boothroyd
- Stanford University School of Medicine, Stanford, California (K.G.H., D.B.B., K.K., J.H., D.H.R., M.R.C., L.P.)
| | - Kristopher Kapphahn
- Stanford University School of Medicine, Stanford, California (K.G.H., D.B.B., K.K., J.H., D.H.R., M.R.C., L.P.)
| | - Jiaqi Hu
- Stanford University School of Medicine, Stanford, California (K.G.H., D.B.B., K.K., J.H., D.H.R., M.R.C., L.P.)
| | - David H Rehkopf
- Stanford University School of Medicine, Stanford, California (K.G.H., D.B.B., K.K., J.H., D.H.R., M.R.C., L.P.)
| | - Mark R Cullen
- Stanford University School of Medicine, Stanford, California (K.G.H., D.B.B., K.K., J.H., D.H.R., M.R.C., L.P.)
| | - Latha Palaniappan
- Stanford University School of Medicine, Stanford, California (K.G.H., D.B.B., K.K., J.H., D.H.R., M.R.C., L.P.)
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40
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Hamad R, Collin DF, Rehkopf DH. Estimating the Short-Term Effects of the Earned Income Tax Credit on Child Health. Am J Epidemiol 2018; 187:2633-2641. [PMID: 30188968 DOI: 10.1093/aje/kwy179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 08/13/2018] [Indexed: 11/13/2022] Open
Abstract
The Earned Income Tax Credit (EITC) is the largest US poverty-alleviation program, yet few studies examine its effects on the health of recipients' children. We employed quasiexperimental techniques to test the hypothesis that EITC refund receipt is associated with short-term improvements in child health. The data set included children in families surveyed in the Third National Health and Nutrition Examination Survey (n = 7,444). We employed a difference-in-differences approach, exploiting the seasonal nature of EITC refund receipt. We compared children of EITC-eligible families interviewed immediately after refund receipt (February to April) with those interviewed during other months (May to January), differencing out seasonal variation among non-EITC-eligible families. We examined outcomes that were likely to be affected immediately after refund receipt, including general health, nutrition, metabolic and inflammatory biomarkers, and test scores. There were improvements in physician-reported overall health after refund receipt but no changes in infection, serum metabolic or inflammatory markers, or test scores, and there were contradictory findings for food insufficiency. In summary, EITC refunds are not strongly associated with most short-term health outcomes among recipients' children, although numerous previous studies have demonstrated impacts on longer-term outcomes. This highlights the importance of examining the effects of public policies on beneficiaries and their children using varying study designs.
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Affiliation(s)
- Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Daniel F Collin
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - David H Rehkopf
- Department of Medicine, School of Medicine, Stanford University, Palo Alto, California
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Hamad R, Elser H, Tran DC, Rehkopf DH, Goodman SN. How and why studies disagree about the effects of education on health: A systematic review and meta-analysis of studies of compulsory schooling laws. Soc Sci Med 2018; 212:168-178. [PMID: 30036767 PMCID: PMC6209316 DOI: 10.1016/j.socscimed.2018.07.016] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [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: 01/11/2018] [Revised: 07/06/2018] [Accepted: 07/10/2018] [Indexed: 12/11/2022]
Abstract
Rich literatures across multiple disciplines document the association between increased educational attainment and improved health. While quasi-experimental studies have exploited variation in educational policies to more rigorously estimate the health effects of education, there remains disagreement about whether education and health are causally linked. The aim of this study was to conduct a systematic review and meta-analysis to characterize this literature, with a focus on quasi-experimental studies of compulsory schooling laws (CSLs). Articles from 1990 to 2015 were obtained through electronic searches and manual searches of reference lists. We searched for English-language studies and included manuscripts if: (1) they involved original data analysis; (2) outcomes were health-related; and (3) the primary predictor utilized variation in CSLs. We identified 89 articles in 25 countries examining over 25 health outcomes, with over 600 individual point estimates. We systematically characterized heterogeneity on key study design features and conducted a meta-analysis of studies with comparable health outcome and exposure variables. Within countries, studies differed in terms of birth cohorts included, the measurement of health outcomes within a given category, and the type of CSL variation examined. Over 90% of manuscripts included multiple analytic techniques, such as econometric and standard regression methods, with as many as 31 "primary" models in a single study. A qualitative synthesis of study findings indicated that educational attainment has an effect on the majority of health outcomes-most beneficial, some negative-while the meta-analysis demonstrated small beneficial effects for mortality, smoking, and obesity. Future work could focus on inconsistent findings identified by this study, or review the health effects of other types of educational policies.
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Affiliation(s)
- Rita Hamad
- University of California San Francisco, Philip R. Lee Institute for Health Policy Studies, Department of Family & Community Medicine, 995 Potrero Avenue, Building 80, Ward 83, San Francisco, CA, 94110, USA.
| | - Holly Elser
- University of California Berkeley, School of Public Health, Division of Epidemiology, Berkeley, CA, USA; Stanford University, School of Medicine, Stanford, CA, USA
| | - Duy C Tran
- Stanford University, School of Medicine, Stanford, CA, USA
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Affiliation(s)
- David H Rehkopf
- From the Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Sanjay Basu
- Division of Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA
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Rehkopf DH, Modrek S, Cantley LF, Cullen MR. Social, Psychological, And Physical Aspects Of The Work Environment Could Contribute To Hypertension Prevalence. Health Aff (Millwood) 2018; 36:258-265. [PMID: 28167714 DOI: 10.1377/hlthaff.2016.1186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Studies on the physical and social characteristics of the workplace have begun to provide evidence for the role of specific workplace factors on health. However, the overall contribution of the workplace to health has not been considered. Estimates of the influences on health across domains of the work environment are a critical first step toward understanding what level of priority the workplace should take as the target for public policies to improve health. The influences or contribution of these domains on health in the work environment are particularly useful to study since they are potentially modifiable through changes in policies and environment. Our analysis used detailed data from blue-collar industrial workers at two dozen Alcoa plants. It includes work environmental measures of psychological hazards, physical hazards, and the workplace social environment, to estimate the overall importance of the workplace environment for hypertension. Our findings suggest that social, psychological, and physical aspects of the work environment could contribute to a substantial proportion of hypertension prevalence. These attributes of the workplace could thus be a useful target for improving workforce health.
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Affiliation(s)
- David H Rehkopf
- David H. Rehkopf is an assistant professor in the Division of General Medicine Disciplines at Stanford Medicine, Stanford University, in California
| | - Sepideh Modrek
- Sepideh Modrek is an assistant professor in the Department of Economics, College of Business, at San Francisco State University, in California
| | - Linda F Cantley
- Linda F. Cantley is a lecturer at the Yale University School of Medicine, in New Haven, Connecticut
| | - Mark R Cullen
- Mark R. Cullen is a professor in the Division of General Medicine Disciplines, Stanford Medicine, Stanford University
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Abstract
We interrogate state-level clustering of polygenic scores at different points in the life course and variation in the association of mean polygenic scores in a respondent's state of birth with corresponding phenotypes. The polygenic scores for height and smoking show the most state-level clustering (2 to 4 percent) with relatively little clustering observed for the other scores. However, even the small amounts of observed clustering are potentially meaningful. The state-mean polygenic score for educational attainment is strongly associated with an individual's educational attainment net of that person's polygenic score. The ecological clustering of polygenic scores may denote a new environmental factor in gene-environment research. We conclude by discussing possible mechanisms that underlie this association and the implications of our findings for social and genetic research.
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Affiliation(s)
| | - David H Rehkopf
- is assistant professor of medicine at the Stanford University School of Medicine
| | | | - Jason D Boardman
- is professor in the Department of Sociology and director of the Health and Society Program in the Institute of Behavioral Science at the University of Colorado at Boulder
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Thompson CA, Boothroyd DB, Hastings KG, Cullen MR, Palaniappan LP, Rehkopf DH. A Multiple-Imputation "Forward Bridging" Approach to Address Changes in the Classification of Asian Race/Ethnicity on the US Death Certificate. Am J Epidemiol 2018; 187:347-357. [PMID: 29401361 DOI: 10.1093/aje/kwx215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 08/09/2016] [Accepted: 03/31/2017] [Indexed: 12/18/2022] Open
Abstract
The incomparability of old and new classification systems for describing the same data can be seen as a missing-data problem, and, under certain assumptions, multiple imputation may be used to "bridge" 2 classification systems. One example of such a change is the introduction of detailed Asian-American race/ethnicity classifications on the 2003 version of the US national death certificate, which was adopted for use by 38 states between 2003 and 2011. Using county- and decedent-level data from 3 different national sources for pre- and postadoption years, we fitted within-state multiple-imputation models to impute ethnicities for decedents classified as "other Asian" during preadoption years. We present mortality rates derived using 3 different methods of calculation: 1) including all states but ignoring the gradual adoption of the new death certificate over time, 2) including only the 7 states with complete reporting of all ethnicities, and 3) including all states and applying multiple imputation. Estimates from our imputation model were consistently in the middle of the other 2 estimates, and trend results demonstrated that the year-by-year estimates of the imputation model were more similar to those of the 7-state model. This work demonstrates how multiple imputation can provide a "forward bridging" approach to make more accurate estimates over time in newly categorized populations.
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Affiliation(s)
- Caroline A Thompson
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, California
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Derek B Boothroyd
- Quantitative Sciences Unit, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Katherine G Hastings
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Mark R Cullen
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Latha P Palaniappan
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - David H Rehkopf
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
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Rehkopf DH, Burmaster K, Landefeld JC, Adler-Milstein S, Flynn EP, Acevedo MC, Jones-Smith JC, Adler N, Fernald LCH. The impact of a private sector living wage intervention on consumption and cardiovascular disease risk factors in a middle income country. BMC Public Health 2018; 18:179. [PMID: 29370797 PMCID: PMC5785889 DOI: 10.1186/s12889-018-5052-2] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 01/10/2018] [Indexed: 11/25/2022] Open
Abstract
Background A positive association of socioeconomic position and health is well established in high-income countries. In poorer nations, however, higher income individuals often have more cardiovascular risk factors (including obesity) than do those with less income. Our study goal was to estimate the effects of receiving a living wage (340% higher income) on short-term changes in consumption and cardiovascular risk factors among low-wage workers in a middle-income country. Methods This cross-sectional study matched workers at an apparel factory (n=105) in the Dominican Republic with those at a similar factory (n=99) nearby, 15 months after the intervention factory introduced a substantially higher living wage. Statistical matching on non-time varying individual characteristics (childhood health, childhood living conditions, work experience, demographic factors) strengthened causal inference. Primary outcomes were blood pressure (systolic and diastolic), pulse rate, body mass index and waist circumference. Secondary outcomes were dietary consumption and spending on services, consumables and durable goods. Results Receiving the living wage was associated with increased consumption of protein, dairy, soda and juice and sugars, but not with cardiovascular risk factors. Intervention factory workers spent more on grocery items and household durable goods. Conclusions While having a higher income in a middle-income country might be expected to increase obesity and its associated health risks, the current study found no short-term negative associations. There may be possible longer-term negative health consequences of increases in consumption of soda, juice and sugars, however. It is important to consider complementary interventions to support healthy dietary intake in areas with increasing wages. Electronic supplementary material The online version of this article (10.1186/s12889-018-5052-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David H Rehkopf
- Division of Primary Care & Population Health, Stanford University, Stanford, CA, USA.
| | | | - John C Landefeld
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | | | | | - Jessica C Jones-Smith
- Department of Health Services & Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Nancy Adler
- Center for Health and Community, University of California San Francisco, San Francisco, CA, USA
| | - Lia C H Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
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Myers J, Doom R, King R, Fonda H, Chan K, Kokkinos P, Rehkopf DH. Association Between Cardiorespiratory Fitness and Health Care Costs: The Veterans Exercise Testing Study. Mayo Clin Proc 2018; 93:48-55. [PMID: 29195922 DOI: 10.1016/j.mayocp.2017.09.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine the association between cardiorespiratory fitness (CRF) and annual health care costs in Veterans. PATIENTS AND METHODS The sample included 9942 subjects (mean age, 59±11 years) undergoing a maximal exercise test for clinical reasons between January 2005 and December 2012. Cardiorespiratory fitness, expressed as a percentage of age-predicted peak metabolic equivalents (METs) achieved, was categorized in quartiles. Total and annualized health care costs, derived from the Veterans Administration Allocated Resource Center, were compared using multiple regression, controlling for demographic and clinical characteristics. RESULTS A gradient for reduced health care costs was observed as CRF increased, with subjects in the least-fit quartile having approximately $14,662 (P<.001) higher overall costs per patient per year compared with those in the fittest quartile, after controlling for potential confounding variables. Each 1-MET higher increment in fitness was associated with a $1592 annual reduction in health care costs (5.6% lower cost per MET), and each higher quartile of fitness was associated with a $4163 annual cost reduction per patient. The effect of CRF was more pronounced among subjects without cardiovascular disease (CVD), suggesting that the results were not driven by the possibility that less-fit individuals had greater CVD. Cost savings attributable to higher fitness were greatest in overweight and obese subjects, with lower savings observed among those individuals with a body mass index less than 25 kg/m2. In a model including historical, clinical, and exercise test responses, heart failure was the strongest predictor of health care costs, followed by CRF (P<.01). CONCLUSION Low CRF is associated with higher health care costs. Efforts to improve CRF may not only improve health but also result in lower health care costs.
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Affiliation(s)
- Jonathan Myers
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Division of Cardiovascular Medicine, Stanford University, Stanford, CA.
| | - Rachelle Doom
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Robert King
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Holly Fonda
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Khin Chan
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | | | - David H Rehkopf
- Division of Clinical Medicine & Population Health, Stanford University, Stanford, CA
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48
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Pega F, Valentine NB, Rasanathan K, Hosseinpoor AR, Torgersen TP, Ramanathan V, Posayanonda T, Röbbel N, Kalboussi Y, Rehkopf DH, Dora C, Montesinos ERV, Neira MP. The need to monitor actions on the social determinants of health. Bull World Health Organ 2017; 95:784-787. [PMID: 29147060 PMCID: PMC5677605 DOI: 10.2471/blt.16.184622] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 06/22/2017] [Accepted: 06/25/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Frank Pega
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Nicole B Valentine
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Kumanan Rasanathan
- Health Section, United Nations Children's Fund (UNICEF), New York, NY 10017, United States of America (USA)
| | - Ahmad Reza Hosseinpoor
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Tone P Torgersen
- Department of Social Determinants of Health, Norwegian Directorate of Health, Oslo, Norway
| | | | | | - Nathalie Röbbel
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Yassine Kalboussi
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Carlos Dora
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Eugenio R Villar Montesinos
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Maria P Neira
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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Abrams B, Coyle J, Cohen AK, Headen I, Hubbard A, Ritchie L, Rehkopf DH. Excessive Gestational Weight Gain and Subsequent Maternal Obesity at Age 40: A Hypothetical Intervention. Am J Public Health 2017; 107:1463-1469. [PMID: 28727522 PMCID: PMC5551596 DOI: 10.2105/ajph.2017.303881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Accepted: 04/26/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To model the hypothetical impact of preventing excessive gestational weight gain on midlife obesity and compare the estimated reduction with the US Healthy People 2020 goal of a 10% reduction of obesity prevalence in adults. METHODS We analyzed 3917 women with 1 to 3 pregnancies in the prospective US National Longitudinal Survey of Youth, from 1979 to 2012. We compared the estimated obesity prevalence between 2 scenarios: gestational weight gain as reported and under the scenario of a hypothetical intervention that all women with excessive gestational weight gain instead gained as recommended by the Institute of Medicine (2009). RESULTS A hypothetical intervention was associated with a significantly reduced estimated prevalence of obesity for first (3.3 percentage points; 95% confidence interval [CI] = 1.0, 5.6) and second (3.0 percentage points; 95% CI = 0.7, 5.2) births, and twice as high in Black as in White mothers, but not significant in Hispanics. The population attributable fraction was 10.7% (95% CI = 3.3%, 18.1%) in first and 9.3% (95% CI = 2.2%, 16.5%) in second births. CONCLUSIONS Development of effective weight-management interventions for childbearing women could lead to meaningful reductions in long-term obesity.
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Affiliation(s)
- Barbara Abrams
- Barbara Abrams, Alison K. Cohen, and Irene Headen are with the Division of Epidemiology, School of Public Health, University of California, Berkeley. Jeremy Coyle and Alan Hubbard are with the Division of Biostatistics, School of Public Health, University of California, Berkeley. Lorrene Ritchie is with the Nutrition Policy Institute, Agriculture and Natural Resources, University of California, Oakland. David H. Rehkopf is with the Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, CA
| | - Jeremy Coyle
- Barbara Abrams, Alison K. Cohen, and Irene Headen are with the Division of Epidemiology, School of Public Health, University of California, Berkeley. Jeremy Coyle and Alan Hubbard are with the Division of Biostatistics, School of Public Health, University of California, Berkeley. Lorrene Ritchie is with the Nutrition Policy Institute, Agriculture and Natural Resources, University of California, Oakland. David H. Rehkopf is with the Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, CA
| | - Alison K Cohen
- Barbara Abrams, Alison K. Cohen, and Irene Headen are with the Division of Epidemiology, School of Public Health, University of California, Berkeley. Jeremy Coyle and Alan Hubbard are with the Division of Biostatistics, School of Public Health, University of California, Berkeley. Lorrene Ritchie is with the Nutrition Policy Institute, Agriculture and Natural Resources, University of California, Oakland. David H. Rehkopf is with the Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, CA
| | - Irene Headen
- Barbara Abrams, Alison K. Cohen, and Irene Headen are with the Division of Epidemiology, School of Public Health, University of California, Berkeley. Jeremy Coyle and Alan Hubbard are with the Division of Biostatistics, School of Public Health, University of California, Berkeley. Lorrene Ritchie is with the Nutrition Policy Institute, Agriculture and Natural Resources, University of California, Oakland. David H. Rehkopf is with the Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, CA
| | - Alan Hubbard
- Barbara Abrams, Alison K. Cohen, and Irene Headen are with the Division of Epidemiology, School of Public Health, University of California, Berkeley. Jeremy Coyle and Alan Hubbard are with the Division of Biostatistics, School of Public Health, University of California, Berkeley. Lorrene Ritchie is with the Nutrition Policy Institute, Agriculture and Natural Resources, University of California, Oakland. David H. Rehkopf is with the Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, CA
| | - Lorrene Ritchie
- Barbara Abrams, Alison K. Cohen, and Irene Headen are with the Division of Epidemiology, School of Public Health, University of California, Berkeley. Jeremy Coyle and Alan Hubbard are with the Division of Biostatistics, School of Public Health, University of California, Berkeley. Lorrene Ritchie is with the Nutrition Policy Institute, Agriculture and Natural Resources, University of California, Oakland. David H. Rehkopf is with the Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, CA
| | - David H Rehkopf
- Barbara Abrams, Alison K. Cohen, and Irene Headen are with the Division of Epidemiology, School of Public Health, University of California, Berkeley. Jeremy Coyle and Alan Hubbard are with the Division of Biostatistics, School of Public Health, University of California, Berkeley. Lorrene Ritchie is with the Nutrition Policy Institute, Agriculture and Natural Resources, University of California, Oakland. David H. Rehkopf is with the Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, CA
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50
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Abstract
BACKGROUND Women's experience of childhood adversity may contribute to their children's risk of obesity. Possible causal pathways include higher maternal weight and gestational weight gain, which have been associated with both maternal childhood adversity and obesity in offspring. METHODS This study included 6718 mother-child pairs from the National Longitudinal Survey of Youth 1979 in the United States (1979-2012). We applied multiple log-binomial regression models to estimate associations between three markers of childhood adversity (physical abuse, household alcoholism, and household mental illness) and offspring obesity in childhood. We estimated natural direct effects to evaluate mediation by prepregnancy BMI and gestational weight gain. RESULTS Among every 100 mothers who reported physical abuse in childhood, there were 3.7 (95% confidence interval: -0.1 to 7.5) excess cases of obesity in 2- to 5-year olds compared with mothers who did not report physical abuse. Differences in prepregnancy BMI, but not gestational weight gain, accounted for 25.7% of these excess cases. There was no evidence of a similar relationship for household alcoholism or mental illness or for obesity in older children. CONCLUSIONS In this national, prospective cohort study, prepregnancy BMI partially explained an association between maternal physical abuse in childhood and obesity in preschool-age children. These findings underscore the importance of life-course exposures in the etiology of child obesity and the potential multi-generational consequences of child abuse. Research is needed to determine whether screening for childhood abuse and treatment of its sequelae could strengthen efforts to prevent obesity in mothers and their children.
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Affiliation(s)
| | - Lucia C. Petito
- Division of Biostatistics, University of California, Berkeley, CA
| | - David H. Rehkopf
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA
| | - Lorrene D. Ritchie
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, Berkeley, CA
| | - Barbara Abrams
- Division of Epidemiology, University of California, Berkeley, CA
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