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Debertin JG, Holzhausen EA, Walker DI, Pacheco BP, James KA, Alderete TL, Corlin L. Associations between metals and metabolomic profiles related to diabetes among adults in a rural region. Environ Res 2024; 243:117776. [PMID: 38043890 PMCID: PMC10872433 DOI: 10.1016/j.envres.2023.117776] [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] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/06/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Exposure to metals is associated with increased risk of type 2 diabetes (T2D). Potential mechanisms for metals-T2D associations involve biological processes including oxidative stress and disruption of insulin-regulated glucose uptake. In this study, we assessed whether associations between metal exposure and metabolite profiles relate to biological pathways linked to T2D. MATERIALS AND METHODS We used data from 29 adults rural Colorado residents enrolled in the San Luis Valley Diabetes Study. Urinary concentrations of arsenic, cadmium, cobalt, lead, manganese, and tungsten were measured. Metabolic effects were evaluated using untargeted metabolic profiling, which included 61,851 metabolite signals detected in serum. We evaluated cross-sectional associations between metals and metabolites present in at least 50% of samples. Primary analyses adjusted urinary heavy metal concentrations for creatinine. Metabolite outcomes associated with each metal exposure were evaluated using pathway enrichment to investigate potential mechanisms underlying the relationship between metals and T2D. RESULTS Participants had a mean age of 58.5 years (standard deviation = 9.2), 48.3% were female, 48.3% identified as Hispanic/Latino, 13.8% were current smokers, and 65.5% had T2D. Of the detected metabolites, 455 were associated with at least one metal, including 42 associated with arsenic, 22 with cadmium, 10 with cobalt, 313 with lead, 66 with manganese, and two with tungsten. The metabolic features were linked to 24 pathways including linoleate metabolism, butanoate metabolism, and arginine and proline metabolism. Several of these pathways have been previously associated with T2D, and our results were similar when including only participants with T2D. CONCLUSIONS Our results support the hypothesis that metals exposure may be associated with biological processes related to T2D, including amino acid, co-enzyme, and sugar and fatty acid metabolism. Insight into biological pathways could influence interventions to prevent adverse health outcomes due to metal exposure.
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Affiliation(s)
- Julia G Debertin
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA; Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| | | | - Douglas I Walker
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Brismar Pinto Pacheco
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine A James
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Tanya L Alderete
- Department of Integrative Physiology, University of Colorado, Boulder, CO, USA
| | - Laura Corlin
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA; Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, MA, USA
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2
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Sears CG, Healy EJ, Soares LF, Palermo D, Eliot M, Li Y, Fruh V, Babalola T, James KA, Harrington JM, Wellenius GA, Tjønneland A, Raaschou-Nielsen O, Meliker JR. Urine antimony and risk of cardiovascular disease - A prospective case-cohort study in Danish Non-Smokers. Environ Int 2023; 181:108269. [PMID: 37866238 DOI: 10.1016/j.envint.2023.108269] [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] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/27/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Limited evidence suggests that antimony induces vascular inflammation and oxidative stress and may play a role in cardiovascular disease (CVD) risk. However, few studies have examined whether environmental antimony from sources other than tobacco smoking is related with CVD risk. The general population may be exposed through air, drinking water, and food that contains antimony from natural and anthropogenic sources, such as mining, coal combustion, and manufacturing. OBJECTIVES To examine the association of urine antimony with incident acute myocardial infarction (AMI), heart failure, and stroke among people who never smoked tobacco. METHODS Between 1993 and 1997, the Danish Diet, Cancer and Health (DCH) cohort enrolled participants (ages 50-64 years), including n = 19,394 participants who reported never smoking at baseline. Among these never smokers, we identified incident cases of AMI (N = 809), heart failure (N = 958), and stroke (N = 534) using the Danish National Patient Registry. We also randomly selected a subcohort of 600 men and 600 women. We quantified urine antimony concentrations in samples provided at enrollment. We used modified Cox proportional hazards models to estimate adjusted hazard ratios (HR) for each incident CVD outcome in relation to urine antimony, statistically adjusted for creatinine. We used a separate prospective cohort, the San Luis Valley Diabetes Study (SLVDS), to replicate these results. RESULTS In the DCH cohort, urine antimony concentrations were positively associated with rates of AMI and heart failure (HR = 1.52; 95%CI = 1.12, 2.08 and HR = 1.58; 95% CI = 1.15, 2.18, respectively, comparing participants in the highest (>0.09 µg/L) with the lowest quartile (<0.02 µg/L) of antimony). In the SLVDS cohort, urinary antimony was positively associated with AMI, but not heart failure. DISCUSSION Among this sample of Danish people who never smoked, we found that low levels of urine antimony are associated with incident CVD. These results were partially confirmed in a smaller US cohort.
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Affiliation(s)
- Clara G Sears
- Christina Lee Brown Envirome Institute, Division of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, KY, USA; Department of Epidemiology, Brown University, Providence, RI, USA.
| | - Erin J Healy
- Department of Medical Informatics, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Lissa F Soares
- Program in Public Health, Department of Family, Population, & Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Dana Palermo
- Program in Public Health, Department of Family, Population, & Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Melissa Eliot
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Yaqiang Li
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, USA
| | - Victoria Fruh
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Tesleem Babalola
- Program in Public Health, Department of Family, Population, & Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Katherine A James
- Department of Family Medicine, University of Colorado Denver, Denver, CO, USA
| | - James M Harrington
- Analytical Science Division, RTI International, Research Triangle Park, NC, USA
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | - Jaymie R Meliker
- Program in Public Health, Department of Family, Population, & Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
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3
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Grover EN, Allshouse WB, Lund AJ, Liu Y, Paull SH, James KA, Crooks JL, Carlton EJ. Open-source environmental data as an alternative to snail surveys to assess schistosomiasis risk in areas approaching elimination. Int J Health Geogr 2023; 22:12. [PMID: 37268933 DOI: 10.1186/s12942-023-00331-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/26/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Although the presence of intermediate snails is a necessary condition for local schistosomiasis transmission to occur, using them as surveillance targets in areas approaching elimination is challenging because the patchy and dynamic quality of snail host habitats makes collecting and testing snails labor-intensive. Meanwhile, geospatial analyses that rely on remotely sensed data are becoming popular tools for identifying environmental conditions that contribute to pathogen emergence and persistence. METHODS In this study, we assessed whether open-source environmental data can be used to predict the presence of human Schistosoma japonicum infections among households with a similar or improved degree of accuracy compared to prediction models developed using data from comprehensive snail surveys. To do this, we used infection data collected from rural communities in Southwestern China in 2016 to develop and compare the predictive performance of two Random Forest machine learning models: one built using snail survey data, and one using open-source environmental data. RESULTS The environmental data models outperformed the snail data models in predicting household S. japonicum infection with an estimated accuracy and Cohen's kappa value of 0.89 and 0.49, respectively, in the environmental model, compared to an accuracy and kappa of 0.86 and 0.37 for the snail model. The Normalized Difference in Water Index (an indicator of surface water presence) within half to one kilometer of the home and the distance from the home to the nearest road were among the top performing predictors in our final model. Homes were more likely to have infected residents if they were further from roads, or nearer to waterways. CONCLUSION Our results suggest that in low-transmission environments, leveraging open-source environmental data can yield more accurate identification of pockets of human infection than using snail surveys. Furthermore, the variable importance measures from our models point to aspects of the local environment that may indicate increased risk of schistosomiasis. For example, households were more likely to have infected residents if they were further from roads or were surrounded by more surface water, highlighting areas to target in future surveillance and control efforts.
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Affiliation(s)
- Elise N Grover
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - William B Allshouse
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Andrea J Lund
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Yang Liu
- Institute of Parasitic Diseases, Sichuan Center for Disease Control and Prevention, Chengdu, China.
| | - Sara H Paull
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Katherine A James
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - James L Crooks
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, USA
| | - Elizabeth J Carlton
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA.
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Baraghoshi D, Niswander C, Strand M, Wheat S, Ramstetter J, Stoll N, Fox J, James KA. Exacerbation of Renal, Cardiovascular, and Respiratory Outcomes Associated with Changes in Climate. Yale J Biol Med 2023; 96:159-169. [PMID: 37396983 PMCID: PMC10303263 DOI: 10.59249/kydf6093] [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] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Exposure to environmental variables including declining air quality and increasing temperatures can exert detrimental effects on human health including acute exacerbations of chronic diseases. We aim to investigate the association between these exposures and acute health outcomes in a rural community in Colorado. Meteorological and adult emergency department visit data were retrospectively collected (2013-2017); for asthma outcomes, additional data were available (2003-2017). Daily environmental exposure data included PM10, maximum daily temperature (MDT), and mean humidity and precipitation. Total daily counts of emergency department (ED) diagnoses for myocardial infarction, congestive heart failure, urolithiasis, and exacerbation of chronic obstructive pulmonary disease (COPD) and asthma, were calculated during the study period. Time series models using generalized estimating equations were fit for each disease and included all four environmental factors. Between 2013 and 2017, asthma and COPD exacerbation accounted for 30.8% and 25.4% of all ED visits (n=5,113), respectively. We found that for every 5˚C increase in MDT, the rate of urolithiasis visits increased by 13% (95% CI: 2%, 26%) and for every 10μg/m3 increase in 3-day moving average PM10, the rate of urolithiasis visits increased by 7% (95% CI: 1%, 13%). The magnitude of association between 3-day moving average PM10 and rate of urolithiasis visits increased with increasing MDT. The rate of asthma exacerbation significantly increased as 3-day, 7-day, and 21-day moving average PM10 increased. This retrospective study on ED visits is one of the first to investigate the impact of several environmental exposures on adverse health outcomes in a rural community. Research into mitigating the negative impacts of these environmental exposures on health outcomes is needed.
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Affiliation(s)
- David Baraghoshi
- Division of Biostatistics and Bioinformatics, National
Jewish Health, Denver, CO, USA
| | - Cameron Niswander
- University of Colorado School of Medicine, Aurora, CO,
USA
- Department of Environmental and Occupational Health,
Colorado School of Public Health, Aurora, CO, USA
| | - Matthew Strand
- Division of Biostatistics and Bioinformatics, National
Jewish Health, Denver, CO, USA
| | - Stefan Wheat
- Department of Emergency Medicine, University of
Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | | | - Nicholas Stoll
- Department of Environmental and Occupational Health,
Colorado School of Public Health, Aurora, CO, USA
| | - Jacob Fox
- University of Colorado School of Medicine, Aurora, CO,
USA
- Department of Environmental and Occupational Health,
Colorado School of Public Health, Aurora, CO, USA
| | - Katherine A. James
- Department of Environmental and Occupational Health,
Colorado School of Public Health, Aurora, CO, USA
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5
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Neumann NR, Butler-Dawson J, Krisher L, Jaramillo D, Pilloni D, Waite G, Li Y, Wittels SB, Schilling K, Newman LS, James KA. Urinary concentrations of metals before and after volcanic eruption: a natural experiment surrounding the eruption of Volcán de Fuego, 2018. Environ Geochem Health 2023; 45:2461-2472. [PMID: 35997967 PMCID: PMC11078547 DOI: 10.1007/s10653-022-01338-1] [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] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/17/2022] [Indexed: 06/15/2023]
Abstract
Volcanic eruptions increase environmental heavy metal concentrations, yet little research has been performed on their extrapulmonary human health effects. We fortuitously collected biological samples in a cohort of Guatemalan sugarcane cutters in the area surrounding Volcán de Fuego before and after the June 2018 eruption. We sought to determine whether stratovolcanic activity was associated with changes in urinary concentrations of heavy metals in a cohort of sugarcane workers. In this exploratory analysis, we found significant increases in urinary arsenic, (β = 1.46, P < 0.0001), cadmium (β = 1.03, P < 0.0001), and lead (β = 0.87, P = 0.003) in participants with residential proximity to Volcán de Fuego as compared to participants farther away, suggesting that volcanic activity could be associated with acute heavy metal exposures. This natural experiment is, to our knowledge, the first of its kind and suggests a need for more research into heavy metal exposure-related health impacts of volcanic eruptions.
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Affiliation(s)
- Natalie R Neumann
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Jaime Butler-Dawson
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Lyndsay Krisher
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Diana Jaramillo
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | | | - Greg Waite
- Department of Geological and Mining Engineering and Sciences, Michigan Technological University, Houghton, MI, USA
| | - Yaqiang Li
- Community and Behavioral Health Department, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | | | - Kathrin Schilling
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Lee S Newman
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Katherine A James
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
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6
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Dally M, Suresh K, Van Dyke M, James KA, Bauer AK, Krisher L, Newman LS. Occurrence of Occupational Injuries and Within Day Changes in Wet Bulb Temperature Among Sugarcane Harvesters. J Agromedicine 2023; 28:523-531. [PMID: 36650099 DOI: 10.1080/1059924x.2023.2169425] [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] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Climate change has implications for human health worldwide, with workers in outdoor occupations in low- to middle-income countries shouldering the burden of increasing average temperatures and more frequent extreme heat days. An overlooked aspect of the human health impact is the relationship between heat exposure and increased risk of occupational injury. In this study, we examined the association between occupational injury occurrence and changes in outdoor temperatures through the workday among a cohort of Guatemalan sugarcane harvesters. METHODS Occupational injuries recorded for the 2014/2015 to 2017/2018 harvest seasons were collected from a large agribusiness employing male sugarcane harvesters in Southwest Guatemala. Wet Bulb Globe Temperature (WBGT) for the same period was collected from the El Balsamo weather station. We used a logistic mixed effects model to examine the association between injury occurrence and (1) the average WBGT during the hour injury was recorded, (2) the average WBGT during the hour prior to the injury being recorded, and (3) the change in the hourly average WBGT prior to the injury being recorded. RESULTS There were 155 injuries recorded during the study period. Injuries were recorded most often between 14:00 and 16:00 (n = 62, 40%) followed by 8:00 and 10:00 (n = 56, 36%). There were significant differences in the average hourly WBGT and the hour in which injuries were recorded (p-value <.001). There were no observable associations between average hourly WBGT (OR: 1.00, 95%CI: 0.94, 1.05; p-value: 0.87), lagged average hourly WBGT (OR: 1.01, 95%CI: 0.97, 1.05; p-value: 0.71), or change in average hourly WBGT (OR: 0.96, 95%CI: 0.89, 1.04; p-value: 0.35) and recorded occupational injury. CONCLUSIONS This is the first study that has examined how changes in WBGT throughout the day are related to occupational injury among agricultural workers. Although this study did not demonstrate an association, there is a need for future research to examine how various measurements of WBGT exposure are related to occupational injury in agricultural worker populations.
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Affiliation(s)
- Miranda Dally
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Krithika Suresh
- Department of Biostatistics & Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mike Van Dyke
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Katherine A James
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alison K Bauer
- Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lyndsay Krisher
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lee S Newman
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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7
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Riseberg E, Melamed RD, James KA, Alderete TL, Corlin L. Development and application of an evidence-based directed acyclic graph to evaluate the associations between metal mixtures and cardiometabolic outcomes. Epidemiol Methods 2023; 12:20220133. [PMID: 37377511 PMCID: PMC10292771 DOI: 10.1515/em-2022-0133] [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: 08/30/2022] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
Objectives Specifying causal models to assess relationships among metal mixtures and cardiometabolic outcomes requires evidence-based models of the causal structures; however, such models have not been previously published. The objective of this study was to develop and evaluate a directed acyclic graph (DAG) diagraming metal mixture exposure and cardiometabolic outcomes. Methods We conducted a literature search to develop the DAG of metal mixtures and cardiometabolic outcomes. To evaluate consistency of the DAG, we tested the suggested conditional independence statements using linear and logistic regression analyses with data from the San Luis Valley Diabetes Study (SLVDS; n=1795). We calculated the proportion of statements supported by the data and compared this to the proportion of conditional independence statements supported by 1,000 DAGs with the same structure but randomly permuted nodes. Next, we used our DAG to identify minimally sufficient adjustment sets needed to estimate the association between metal mixtures and cardiometabolic outcomes (i.e., cardiovascular disease, fasting glucose, and systolic blood pressure). We applied them to the SLVDS using Bayesian kernel machine regression, linear mixed effects, and Cox proportional hazards models. Results From the 42 articles included in the review, we developed an evidence-based DAG with 74 testable conditional independence statements (43 % supported by SLVDS data). We observed evidence for an association between As and Mn and fasting glucose. Conclusions We developed, tested, and applied an evidence-based approach to analyze associations between metal mixtures and cardiometabolic health.
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Affiliation(s)
- Emily Riseberg
- Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Katherine A. James
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Tanya L. Alderete
- Department of Integrative Physiology, University of Colorado, Boulder, CO, USA
| | - Laura Corlin
- Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
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8
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Lohmiller K, Gruber H, Harpin S, Belansky ES, James KA, Pfeiffer JP, Leiferman J. The S.I.T.E. Framework: A Novel Approach for Sustainably Integrating Trauma-Informed Approaches in Schools. J Child Adolesc Trauma 2022; 15:1011-1027. [PMID: 36439671 PMCID: PMC9684395 DOI: 10.1007/s40653-022-00461-6] [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] [Accepted: 05/19/2022] [Indexed: 06/16/2023]
Abstract
Students who present as dysregulated due to the impacts of trauma and toxic stress can challenge educators and find themselves improperly or insufficiently supported, punitively consequenced and unable to equitably access education. Trauma-informed approaches based on an understanding of brain development and function have been put forth as best practice for supporting students with trauma histories. The novel Sustainably Integrated Trauma-Informed Education Framework (S.I.T.E. Framework) facilitates systemic integration of trauma-informed approaches across a school and was developed through a community-informed process to address implementation challenges traditionally linked to trauma-informed initiatives. The S.I.T.E Framework promotes the science-based content of the Neurosequential Model in Education (NME) and was piloted during the 2017-18 school year at a metropolitan elementary school in Colorado. Mixed analytic methods identified four components, 1) establish and facilitate school-based Core Team, 2) deliver school-wide professional development training, 3) provide on-site staff support and consultation and 4) conduct a comprehensive evaluation as critical to the successful implementation of the framework. Pilot testing of the S.I.T.E. Framework's innovative, multicomponent structure illustrates the potential for sustainable, whole-school integration of brain-based, trauma-informed approaches that are supportive of both educators and students regardless of their trauma history.
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Affiliation(s)
- Katie Lohmiller
- Department of Community & Behavioral Health, Colorado School of Public Health, Aurora, CO USA
| | | | - Scott Harpin
- College of Nursing, University of Colorado, Aurora, CO USA
| | - Elaine S. Belansky
- Center for Rural School Health & Education, Morgridge College of Education, University of Denver, Denver, CO USA
| | - Katherine A. James
- Department of Environmental and Occupational Health, Colorado School of Public Health, Aurora, CO USA
| | | | - Jenn Leiferman
- Department of Community & Behavioral Health, Colorado School of Public Health, Aurora, CO USA
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9
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Huang J, El-Kersh K, Mann KK, James KA, Cai L. Overview of the cardiovascular effects of environmental metals: New preclinical and clinical insights. Toxicol Appl Pharmacol 2022; 454:116247. [PMID: 36122736 PMCID: PMC9941893 DOI: 10.1016/j.taap.2022.116247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/01/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 02/06/2023]
Abstract
Environmental causes of cardiovascular diseases (CVDs) are global health issues. In particular, an association between metal exposure and CVDs has become evident but causal evidence still lacks. Therefore, this symposium at the Society of Toxicology 2022 annual meeting addressed epidemiological, clinical, pre-clinical animal model-derived and mechanism-based evidence by five presentations: 1) An epidemiologic study on potential CVD risks of individuals exposed occupationally and environmentally to heavy metals; 2) Both presentations of the second and third were clinical studies focusing on the potential link between heavy metals and pulmonary arterial hypertension (PAH), by presenting altered blood metal concentrations of both non-essential and essential metals in the patients with PAH and potential therapeutic approaches; 3) Arsenic-induced atherosclerosis via inflammatory cells in mouse model; 4) Pathogenic effects on the heart by adult chronic exposure to very low-dose cadmium via epigenetic mechanisms and whole life exposure to low dose cadmium via exacerbating high-fat-diet-lipotoxicity. This symposium has brought epidemiologists, therapeutic industry, physicians, and translational scientists together to discuss the health risks of occupational and environmental exposure to heavy metals through direct cardiotoxicity and indirect disruption of homeostatic mechanisms regulating essential metals, as well as lipid levels. The data summarized by the presenters infers a potential causal link between multiple metals and CVDs and defines differences and commonalities. Therefore, summary of these presentations may accelerate the development of efficient preventive and therapeutic strategies by facilitating collaborations among multidisciplinary investigators.
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Affiliation(s)
- Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, KY, USA,Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, USA,Cardiovascular Innovation Institute, Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Karim El-Kersh
- Department of Internal Medicine, Division of Pulmonary Critical Care and Sleep Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Koren K. Mann
- Departments of Pharmacology & Therapeutics and Oncology and Medicine, McGill University, Canada,Segal Cancer Center, Lady Davis Institute for Medical Research, Montréal, Québec H3T 1E2, Canada
| | - Katherine A. James
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA,, Correspondence to: K. A. James, 13001 E 17th PL MS B119 Bldg 500 3rd FLR Aurora, CO 80045, USA. (K.A. James)
| | - Lu Cai
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, USA; Pediatric Research Institute, Departments of Pediatrics and Radiation Oncology, University of Louisville School of Medicine, Louisville, KY, USA.
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10
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Riseberg E, Chui K, James KA, Melamed R, Alderete TL, Corlin L. A Longitudinal Study of Exposure to Manganese and Incidence of Metabolic Syndrome. Nutrients 2022; 14:nu14204271. [PMID: 36296955 PMCID: PMC9607173 DOI: 10.3390/nu14204271] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 11/17/2022] Open
Abstract
The association between manganese (Mn) and metabolic syndrome (MetS) is unclear, and no prior study has studied this association longitudinally. The aim of this study was to assess longitudinal associations of Mn exposure with MetS and metabolic outcomes. We used data from the San Luis Valley Diabetes Study (SLVDS), a prospective cohort from rural Colorado with data collected from 1984−1998 (n = 1478). Urinary Mn was measured at baseline (range = 0.20−42.5 µg/L). We assessed the shape of the cross-sectional association between Mn and MetS accounting for effect modification by other metals at baseline using Bayesian kernel machine regression. We assessed longitudinal associations between baseline quartiles of Mn and incident MetS using Fine and Gray competing risks regression models (competing risk = mortality) and between quartiles of Mn and metabolic outcomes using linear mixed effects models. We did not observe evidence that quartiles of Mn were associated with incident MetS (p-value for trend = 0.52). Quartiles of Mn were significantly associated with lower fasting glucose (p-value for trend < 0.01). Lead was found to be a possible effect modifier of the association between Mn and incident MetS. Mn was associated with lower fasting glucose in this rural population. Our results support a possible beneficial effect of Mn on diabetic markers.
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Affiliation(s)
- Emily Riseberg
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Correspondence:
| | - Kenneth Chui
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Katherine A. James
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Rachel Melamed
- Department of Biological Sciences, University of Massachusetts, Lowell, MA 01854, USA
| | - Tanya L. Alderete
- Department of Integrative Physiology, University of Colorado, Boulder, CO 80309, USA
| | - Laura Corlin
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, MA 02155, USA
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11
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Vaughn AM, Lohmiller K, James KA, Van Dyke M, Whitesell N, Allshouse WB, Macaluso F, Kelley C. Characterization of Colorado residents and radon reduction behaviors through latent class analysis and path models. J Environ Radioact 2022; 250:106910. [PMID: 35653873 DOI: 10.1016/j.jenvrad.2022.106910] [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] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
Radon is a naturally occurring radioactive gas that enters homes through cracks in the foundation where accumulated levels can cause lung cancer. Within the United States (U.S.), state level radon reduction strategies rely on education and outreach to motivate people to test and mitigate their home. Only about 5% of the housing units in Colorado, U.S. have been tested for radon. This study looks at the 2012 Behavioral Risk Factors Surveillance System (BRFSS) in Colorado to identify distinct groups of people using Latent Class Analysis, and compares radon awareness, testing, and mitigation to understand underlying differences of radon reduction behaviors using path models. Five classes were identified: 1) Wealthy Young Families, 2) Older Singles, 3) Empty Nesters, 4) Smokers, and 5) Struggling Young Families. Significant differences in responses to radon survey questions existed across groups in which Struggling Young Families were the least likely to be aware of radon, have tested their home for radon, and have their home mitigated. Average radon awareness, testing, and mitigation appeared to be influenced by financial stress. Results from this study can be used to tailor future radon interventions and policy initiatives to enhance equity of radon reduction behaviors including legal framework to ensure radon mitigation takes place in rental properties.
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Affiliation(s)
- Amber M Vaughn
- Colorado School of Public Health, 13001 E 17th Pl, Aurora, CO, 80045, USA.
| | | | - Katherine A James
- Colorado School of Public Health, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Mike Van Dyke
- Colorado School of Public Health, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Nancy Whitesell
- Colorado School of Public Health, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | | | - Francesca Macaluso
- Colorado School of Public Health, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Chrystine Kelley
- Colorado Department of Public Health and Environment, 4300 Cherry Creek S Dr, Denver, CO, 80246, USA
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12
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Dally M, Macaluso F, James KA, Newman LS, Sorensen CJ. Addressing Climate Change in the Workplace. Workplace Health Saf 2022; 70:340. [PMID: 35822465 DOI: 10.1177/21650799221103767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Deutchman M, Macaluso F, Bray E, Evans D, Boulger J, Quinn K, Pierce C, Onello E, Porter J, Warren W, Erickson JS, Bright P, Maness P, Luke S, James KA. The impact of family physicians in rural maternity care. Birth 2022; 49:220-232. [PMID: 34558093 DOI: 10.1111/birt.12591] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/06/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Reduced access to maternity care in rural areas of the United States presents a significant burden to pregnant persons and infants. The objective of this study was to estimate the impact of family physicians (FPs) on access to maternity care in rural United States hospitals, especially where other providers may not be available. METHODS We administered a survey to 216 rural hospitals in 10 US states inquiring about the number of babies delivered from 2013 to 2017, the types of delivering physicians, and the maternity services offered. We calculated the percentage of rural hospitals in our sample where FPs performed vaginal deliveries, cesareans, and vaginal births after cesarean (VBACs), and the percentage of all babies delivered by FPs. We estimated the distance patients would have to travel for care if FPs were not providing care locally. RESULTS The final study population consisted of 185 rural hospitals. FPs delivered babies in 67% of these hospitals and were the only physicians who delivered babies in 27% of these hospitals. FPs provided VBAC at 18% and cesarean birth services at 46% of the rural hospitals, but with wide geographic differences. Many patients would have to drive an average of 86 miles round-trip to access care if those FPs were to stop delivering. CONCLUSIONS Family physicians are essential providers of maternity care in the rural United States. Family Medicine residency programs should ensure that trainees who intend to practice in rural locations have adequate maternity care training to maintain and expand access to maternity care for rural patients and their families.
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Affiliation(s)
- Mark Deutchman
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Francesca Macaluso
- Department of Environmental and Occupational Health, University of Colorado School of Public Health, Aurora, Colorado, USA
| | - Emily Bray
- Department of Family Medicine, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | - David Evans
- Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - James Boulger
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Duluth Medical School, Duluth, Minnesota, USA
| | - Kathleen Quinn
- University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Carrie Pierce
- Department of Family Medicine, Oregon Health and Science University School of Medicine and Faculty, Portland, Oregon, USA.,Cascades East Family Medicine Residency, Klamath Falls, Oregon, USA
| | - Emily Onello
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Duluth Medical School, Duluth, Minnesota, USA
| | - Jana Porter
- University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Wendy Warren
- Department of Family Medicine, Oregon Health and Science University School of Medicine and Faculty, Portland, Oregon, USA.,Cascades East Family Medicine Residency, Klamath Falls, Oregon, USA
| | - Jay S Erickson
- Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,WWAMI Montana, University of Washington School of Medicine, Seattle, Washington, USA
| | - Patrick Bright
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Duluth Medical School, Duluth, Minnesota, USA
| | - Philip Maness
- Department of Family Medicine, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | - Shanon Luke
- University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Katherine A James
- Department of Environmental and Occupational Health, University of Colorado School of Public Health, Aurora, Colorado, USA
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14
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Butler-Dawson J, James KA, Krisher L, Jaramillo D, Dally M, Neumann N, Pilloni D, Cruz A, Asensio C, Johnson RJ, Adgate J, Newman LS. Environmental metal exposures and kidney function of Guatemalan sugarcane workers. J Expo Sci Environ Epidemiol 2022; 32:461-471. [PMID: 33603096 PMCID: PMC8371072 DOI: 10.1038/s41370-021-00292-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 12/09/2020] [Accepted: 01/15/2021] [Indexed: 05/06/2023]
Abstract
BACKGROUND Exposure to environmental metals can cause nephrotoxicity. There is an international epidemic of chronic kidney disease of unknown cause (CKDu). Whether metal exposures contribute to kidney dysfunction in populations at risk for CKDu remains unresolved. OBJECTIVE Urinary metals (arsenic, cadmium, nickel, and uranium) were examined in 222 sugarcane cutters in Guatemala at three time points over 1 year. METHODS We explored the relationships between metal concentrations and markers of kidney function using multivariable linear mixed-effect models. RESULTS Arsenic, cadmium, and nickel were detected in the majority of the 340 urine samples and were generally within limits previously considered to be nonnephrotoxic. Nevertheless, higher urine cadmium was inversely associated with estimated glomerular filtration rate (eGFR) (β: -4.23, 95% confidence interval [CI]: -6.92, -1.54) and positively associated with neutrophil gelatinase-associated lipocalin (NGAL) (β: 2.92, 95% CI: 1.20, 4.64). Higher urine arsenic was also inversely associated with eGFR (β: -4.36, 95% CI: -7.07, -1.64). SIGNIFICANCE Our findings suggest that exposures to metals, including cadmium and arsenic, might contribute to kidney toxicity seen in workers at risk for CKDu. These findings are consistent with the potential for metal nephrotoxicity at lower than expected levels in the setting of manual work in a very hot environment.
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Affiliation(s)
- Jaime Butler-Dawson
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Aurora, CO, USA.
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA.
- Colorado Consortium on Climate Change and Human Health, University of Colorado, Aurora, CO, USA.
| | - Katherine A James
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Colorado Consortium on Climate Change and Human Health, University of Colorado, Aurora, CO, USA
| | - Lyndsay Krisher
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Colorado Consortium on Climate Change and Human Health, University of Colorado, Aurora, CO, USA
| | - Diana Jaramillo
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Colorado Consortium on Climate Change and Human Health, University of Colorado, Aurora, CO, USA
| | - Miranda Dally
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Colorado Consortium on Climate Change and Human Health, University of Colorado, Aurora, CO, USA
| | - Natalie Neumann
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Alex Cruz
- Pantaleon, Guatemala City, Guatemala
| | | | - Richard J Johnson
- Colorado Consortium on Climate Change and Human Health, University of Colorado, Aurora, CO, USA
- Division of Renal Diseases and Hypertension, Department of Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | - John Adgate
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Lee S Newman
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Colorado Consortium on Climate Change and Human Health, University of Colorado, Aurora, CO, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
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15
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Sears CG, Eliot M, Raaschou-Nielsen O, Poulsen AH, Harrington JM, Howe CJ, James KA, Roswall N, Overvad K, Tjønneland A, Meliker J, Wellenius GA. Urinary Cadmium and Incident Heart Failure: A Case-Cohort Analysis Among Never-Smokers in Denmark. Epidemiology 2022; 33:185-192. [PMID: 34860726 PMCID: PMC8810592 DOI: 10.1097/ede.0000000000001446] [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: 11/25/2022]
Abstract
BACKGROUND Epidemiologic studies suggest cadmium exposure is associated with cardiovascular disease risk, including heart failure. However, prior findings may be influenced by tobacco smoking, a dominant source of cadmium exposure and risk factor for heart failure. The present study leverages up to 20 years of follow-up in the Danish Diet, Cancer and Health cohort to examine the relationship between urinary cadmium and incident heart failure among people who never smoked. METHODS Between 1993 and 1997, 19,394 never-smoking participants (ages 50-64 years) enrolled and provided a urine sample. From this sample, we randomly selected a subcohort of 600 men and 600 women and identified 958 incident heart failure cases occurring between baseline and 2015. Using a case-cohort approach, we estimated adjusted hazard ratios (aHR) for heart failure in Cox proportional hazards models with age as the time scale. RESULTS Participants had relatively low concentrations of urinary cadmium, as expected for never smokers (median = 0.20; 25th, 75th = 0.13, 0.32 μg cadmium/g creatinine). In adjusted models, we found that higher urinary cadmium was associated with a higher rate of incident heart failure overall (aHR = 1.1 per interquartile range difference [95% CI = 1.0, 1.2). In sex-stratified analyses, the association seemed restricted to men (aHR = 1.5 [95% CI = 1.2, 1.9]). CONCLUSIONS In this cohort of people who never smoked tobacco, environmental cadmium was positively associated with incident heart failure, especially among men.
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Affiliation(s)
- Clara G. Sears
- Department of Epidemiology, Brown University School of
Public Health, Providence, RI, USA
- Christina Lee Brown Envirome Institute, Division of
Environmental Medicine, Department of Medicine, University of Louisville,
Louisville, KY, USA
| | - Melissa Eliot
- Department of Epidemiology, Brown University School of
Public Health, Providence, RI, USA
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen,
Denmark
- Department of Environmental Science, Aarhus University,
Roskilde, Denmark
| | | | - James M. Harrington
- Center for Analytical Science, Research Triangle Institute,
Research Triangle Park, NC, USA
| | - Chanelle J. Howe
- Department of Epidemiology, Brown University School of
Public Health, Providence, RI, USA
| | - Katherine A. James
- Department of Family Medicine, University of Colorado
Denver, Denver, CO, USA
| | - Nina Roswall
- Danish Cancer Society Research Center, Copenhagen,
Denmark
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus,
Denmark
- Department of Cardiology, Aalborg University Hospital,
Aalborg, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen,
Denmark
- Department of Public Health, University of Copenhagen,
Copenhagen, Denmark
| | - Jaymie Meliker
- Program in Public Health, Department of Family,
Population, & Preventive Medicine, Stony Brook University, NY, USA
| | - Gregory A. Wellenius
- Department of Epidemiology, Brown University School of
Public Health, Providence, RI, USA
- Department of Environmental Health, Boston University,
Boston, MA, USA
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16
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Malecki KMC, Andersen JK, Geller AM, Harry GJ, Jackson CL, James KA, Miller GW, Ottinger MA. Integrating Environment and Aging Research: Opportunities for Synergy and Acceleration. Front Aging Neurosci 2022; 14:824921. [PMID: 35264945 PMCID: PMC8901047 DOI: 10.3389/fnagi.2022.824921] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/12/2022] [Indexed: 12/25/2022] Open
Abstract
Despite significant overlaps in mission, the fields of environmental health sciences and aging biology are just beginning to intersect. It is increasingly clear that genetics alone does not predict an individual’s neurological aging and sensitivity to disease. Accordingly, aging neuroscience is a growing area of mutual interest within environmental health sciences. The impetus for this review came from a workshop hosted by the National Academies of Sciences, Engineering, and Medicine in June of 2020, which focused on integrating the science of aging and environmental health research. It is critical to bridge disciplines with multidisciplinary collaborations across toxicology, comparative biology, epidemiology to understand the impacts of environmental toxicant exposures and age-related outcomes. This scoping review aims to highlight overlaps and gaps in existing knowledge and identify essential research initiatives. It begins with an overview of aging biology and biomarkers, followed by examples of synergy with environmental health sciences. New areas for synergistic research and policy development are also discussed. Technological advances including next-generation sequencing and other-omics tools now offer new opportunities, including exposomic research, to integrate aging biomarkers into environmental health assessments and bridge disciplinary gaps. This is necessary to advance a more complete mechanistic understanding of how life-time exposures to toxicants and other physical and social stressors alter biological aging. New cumulative risk frameworks in environmental health sciences acknowledge that exposures and other external stressors can accumulate across the life course and the advancement of new biomarkers of exposure and response grounded in aging biology can support increased understanding of population vulnerability. Identifying the role of environmental stressors, broadly defined, on aging biology and neuroscience can similarly advance opportunities for intervention and translational research. Several areas of growing research interest include expanding exposomics and use of multi-omics, the microbiome as a mediator of environmental stressors, toxicant mixtures and neurobiology, and the role of structural and historical marginalization and racism in shaping persistent disparities in population aging and outcomes. Integrated foundational and translational aging biology research in environmental health sciences is needed to improve policy, reduce disparities, and enhance the quality of life for older individuals.
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Affiliation(s)
- Kristen M. C. Malecki
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- *Correspondence: Kristen M. C. Malecki,
| | | | - Andrew M. Geller
- United States Environmental Protection Agency, Office of Research and Development, Durham, NC, United States
| | - G. Jean Harry
- Division of National Toxicology Program, National Institute of Environmental Health Sciences, Durham, NC, United States
| | - Chandra L. Jackson
- Division of Intramural Research, Department of Health and Human Services, Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, United States
- Department of Health and Human Services, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | - Katherine A. James
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Denver, Denver, CO, United States
| | - Gary W. Miller
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Mary Ann Ottinger
- Department of Biology and Biochemistry, University of Houston, Houston, TX, United States
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17
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Wild LE, Walters M, Powell A, James KA, Corlin L, Alderete TL. County-Level Social Vulnerability Is Positively Associated with Cardiometabolic Disease in Colorado. Int J Environ Res Public Health 2022; 19:ijerph19042202. [PMID: 35206386 PMCID: PMC8872484 DOI: 10.3390/ijerph19042202] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 02/06/2023]
Abstract
Cardiometabolic diseases are a group of interrelated diseases that pose greater burden among socially vulnerable communities. The social vulnerability index (SVI) identifies communities vulnerable to emergencies and may also help determine communities at risk of adverse chronic health outcomes. However, no studies have examined the relationship between the SVI and cardiometabolic health outcomes in Colorado or focused on rural settings. The aim of this ecological study was to determine whether the county-level SVI is associated with county-level cardiometabolic health indicators with a particular focus on rurality and racial/ethnic diversity. We obtained 2014 SVI scores from the Centers for Disease Control and Prevention (scored 0–1; higher = more vulnerable) and 2013–2015 cardiometabolic health estimates from the Colorado Department of Public Health and Environment. The distribution of social determinants of health was spatially evaluated. Bivariate relationships between the SVI and cardiometabolic indicators were estimated using simple linear regression models. The highest SVI scores were observed in rural areas, including the San Luis Valley (mean: 0.78, median: 0.91), Southeast (mean: 0.72, median: 0.73), and Northeast (mean: 0.66, median: 0.76) regions. Across Colorado, the SVI accounted for 41% of the variability in overweight and obesity prevalence (p < 0.001), 17% of the variability in diabetes prevalence (p = 0.001), and 58% of the age-adjusted myocardial infarction hospitalization rate (p < 0.001). SVI values may be useful in determining a community’s burden of cardiometabolic diseases.
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Affiliation(s)
- Laura E. Wild
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; (L.E.W.); (A.P.)
| | - McKailey Walters
- Department of Public Health and Community Medicine, Tufts University, Boston, MA 02111, USA; (M.W.); (L.C.)
| | - Alaina Powell
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; (L.E.W.); (A.P.)
| | - Katherine A. James
- Department Environmental and Occupational Health, University of Colorado Anschutz Medical Campus, Denver, CO 80045, USA;
| | - Laura Corlin
- Department of Public Health and Community Medicine, Tufts University, Boston, MA 02111, USA; (M.W.); (L.C.)
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA 02155, USA
| | - Tanya L. Alderete
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; (L.E.W.); (A.P.)
- Correspondence:
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18
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Riseberg E, James KA, Woodin M, Melamed R, Alderete T, Corlin L. Multipollutant, longitudinal analysis of the association between urinary tungsten and incident diabetes in a rural population. Environ Epidemiol 2021; 5:e173. [PMID: 34909553 PMCID: PMC8663879 DOI: 10.1097/ee9.0000000000000173] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/17/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cross-sectional studies suggest tungsten (W) exposure may be associated with diabetes. We assessed longitudinal associations between urinary W and fasting glucose, 2-hour glucose, insulin resistance (HOMA-IR), β-cell function (HOMA-β), and incident type 2 diabetes. METHODS We used data from 1,609 Hispanic and non-Hispanic White adults with 20 to 74 years of age residing in rural Colorado and participating in the San Luis Valley Diabetes Study. Urinary metal exposure values were measured at baseline and natural log-transformed. We assessed longitudinal associations between urinary W and continuous outcome measures using linear-mixed effect models and associations with incident diabetes using Fine and Gray competing risks regression models (competing event = all-cause mortality). The main adjustment set of covariates included: age, sex, ethnicity, education, smoking status, hypertension, body mass index, caloric intake, alcohol intake, and urinary creatinine levels. Secondary models were further adjusted for arsenic, cadmium, and lead exposures. We assessed whether sex or ethnicity were effect modifiers. RESULTS At baseline, the median W concentration was 0.22 μg/L (interquartile range = 0.20, 0.59). In the main cross-sectional analyses, lnW levels were significantly associated with 3% higher lnHOMA-IR (95% CI = 1 to 5). In the main longitudinal models, lnW was significantly associated with 1% higher natural log-transformed fasting glucose (95% CI = <1 to 1), 3% higher natural log-transformed HOMA-IR (95% CI = 2 to 5), and 28% higher incident diabetes (subdistribution hazard ratio=1.28, 95% CI = 1.09 to 1.50). Results remained significant when further adjusting for other metals. We observed evidence for effect modification by sex and ethnicity. CONCLUSION Urinary W was longitudinally associated with adverse metabolic health indicators.
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Affiliation(s)
- Emily Riseberg
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Katherine A. James
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, Colorado
| | - Mark Woodin
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, Massachusetts
| | - Rachel Melamed
- Biological Sciences, University of Massachusetts, Lowell, Lowell, Massachusetts
| | - Tanya Alderete
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado
| | - Laura Corlin
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, Massachusetts
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19
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Ozdemir S, Sears CG, Harrington JM, Poulsen AH, Buckley J, Howe CJ, James KA, Tjonneland A, Wellenius GA, Raaschou-Nielsen O, Meliker J. Relationship between Urine Creatinine and Urine Osmolality in Spot Samples among Men and Women in the Danish Diet Cancer and Health Cohort. Toxics 2021; 9:282. [PMID: 34822673 PMCID: PMC8625939 DOI: 10.3390/toxics9110282] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022]
Abstract
Assays of urine biomarkers often use urine creatinine to account for urinary dilution, even though creatinine levels are influenced by underlying physiology and muscle catabolism. Urine osmolality-a measure of dissolved particles including ions, glucose, and urea-is thought to provide a more robust marker of urinary dilution but is seldom measured. The relationship between urine osmolality and creatinine is not well understood. We calculated correlation coefficients between urine creatinine and osmolality among 1375 members of a subcohort of the Danish Diet, Cancer, and Health Cohort, and within different subgroups. We used linear regression to relate creatinine with osmolality, and a lasso selection procedure to identify other variables that explain remaining variability in osmolality. Spearman correlation between urine creatinine and osmolality was strong overall (ρ = 0.90; 95% CI: 0.89-0.91) and in most subgroups. Linear regression showed that urine creatinine explained 60% of the variability in urine osmolality, with another 9% explained by urine thallium (Tl), cesium (Cs), and strontium (Sr). Urinary creatinine and osmolality are strongly correlated, although urine Tl, Cs, and Sr might help supplement urine creatinine for purposes of urine dilution adjustment when osmolality is not available.
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Affiliation(s)
- Selinay Ozdemir
- Department of Biology, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Clara G. Sears
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02903, USA; (C.G.S.); (C.J.H.); (G.A.W.)
| | - James M. Harrington
- Analytical Science Division, RTI International, Research Triangle Park, NC 27709, USA;
| | - Aslak Harbo Poulsen
- Danish Cancer Society Research Center, 2100 Copenhagen, Denmark; (A.H.P.); (A.T.); (O.R.-N.)
| | - Jessie Buckley
- Departments of Environment Health and Engineering & Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Chanelle J. Howe
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02903, USA; (C.G.S.); (C.J.H.); (G.A.W.)
| | - Katherine A. James
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Denver, CO 80217, USA;
| | - Anne Tjonneland
- Danish Cancer Society Research Center, 2100 Copenhagen, Denmark; (A.H.P.); (A.T.); (O.R.-N.)
- Department of Public Health, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Gregory A. Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02903, USA; (C.G.S.); (C.J.H.); (G.A.W.)
- Department of Environmental Health, Boston University, Boston, MA 02215, USA
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, 2100 Copenhagen, Denmark; (A.H.P.); (A.T.); (O.R.-N.)
- Department of Environmental Science, Aarhus University, 4000 Roskilde, Denmark
| | - Jaymie Meliker
- Program in Public Health, Department of Family, Population, & Preventive Medicine, Stony Brook University, Stony Brook, NY 11794, USA
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Spark TL, Wright-Kelly E, Ma M, James KA, Reid CE, Brooks-Russell A. Assessment of Rural-Urban and Geospatial Differences in Perceived Handgun Access and Reported Suicidality Among Youth in Colorado. JAMA Netw Open 2021; 4:e2127816. [PMID: 34623407 PMCID: PMC8501400 DOI: 10.1001/jamanetworkopen.2021.27816] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Suicide is the second leading cause of death in adolescents, with firearms the most common method, especially in rural communities. Identifying where to target lethal means safety interventions could better leverage limited resources. OBJECTIVES To understand the associations of rurality, school-level prevalence of easy handgun access, and suicidality measures in Colorado youth, to explore spatial distribution of school-level measures, and to identify communities with high prevalence of both easy handgun access and suicidality. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the 2019 Healthy Kids Colorado Survey, an anonymous cross-sectional school-based survey conducted at 256 participating Colorado high schools. Participants included students from schools recruited for statewide population-based estimates and additional schools opting in. Data were analyzed from November 9, 2020, to March 13, 2021. EXPOSURES Urban-centric locale according to a 7-level continuum. Geocoded location of schools was used for spatial analysis. MAIN OUTCOMES AND MEASURES The main outcomes were weighted prevalence for easy handgun access and 4 measures of mental health and suicidality in the previous year (ie, feeling sad for 2 weeks and considering suicide, planning suicide attempt, or attempting suicide in the past year). RESULTS A total of 59 556 students (49.7% [95% CI, 49.3%-50.1%] male and 50.3% [95% CI, 49.9%-50.7%] female; 53.9% [95% CI, 53.5%-54.3%] in 9th and 10th grade; 36.4% [95% CI, 36.0%-36.8%] Hispanic and 50.8% [95% CI, 50.4%-51.2%] non-Hispanic White) from 256 schools participated. Most schools were rural or in small towns (56.8% [95% CI, 50.7%-62.9%]), while more students participated from urban and suburban schools (57.8% [95% CI, 57.6%-58.0%]). Prevalence of perceived easy access to handguns increased with increasing rurality, with 36.2% (95% CI, 35.2%-37.1%) of students in rural (remote) schools reporting easy access, compared with 18.2% (95% CI, 17.3%-19.1%) for city (large) schools. The spatial distribution of easy handgun access and suicidality measures had minimal overlap, but there was correlation at school-level between easy handgun access and considering suicide (ρ = 0.203 [95% CI, 0.0748-0.331]), planning suicide (ρ = 0.300 [95% CI, 0.173-0.427]), and attempting suicide (ρ = 0.218 [95% CI, 0.0869-0.350) in the previous year. The highest quartile for prevalence of both perceived easy access to handguns and planning suicide in the previous year included 21 schools (81.0% [95% CI, 64.0%-97.9%] rural [remote] or rural [distant]). CONCLUSIONS AND RELEVANCE These findings suggest that rural-remote communities in Colorado may benefit most from interventions focused on limiting youth access to handguns when youth are in crisis, with some communities at especially high risk. Spatially referenced data may improve targeting interventions to where they are needed most.
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Affiliation(s)
- Talia L. Spark
- Rocky Mountain Mental Illness Research, Education, and Clinical Care, Department of Veteran Affairs, Aurora, Colorado
- Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
- Injury and Violence Prevention Center, University of Colorado Anschutz Medical Campus, Aurora
| | - Erin Wright-Kelly
- Injury and Violence Prevention Center, University of Colorado Anschutz Medical Campus, Aurora
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Ming Ma
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Katherine A. James
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | | | - Ashley Brooks-Russell
- Injury and Violence Prevention Center, University of Colorado Anschutz Medical Campus, Aurora
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
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Butler-Dawson J, Krisher L, Dally M, James KA, Johnson RJ, Jaramillo D, Yoder H, Johnson EC, Pilloni D, Asensio C, Cruz A, Newman LS. Sugarcane Workweek Study: Risk Factors for Daily Changes in Creatinine. Kidney Int Rep 2021; 6:2404-2414. [PMID: 34514201 PMCID: PMC8418948 DOI: 10.1016/j.ekir.2021.06.003] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Agricultural workers laboring in thermally stressful environments are at increased risk for kidney injury and chronic kidney disease of unknown origin (CKDu), and their environmental and occupational exposures have been considered to be important risk factors. This study examined the effects of repeated kidney stress from the simultaneous strain of work and other factors experienced by workers in Guatemala during a typical workweek. METHODS We collected data from 107 sugarcane workers across 7 consecutive work shifts. Data included information on daily occupational, meteorological, environmental, and lifestyle factors. We used multivariable linear mixed models to evaluate associations of these factors with percent change in creatinine. RESULTS We observed that increasing wet bulb globe temperature (β = 2.5%, 95% confidence interval [CI] = 0.3%, 4.7%) and increasing diastolic blood pressure (β = 6.2%, 95% CI = 0.9%, 11.6%) were associated with increases in creatinine across the shift, whereas consumption of water from chlorinated dormitory tanks as compared to artesian well water (β = -17.5%, 95% CI = -29.6%, -5.4%) and increasing number of rest breaks (β = -5.8%, 95% CI = -9.0%, -2.6%) were found to be protective against increases in creatinine. Workers reporting drinking tank water had lower concentrations of urine creatinine-corrected arsenic, lead, uranium, and glyphosate compared to workers reporting the use of well water or municipal water. CONCLUSION These results reinforce the need to focus on preventive actions that reduce kidney injury among this worker population, including strategies to reduce heat stress, managing blood pressure, and examining water sources of workers for nephrotoxic contaminants.
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Affiliation(s)
- Jaime Butler-Dawson
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lyndsay Krisher
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Miranda Dally
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Katherine A. James
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Diana Jaramillo
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Hillary Yoder
- Department Kinesiology & Health, University of Wyoming, Laramie, Wyoming, USA
| | - Evan C. Johnson
- Department Kinesiology & Health, University of Wyoming, Laramie, Wyoming, USA
| | | | | | - Alex Cruz
- Pantaleon, Guatemala City, Guatemala
| | - Lee S. Newman
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
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Poulsen AH, Sears CG, Harrington J, Howe CJ, James KA, Roswall N, Overvad K, Tjønneland A, Wellenius GA, Meliker J, Raaschou-Nielsen O. Urinary cadmium and stroke - a case-cohort study in Danish never-smokers. Environ Res 2021; 200:111394. [PMID: 34062200 PMCID: PMC8403651 DOI: 10.1016/j.envres.2021.111394] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 06/10/2023]
Abstract
BACKGROUND and Purpose: Cadmium has been associated with risk of cardiovascular events, including stroke. Human cadmium exposure occurs primarily through diet and tobacco smoke. Recent cohort studies have found an association with stroke, but residual confounding from smoking, could not be ruled out. We therefore conducted a case-cohort study to evaluate whether cadmium is associated with stroke in never-smokers. METHODS The Danish Diet Cancer and Health cohort consists of Danes 50-64 years old, recruited in 1993-1997. From never-smoking cohort members without previous cancer or stroke we sampled a sub-cohort of 1200 persons. We also identified all (n = 534) cases in the cohort with a validated stroke diagnosis between baseline and 2009. We quantified cadmium and creatinine concentrations from baseline urine samples and used cadmium per creatinine as our main exposure metric. We used Cox proportional hazards models to estimate hazard ratios (HRs) with age as time scale and adjusting for BMI, education and urinary cotinine with and without stratification by sex. RESULTS The median urinary cadmium concentration was 0.21 μg cadmium/g creatinine in cases and 0.19 μg/g in the sub-cohort. The majority (83%) of stroke cases were diagnosed with ischemic stroke. The HR for stroke in the highest quartile of exposure (median 0.44 μg/g creatinine) was 1.11 (95% CI: 0.79-1.54) compared with the lowest quartile (median 0.10 μg/g creatinine). The HR per inter quartile range (IQR, 0.19 μg/g creatinine) was 1.02 (95% CI: 0.92-1.12). Among men, the HR per IQR higher levels of cadmium (0.16 μg/g creatinine) was 1.18 (95% CI: 0.92-1.52), and 1.00 (95% CI: 0.89-1.12) among women. Adjusting for creatinine or using osmolality instead of creatinine standardization generally attenuated observed relationships. CONCLUSIONS Our results do not support that low levels of cadmium exposure among never-smokers are strongly associated with risk of stroke, although results varied somewhat by sex and method of accounting for urinary dilution.
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Affiliation(s)
| | - Clara G Sears
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - James Harrington
- Center for Analytical Science, Research Triangle Institute, Research Triangle Park, NC, USA
| | - Chanelle J Howe
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Katherine A James
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, USA
| | - Nina Roswall
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Public Health University of Copenhagen. Copenhagen, Denmark
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Department of Environmental Health, Boston University, Boston, MA, USA
| | - Jaymie Meliker
- Program in Public Health, Department of Family, Population, & Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark
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Sears CG, Poulsen AH, Eliot M, Howe CJ, James KA, Harrington JM, Roswall N, Overvad K, Tjønneland A, Raaschou-Nielsen O, Wellenius GA, Meliker J. Urine cadmium and acute myocardial infarction among never smokers in the Danish Diet, Cancer and Health cohort. Environ Int 2021; 150:106428. [PMID: 33571817 PMCID: PMC7940585 DOI: 10.1016/j.envint.2021.106428] [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] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 05/11/2023]
Abstract
Cadmium exposure has been associated with cardiovascular disease. Cigarette smoking is a key source of cadmium exposure and thus a potential confounder in observational studies of environmental cadmium and cardiovascular disease that include tobacco smokers. We leveraged up to 20 years of follow-up in the Danish Diet, Cancer and Health cohort to test the hypothesis that cadmium exposure is associated with acute myocardial infarction (AMI) among people who never smoked. Between 1993 and 1997, 19,394 never-smoking participants (ages 50-64 years) were enrolled and provided a urine sample. From this sample, we randomly selected a subcohort of 600 males and 600 females. We identified 809 AMI cases occurring between baseline and the end of 2015 using the Danish National Patient Registry. We quantified cadmium, creatinine, and osmolality in baseline urine samples. Using an unweighted case-cohort approach, we estimated adjusted hazard ratios (aHR) for AMI in Cox proportional hazards models with age as the time axis. Participants had relatively low concentrations of urinary cadmium, as expected for never smokers (median = 0.20; 25th, 75th = 0.13, 0.32 μg cadmium/g creatinine). We did not find strong evidence to support an association between higher urinary cadmium and AMI when comparing the highest versus lowest quartile (aHR = 1.16; 95% CI: 0.86 - 1.56) and per IQR increment in cadmium concentration (aHR = 1.02; 95% CI: 0.93 - 1.12). Results were not materially different across strata defined by sex. Results were generally similar using creatinine or osmolality to account for differences in urine dilution. While cadmium exposure has been identified as a risk factor for cardiovascular disease, we did not find strong evidence that urinary cadmium at relatively low-levels is associated with AMI among people who have never smoked.
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Affiliation(s)
- Clara G Sears
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
| | | | - Melissa Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Chanelle J Howe
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Katherine A James
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, CO, USA
| | - James M Harrington
- Center for Analytical Science, Research Triangle Institute, Research Triangle Park, NC, USA
| | - Nina Roswall
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Department of Environmental Health, Boston University, Boston, MA, USA
| | - Jaymie Meliker
- Program in Public Health, Department of Family, Population, & Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
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Nwanaji-Enwerem JC, Jackson CL, Ottinger MA, Cardenas A, James KA, Malecki KM, Chen JC, Geller AM, Mitchell UA. Adopting a "Compound" Exposome Approach in Environmental Aging Biomarker Research: A Call to Action for Advancing Racial Health Equity. Environ Health Perspect 2021; 129:45001. [PMID: 33822649 PMCID: PMC8043128 DOI: 10.1289/ehp8392] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/24/2021] [Accepted: 03/15/2021] [Indexed: 05/02/2023]
Abstract
BACKGROUND In June 2020, the National Academies of Sciences, Engineering, and Medicine hosted a virtual workshop focused on integrating the science of aging and environmental health research. The concurrent COVID-19 pandemic and national attention on racism exposed shortcomings in the environmental research field's conceptualization and methodological use of race, which have subsequently hindered the ability of research to address racial health disparities. By the workshop's conclusion, the authors deduced that the utility of environmental aging biomarkers-aging biomarkers shown to be specifically influenced by environmental exposures-would be greatly diminished if these biomarkers are developed absent of considerations of broader societal factors-like structural racism-that impinge on racial health equity. OBJECTIVES The authors reached a post-workshop consensus recommendation: To advance racial health equity, a "compound" exposome approach should be widely adopted in environmental aging biomarker research. We present this recommendation here. DISCUSSION The authors believe that without explicit considerations of racial health equity, people in most need of the benefits afforded by a better understanding of the relationships between exposures and aging will be the least likely to receive them because biomarkers may not encompass cumulative impacts from their unique social and environmental stressors. Employing an exposome approach that allows for more comprehensive exposure-disease pathway characterization across broad domains, including the social exposome and neighborhood factors, is the first step. Exposome-centered study designs must then be supported with efforts aimed at increasing the recruitment and retention of racially diverse study populations and researchers and further "compounded" with strategies directed at improving the use and interpretation of race throughout the publication and dissemination process. This compound exposome approach maximizes the ability of our science to identify environmental aging biomarkers that explicate racial disparities in health and best positions the environmental research community to contribute to the elimination of racial health disparities. https://doi.org/10.1289/EHP8392.
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Affiliation(s)
- Jamaji C. Nwanaji-Enwerem
- Department of Environmental Health, Harvard T.H. Chan School of Public Health and MD/PhD Program, Harvard Medical School, Boston, Massachusetts, USA
- Division of Environmental Health Sciences, School of Public Health and Center for Computational Biology, University of California, Berkeley, Berkeley, California, USA
| | - Chandra L. Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health (NIH), U.S. Department of Health and Human Services (U.S. HHS), Research Triangle Park, North Carolina, USA
- Intramural Program, National Institute on Minority Health and Health Disparities, NIH, U.S. HHS, Bethesda, Maryland, USA
| | - Mary Ann Ottinger
- Department of Biology and Biochemistry, University of Houston, Houston, Texas USA
| | - Andres Cardenas
- Division of Environmental Health Sciences, School of Public Health and Center for Computational Biology, University of California, Berkeley, Berkeley, California, USA
| | - Katherine A. James
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kristen M.C. Malecki
- Department of Population Health Sciences, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jiu-Chiuan Chen
- Departments of Preventive Medicine and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Andrew M. Geller
- Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Uchechi A. Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
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Fox J, Macaluso F, Moore C, Mesenbring E, Johnson RJ, Hamman RF, James KA. Urine tungsten and chronic kidney disease in rural Colorado. Environ Res 2021; 195:110710. [PMID: 33460634 PMCID: PMC7987874 DOI: 10.1016/j.envres.2021.110710] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a cause of global morbidity and mortality in agricultural communities. The San Luis Valley (SLV) is a rural agricultural community in southern Colorado with geographic and sociodemographic risk factors for CKD, including a water supply contaminated by heavy metals. METHODS We obtained pre-existing sociodemographic, clinical, and urine trace metal data for 1659 subjects from the San Luis Valley Diabetes Study, a prospective cohort study. We assessed prospective associations between urine tungsten (W) and time-to-CKD using accelerated failure time models (n = 1659). Additionally, logistic models were used to assess relationships between urine W and renal injury markers (NGAL, KIM1) using Tobit regression (n = 816), as well as epidemiologically-defined CKD of unknown origin (CKDu) using multiple logistic regression (n = 620). RESULTS Elevated urine W was strongly associated with decreased time-to-CKD, even after controlling for hypertension and diabetes. Depending on how CKD was defined, a doubling of urine W was associated with a 27% (95% CI 11%, 46%) to 31% (14%, 51%) higher odds of developing CKD within 5 years. The relationship between urine W and select renal injury markers was not significant, although urine NGAL was modified by diabetes status. Elevated (>95%ile) urinary W was significantly associated with CKDu (OR 5.93, 1.83, 19.21) while adjusting for known CKD risk factors. CONCLUSIONS Our data suggest that increased exposure to W is associated with decreased time-to-CKD and may be associated with CKDu. Given persistence of associations after controlling for diabetes and hypertension, W may exert a primary effect on the kidney, although this needs to be evaluated further in future studies.
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Affiliation(s)
- Jacob Fox
- Colorado School of Public Health, Departments of Environmental & Occupational Health and Epidemiology, University of Colorado Anschutz Medical Campus, Fitzsimons Building, 3rd Floor, 13001 E. 17th Place, B119, Aurora, CO, 80045, USA.
| | - Francesca Macaluso
- Colorado School of Public Health, Departments of Environmental & Occupational Health and Epidemiology, University of Colorado Anschutz Medical Campus, Fitzsimons Building, 3rd Floor, 13001 E. 17th Place, B119, Aurora, CO, 80045, USA.
| | - Camille Moore
- Colorado School of Public Health, Departments of Environmental & Occupational Health and Epidemiology, University of Colorado Anschutz Medical Campus, Fitzsimons Building, 3rd Floor, 13001 E. 17th Place, B119, Aurora, CO, 80045, USA; Center for Genes, Environment and Health, National Jewish Health, Smith Building; A647, 1400 Jackson Street, Denver, CO, 80206, USA.
| | - Elise Mesenbring
- Colorado School of Public Health, Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Fitzsimons Building, 3rd Floor, 13001 E. 17th Place, B119, Aurora, CO, 80045, USA.
| | - Richard J Johnson
- School of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Fitzsimons Building, 3rd Floor 13001 E. 17th Place, B119, Aurora, CO, 80045, USA.
| | - Richard F Hamman
- Colorado School of Public Health, Departments of Environmental & Occupational Health and Epidemiology, University of Colorado Anschutz Medical Campus, Fitzsimons Building, 3rd Floor, 13001 E. 17th Place, B119, Aurora, CO, 80045, USA.
| | - Katherine A James
- Colorado School of Public Health, Departments of Environmental & Occupational Health and Epidemiology, University of Colorado Anschutz Medical Campus, Fitzsimons Building, 3rd Floor, 13001 E. 17th Place, B119, Aurora, CO, 80045, USA.
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Tyndall Snow LM, Hall KE, Custis C, Rosenthal AL, Pasalic E, Nechuta S, Davis JW, Jacquemin BJ, Jagroep SR, Rock P, Contreras E, Gabella BA, James KA. Descriptive exploration of overdose codes in hospital and emergency department discharge data to inform development of drug overdose morbidity surveillance indicator definitions in ICD-10-CM. Inj Prev 2021; 27:i27-i34. [PMID: 33674330 PMCID: PMC7948180 DOI: 10.1136/injuryprev-2019-043520] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 11/02/2020] [Accepted: 11/13/2020] [Indexed: 11/05/2022]
Abstract
Background In October 2015, discharge data coding in the USA shifted to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), necessitating new indicator definitions for drug overdose morbidity. Amid the drug overdose crisis, characterising discharge records that have ICD-10-CM drug overdose codes can inform the development of standardised drug overdose morbidity indicator definitions for epidemiological surveillance. Methods Eight states submitted aggregated data involving hospital and emergency department (ED) discharge records with ICD-10-CM codes starting with T36–T50, for visits occurring from October 2015 to December 2016. Frequencies were calculated for (1) the position within the diagnosis billing fields where the drug overdose code occurred; (2) primary diagnosis code grouped by ICD-10-CM chapter; (3) encounter types; and (4) intents, underdosing and adverse effects. Results Among all records with a drug overdose code, the primary diagnosis field captured 70.6% of hospitalisations (median=69.5%, range=66.2%–76.8%) and 79.9% of ED visits (median=80.7%; range=69.8%–88.0%) on average across participating states. The most frequent primary diagnosis chapters included injury and mental disorder chapters. Among visits with codes for drug overdose initial encounters, subsequent encounters and sequelae, on average 94.6% of hospitalisation records (median=98.3%; range=68.8%–98.8%) and 95.5% of ED records (median=99.5%; range=79.2%–99.8%), represented initial encounters. Among records with drug overdose of any intent, adverse effect and underdosing codes, adverse effects comprised an average of 74.9% of hospitalisation records (median=76.3%; range=57.6%–81.1%) and 50.8% of ED records (median=48.9%; range=42.3%–66.8%), while unintentional intent comprised an average of 11.1% of hospitalisation records (median=11.0%; range=8.3%–14.5%) and 28.2% of ED records (median=25.6%; range=20.8%–40.7%). Conclusion Results highlight considerations for adapting and standardising drug overdose indicator definitions in ICD-10-CM.
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Affiliation(s)
- Leigh M Tyndall Snow
- Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, USA
| | - Katelyn E Hall
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Cody Custis
- Montana Department of Public Health and Human Services, Helena, Montana, USA
| | | | - Emilia Pasalic
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Nechuta
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, TN, USA
| | - James W Davis
- New Mexico Department of Health, Injury & Behavioral Epidemiology Bureau, Santa Fe, New Mexico, USA
| | - Bretta Jane Jacquemin
- New Jersey Department of Health, Center for Health Statistics and Informatics, Trenton, New Jersey, USA
| | - Sherani R Jagroep
- North Carolina Department of Health and Human Services, Injury and Violence Prevention Branch, Raleigh, North Carolina, USA
| | - Peter Rock
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky, USA
| | - Elyse Contreras
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Barbara A Gabella
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Katherine A James
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Hall KE, Yang H, Goulding D, Contreras E, James KA. Interrupted time series analysis of cannabis coding in Colorado during the ICD-10-CM transition. Inj Prev 2021; 27:i66-i70. [PMID: 33674336 PMCID: PMC7948183 DOI: 10.1136/injuryprev-2019-043511] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 12/03/2022]
Abstract
The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), implemented in 2015, has more codes than ICD-9-CM for events involving cannabis. We examined cannabis indicator trends across the transition from ICD-9-CM to ICD-10-CM in Colorado, where state law regulates adult cannabis use. Using 2011 to 2018 data from hospital and emergency department (ED) discharges, we calculated monthly rates per 1000 discharges for two indicators: (1) cannabis use disorders and (2) poisoning and adverse effects of psychodysleptics. Immediate, point-of-transition (level) and gradual, post-transition (slope) changes across the ICD-9-CM to ICD-10-CM transition were tested using interrupted time series models adjusted for legalisation, seasonality and autocorrelation. We observed a level increase and slope increase in the rate of ED discharges with cannabis use disorders. Hospital discharges with cannabis use disorders had a negative slope change after the transition and no level change. ED discharges with poisoning and adverse effects of psychodysleptics showed an increase in slope after the transition. No effects of the transition were observed on hospital discharges with poisoning and adverse effects of psychodysleptics. Shifts in the level and slope of cannabis indicator rates after implementation of the new coding scheme suggest the use of caution when interpreting trends spanning the ICD-9-CM to ICD-10-CM transition.
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Affiliation(s)
- Katelyn E Hall
- Marijuana Health Monitoring Program, Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Hannah Yang
- EMS and Trauma Systems Section, Montana Department of Public Health and Human Services, Helena, Montana, USA
| | - DeLayna Goulding
- Marijuana Health Monitoring Program, Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Elyse Contreras
- Marijuana Health Monitoring Program, Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Katherine A James
- Colorado School of Public Health, University of Colorado Denver Graduate School, Aurora, Colorado, USA
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Zhang Y, Mann JR, James KA, McDermott S, Conway KM, Paramsothy P, Smith T, Cai B. Duchenne and Becker Muscular Dystrophies' Prevalence in MD STARnet Surveillance Sites: An Examination of Racial and Ethnic Differences. Neuroepidemiology 2021; 55:47-55. [PMID: 33477152 DOI: 10.1159/000512647] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/19/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Previous studies indicated variability in the prevalence of Duchenne and Becker muscular dystrophies (DBMD) by racial/ethnic groups. The Centers for Disease Control and Prevention's (CDC) Muscular Dystrophy Surveillance, Tracking, and Research network (MD STARnet) conducts muscular dystrophy surveillance in multiple geographic areas of the USA and continues to enroll new cases. This provides an opportunity to continue investigating differences in DBMD prevalence by race and ethnicity and to compare the impact of using varying approaches for estimating prevalence. OBJECTIVE To estimate overall and race/ethnicity-specific prevalence of DBMD among males aged 5-9 years and compare the performance of three prevalence estimation methods. METHODS The overall and race/ethnicity-specific 5-year period prevalence rates were estimated with MD STARnet data using three methods. Method 1 used the median of 5-year prevalence, and methods 2 and 3 calculated prevalence directly with different birth cohorts. To compare prevalence between racial/ethnic groups, Poisson modeling was used to estimate prevalence ratios (PRs) with non-Hispanic (NH) whites as the referent group. Comparison between methods was also conducted. RESULTS In the final population-based sample of 1,164 DBMD males, the overall 5-year prevalence for DBMD among 5-9 years of age ranged from 1.92 to 2.48 per 10,000 males, 0.74-1.26 for NH blacks, 1.78-2.26 for NH whites, 2.24-4.02 for Hispanics, and 0.61-1.83 for NH American Indian or Alaska Native and Asian or Native Hawaiian or Pacific Islander (AIAN/API). The PRs for NH blacks/NH whites, Hispanics/NH whites, and NH AIAN/API/NH whites were 0.46 (95% CI: 0.36-0.59), 1.37 (1.17-1.61), and 0.61 (0.40-0.93), respectively. CONCLUSIONS In males aged 5-9 years, compared to the prevalence of DBMD in NH whites, prevalence in NH blacks and NH AIAN/API was lower and higher in Hispanics. All methods produced similar prevalence estimates; however, method 1 produced narrower confidence intervals and method 2 produced fewer zero prevalence estimates than the other two methods.
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Affiliation(s)
- Yanan Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Joshua R Mann
- Department of Preventive Medicine, School of Medicine and John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA,
| | - Katherine A James
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Suzanne McDermott
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Kristin M Conway
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Pangaja Paramsothy
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Haber G, Conway KM, Paramsothy P, Roy A, Rogers H, Ling X, Kozauer N, Street N, Romitti PA, Fox DJ, Phan HC, Matthews D, Ciafaloni E, Oleszek J, James KA, Galindo M, Whitehead N, Johnson N, Butterfield RJ, Pandya S, Venkatesh S, Bhattaram VA. Association of genetic mutations and loss of ambulation in childhood-onset dystrophinopathy. Muscle Nerve 2020; 63:181-191. [PMID: 33150975 DOI: 10.1002/mus.27113] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Quantifying associations between genetic mutations and loss of ambulation (LoA) among males diagnosed with childhood-onset dystrophinopathy is important for understanding variation in disease progression and may be useful in clinical trial design. METHODS Genetic and clinical data from the Muscular Dystrophy Surveillance, Tracking, and Research Network for 358 males born and diagnosed from 1982 to 2011 were analyzed. LoA was defined as the age at which independent ambulation ceased. Genetic mutations were defined by overall type (deletion/duplication/point mutation) and among deletions, those amenable to exon-skipping therapy (exons 8, 20, 44-46, 51-53) and another group. Cox proportional hazards regression modeling was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Mutation type did not predict time to LoA. Controlling for corticosteroids, Exons 8 (HR = 0.22; 95% CI = 0.08, 0.63) and 44 (HR = 0.30; 95% CI = 0.12, 0.78) were associated with delayed LoA compared to other exon deletions. CONCLUSIONS Delayed LoA in males with mutations amenable to exon-skipping therapy is consistent with previous studies. These findings suggest that clinical trials including exon 8 and 44 skippable males should consider mutation information prior to randomization.
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Affiliation(s)
- Gregory Haber
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Kristin M Conway
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA
| | - Pangaja Paramsothy
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anindya Roy
- Department of Mathematics and Statistics, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Hobart Rogers
- Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, Maryland, USA
| | - Xiang Ling
- Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, Maryland, USA
| | - Nicholas Kozauer
- Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, Maryland, USA
| | - Natalie Street
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul A Romitti
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA
| | - Deborah J Fox
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Han C Phan
- Department of Pediatrics, Division of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Dennis Matthews
- Department of Physical Medicine and Rehabilitation, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Emma Ciafaloni
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Joyce Oleszek
- Department of Physical Medicine and Rehabilitation, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Katherine A James
- School of Public Health, University of Colorado, Boulder, Colorado, USA
| | - Maureen Galindo
- Department of Pediatrics, University of Arizona, Tucson, Arizona, USA
| | - Nedra Whitehead
- Research Triangle Institute International, Research Triangle Park, North Carolina, USA
| | - Nicholas Johnson
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Russell J Butterfield
- Department of Pediatrics and Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Shree Pandya
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Swamy Venkatesh
- Department of Neurology, University of South Carolina, Columbia, South Carolina, USA
| | - Venkatesh Atul Bhattaram
- Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, Maryland, USA
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Dally M, Butler-Dawson J, Sorensen CJ, Van Dyke M, James KA, Krisher L, Jaramillo D, Newman LS. Wet Bulb Globe Temperature and Recorded Occupational Injury Rates among Sugarcane Harvesters in Southwest Guatemala. Int J Environ Res Public Health 2020; 17:ijerph17218195. [PMID: 33171945 PMCID: PMC7664243 DOI: 10.3390/ijerph17218195] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 12/13/2022]
Abstract
As global temperatures continue to rise it is imperative to understand the adverse effects this will pose to workers laboring outdoors. The purpose of this study was to investigate the relationship between increases in wet bulb globe temperature (WBGT) and risk of occupational injury or dehydration among agricultural workers. We used data collected by an agribusiness in Southwest Guatemala over the course of four harvest seasons and Poisson generalized linear modelling for this analysis. Our analyses suggest a 3% increase in recorded injury risk with each degree increase in daily average WBGT above 30 °C (95% CI: -6%, 14%). Additionally, these data suggest that the relationship between WBGT and injury risk is non-linear with an additional 4% acceleration in risk for every degree increase in WBGT above 30 °C (95% CI: 0%, 8%). No relationship was found between daily average WBGT and risk of dehydration. Our results indicate that agricultural workers are at an increased risk of occupational injury in humid and hot environments and that businesses need to plan and adapt to increasing global temperatures by implementing and evaluating effective occupational safety and health programs to protect the health, safety, and well-being of their workers.
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Affiliation(s)
- Miranda Dally
- Center for Health, Work & Environment, Department of Environmental and Occupational Health, and Colorado Consortium for Climate Change & Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (J.B.-D.); (C.J.S.); (M.V.D.); (K.A.J.); (L.K.); (D.J.); (L.S.N.)
- Correspondence: ; Tel.: +1-303-724-2463
| | - Jaime Butler-Dawson
- Center for Health, Work & Environment, Department of Environmental and Occupational Health, and Colorado Consortium for Climate Change & Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (J.B.-D.); (C.J.S.); (M.V.D.); (K.A.J.); (L.K.); (D.J.); (L.S.N.)
| | - Cecilia J. Sorensen
- Center for Health, Work & Environment, Department of Environmental and Occupational Health, and Colorado Consortium for Climate Change & Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (J.B.-D.); (C.J.S.); (M.V.D.); (K.A.J.); (L.K.); (D.J.); (L.S.N.)
- Department of Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA
| | - Mike Van Dyke
- Center for Health, Work & Environment, Department of Environmental and Occupational Health, and Colorado Consortium for Climate Change & Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (J.B.-D.); (C.J.S.); (M.V.D.); (K.A.J.); (L.K.); (D.J.); (L.S.N.)
| | - Katherine A. James
- Center for Health, Work & Environment, Department of Environmental and Occupational Health, and Colorado Consortium for Climate Change & Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (J.B.-D.); (C.J.S.); (M.V.D.); (K.A.J.); (L.K.); (D.J.); (L.S.N.)
| | - Lyndsay Krisher
- Center for Health, Work & Environment, Department of Environmental and Occupational Health, and Colorado Consortium for Climate Change & Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (J.B.-D.); (C.J.S.); (M.V.D.); (K.A.J.); (L.K.); (D.J.); (L.S.N.)
| | - Diana Jaramillo
- Center for Health, Work & Environment, Department of Environmental and Occupational Health, and Colorado Consortium for Climate Change & Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (J.B.-D.); (C.J.S.); (M.V.D.); (K.A.J.); (L.K.); (D.J.); (L.S.N.)
| | - Lee S. Newman
- Center for Health, Work & Environment, Department of Environmental and Occupational Health, and Colorado Consortium for Climate Change & Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (J.B.-D.); (C.J.S.); (M.V.D.); (K.A.J.); (L.K.); (D.J.); (L.S.N.)
- Department of Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA
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James KA, Calanan R, Macaluso F, Li Y, Levinson AH. Convenience and corner store fruit and vegetable access: attitudes and intentions among Colorado adults, 2014. J Public Health (Oxf) 2020; 30:871-878. [PMID: 37868935 PMCID: PMC10588133 DOI: 10.1007/s10389-020-01358-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/01/2020] [Indexed: 11/27/2022] Open
Abstract
Aim The term food desert generally refers to areas where healthy food options, such as fresh fruits and vegetables, are unavailable within a certain number of miles. However, other factors besides distance may affect the ability to purchase healthier foods. The goal of this study was to understand Colorado adults' perceptions of their access to healthy food options and to assess how other structural and socio-demographic factors may affect that access. Subject and methods Colorado adults were asked questions about self-reported access to healthy food, likelihood of buying fresh fruits and vegetables from convenience/corner stores if available, perceived characteristics of fruits and vegetables available for purchase near respondents' residence, and demographics. Results A majority of Colorado adults in 2013-14 reported wanting fresh fruits and vegetables to be more available, more varied, higher quality, and/or less expensive. Socioeconomic status, race/ethnicity, and regular shopping habits were significantly associated with reported likelihood of purchasing fruits and vegetables from a convenience/corner store if available. Conclusion Factors other than proximity to a grocery store affect Colorado adults' perceived access to healthy food options and should be considered in the development and implementation of public health programs and policies geared toward improving healthy food access.
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Affiliation(s)
- Katherine A James
- School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E 17th PL, MS B119, Bldg 500 3rd FLR, Aurora, CO 80045, USA
| | - Renee Calanan
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, USA
- Present address: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, USA
| | - Francesca Macaluso
- School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E 17th PL, MS B119, Bldg 500 3rd FLR, Aurora, CO 80045, USA
| | - Yaqiang Li
- School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E 17th PL, MS B119, Bldg 500 3rd FLR, Aurora, CO 80045, USA
| | - Arnold H Levinson
- School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E 17th PL, MS B119, Bldg 500 3rd FLR, Aurora, CO 80045, USA
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Deutchman M, Macaluso F, Chao J, Duffrin C, Hanna K, Avery DM, Onello E, Quinn K, Griswold MT, Alavi M, Boulger J, Bright P, Schneider B, Porter J, Luke S, Durham J, Hasnain M, James KA. Contributions of US Medical Schools to Primary Care (2003-2014): Determining and Predicting Who Really Goes Into Primary Care. Fam Med 2020; 52:483-490. [PMID: 32640470 DOI: 10.22454/fammed.2020.785068] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Schools of medicine in the United States may overstate the placement of their graduates in primary care. The purpose of this project was to determine the magnitude by which primary care output is overestimated by commonly used metrics and identify a more accurate method for predicting actual primary care output. METHODS We used a retrospective cohort study with a convenience sample of graduates from US medical schools granting the MD degree. We determined the actual practicing specialty of those graduates considered primary care based on the Residency Match Method by using a variety of online sources. Analyses compared the percentage of graduates actually practicing primary care between the Residency Match Method and the Intent to Practice Primary Care Method. RESULTS The final study population included 17,509 graduates from 20 campuses across 14 university systems widely distributed across the United States and widely varying in published ranking for producing primary care graduates. The commonly used Residency Match Method predicted a 41.2% primary care output rate. The actual primary care output rate was 22.3%. The proposed new method, the Intent to Practice Primary Care Method, predicted a 17.1% primary care output rate, which was closer to the actual primary care rate. CONCLUSIONS A valid, reliable method of predicting primary care output is essential for workforce training and planning. Medical schools, administrators, policy makers, and popular press should adopt this new, more reliable primary care reporting method.
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Affiliation(s)
- Mark Deutchman
- University of Colorado, Anschutz Medical Campus, School of Medicine
| | - Francesca Macaluso
- School of Public Health, University of Colorado, Anschutz Medical Campus
| | - Jason Chao
- Case Western Reserve University, School of Medicine
| | | | - Karim Hanna
- University of South Florida, Morsani College of Medicine
| | - Daniel M Avery
- University of Alabama, College of Community Health Sciences
| | - Emily Onello
- University of Minnesota Medical School, Duluth Campus
| | | | | | | | | | | | | | | | | | | | | | - Katherine A James
- School of Public Health, University of Colorado, Anschutz Medical Campus
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El Hajj D, Cook PF, James KA, Battaglia C, Prochazca AV. Newer Forms of Tobacco Products: Characteristics of Poly Users Among Adults Living in Colorado-A Secondary Data Analysis of the Attitudes and Behaviors Survey on Health 2015. Tob Use Insights 2019; 12:1179173X19874811. [PMID: 31523133 PMCID: PMC6734605 DOI: 10.1177/1179173x19874811] [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: 07/10/2019] [Accepted: 08/18/2019] [Indexed: 12/05/2022] Open
Abstract
Aims: Data from The Attitudes and Behaviors Survey (TABS) conducted in 2015 were used to investigate the prevalence of different forms of tobacco use and marijuana use among adults in Colorado. Methods: A secondary analysis of TABS on health data was conducted. A representative sample of 8616 adults 18 years and older participated in the survey, with sample weights used to adjust for oversampling. Results: Lifetime prevalence of cigarette-only use was 25.8%, compared with 10.6% for hookah use, 7.0% for both hookah and cigarettes, 12.6% for anything except cigarettes, and 43.0% for marijuana. The typical hookah user was a single/living alone (15.9%), English-speaking (11.6%), male (16.7%), age < 30 years (24.2%), with some college education (13.0%), and income less than 35 000 per year (14.3%). Hookah users, whether or not they also used cigarettes, were similar to those who used any other noncigarette tobacco products. The typical marijuana user was a single/living alone (50.2%), white (46.0%), English-speaking (46.7%), male (48.5%), age < 30 years (50.1%), with a graduate degree (40.8%) and salary of at least 50 000 per year (43.4%). Implications: In Colorado, in 2015, cigarette use was still highest among all forms of tobacco, but the use of other tobacco products such as vaping and hookah is on the rise, especially among young adults. Marijuana and hookah users were demographically similar to each other, and different from the typical cigarette user. These results indicate the need for further study of alternative tobacco product use, especially among young adults.
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Affiliation(s)
- Dana El Hajj
- Rocky Mountain Regional Medical Center, Denver-Seattle Center of Innovation (COIN), Aurora, CO, USA
| | - Paul F Cook
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Katherine A James
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Catherine Battaglia
- Rocky Mountain Regional Medical Center, Denver-Seattle Center of Innovation (COIN), Aurora, CO, USA
| | - Allan V Prochazca
- Rocky Mountain Regional Medical Center, Denver-Seattle Center of Innovation (COIN), Aurora, CO, USA
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James KA, Strand M, Hamer MK, Cicutto L. Health Services Utilization in Asthma Exacerbations and PM 10 Levels in Rural Colorado. Ann Am Thorac Soc 2018; 15:947-954. [PMID: 29979621 PMCID: PMC6322037 DOI: 10.1513/annalsats.201804-273oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 02/01/2023] Open
Abstract
RATIONALE The San Luis Valley in rural Colorado often has elevated levels of ambient particulate matter. To date little is known about the impact of ambient particulate matter levels and medical care utilization due to asthma exacerbation in rural communities. OBJECTIVES We investigated the impact of ambient particulate matter concentrations on emergency/urgent visits and hospitalizations for asthma in a rural community. METHODS Daily ambient particulate matter concentrations from an air quality monitor in the San Luis Valley (2003-2012) were obtained from the state health department. Deidentified data for emergency/urgent visits with a diagnosis code for asthma were collected from the local health care system organization. A generalized linear model using splines and employing generalized estimating equations for correlated measures over time was used to examine the association between daily counts of emergency/urgent visits for asthma and 3- to 5-day averaged ambient particulate matter concentrations. RESULTS For each 15-μg/m3 increase in 3-day averaged ambient particulate matter, there was an associated 3.1% increase in hospital counts for all patients with asthma (95% confidence interval, 0.3-5.9%; P = 0.03). When the 3-day average exceeded 50 μg/m3, asthma hospital visits increased by 16.8% (P = 0.03), and when it exceeded 100 μg/m3, visits increased by 65.8% (P = 0.002). In children, the odds of one asthma event requiring an emergency/urgent care visit increased 5.0% with each 15-μg/m3 increase in 3-day averaged ambient particulate matter (P = 0.22). CONCLUSIONS We observed associations between ambient air levels of particulate matter with a diameter less than 10 μm and emergency/urgent care visits and hospitalization counts in a rural U.S. community prone to dust storms and Environmental Protection Agency exceedances.
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Affiliation(s)
| | | | | | - Lisa Cicutto
- 1 University of Colorado, Denver, Colorado; and
- 2 National Jewish Health, Denver, Colorado
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Hall KE, Monte AA, Chang T, Fox J, Brevik C, Vigil DI, Van Dyke M, James KA. Mental Health-related Emergency Department Visits Associated With Cannabis in Colorado. Acad Emerg Med 2018; 25:526-537. [PMID: 29476688 DOI: 10.1111/acem.13393] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 01/05/2018] [Accepted: 02/17/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cannabis legalization in Colorado resulted in increased cannabis-associated health care utilization. Our objective was to examine cooccurrence of cannabis and mental health diagnostic coding in Colorado emergency department (ED) discharges and replicate the study in a subpopulation of ED visits where cannabis involvement and psychiatric diagnosis were confirmed through medical review. METHODS We collected statewide ED International Classification of Diseases, 9th Revision, Clinical Modification diagnoses from the Colorado Hospital Association and a subpopulation of ED visits from a large, academic hospital from 2012 to 2014. Diagnosis codes identified visits associated with mental health and cannabis. Codes for mental health conditions and cannabis were confirmed by manual records review in the academic hospital subpopulation. Prevalence ratios (PRs) of mental health ED discharges were calculated to compare cannabis-associated visits to those without cannabis. Rates of mental health and cannabis-associated ED discharges were examined over time. RESULTS Statewide data demonstrated a fivefold higher prevalence of mental health diagnoses in cannabis-associated ED visits (PR = 5.35, 95% confidence interval [CI], 5.27-5.43) compared to visits without cannabis. The hospital subpopulation supported this finding with a fourfold higher prevalence of psychiatric complaints in cannabis attributable ED visits (PR = 4.87, 95% CI = 4.36-5.44) compared to visits not attributable to cannabis. Statewide rates of ED visits associated with both cannabis and mental health significantly increased from 2012 to 2014 from 224.5 to 268.4 per 100,000 (p < 0.0001). CONCLUSIONS In Colorado, the prevalence of mental health conditions in ED visits with cannabis-associated diagnostic codes is higher than in those without cannabis. There is a need for further research determining if these findings are truly attributed to cannabis or merely coincident with concurrent increased use and availability.
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Affiliation(s)
- Katelyn E. Hall
- Department of Environmental Epidemiology Occupational Health, and Toxicology Colorado Department of Public Health and Environment Denver CO
| | - Andrew A. Monte
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
- Rocky Mountain Poison & Drug Center Denver Health and Hospital Authority Denver CO
| | - Tae Chang
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
| | - Jacob Fox
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
| | - Cody Brevik
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
| | - Daniel I. Vigil
- Department of Environmental Epidemiology Occupational Health, and Toxicology Colorado Department of Public Health and Environment Denver CO
| | - Mike Van Dyke
- Department of Environmental Epidemiology Occupational Health, and Toxicology Colorado Department of Public Health and Environment Denver CO
| | - Katherine A. James
- Department of Family Medicine University of Colorado School of Medicine Aurora CO
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Moon KA, Oberoi S, Barchowsky A, Chen Y, Guallar E, Nachman KE, Rahman M, Sohel N, D'Ippoliti D, Wade TJ, James KA, Farzan SF, Karagas MR, Ahsan H, Navas-Acien A. A dose-response meta-analysis of chronic arsenic exposure and incident cardiovascular disease. Int J Epidemiol 2018; 47:1013. [PMID: 29697784 DOI: 10.1093/ije/dyy073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pandya S, James KA, Westfield C, Thomas S, Fox DJ, Ciafaloni E, Moxley RT. Health profile of a cohort of adults with Duchenne muscular dystrophy. Muscle Nerve 2018; 58:219-223. [PMID: 29543994 DOI: 10.1002/mus.26129] [Citation(s) in RCA: 10] [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] [Received: 04/04/2017] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION As the Duchenne muscular dystrophy (DMD) population ages, it is essential that we understand the late-stage health profile and provide the appropriate care for this emerging population. METHODS We undertook a descriptive study to document the health profile of a cohort of adults with DMD using data from the Muscular Dystrophy Surveillance Tracking and Research network (MD STARnet). Data included information collected from Arizona, Colorado, Iowa, Georgia, and 12 counties in western New York on individuals born since January 1982 and followed through December 2012. RESULTS In 208 adults with DMD, the number of individuals (N) and median ages (years) at which certain critical milestones were crossed and interventions initiated were as follows: development of cardiomyopathy, N = 145 (16.7); initiation of non-invasive ventilation, N = 99 (18.0); gastrostomy, N = 47 (19.0); and death, N = 59 (21.8). DISCUSSION These population-based data provide critical information about late-stage health profiles among adults with DMD for developing appropriate models of care. Muscle Nerve 58: 219-223, 2018.
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Affiliation(s)
- Shree Pandya
- Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, Box 673, 601 Elmwood Avenue, New York, 14642, USA
| | - Katherine A James
- Colorado School of Public Health, University of Colorado, Aurora Colorado, USA
| | | | - Shiny Thomas
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Deborah J Fox
- Congenital Malformations Registry, New York State Department of Health, Albany, New York, USA
| | - Emma Ciafaloni
- Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, Box 673, 601 Elmwood Avenue, New York, 14642, USA
| | - Richard T Moxley
- Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, Box 673, 601 Elmwood Avenue, New York, 14642, USA
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Harpin SB, Brooks-Russell A, Ma M, James KA, Levinson AH. Adolescent Marijuana Use and Perceived Ease of Access Before and After Recreational Marijuana Implementation in Colorado. Subst Use Misuse 2018; 53:451-456. [PMID: 28816599 DOI: 10.1080/10826084.2017.1334069] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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] [Indexed: 10/19/2022]
Abstract
BACKGROUND As of January 1, 2017, eight states have approved laws for recreational marijuana use. While the social impacts of these changes remain under debate, the influence on adolescent marijuana use is a key policy and health issue across the U.S. OBJECTIVE To examine changes in adolescent marijuana-use behaviors in the first year after recreational marijuana implementation in Colorado, and to analyze the effect of retail marijuana store proximity on youth use and perceptions. METHOD Secondary analysis of Healthy Kids Colorado Survey data from 40 schools surveyed before and after recreational marijuana sales were implemented (2013 student n = 12,240; 2014 student n = 11,931). Self-reported marijuana use, ease of access, and perceived harms were compared between years and by proximity of recreational marijuana stores to surveyed schools. RESULTS Adolescent marijuana use behaviors, wrongness of use, and perceptions of risk of harm were unchanged from baseline to one-year follow-up. Perceived ease of access to marijuana increased (from 46% to 52%). Proximity of recreational marijuana stores was not significantly associated with perceived ease of access to marijuana. Conclusions/Importance: In the first study of adolescent marijuana use and perceptions after state retail implementation of recreational marijuana, there was little change in adolescent marijuana use but a significant change in perception of ease of access. Public health workers and policymakers should continue to monitor these changes as essential for evaluating the impact of liberalization of marijuana policies.
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Affiliation(s)
- Scott B Harpin
- a College of Nursing , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA
| | - Ashley Brooks-Russell
- b Department of Community and Behavioral Health, School of Public Health , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA
| | - Ming Ma
- b Department of Community and Behavioral Health, School of Public Health , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA
| | - Katherine A James
- c Department of Family Medicine, School of Medicine , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA
| | - Arnold H Levinson
- b Department of Community and Behavioral Health, School of Public Health , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA.,d University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA
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Moon KA, Oberoi S, Barchowsky A, Chen Y, Guallar E, Nachman KE, Rahman M, Sohel N, D’Ippoliti D, Wade TJ, James KA, Farzan SF, Karagas MR, Ahsan H, Navas-Acien A. A dose-response meta-analysis of chronic arsenic exposure and incident cardiovascular disease. Int J Epidemiol 2017; 46:1924-1939. [PMID: 29040626 PMCID: PMC5837344 DOI: 10.1093/ije/dyx202] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [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] [Revised: 08/17/2017] [Accepted: 08/30/2017] [Indexed: 01/08/2023] Open
Abstract
Background Consistent evidence at high levels of water arsenic (≥100 µg/l), and growing evidence at low-moderate levels (<100 µg/l), support a link with cardiovascular disease (CVD). The shape of the dose-response across low-moderate and high levels of arsenic in drinking water is uncertain and critical for risk assessment. Methods We conducted a systematic review of general population epidemiological studies of arsenic and incident clinical CVD (all CVD, coronary heart disease (CHD) and stroke) with three or more exposure categories. In a dose-response meta-analysis, we estimated the pooled association between log-transformed water arsenic (log-linear) and restricted cubic splines of log-transformed water arsenic (non-linear) and the relative risk of each CVD endpoint. Results Twelve studies (pooled N = 408 945) conducted at high (N = 7) and low-moderate (N = 5) levels of water arsenic met inclusion criteria, and 11 studies were included in the meta-analysis. Compared with 10 µg/l, the estimated pooled relative risks [95% confidence interval (CI)] for 20 µg/l water arsenic, based on a log-linear model, were 1.09 (1.03, 1.14) (N = 2) for CVD incidence, 1.07 (1.01, 1.14) (N = 6) for CVD mortality, 1.11 (1.05, 1.17) (N = 4) for CHD incidence, 1.16 (1.07, 1.26) (N = 6) for CHD mortality, 1.08 (0.99, 1.17) (N = 2) for stroke incidence and 1.06 (0.93, 1.20) (N = 6) for stroke mortality. We found no evidence of non-linearity, although these tests had low statistical power. Conclusions Although limited by the small number of studies, this analysis supports quantitatively including CVD in inorganic arsenic risk assessment, and strengthens the evidence for an association between arsenic and CVD across low-moderate to high levels.
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Affiliation(s)
- Katherine A Moon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shilpi Oberoi
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Aaron Barchowsky
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yu Chen
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keeve E Nachman
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Nazmul Sohel
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | | | - Timothy J Wade
- United States Environmental Protection Agency, Office of Research and Development, Chapel Hill, NC, USA
| | - Katherine A James
- Department of Family Medicine, University of Colorado, Denver, CO, USA
| | - Shohreh F Farzan
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Habibul Ahsan
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Ana Navas-Acien
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
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James KA, Byers T, Hokanson JE, Meliker JR, Marshall JA. Response to "Comment on 'Association between Lifetime Exposure to Inorganic Arsenic in Drinking Water and Coronary Heart Disease in Colorado Residents'". Environ Health Perspect 2015; 123:A169. [PMID: 26132290 PMCID: PMC4492273 DOI: 10.1289/ehp.1509791r] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Katherine A James
- University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
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Abstract
It is unclear whether exposure to environmentally relevant levels of pesticides in groundwater is associated with an increased risk of Parkinson disease (PD). The purpose of this study was to examine the relationship between PD and pesticide levels in groundwater. This cross-sectional study included 332 971 Medicare beneficiaries, including 4207 prevalent cases of PD from the 2007 Colorado Medicare Beneficiary Database. Residential pesticide levels were estimated from a spatial model based on 286 well water samples with atrazine, simazine, alachlor, and metolachlor measurements. A logistic regression model with known PD risk factors was used to assess the association between residential groundwater pesticide levels and prevalent PD. We found that for every 1.0 µg/L of pesticide in groundwater, the risk of PD increases by 3% (odds ratio = 1.03; 95% confidence interval: 1.02-1.04) while adjusting for age, race/ethnicity, and gender suggesting that higher age-standardized PD prevalence ratios are associated with increasing levels of pesticides in groundwater.
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Affiliation(s)
| | - Deborah A. Hall
- Department of Neurological Sciences, Rush University, Chicago, IL, USA
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James KA, Ross SE, Vance B, Nath R, Harrison MI, West DR. Inefficiency in primary care: common causes and potential solutions. Fam Pract Manag 2015; 22:18-22. [PMID: 25884969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Romitti PA, Zhu Y, Puzhankara S, James KA, Nabukera SK, Zamba GK, Ciafaloni E, Cunniff C, Druschel CM, Mathews KD, Matthews DJ, Meaney FJ, Andrews JG, Caspers Conway KM, Fox DJ, Street N, Adams MM, Bolen J. Prevalence of Duchenne and Becker muscular dystrophies in the United States. Pediatrics 2015; 135:513-21. [PMID: 25687144 PMCID: PMC4477633 DOI: 10.1542/peds.2014-2044] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [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] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To estimate prevalence of childhood-onset Duchenne and Becker muscular dystrophies (DBMD) in 6 sites in the United States by race/ethnicity and phenotype (Duchenne muscular dystrophy [DMD] or Becker muscular dystrophy [BMD]). METHODS In 2002, the Centers for Disease Control and Prevention established the Muscular Dystrophy Surveillance, Tracking, and Research Network (MD STARnet) to conduct longitudinal, population-based surveillance and research of DBMD in the United States. Six sites conducted active, multiple-source case finding and record abstraction to identify MD STARnet cases born January 1982 to December 2011. We used cross-sectional analyses to estimate prevalence of DBMD per 10 000 boys, ages 5 to 9 years, for 4 quinquennia (1991-1995, 1996-2000, 2001-2005, and 2006-2010) and prevalence per 10 000 male individuals, ages 5 to 24 years, in 2010. Prevalence was also estimated by race/ethnicity and phenotype. RESULTS Overall, 649 cases resided in an MD STARnet site during ≥1 quinquennia. Prevalence estimates per 10 000 boys, ages 5 to 9 years, were 1.93, 2.05, 2.04, and 1.51, respectively, for 1991-1995, 1996-2000, 2001-2005, and 2006-2010. Prevalence tended to be higher for Hispanic individuals than non-Hispanic white or black individuals, and higher for DMD than BMD. In 2010, prevalence of DBMD was 1.38 per 10 000 male individuals, ages 5 to 24 years. CONCLUSIONS We present population-based prevalence estimates for DBMD in 6 US sites. Prevalence differed by race/ethnicity, suggesting potential cultural and socioeconomic influences in the diagnosis of DBMD. Prevalence also was higher for DMD than BMD. Continued longitudinal surveillance will permit us to examine racial/ethnic and socioeconomic differences in treatment and outcomes for MD STARnet cases.
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Affiliation(s)
| | - Yong Zhu
- The University of Iowa, Iowa City, Iowa
| | | | | | | | | | | | | | - Charlotte M. Druschel
- New York State Department of Health, Albany, New York,State University of New York, Albany, Rensselaer, New York
| | | | | | | | | | | | | | - Natalie Street
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Melissa M. Adams
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julie Bolen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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James KA, Byers T, Hokanson JE, Meliker JR, Zerbe GO, Marshall JA. Association between lifetime exposure to inorganic arsenic in drinking water and coronary heart disease in Colorado residents. Environ Health Perspect 2015; 123:128-34. [PMID: 25350952 PMCID: PMC4314243 DOI: 10.1289/ehp.1307839] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 10/27/2014] [Indexed: 05/04/2023]
Abstract
BACKGROUND Chronic diseases, including coronary heart disease (CHD), have been associated with ingestion of drinking water with high levels of inorganic arsenic (> 1,000 μg/L). However, associations have been inconclusive in populations with lower levels (< 100 μg/L) of inorganic arsenic exposure. OBJECTIVES We conducted a case-cohort study based on individual estimates of lifetime arsenic exposure to examine the relationship between chronic low-level arsenic exposure and risk of CHD. METHODS This study included 555 participants with 96 CHD events diagnosed between 1984 and 1998 for which individual lifetime arsenic exposure estimates were determined using data from structured interviews and secondary data sources to determine lifetime residence, which was linked to a geospatial model of arsenic concentrations in drinking water. These lifetime arsenic exposure estimates were correlated with historically collected urinary arsenic concentrations. A Cox proportional-hazards model with time-dependent CHD risk factors was used to assess the association between time-weighted average (TWA) lifetime exposure to low-level inorganic arsenic in drinking water and incident CHD. RESULTS We estimated a positive association between low-level inorganic arsenic exposure and CHD risk [hazard ratio (HR): = 1.38, 95% CI: 1.09, 1.78] per 15 μg/L while adjusting for age, sex, first-degree family history of CHD, and serum low-density lipoprotein levels. The risk of CHD increased monotonically with increasing TWAs for inorganic arsenic exposure in water relative to < 20 μg/L (HR = 1.2, 95% CI: 0.6, 2.2 for 20-30 μg/L; HR = 2.2; 95% CI: 1.2, 4.0 for 30-45 μg/L; and HR = 3, 95% CI: 1.1, 9.1 for 45-88 μg/L). CONCLUSIONS Lifetime exposure to low-level inorganic arsenic in drinking water was associated with increased risk for CHD in this population.
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Affiliation(s)
- Katherine A James
- Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado, USA
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Abstract
This study examines trends in corticosteroid use for males with Duchenne muscular dystrophy by birth year, race/ethnicity, and knowledge of Duchenne muscular dystrophy family history. Firstborn males (n = 521) selected from a population-based surveillance system of Duchenne muscular dystrophy were analyzed using Kaplan Meier and regression methods. Comparing males born 1982 to 1986 with males born 1997 to 2001, steroid use increased from 54% to 72% and mean age at steroid initiation decreased from 8.2 to 7.1 years. Hispanics and non-Hispanic Black males used steroids less frequently and delayed initiation compared to white males. Compared to males without a Duchenne muscular dystrophy family history, males with known family history were half as likely to use steroids. Duration of steroid use increased over time and age at initiation decreased. Racial/ethnic disparities exist for steroid use and should be addressed to improve outcome and quality of life for boys with Duchenne muscular dystrophy.
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Affiliation(s)
- Deborah J Fox
- New York State Department of Health, Albany, NY, USA
| | - Anil Kumar
- New York State Department of Health, Albany, NY, USA
| | - Nancy A West
- Department of Epidemiology, University of Colorado School of Public Health, Aurora, CO, USA
| | - A Gregory DiRienzo
- Department of Epidemiology and Biostatistics, State University of New York at Albany, Rensselaer, NY, USA
| | - Katherine A James
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Joyce Oleszek
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
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James KA, Meliker JR, Buttenfield BE, Byers T, Zerbe GO, Hokanson JE, Marshall JA. Predicting arsenic concentrations in groundwater of San Luis Valley, Colorado: implications for individual-level lifetime exposure assessment. Environ Geochem Health 2014; 36:773-782. [PMID: 24429726 DOI: 10.1007/s10653-014-9595-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 01/08/2014] [Indexed: 06/03/2023]
Abstract
Consumption of inorganic arsenic in drinking water at high levels has been associated with chronic diseases. Risk is less clear at lower levels of arsenic, in part due to difficulties in estimating exposure. Herein we characterize spatial and temporal variability of arsenic concentrations and develop models for predicting aquifer arsenic concentrations in the San Luis Valley, Colorado, an area of moderately elevated arsenic in groundwater. This study included historical water samples with total arsenic concentrations from 595 unique well locations. A longitudinal analysis established temporal stability in arsenic levels in individual wells. The mean arsenic levels for a random sample of 535 wells were incorporated into five kriging models to predict groundwater arsenic concentrations at any point in time. A separate validation dataset (n = 60 wells) was used to identify the model with strongest predictability. Findings indicate that arsenic concentrations are temporally stable (r = 0.88; 95 % CI 0.83-0.92 for samples collected from the same well 15-25 years apart) and the spatial model created using ordinary kriging best predicted arsenic concentrations (ρ = 0.72 between predicted and observed validation data). These findings illustrate the value of geostatistical modeling of arsenic and suggest the San Luis Valley is a good region for conducting epidemiologic studies of groundwater metals because of the ability to accurately predict variation in groundwater arsenic concentrations.
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James KA, Meliker JR, Marshall JA, Hokanson JE, Zerbe GO, Byers TE. Validation of estimates of past exposure to arsenic in drinking water using historical urinary arsenic concentrations. J Expo Sci Environ Epidemiol 2013; 23:450-454. [PMID: 23443236 DOI: 10.1038/jes.2013.8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 01/02/2013] [Accepted: 01/08/2013] [Indexed: 06/01/2023]
Abstract
Consumption of inorganic arsenic in drinking water at high levels has been associated with chronic diseases. Research groups have estimated historic exposure using databases and models of arsenic in drinking water supplies, along with participant residential histories. Urinary arsenic species are an established biomarker of recent exposure; we compare arsenic concentrations in historically collected urine samples with predicted estimates of arsenic exposure. Using a cohort of 462 subjects with at least one urine sample collected from 1984-1992 and an arsenic exposure estimate through drinking water at the time of the urine sample, individual exposure estimates were compared with speciated urine arsenic (UAs) concentrations using correlation and multiple regression analyses. Urine inorganic arsenic (UIAs) concentrations (trivalent arsenic, pentavalent arsenic, monomethylarsonic acid, dimethylarsonic acid) were best predicted by residential water arsenic concentrations (R(2)=0.3688), compared with metrics including water consumption (R(2)=0.2038) or water concentrations at employment locations (R(2)=0.2331). UIAs concentrations showed similar correlation when stratified by whether the arsenic concentration was predicted or measured. Residential water arsenic concentrations, independent of water intake or water concentrations at places of employment, best explain the variability in UIAs concentrations, suggesting historical reconstruction of arsenic exposure that accounts for space-time variability and water concentrations may serve as a proxy for exposure.
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Affiliation(s)
- Katherine A James
- Department of Family Medicine, University of Colorado Denver, Mail Stop F443, 13991 E Montview Ave, Aurora, Colorado, 80045, USA.
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James KA, Marshall JA, Hokanson JE, Meliker JR, Zerbe GO, Byers TE. A case-cohort study examining lifetime exposure to inorganic arsenic in drinking water and diabetes mellitus. Environ Res 2013; 123:33-8. [PMID: 23507312 DOI: 10.1016/j.envres.2013.02.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 01/30/2013] [Accepted: 02/21/2013] [Indexed: 05/18/2023]
Abstract
BACKGROUND Consumption of drinking water with high levels of inorganic arsenic (over 500 μg/L) has been associated with type II diabetes mellitus (DM), but previous studies have been inconclusive about risks at lower levels (<100 μg/L). We present a case-cohort study based on individual estimates of lifetime arsenic exposure to examine the relationship between chronic low-level arsenic exposure and risk of DM. METHODS This case-cohort study included 141 cases of DM diagnosed between 1984 and 1998 as part of the prospective San Luis Valley Diabetes Study. A comparison sub-cohort of 488 participants was randomly sampled from 936 eligible participants who were disease free at baseline. Individual lifetime arsenic exposure estimates were determined using a methodology that incorporates the use of a structured interview to determine lifetime residence and employment history, geospatial modeling of arsenic concentrations in drinking water, and urine arsenic concentrations. A Cox proportional hazards model with known DM risk factors as time-dependent covariates was used to assess the association between lifetime exposure to inorganic arsenic in drinking water and incident DM. RESULTS Our findings show a significant association between inorganic arsenic exposure and DM risk (hazard ratio [HR]=1.27, 95%=1.01, 1.59 per 15 μg/L) while adjusting for ethnicity and time varying covariates age, body mass index and physical activity level. CONCLUSIONS Exposure to low-level inorganic arsenic in drinking water is associated with increased risk for type II DM in this population based on a comprehensive lifetime exposure assessment.
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Smith ML, Raab SS, Fernald DH, James KA, Lebin JA, Grzybicki DM, Zelie C, West DR. Evaluating the Connections Between Primary Care Practice and Clinical Laboratory Testing: A Review of the Literature and Call for Laboratory Involvement in the Solutions. Arch Pathol Lab Med 2013; 137:120-5. [DOI: 10.5858/arpa.2011-0555-ra] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Growing evidence has demonstrated a high frequency of quality gaps in laboratory medicine, with recent studies estimating that 15% to 54% of primary care medical errors reported by primary care physicians and staff are related to the testing process. However, there is lack of evidence-based performance metrics in the preanalytic and postanalytic phases of the testing pathway for primary care practices.
Objective.—To use results of the literature review to assist in the development of quality indicators that could improve preanalytic and postanalytic processes in primary care–based laboratory medicine.
Data Sources.—Literature in Ovid/MEDLINE from 2001 through 2011 was searched as a primary source of information. Ninety-five peer-reviewed and non–peer-reviewed publications were retrieved following title and abstract review and 10 articles were reviewed in their entirety by the authors. A systematic review of the literature was conducted regarding the connections between clinical laboratories and primary care offices and the resulting errors. Root causes of errors were categorized into 7 major themes: process failures, delays, communication gaps, errors in judgment and cognition, influence of minorities/language, practice culture, and lack of patient centeredness. Selected articles were evaluated for evidence quality using the Systematic Evidence Review and Evaluation Methods for Quality Improvement grading scale developed by the Centers for Disease Control and Prevention.
Conclusions.—The focused literature review documented 7 key error themes in the laboratory medicine/primary care testing process. Performance metrics related to these themes are proposed that deserve future study for evidence-based improvement.
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Affiliation(s)
- Maxwell L. Smith
- From the Department of Laboratory-Pathology, Mayo Clinic, Scottsdale, Arizona (Dr Smith); the Department of Family Medicine, University of Colorado Denver, Aurora (Messrs Fernald and Lebin, Drs James and West, and Ms Zelie); the Department of Pathology, University of Washington, Seattle (Dr Raab); the Department of Pathology, Memorial University/Eastern Health, St John's, Newfoundland, Canada (Dr Raab), and the Department of Pathology, Rocky Vista University, Parker, Colorado (Dr Grzybicki)
| | - Stephen S. Raab
- From the Department of Laboratory-Pathology, Mayo Clinic, Scottsdale, Arizona (Dr Smith); the Department of Family Medicine, University of Colorado Denver, Aurora (Messrs Fernald and Lebin, Drs James and West, and Ms Zelie); the Department of Pathology, University of Washington, Seattle (Dr Raab); the Department of Pathology, Memorial University/Eastern Health, St John's, Newfoundland, Canada (Dr Raab), and the Department of Pathology, Rocky Vista University, Parker, Colorado (Dr Grzybicki)
| | - Douglas H. Fernald
- From the Department of Laboratory-Pathology, Mayo Clinic, Scottsdale, Arizona (Dr Smith); the Department of Family Medicine, University of Colorado Denver, Aurora (Messrs Fernald and Lebin, Drs James and West, and Ms Zelie); the Department of Pathology, University of Washington, Seattle (Dr Raab); the Department of Pathology, Memorial University/Eastern Health, St John's, Newfoundland, Canada (Dr Raab), and the Department of Pathology, Rocky Vista University, Parker, Colorado (Dr Grzybicki)
| | - Katherine A. James
- From the Department of Laboratory-Pathology, Mayo Clinic, Scottsdale, Arizona (Dr Smith); the Department of Family Medicine, University of Colorado Denver, Aurora (Messrs Fernald and Lebin, Drs James and West, and Ms Zelie); the Department of Pathology, University of Washington, Seattle (Dr Raab); the Department of Pathology, Memorial University/Eastern Health, St John's, Newfoundland, Canada (Dr Raab), and the Department of Pathology, Rocky Vista University, Parker, Colorado (Dr Grzybicki)
| | - Jacob A. Lebin
- From the Department of Laboratory-Pathology, Mayo Clinic, Scottsdale, Arizona (Dr Smith); the Department of Family Medicine, University of Colorado Denver, Aurora (Messrs Fernald and Lebin, Drs James and West, and Ms Zelie); the Department of Pathology, University of Washington, Seattle (Dr Raab); the Department of Pathology, Memorial University/Eastern Health, St John's, Newfoundland, Canada (Dr Raab), and the Department of Pathology, Rocky Vista University, Parker, Colorado (Dr Grzybicki)
| | - Dana M. Grzybicki
- From the Department of Laboratory-Pathology, Mayo Clinic, Scottsdale, Arizona (Dr Smith); the Department of Family Medicine, University of Colorado Denver, Aurora (Messrs Fernald and Lebin, Drs James and West, and Ms Zelie); the Department of Pathology, University of Washington, Seattle (Dr Raab); the Department of Pathology, Memorial University/Eastern Health, St John's, Newfoundland, Canada (Dr Raab), and the Department of Pathology, Rocky Vista University, Parker, Colorado (Dr Grzybicki)
| | - Claire Zelie
- From the Department of Laboratory-Pathology, Mayo Clinic, Scottsdale, Arizona (Dr Smith); the Department of Family Medicine, University of Colorado Denver, Aurora (Messrs Fernald and Lebin, Drs James and West, and Ms Zelie); the Department of Pathology, University of Washington, Seattle (Dr Raab); the Department of Pathology, Memorial University/Eastern Health, St John's, Newfoundland, Canada (Dr Raab), and the Department of Pathology, Rocky Vista University, Parker, Colorado (Dr Grzybicki)
| | - David R. West
- From the Department of Laboratory-Pathology, Mayo Clinic, Scottsdale, Arizona (Dr Smith); the Department of Family Medicine, University of Colorado Denver, Aurora (Messrs Fernald and Lebin, Drs James and West, and Ms Zelie); the Department of Pathology, University of Washington, Seattle (Dr Raab); the Department of Pathology, Memorial University/Eastern Health, St John's, Newfoundland, Canada (Dr Raab), and the Department of Pathology, Rocky Vista University, Parker, Colorado (Dr Grzybicki)
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Nabukera SK, Romitti PA, Caspers KM, Street N, Cunniff C, Mathews KD, Fox DJ, Puzhankara S, Ciafaloni E, James KA, Su Y. Reproductive patterns among mothers of males diagnosed with Duchenne or Becker muscular dystrophy. Am J Med Genet A 2012; 161A:70-5. [PMID: 23239595 DOI: 10.1002/ajmg.a.35682] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 08/24/2012] [Indexed: 11/07/2022]
Abstract
Diagnosis of a child with Duchenne or Becker muscular dystrophy (DBMD) may impact future maternal reproductive choice; however, little is known about the reproductive patterns of mothers with a male child diagnosed with DBMD. Using population-based surveillance data collected by the muscular dystrophy surveillance, tracking, and research network, the proportion of mothers who conceived and delivered a live birth following the diagnosis of DBMD in an affected male child and factors associated with such reproductive choice were identified. To accomplish this, maternal demographic data were linked to birth certificate data to construct the reproductive history for 239 mothers. Univariable and bivariable analyses were conducted to determine the proportion of mothers delivering a live birth and associated factors. By the time of the current study, 96 (40.2%) of the 239 mothers had at least one live birth following delivery of their oldest affected male child; 53 (22.2%) of these mothers had a live birth before and 43 (18.0%) had a live birth after DBMD diagnosis of a male child. Mothers with a live birth after diagnosis were significantly younger at diagnosis of the oldest affected male child (26.2 ± 4.2 years vs. 31.5 ± 5.5 years), and were less likely to be white non-Hispanic compared to those with no live birth after diagnosis. These results suggest that about one in five mothers deliver a live birth subsequent to DBMD diagnosis in a male child. Maternal age and race/ethnicity were associated with this reproductive choice.
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Affiliation(s)
- Sarah K Nabukera
- Department of Epidemiology, The University of Iowa, Iowa City, IA, USA
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